Seanad Éireann

Vol. 217 Wednesday, No. 4 26 September 2012

DÍOSPÓIREACHTAÍ PARLAIMINTE PARLIAMENTARY DEBATES Seanad Éireann

TUAIRISC OIFIGIÚIL—Neamhcheartaithe (OFFICIAL REPORT—Unrevised)

Insert Date Here

Business of Seanad ��193 Order of Business ��193 Ombudsman (Amendment) Bill 2008: Second Stage ��207 2 o’clock ��231 Health Service Executive (Governance) Bill 2012: Order for Second Stage ��231 Health Service Executive (Governance) Bill 2012: Second Stage ��231 Business of Seanad ��264 Health Service Executive (Governance) Bill 2012: Second Stage (Resumed) ��265 School Transport: Statements ��268 Life-Limiting Health Conditions in Children: Motion ��284 SEANAD ÉIREANN

Dé Céadaoin, 26 Meán Fómhair 2012

Wednesday, 26 September 2012

Chuaigh an Cathaoirleach i gceannas ar 10.30 a.m.

Machnamh agus Paidir. Reflection and Prayer.

Business of Seanad

26/09/2012A00100An Cathaoirleach: I have received notice from Senator Lorraine Higgins that, on the motion for the Adjournment of the House today, she proposes to raise the following matter:

The need for the Minister for Health to expand the primary care facility concept to Por- tumna, County Galway, in the interests of providing accessible community care facilities for the citizens of this area and to make the necessary arrangements in his capital budget to implement this programme over the course of the Government.

I have also received notice from Senator Deirdre Clune of the following matter:

The need for the Minister for Health to discuss the plans to tackle the issue of alcohol abuse.

I regard the matters raised by the Senators as suitable for discussion on the Adjournment and they will be taken at the conclusion of business.

Order of Business

26/09/2012A00200Senator Maurice Cummins: The Order of Business is No. 1, Ombudsman (Amendment) Bill 2008 - Second Stage, to be taken at the conclusion of the Order of Business and conclude not later than 1.45 p.m., with the contributions of group spokespersons not to exceed ten minutes and those of all other Senators not to exceed six minutes and the Minister to be called to reply to the debate not later than 1.35 p.m.; No. 2, Health Service Executive (Governance) Bill 2012 - Order for Second Stage and Second Stage, to be taken at 2 p.m. and adjourned at 4.30 p.m., if not previously concluded, with the contributions of group spokespersons not to exceed 12 minutes and those of all other Senators not to exceed eight minutes; No. 3, statements on school transport, to be taken at 4.30 p.m. and conclude not later than 6 p.m., with the contributions of group spokespersons not to exceed eight minutes and those of all other Senators not to exceed five minutes and the Minister to be called to reply not later than 5.50 p.m.; and No. 20, Private Members’ business, motion No. 8 re life-limiting health conditions in children, to be taken at 6 p.m. and conclude at 8 p.m.

193 Seanad Éireann

26/09/2012A00300Senator Darragh O’Brien: To follow up on a couple of points from last week, has there been any progress in the issue of the vacancy in Temple Street Children’s University Hospital? The paediatric physiotherapist post remains vacant and the hospital is awaiting sanction for the replacement of the post. I remind the House that approximately 94 children with cystic fibrosis are using those services in the hospital. Nobody would disagree that the delay in filling the vacancy is unacceptable and I will be raising the matter with the Minister for Health today. Has the Leader had an opportunity to raise the issue?

We urgently need a debate - next week, if possible - on the household charge and the effect it is having with cuts to local authority funding. In particular, there was a promise from the Minister for the Environment, Community and Local Government that should a local authority attain 66% of collection, the third quarter cut imposed on local authorities would be refunded. I use the example of Clare County Council, which had €250,000 cut from its budget despite at- taining 67% collection. As the council has been informed that the money will not be refunded, that is a broken promise.

I have heard Members of this House on the Government side going on local radio in Clare, giving out yards about how they are appalled at this and they will speak with the Minister. They said this was a promise and it was awful that it was being broken. I would like some clarification on the issue. The Minister made the promise and local authorities are doing their best to collect these funds. They were told there would be a rebate of the third quarter cut if a certain level of collections was attained but the Minister has rowed back by indicating this will not happen. Senator Conway was very exercised on Clare FM during the week about this. It might be an idea to bring the Minister into the Chamber to let Senator Conway and others ask the Minister specific questions as they may not have had a chance to meet him.

I propose an amendment to the Order of Business, that non-Government motion No. 9 be taken before No. 1. I raised the issue of mortgage arrears yesterday and on many occasions, and I have tabled what I see as a non-partisan motion, “That Seanad Éireann condemns the recently announced variable mortgage interest rate of 0.5% being imposed on mortgage holders by Bank of Ireland and ICS Building Society; and calls on the Government to take all necessary steps to reverse this unacceptable increase”. We have an opportunity this morning for Members of the Seanad to speak as one, laying down a marker to Bank of Ireland. We should not forget that although we only own 15% of the bank, we guarantee the bank and ICS, including its deposits and liabilities.

There are now thousands of people who will, from 24 October, face substantial mortgage increases, as the rate is 4.49%. All of us across parties and those in none can surely agree that this rate increase is not right. There has been much discussion about what will happen but there is an opportunity for the Seanad Members to speak as one. We should allow the Minister, Deputy Noonan, come to the House by accepting this motion. I am sure he and the Minister of State, Deputy Hayes, are very concerned about the rate increase. I mentioned yesterday that figures for mortgage arrears are up 50% since June last year. The crisis is getting worse. That two institutions guaranteed by the Irish taxpayer can arbitrarily increase the rate to 4.490% when the base ECB lending rate is 0.75% is a scandal. I ask all colleagues to look at this motion. I am not trying to beat up the Government on this.

26/09/2012B00200An Cathaoirleach: By way of clarification, it is No. 20, motion No. 9, on the Order Paper.

Senator Darragh O’Brien: It is real opportunity for the Seanad. By simply passing this 194 26 September 2012 motion, it would show that all representatives in this House condemn this mortgage interest rate increase and understand that the vast majority of mortgage holders are doing their level best to pay their mortgages. On a €300,000 mortgage, more than €100 net per month will be extracted from these families which are struggling already. By passing this motion, we have a chance to send a clear message from Seanad Éireann that this is not acceptable.

Senator Ivana Bacik: Yesterday I raised the issue of the youth guarantee which the Minis- ter for Social Protection, Deputy Burton, announced would be discussed during Ireland’s Presi- dency of the EU next year. A number of other colleagues raised issues around this guarantee and youth unemployment. I am grateful to the Leader for reminding us that the Minister for Social Protection will be in the House on 18 October for a debate on social protection during which we will be able to discuss this guarantee. The Minister of State at the Department of Foreign Affairs and Trade, Deputy Creighton, will be in the House for a debate on EU affairs in the next few weeks and I ask the Leader that we might also be able to cover the issue of the youth guarantee in that debate. It offers a significant prospect of an effective way to tackle youth unemployment which is at unacceptably high levels in Ireland and across the EU and which clearly needs a European-wide response. I spoke about this yesterday and it is something we could all work towards. It would be great to try to address it in this House with the Minister, Deputy Burton, and the Minister of State, Deputy Creighton.

Will the Leader confirm the date of an education debate with the Minister for Education and Skills, Deputy Quinn? Such a debate might include third level education. Yesterday my colleague and friend, Senator Barrett, rightly raised reports of a recommended merger of Trin- ity College and UCD. That was on the front pages of the newspapers yesterday arising from a report commissioned by the Higher Education Authority. Senator Barrett made some justified criticism of the nature of that report. His criticism has been even further vindicated today. The HEA has questions to answer about the reason it commissioned this report, from whom it commissioned it and how it was carried out. I saw reports that it was carried out based on a port- folio of information supplied to the international experts. I do not see any indication that they visited any of the universities, institutes of technology or third level institutions or that they spoke to any stakeholders. I know, as would Senator Barrett and others, having been involved in academic assessments of other institutions and departments in universities, that one of the first things one does is go to the university or institution and try to see how it works in practice through speaking to all of the stakeholders, including the students, lecturers and so on. There are real questions to be answered about this report and I am glad the Minister, Deputy Quinn, has come out very strongly against it, in particular this proposed merger, describing it as unfea- sible. He is right about that.

I commend the members of GLEN and BeLonG To and other groups which helped us greatly yesterday in briefing Senators in advance of the debate on homophobic bullying which was addressed by the Minister of State at the Department of Health, Deputy Lynch. It was a good debate and in her response to the speeches on homophobic bullying, the Minister of State made a point of saying how useful she had found it and how valuable she found Seanad debates generally. It was good to see stakeholders and members of GLEN in the Visitors’ Gallery. We all appreciated that.

Senator Jillian van Turnhout: I take the opportunity to remind Senators that this evening, our Independent group has a Private Members’ motion down to support the 1,400 children with life-limiting conditions and their families to ensure they can get provision of home care. In our motion, we have clearly shown the savings to the State. We worded our motion very carefully, 195 Seanad Éireann being aware of the environment we are in and of the fact that parents who should be giving their undivided attention to those precious days, months and years with their children are instead having to fight a system.

I must admit that when I got the Government amendment last night, it was a body blow. It was a low point for me. The motion we are putting before the House this evening is a way for the Government to bring in a discrete policy for these 1,400 children around the model of the money follows the patient. Why not test it with these children? Let us do it now. Why are we waiting for more general policy? I appeal to the Leader and all Senators, in particular Govern- ment Senators, to attend the debate, to be open and to listen to the arguments. Hopefully, we can convince them to support out motion.

While a small number of families are affected, each of them has to fight for a medical card and support for their child. There are few things we can solve very easily but this is one. Let the Seanad take a lead today.

26/09/2012B00600Senator Feargal Quinn: Will the Leader consider a debate on the document issued yesterday by Senator Zappone, me and some former Senators, including Joe O’Toole, when people have had the chance to discuss it? It is a discussion document and, I hope, is non-controversial. I would like to think we could have a debate which would be non-controversial. When people have had the chance to read the document, I urge the Leader to have a debate in which there will be no vote. We can have statements rather than put down a motion which might perhaps embarrass those whose parties do not approve of it.

This is similar to what Senator van Turnhout said. It is a shame that every time a motion is put down, the Government feels obliged to table an amendment to it which contradicts the objectives of the motion. We should have a non-controversial and a non-divisive method of discussing items like that.

I agree entirely with what Senator Barrett said yesterday in regard to his concern about third level education and I was delighted to hear Senator Bacik refer to it today. There is much to discuss there. Senator Cullinane will be interested to see that one of the proposals is for a joint college of technology between Dublin and Waterford. It would appear there is much to debate in this area.

Let us try to ensure this House is not always controversial. We do not have controversies that often but let us ensure we can avoid them. A good discussion on third level education would be very welcome and from what I gather, the Minister, Deputy Quinn, would also welcome the opportunity to have that debate here.

Senator Cáit Keane: I heard Senator Zappone on “Morning Ireland” today talking about the Seanad being used more to debate EU legislation. However, the following issue cannot wait for the reform of or abolition of the Seanad, if the people so decide. EU Commissioner Red- ing has proposed legislation which is going through. On 5 March last, Ms Reding announced the launch of a three-month public consultation process on the legislation asking what type of measures the EU should take to get more women into the boardrooms of companies in the EU and said the Commission would decide on further action.

One of the questions asked in that consultation process was whether 20%, 30%, 40% or 60% should be defined for the under-represented sex. We all know what the under-represented sex is; it is the female species. The proposed EU legislation is aimed at what EU officials have 196 26 September 2012 described as a severe gender imbalance across the 27 member states with 13.7% representation.

The proposal from the EU will not apply to all companies because small companies will ask how can they be expected to comply. It applies to larger companies with perhaps more than 200 employees or a turnover of €50 million. I do not want to frighten all the men sitting on the boards of small companies, or all the men sitting on boards of most companies in Ireland and the EU, that this will apply to all companies. My understanding is that it will not.

When I started out in politics, I was fiercely opposed to quotas for anything, whether gender or otherwise. I have taken a full whirl on this, as it were, because the proof is in the pudding and all statistics show that only quotas work. The commissioner has stated that she does not like quotas, but she likes what quotas do. One year ago, the commissioner invited voluntary participation in this and only 24 companies across the EU took up the voluntary proposal. I do not know how many of them are Irish. The commissioner said we can count on her regulatory creativity so rather than be caught on the hop because it is coming down the track, I want a debate in this House on the proposal. The decision will be taken by qualified majority vote and will not be a blocking vote. I seek a debate on this serious issue. A study by the international law firm Eversheds has shown that share prices go up when women are on boards. I met a man from Iceland yesterday who told me the only bank that did not fail in Iceland was one headed by a woman. I want a debate on this issue sooner rather than later.

26/09/2012C00200Senator Darragh O’Brien: Permanent TSB is not a great example. Where is it now? Do we not own it?

Senator Cáit Keane: I congratulate the Minister for the Environment, Community and Local Government, Deputy Hogan, on accepting the figure of 30% in politics but we are only beginning.

26/09/2012C00400Senator Labhrás Ó Murchú: I second the amendment to the Order of Business proposed by Senator Darragh O’Brien. There has been much debate over the years on the reform of the Oireachtas, not just the Seanad but also the Dáil, and how we do our business. Many of the de- mands we hear possibly come from people’s perception of the way we work within the Houses of the Oireachtas. A point was raised by the Independent Senators and I agree with the sentiments they put forward. If a motion is tabled by a non-Government source, we should not automatically feel it necessary to oppose it. I have seen this not just with the current Government but with previous Governments. I was often surprised when I saw amendments tabled because many of the motions we debated on Wednesday evenings were generally ones with which, in our hearts, we agreed. We were trying to make a contribution, first, to highlight the issue put on the agenda and, second, to provide information. We have specialists in this House who table motions, which gives us an opportunity to build up our store of information. If the motion is passed eventually without a Government amendment, it does not bring down the Government or radically change how we do our business. It does, however, give us an opportunity to flag certain issues of importance. I cannot think of any issue more important than vulnerable children . In the context of the motion to be debated today, while I am not being critical of the Government because the previous Government did exactly the same thing, when it comes to reform, it would show we are capable of getting out of the straitjacket of party politics and the way we traditionally have done business. We all know times have changed. Whatever may happen to the motion to be debated today, I would like to think that in the future, more consideration would be given to arriving at consensus rather than division when people bring forward issues that are fundamental to society and vulnerable people who expect us to give them a voice 197 Seanad Éireann when they have none.

Senator Paul Coghlan: Senator Quinn is one of the most reasonable and non-controversial people we have the good fortune to know. I liked his words with regard to the discussion document he circulated to us all. He has always endeavoured to be constructive and I agree with his call on the Leader to table the subject he raised for debate in the near future, in a non- controversial way and without a motion or vote. We want to ensure we are not divided on this subject. It is very well-meaning and meritorious and perhaps the Leader would consider it for debate for a few hours.

Senator Sean D. Barrett: I echo the comments by Senators Coghlan and Ó Murchú. We do not come here for a Punch and Judy show and to have produced articles with lines like “Ashen-faced Minister will have to answer to the junior Minister because he was defeated in the Senate”. We come here to serve the country and we should look at motions in that spirit because the previous type of politics led us to where we are now.

I thank the Leader for facilitating the education reference yesterday. It was very important and we knew the Minister would agree with what the Seanad said but the Seanad was here first and it is very important the Leader facilitated that.

I also wish to raise Senator Kelly’s motion on the Order Paper concerning windmills. I believe the public service obligation part of one’s electricity bill will increase because of the subsidies needed for the windmills. I appreciate Senator Kelly has other objections but we need to discuss this, particularly proposals that would involve Irish electricity consumers paying more in the public service obligation to export electricity to England. One estimate is that it will go up by 42% this year. It seems those projects need to be analysed and perhaps it is a topic to which we might return.

Senator Michael Mullins: It is appropriate that there are many young people in the Gal- lery at the moment in light of the issue I am about to raise, namely, a survey on alcohol use in the 18 to 24 year age group published today by Alcohol Action Ireland. This survey has some alarming statistics. One quarter of the respondents reported that they experienced a variety of harm as a result of another person’s drinking. The survey found that one in 11 said that a family member had been assaulted by a person under the influence of drink, 45% said they go out of their way to avoid drunk people or places where drinkers were known to hang out, 21% said they were kept awake at night as a result of late night drinking, 18% said they felt unsafe while waiting for public transport and 12% said they were involved in a serious argument.

I ask the Leader to organise a debate at an early stage to discuss alcohol and alcohol abuse. I know this has been raised on a number of occasions. Not alone is there an impact on young people’s health, relationships, the cost to the health service-----

An Cathaoirleach: There is a motion on the Adjournment on this matter in the name of Senator Clune and I am sure she will give Senator Mullins a minute of her time.

Senator Michael Mullins: I was not aware of that. I certainly welcome it but we need a full Seanad debate at an early stage. The motion on the Adjournment is one issue but this issue impacts society generally. As a country, we must face up to the serious issues of alcohol and drug abuse. We should devote at least one half day to discuss this major issue, which has been raised over several months by many Senators. It is time we bit the bullet on some of the issues we must confront as a nation. 198 26 September 2012

26/09/2012C01000Senator David Cullinane: I support the amendment to the Order of Business proposed by Senator Darragh O’Brien. It is important for us to have a debate on the increase in the interest rate by Bank of Ireland and other banks. It is an important amendment, which I support. I also strongly support the call for a debate on the higher education sector, which would be an important debate to have in the next few weeks or months.

I also support the very constructive proposal from Senator Quinn for us to have a non- controversial debate about the future of this House. However, I would like to see this debate broadened to discuss reform of the Oireachtas and not just the Seanad. Obviously, it concerns the proposal made, but I imagine we all want to see reform of the Oireachtas in its entirety, not just a narrow focus on the Seanad.

I wish to raise two very important reports published and in the public domain in the past 24 hours and which reinforce the need for a strong debate in this House on the economy. The first is a statement by three European finance ministers that casts some doubt over a possible bank deal for the State.

11 o’clock

We have to be strong and resolute in defending the interests of the people. It is important that we get a bank deal. While the Government is working with the Heads of State it is a matter of concern when three powerful politicians in the European Union issue a statement to the effect that the deal will not deal with legacy assets, in other words, previous banking debt, but only new banking debt. We also had a commentary from the Central Bank on the fiscal com- pact treaty which stated clearly that adjustments will be needed up to 2020, which means eight more austerity budgets. Therefore, those of us who said that the treaty would mean an extra €6 billion in cuts, in addition of what was committed to up to 2015, have been vindicated. That is linked to the Private Members’ business matter tabled by the Independent Senators. In eight years time, following all those austerity budgets, I wonder how many more people will be living in poverty as a consequence of those decisions. It is important to have a focused debate on the economy and ensure we get the right banking deal and that when adjustments have to be made we protect the most vulnerable.

Senator Deirdre Clune: On Thursday last we had statements on flooding and flood preven- tion measures when the Minister of State at the Department of Finance, Deputy Brian Hayes, was present. Senator Barrett and I raised the issue of insurance cover with him. I am concerned that there are areas in Cork and elsewhere where flood cover is not available because of a flooding history in the area. The Office of Public Works and the Irish Insurance Federation need to negotiate protocols. The Minister of State told the House bluntly that he was very frustrated at the lack of progress he is making with the Irish Insurance Federation. The effect of his comments was that one can bring the Irish Insurance Federation to the table but it is not engaging.

Yesterday the Irish Insurance Federation appeared before the Joint Committee on the En- vironment, Culture and the Gaeltacht, under the chairmanship of Deputy Ciarán Lynch, and said the Office of Public Works needs to communicate reliable information to it and it needs to have confidence in the OPW’s review. That indicates it does not have confidence in the OPW. Within one week two views have been communicated to the Houses and in the meantime individuals, businesses and households cannot get insurance because they are in a flood risk area. I ask the Leader to convey the comments of the Irish Insurance Federation to the Minister of State who expressed a different view on Thursday last and have the matter resolved in order that 199 Seanad Éireann those on the ground can move forward because they are frustrated.

Senator Colm Burke: I wish to follow up on what the Senator has just said in regard to the insurance industry. I am concerned that local authorities have not corresponded with the Irish Insurance Federation outlining what action they have taken to ensure there is not a repeat of the flood event that occurred in Cork. A councillor had a question tabled to one of the local authorities in the past week and the response was that the local authority felt it had no obligation to correspond with the Irish Insurance Federation. That is appalling because these are people who are experiencing difficulty in getting insurance. The Office of Public Works and local authorities should correspond with the Irish Insurance Federation and set out what action they have taken in order that there is not a repeat of the flood event that occurred in the past 12 months to two years.

I had a sad case recently where an elderly gentleman who came to my office understood he had full insurance cover. When he submitted a claim he was told by the insurance company that the first €10,000 was not claimable; the old rule was €1,000. We argued with the insurance company that this was unfair. He got no letter advising him that the excess had been increased from €1,000 to €10,000. I ask the insurance industry to be careful in how it manages its own affairs. We argued with the company and insisted on the claim, other than the €1,000, being paid and eventually it gave in. This elderly man had to engage other people to fight for what he was entitled to. That was appalling behaviour by the insurance industry which collects a good deal of money from householders and to behave in this way is unfair. Returning to the earlier issue I ask the Minister to correspond with local authorities requesting them to write to the Irish Insurance Federation setting out what action they have taken, as well as getting the Office of Public Works to do likewise.

26/09/2012D00400Senator Martin Conway: Following on from the two previous speakers I call on the insurance industry to update and issue a new charter and code of practice. It is a matter of concern that a situation can arise where a person is of the view that he or she is covered for everything in excess of €1,000 and then it becomes in excess of €10,000. In simple language that can be described as sharp practice, that is, an insurance company chancing its arm by taking advantage of a vulnerable citizen for greed.

I welcome the comments on “Morning Ireland” today by Michael Fuchs, vice-president of Angela Merkel’s party, who strongly supported the concept of a renegotiated debt scenario for Ireland. With such powerful people in our corner we will see clear blue water in this area.

I support calls to the Leader for a debate on the report on alcoholism published yesterday. We have a serious problem. However, I am not happy at the notion that it will be later than 2016 before sporting events are banned from using drinks companies to fund themselves. Drinks company advertisements should be banned from the national airwaves. As a society we will have to seriously consider raising the legal age for consuming alcohol to 21, as in other countries. We have a serious problem.

Senator Darragh O’Brien: Guinness sponsored County Clare once. The Senator may need to speak to the Minister for the Environment, Community and Local Government, Deputy Phil Hogan, about the cuts in Clare.

Senator Martin Conway: We have a serious problem. We could start in the great offices of the House to lead a national crusade to deal with the problem.

200 26 September 2012

26/09/2012D00700Senator Trevor Ó Clochartaigh: Thug mé faoi deara sa liosta den reachtaíocht atá le plé, faighte an tseachtain seo caite, go bhfuil an Bille iascaireachta curtha siar. Is ábhar imní dom é sin agus ba mhaith liom aird a tharraingt ar sin. I draw attention to the fact that on the legislative agenda received last week the fisheries Bill has once again been deferred. I have raised the issue on a number of occasions, particularly the decriminalisation of penalties that fishing cap- tains receive if found to be remiss in filling out their log books etc. This was a huge campaign issue for the Minister for Agriculture, Fisheries and Food, Deputy Simon Coveney, prior to the election, and he promised to address the anomaly of criminalising fishermen which was introduced by the previous Administration. It is a complicated and stressful issue for those involved because the sanctions for a criminal prosecution for inserting incorrect dates on log books are massive. A number of cases have been struck out by judges who consider the Government is remiss in dealing with the issue.

As it is a matter of utmost importance and a serious issue for fishing families who are in a difficult situation and it is a difficult industry in which to be involved, it is pertinent to discuss the issue with the Minister as soon as possible. It is a huge industry and one that has been under pressure. I appreciate the Minister has done much good work on quotas but it is a case of a lot done and more to do. We should have a debate on the issue and the Bill should be brought forward as soon as possible. Beidh mé ag súil go dtiocfaidh an tAire i bhfeighil iascaireachta isteach leis an ábhar an-tábhachtach seo a phlé chomh luath agus is féidir.

Senator Pat O’Neill: I compliment the Minister for agriculture on his announced yesterday of a new AEOS 3 scheme that will provide €20 million. I also compliment him on savings made in his Department over the past 18 months or more at a testing time for the economy. The announcement means that 6,000 new farmers will be able to participate in the scheme and I would welcome an acknowledgement from the other side of the House.

Today €154 million will also be paid to farmers under the disadvantaged areas scheme. The payment has been made on time. It has been such a testing time weather wise and the payment will be a welcome boost to cashflow for most farmers.

26/09/2012E00200Senator Denis Landy: I request the Leader to seek a debate on the HSE’s directive to withdraw funding for travel for non-clinical work. As Members of this House may know, suicide awareness training falls into the category. The directive means that the allowances paid to current specialised tutors will be cut and a service that is aimed at removing the stigma attached to suicide and giving support to communities is now at risk. In my home town, 29 people from the community have signed up for the course at the Nano Nagle Centre, Carrick-on-Suir. The course provides people with support and an opportunity to learn the skills required to spot signs of suicidal behaviour. It gives people the lifesaving tools they need to help others in their community affected by suicide. After the first three sessions funding towards the travel costs for the tutor has been cut. The drastic action has caused great disappointment among participants and the likelihood is that training will be put on hold until at least the New Year. This is at a time when more people are being treated for self-harm in our accident and emergency centres caused by either cyber-bullying, loss of a job or loneliness and isolation in rural Ireland. The relatively small amount of money allocated for the running of the service should be reinstated as soon as possible. I appeal to the Minister of State and my Labour Party colleague, Deputy Kathleen Lynch, to find out if anything can be done to reverse such a drastic decision to cut services of this nature. I ask the Leader to request the relevant Minister to deal with the issue as a matter of urgency.

201 Seanad Éireann Senator Mark Daly: I ask the Leader to organise a debate on driving licences on two fronts. First, many people have worked on the campaign for a new EU driving licence - myself included - along with various organ donor organisations here. We want a tick box to be included on all driving licences in the EU in order that more families are aware of the intention of their loved ones. A central database would hold such information in order that a hospital and loved ones could find out a person’s intentions should he or she pass away.

Second, I also seek a debate with the Minister for Transport, Tourism and Sport on driving licences for Irish citizens in Canada. We have pushed for a reciprocal arrangement where we would recognise their full licences and they would recognise ours. Unfortunately, there seems to be a great resistance to it in the Department and the Road Safety Authority. About 5,000 Irish citizens travel to Canada and they must go through its entire process in order to get a licence. I had a meeting with the Canadian ambassador who has pushed hard for the cause. The prov- inces of New Brunswick and Saskatchewan have unilaterally decided to recognise Irish driving licences and Ireland needs to take a step in a similar direction. I ask the Leader to organise a debate in order to ensure that Irish citizens receive a full licence in exchange for their Irish one when they travel to Canada.

During the week an EU Commissioner commented on a federal Europe and stated that a federal Europe was the only solution to the current crisis. A fortnight ago President Barroso also talked about a federal Europe and now a new commissioner has mentioned it. I would like the Leader to organise a debate on a federal Europe because we did not sign up to one.

Senator David Cullinane: Deputy Micheál Martin promised it.

Senator Mark Daly: A union of nation states is what people signed up to. Federalism was not in the charter.

Senator David Cullinane: Micheál is listening.

Senator Mark Daly: We have an incremental federalism being proposed by the bureaucrats at the top who are unelected. We must arrange a debate on the matter as soon as possible.

Senator John Kelly: I ask the Leader to bring the following matter to the attention of the Minister for Health because the problems related to medical card assessments have not gone away. I know for a fact that families who submitted comprehensive information to the primary care reimbursement service, PCRS, have had some of their documentation selected but not some documentation that would favour their application. It is quite frustrating to deal with the PCRS. Only two weeks ago I had a situation where a fellow who submitted a P60 showing that he earned €19,000 per year received a written reply stating that he was €8,450 a week over the limit for receipt of a medical card. If that is an example of the work being done then it is important that the Minister steps in again to resolve the issues.

Senator Fidelma Healy Eames: I would like to touch on two items briefly and perhaps the Leader can help us. The Minister for Education and Skills is about to introduce a Bill on the education and training boards but it has been brought to my attention that there is no seat on that board for the further education sector. We know that the education and training boards means the reduction of 33 VECs down to 16. A core component and key part of their work is adult education. It would be outrageous if no seat was provided on the board for people that represent adult education, adult literary and further education. I ask the Minister to flag the issue now but Members will raise the matter during the debate on the Bill. Ideally, the legislation 202 26 September 2012 needs to be amended beforehand to include the provision. It would be good if the legislation arrived here already drafted.

We have raised the following matter before when we debated the Civil Registration Act with the Minister for Social Protection, Deputy Joan Burton. We need to table an amendment to help Irish families whose loved ones die abroad to have their deaths registered at home. We only think of the matter when it affects ourselves but there are quite a few families in Ireland who are upset. Examples that come to mind are those people whose young sons have died while on a working visa or during a summer abroad or their husbands died in the Middle East. We need to put pressure on the Minister. I was assured by the registrar that a memo was being sent to Cabinet last spring but that has still not happened. Resolving both of the issues that I raised would greatly help a lot of people.

26/09/2012E01300Senator Diarmuid Wilson: I support Senator Healy Eames in her call for the adult education service to be afforded a place on the new ETBs because it is an important matter. The adult education sector provides training for tens of thousands of people on a yearly basis throughout the 26 counties and is due a place on the education and training boards. Adult education officers provide an excellent service to people who were not afforded the opportunity of an education heretofore. I support the Senator’s call that they should be represented on the education and training boards.

I call on the Leader to contact the Minister for Foreign Affairs and Trade about the Pass- port Office which provides an excellent service for the general public but delays arise at peak times. Trips have been cancelled because passports were not issued in time. We are told by the Passport Office that members of the public that use the postal system are guaranteed a passport within ten working days but that is not the case.

Another difficulty that I discovered during the summer was where a constituent contacted me stating that he or she had lost or mislaid his or her passport and therefore was not entitled to avail of the excellent emergency service provided by the Department of Foreign Affairs and Trade. In fact, there is a rule in operation for the last 18 months or so whereby if one loses one’s passport one must wait a minimum of five days before it will be processed. That must be examined and I ask the Leader to contact the Department of Foreign Affairs and Trade to see if that difficulty can be overcome. While he is in contact with the Department he might inquire if the Oireachtas passport system could be reinstated. It has been very valuable to our constituents.

26/09/2012F00200Senator Maurice Cummins: A number of Members have raised specific items on the Or- der of Business. Adjournment motions would be the more appropriate means of dealing with such specific matters, as there is little I can do about them. It would be a better way for Mem- bers to get answers about specific problems that they quite correctly raise.

Senator Darragh O’Brien has asked about the vacancy in Temple Street Children’s Univer- sity Hospital and mentioned that he is having a meeting with the Minister-----

26/09/2012F00300Senator Darragh O’Brien: No, I will ask him about it when he is in the House to deal with the Bill today.

26/09/2012F00400Senator Maurice Cummins: Okay.

On the household charge and the withholding of funding to local authorities, my under- 203 Seanad Éireann standing is that a number of local authorities have received moneys already in the context of money that had been withheld because the percentage had not been reached. I do not think there is a specific percentage. However, I understand that Waterford County Council and others have received a large percentage of the money that had been withheld. I cannot say if that is the situation in Clare but I will make further inquiries about it.

I addressed the question the Senator raised about motion No. 9 relating to mortgages yesterday. Bank of Ireland is a private commercial company-----

26/09/2012F00500Senator Darragh O’Brien: Guaranteed by us.

26/09/2012F00600Senator Maurice Cummins: -----and I do not propose to accept the proposed amendment to the Order of Business.

Senators Bacik, Barrett, Cullinane and others sought a debate on education. The Minister for Education and Skills will be in the House on either 16 or 23 October, but the date has not been finalised. The Minister has to confirm one of the dates for me.

Senator van Turnhout and other Members referred to the Private Members’ motion that will be discussed this evening. I join Senator van Turnhout in hoping that we will have a very constructive debate. Governments decide whether to submit an amendment to a motion. That is the way it has been and the previous Government always tabled amendments to motions. However, we have reached agreement in the House on motions in the past. It is not just a matter of tabling amendments to them. Let us see how we get on with this. I am sure there will be a constructive debate this evening on the excellent motion proposed by the Independent Senators.

Senator Quinn and all other Senators received the consultation document on proposed Se- anad reform. I will accede to the Senator’s request and we might have a discussion on it next week.

26/09/2012F00700Senator Feargal Quinn: I thank the Leader.

26/09/2012F00800Senator Maurice Cummins: We probably will not require a Minister to be present to listen to the debate. We can have a constructive debate among ourselves on the document. I have only read part of it yet.

Senator Keane referred to Commissioner Reding and the issue of gender imbalance in the board rooms of large companies in the EU. As she said, the Government has taken steps with regard to the participation of women in politics through the introduction of quotas. I will consider whether to have a debate on Commissioner Reding’s proposals.

Senator Barrett raised the issue of wind energy and windmills and suggested that a cost- benefit analysis be carried out. We will definitely return to that issue in the near future.

Senator Mullins referred to the report Senators received this morning from Alcohol Action Ireland. I have arranged for the Minister of State, Deputy Róisín Shortall, to come to the House before the end of October to address the issues raised in the report and to have a broader debate on alcohol. She has been to the House previously and expressed the wish to return again. We will facilitate her before the end of next month.

Senator Cullinane raised the HEA report and the Seanad consultation report and correctly pointed out that we must get a deal on our bank debt. I assure the Senator that the Government 204 26 September 2012 will continue to work on securing the best possible deal for the country. It is essential.

Senators Clune, Conway and Colm Burke raised the insurance industry. Senator Clune referred to the lack of insurance for homes and businesses in areas that are at risk of flooding. Each of the Senators spoke about the need for greater communication between all bodies involved in this area, with Senator Colm Burke mentioning local authorities in particular. I could not agree more with him and note the point he made relating to the excess on policies moving from €1,000 to €10,000 with some insurance companies. There is certainly an obligation on insurance companies to notify their customers of such changes.

Senator Ó Clochartaigh raised the sanctions against fishermen. I agree that the vast majority of fishermen are law abiding. The Minister for Agriculture, Food and the Marine will be in the House on Thursday next week to discuss Common Agricultural Policy reforms and there might be an opportunity to raise that matter with him then or, perhaps, the Senator could raise the issue on the Adjournment.

Senator O’Neill has obviously just returned from the ploughing championships because he was able to announce the new agri-environment options scheme and the €154 million for disadvantaged areas which will be paid out today. I am sure the Minister will expand on those issues when he is in the House on Thursday week.

Senator Landy raised a specific case and I believe he would get a more specific answer if he tabled a motion on that issue for debate on the Adjournment. Likewise, the issue raised by Senator Kelly, an update on the situation with medical card assessments, would probably get a specific answer through an Adjournment debate. I realise there are long and unacceptable delays not only with regard to medical card assessments but also in many other areas such as invalidity benefit and carer’s benefit. I am sure the Senator will raise the matter on the Adjourn- ment.

The matter raised by Senator Daly is also a specific item. Rather than having a debate on the issue of driving licences, he should table an Adjournment motion and get a specific answer to the question he raised. The EU and the issue of federalism is a matter for another day. We will try to arrange a debate on European affairs in which the Senator can address that issue.

Senator Healy Eames raised education and training boards. The Minister will be introducing legislation but I do not know if it has been published yet. If not, we can certainly make representations regarding boards and the members of such boards. On the registration of deaths, perhaps the Senator would table an Adjournment motion to seek an update on the situation. She has raised the matter previously.

The same applies to Senator Wilson. I will make inquiries about the delays in the Passport Office. Generally, it is very good but if it is not meeting the ten day target, something is astray and must be addressed.

26/09/2012G00200An Cathaoirleach: Senator Darragh O’Brien has proposed an amendment to the Order of Business, “That No. 20, motion No. 9, be taken before No. 1.” Is the amendment being pressed?

26/09/2012G00300Senator Darragh O’Brien: Yes.

Amendment put:

205 Seanad Éireann The Seanad divided: Tá, 18; Níl, 28. Tá Níl Barrett, Sean D. Bacik, Ivana. Byrne, Thomas. Bradford, Paul. Crown, John. Brennan, Terry. Cullinane, David. Burke, Colm. Daly, Mark. Clune, Deirdre. Leyden, Terry. Coghlan, Eamonn. MacSharry, Marc. Coghlan, Paul. Mooney, Paschal. Conway, Martin. Mullen, Rónán. Cummins, Maurice. O’Brien, Darragh. D’Arcy, Jim. O’Sullivan, Ned. Gilroy, John. Ó Clochartaigh, Trevor. Harte, Jimmy. Ó Murchú, Labhrás. Hayden, Aideen. Power, Averil. Healy Eames, Fidelma. Quinn, Feargal. Heffernan, James. van Turnhout, Jillian. Henry, Imelda. White, Mary M. Higgins, Lorraine. Wilson, Diarmuid. Keane, Cáit. Kelly, John. Landy, Denis. Moloney, Marie. Moran, Mary. Mulcahy, Tony. Mullins, Michael. Noone, Catherine. O’Keeffe, Susan. O’Neill, Pat. Whelan, John.

Tellers: Tá, Senators Ned O’Sullivan and Diarmuid Wilson; Níl, Senators Paul Coghlan and Susan O’Keeffe.

Amendment declared lost.

Question, “That the Order of Business be agreed to,” put and declared carried.

206 26 September 2012 Ombudsman (Amendment) Bill 2008: Second Stage

Question proposed: “That the Bill be now read a Second Time.”

26/09/2012H00400Minister for Public Expenditure and Reform (Deputy Brendan Howlin): I welcome the opportunity to introduce this important legislation to the Seanad. While I am sure many Senators will be aware the first equivalent to a modern-day office of the Ombudsman was established in Sweden in the 18th century, the starting point for the establishment of the Office of the Ombudsman in Ireland goes back to 1969 and the report of the public services organisation review group, better known as the Devlin report, which recommended the appointment of a commissioner for administrative justice, the theoretical prototype for the Ombudsman, which would emerge later. Six years after the publication of that report, a Dáil Private Members’ motion led to the establishment of an informal all-party committee, which reported in 1977 and recommended the establishment of an Ombudsman’s office. The Bill establishing the office was enacted in 1980 and came into operation, by Government order, in July 1983.

This Bill represents the most significant legislative development in the jurisdiction and role of the Ombudsman since that original Act came into force. In seeking to have the Second Stage debate completed in this House, I wish to highlight the role of the legislation as a key pillar of the Government’s political reform agenda to strengthen the accountability of public bodies, enhance the transparency of public administration and improve the quality of decision making in the public sector. The programme for Government contains a commitment to extend the Om- budsman Act to ensure all statutory bodies and all bodies significantly funded from the public purse are covered, as well as third level institutions. The primary purpose of the Bill, therefore, is to deliver this commitment regarding public bodies and thereby ensure members of the public have recourse to the Ombudsman in respect of the administrative actions of a significantly wider range of public bodies than heretofore. The Ombudsman has expressed her own views on this matter, which have been used to inform the drafting of this legislation.

The Ombudsman is empowered to investigate complaints about the administrative actions of Departments and Government offices, a number of agencies, the Health Service Executive, including public voluntary hospitals, and local authorities. It should be noted the Ombudsman also has certain functions under the Disability Act 2005 with regard to compliance with obligations placed on public bodies by that Act. In overall terms, the Ombudsman currently has jurisdiction over approximately 35 Government Departments, offices and agencies, as well as over all local authorities and voluntary hospitals.

It is important to stress the Government’s ambition for this Bill, if it is to be realised, must be fulfilled through its further amendment on Committee Stage in this House. I will explain by noting it will extend to comprehending all public bodies considered appropriate for review by the Ombudsman. My Department believes that more than 140 additional bodies, on top of the 35 bodies currently enveloped, will be brought within the Ombudsman’s remit in terms of agencies and educational institutions and this will be extended further when significantly funded non-public bodies are added in due course. There has been a debate on whether bodies which get a significant chunk of money from the State also should be subject to the Ombudsman’s review. More than 30 years after the enactment of the Ombudsman Act 1980, this Bill therefore provides the framework for the full realisation of the potential of the Ombudsman in providing redress to citizens in circumstances in which the system of public administration has performed inadequately. In addition to the highly significant extension in the scope of administrative re-

207 Seanad Éireann view, the Bill also provides the Ombudsman with additional powers and updates various provisions in the original Act to provide the Ombudsman with strengthened and updated powers to effectively and efficiently discharge the critical functions and responsibilities of her office.

The role of the Ombudsman is not simply to examine individual complaints but also to ensure a better quality service to customers or clients of public bodies or citizens by improving the system of public administration in general. An important part of the service is also the assistance given to members of the public on issues and areas which do not fall formally within the Ombudsman’s remit. The Ombudsman’s office does its best to offer advice, support and guidance in directing these inquirers to the right place to get assistance.

By the middle of September this year, approximately 80,000 complaints had been handled by the Ombudsman. Over the years, approximately 46% of complaints have been upheld in whole or in part or some assistance has been provided to the complainant. Last year the Om- budsman’s office received more than 3,600 valid complaints. More than 11,500 inquiries were also received that year.

I am very conscious that the wider improvements in public administration which the Om- budsman can help bring about are often achieved through the unearthing of systemic issues which come to light, in the first instance, through individual complaints. The positive spin-off that this yields manifests itself in a number of ways. For instance, while the primary purpose of the Ombudsman’s annual report is to report to the Oireachtas on the carrying out of her functions, it also serves to alert the public and public bodies to cases of interest which the Ombuds- man deals with over the previous year.

The Ombudsman caseload can also act as a valuable mechanism for identifying where broader improvements are required in administrative systems and processes to meet the customer service objective of the public service reform plan of placing the customer, the citizen, at the core of public services. As highlighted in that plan to meet the challenge of delivering better for less, the public service must be focused on making the citizen’s interaction with the State as simple and seamless as possible and improving the customer’s experience in engaging with governmental systems.

Many of the public bodies which the Ombudsman deals with deliver services or admin- ister schemes which are similar in nature. For instance, all hospitals face similar challenges in seeking to provide first-class patient care. An individual case where the Ombudsman finds fault with a particular public body and suggests improvements in practices and procedures can therefore provide a valuable learning experience for other public bodies which carry out similar work. In order to strengthen the role of the Ombudsman in this area, the Bill provides for the Ombudsman to make general recommendations to any of the bodies within her remit where, following an investigation, she considers it appropriate to do so. She can have a general application from a specific case.

A further benefit arising from the work of the office is the correction of issues which the Ombudsman identified in one case involving a public body which, in turn, leads to a retrospec- tive review of similar cases which had arisen previously and where appropriate redress may be warranted arising from the decision reached after considering an individual complaint. This can yield benefits for a class of people who had never actually complained to the Ombudsman or were unaware of the capacity to complain.

208 26 September 2012 The annual and special reports published by the Office of the Ombudsman show how the office can make a difference in the lives of many people while at the same time helping to raise the standards of public administration in Ireland. Public bodies can use the outcome of an Om- budsman investigation as an opportunity to turn complaints into a positive learning experience for the benefit of their organisation and those members of the public with whom they deal.

In advance of outlining the main provisions of the Bill, Senators should note that I intend to table a series of amendments on Committee Stage. This reflects the further consideration that Government has given to the provisions of the Bill and the opportunity the legislation provides for delivering key objectives in the programme for Government. The Office of the Ombudsman has been closely consulted on these proposals and the Ombudsman’s views have been taken into account in finalising them. I wish to acknowledge that the genesis of the Bill lies with the previous Government. It was introduced into and passed by the other House, but never made it to this House because of the fall of that Dáil. We want to build on that foundation and extend it further.

I will now briefly outline the main provisions of the Bill. Section 4 amends provisions in the 1980 Act whereby the Government can add or remove bodies to the Ombudsman’s remit by order. It is important that we will not be required to formally change the law to add a new body to the oversight of the Ombudsman. On Committee Stage, I propose to ensure that there will be automatic application of the Ombudsman to any new public body created thereby not requiring an order or legislation. I will also be proposing to allow for further extension of the application of the Act to non-public, significantly funded bodies on a case-by-case basis. I will be interested to get the views of the Senators on this matter. There are a number of significant non-public bodies that are largely funded by the State and the Government believes they, by and large, should be under the remit of the Ombudsman.

Section 5 updates the reference to “European Parliament” in section 2 of the 1980 Act. I also propose to amend section 5 further on Committee Stage to provide for a consultation for a committee of the Houses of the Oireachtas before making any proposal to appoint the Ombuds- man. This is in line with what is happening generally with incoming heads of semi-State bodies appearing before committees. I want to go somewhat further in this case requiring a consultation in advance of any proposal to appoint the next Ombudsman.

Section 6 updates section 4 of the 1980 Act to allow the Ombudsman to investigate a failure by a body to comply with the provisions being introduced in the Bill requiring bodies under the remit of the Ombudsman to give reasonable assistance and guidance in dealings they have with members of the public. The section also clarifies that the Ombudsman may, in her general discretion, continue to investigate actions by bodies within her remit on her own initiative - an “own-initiative” investigation - without formal complaint being made. This allows the Om- budsman to be a self-starter and would not be required to be triggered by a formal complaint.

Section 7 introduces a new provision on the rights of citizens in their dealings with public bodies on administrative matters. The section sets out the entitlement of citizens to a high level of service from those bodies which come within the remit of the Ombudsman. Consistent with the resources available to them, public bodies will be required to: give reasonable assistance and guidance in their dealings with the public; ensure that the business of the person is dealt with properly, fairly and impartially; and provide information on any rights of appeal or review that people have.

209 Seanad Éireann Section 8 amends section 5 of the 1980 Act which excludes matters relating to the recruitment or appointment and the terms and conditions on which a person in a reviewable agency is employed. The Bill now provides that, on these types of employment-related issues, the Ombudsman will have no jurisdiction, regardless of the organisation concerned. The rationale for this is clear, namely, the role of the Ombudsman is to safeguard the rights of individuals and society in dealing with public bodies and not to investigate issues relating to terms and conditions of employment, for which there are already very well established and elaborate State procedures.

Section 9 amends section 6 of the 1980 Act to provide that the Ombudsman can make a general recommendation to public bodies within her remit as she considers appropriate following an investigation. Sections 10 to 14, inclusive, provide for the strengthening of the powers of the Ombudsman as well as making some technical amendments. Section 15 limits the use of the title of “Ombudsman” to positions that are either authorised to use the title by an Act of the Oireachtas, have obtained the consent of the Minister for Public Expenditure and Reform to do so on foot of consultation by the Minister with the Ombudsman and relevant Ministers, or had commenced using the term before the publication of this Bill in 2008. The purpose of these provisions is to prevent a proliferation of entities using the term “Ombudsman” and safeguard the position and status which the Ombudsman and related offices hold in society.

12 o’clock

Section 16 provides for the replacement of First and Second Schedules to the principal Act. As I have emphasised, the Bill deals primarily with the remit of the Ombudsman. Listed in the current Schedule of the Bill are, for example, the vocational educational committees, higher education institutes, organisations such as the National Roads Authority, the Central Applica- tions Office, the Sustainable Energy Ireland Authority, the National Treatment Purchase Fund, the Courts Service, the Family Support Agency and many other semi-State bodies the activities of which affect the daily lives of citizens.

I will be proposing a further amendment on Committee Stage, to delete Part I and Part II of the First Schedule of the 1980 Act and to replace them with a general definitional provision in the First Schedule, with a list of specific bodies whose functions are to be partially brought within the Ombudsman’s remit as “reviewable agencies”. This will ensure that the Ombuds- man’s remit will automatically extend to all public bodies by way of a general definition of such bodies, except those bodies that are to be specifically excluded in whole or in part.

The Second Schedule to the Bill lists the bodies which are not subject to the Ombuds- man’s remit. The Ombudsman is precluded from investigating an action taken by or on behalf of a body specified in the Second Schedule. Bodies which are to be specifically excluded from the Ombudsman’s remit include commercial State bodies; regulatory agencies operating in the commercial domain; bodies involved in the legal and criminal justice system or with closely analogous functions and research and advisory bodies with little or no direct interface with members of the public. The final list of exempted bodies is currently being compiled for Com- mittee Stage on the basis of the advice of Government colleagues.

Sections 17 to 20 currently contain a number of consequential technical amendments to other Acts. I will be proposing further amendments on Committee Stage to provide for the merger of the Office of the Commission for Public Service Appointments with the Office of the Ombudsman. This merger is a recommendation of the McCarthy report and should lead to 210 26 September 2012 greater flexibility in the deployment of staff and administrative efficiencies through the amalgamation of back office functions. The Commission for Public Service Appointments and the commissioners are to continue with no change to their statutory roles.

I also advise the House of my intention to propose an amendment on Committee Stage to the Ombudsman for Children Act 2002. The amendment provides that the jurisdiction of the Ombudsman for Children will automatically follow any changes to the jurisdiction to the Om- budsman in order that, as the Schedules are amended, the change will apply to both.

The work of Transparency International highlights the Office of the Ombudsman as an important pillar of what is called “Ireland’s national integrity systems”, the key institutions, sectors, culture and activities that contribute to integrity, transparency and accountability in a society. Transparency International in its 2009 Country Study on Ireland observed that the Of- fice of the Ombudsman was widely respected, has grown in confidence in recent years and is seeking to be more proactive in addressing more issues of public concern. It is essential that the continued effectiveness of the Ombudsman is secured by ensuring that the Ombudsman ex- ercises oversight over the administrative decision making of all appropriate public bodies and that the Ombudsman’s governing legislation is appropriately reformed and updated. This Bill achieves these dual objectives.

I trust Senators will strongly support this Bill and will welcome the new powers being given to the Ombudsman and the significant expansion of her remit. The Bill introduces a positive set of measures which will empower citizens in their interactions with public bodies and help to further improve standards of public administration. I commend it to the House.

26/09/2012K00200Acting Chairman (Senator Diarmuid Wilson): I welcome the Minister, Deputy Howlin, to the House.

26/09/2012K00300Senator Thomas Byrne: Fianna Fáil welcomes this Bill, the introduction of which it proposed in 2008. It is a pity the previous and current Governments delayed in this regard. How- ever, I acknowledge there were other priorities for both.

The Office of the Ombudsman is one of the few offices of State which attracts universal respect and praise in terms of citizens’ interactions with it. I have never heard a complaint about that office and I am sure that will never be the case. The Bill is a welcome extension of the number of bodies that fall within the remit of the Ombudsman, which bodies were outlined by the Minister. Included are many bodies whose actions affect people in their daily lives. This Bill provides for the most significant extension of the Ombudsman’s functions in the past 25 years, which is to be welcomed.

My own experiences in terms of dealings on behalf of citizens with the Ombudsman have been positive. In one case, where a citizen was being forced to remove himself from this jurisdiction because there were no care facilities for him here and the Department of Social Protec- tion had denied him social welfare benefits, the Ombudsman rectified the matter by ensuring the Department recognised the reality of the situation, which was a welcome decision. I have also had a number of interactions with the Ombudsman in regard to mortgage interest supplement and rent allowance, which interactions were also positive.

The need for an Ombudsman is even more acute at a time when the economy is in the troughs. During this time, people become more aware of their rights and have, out of financial necessity or as a matter of justice for the sake of their families, a greater need to enforce them. 211 Seanad Éireann The Government makes choices based on budgetary policy, thus abolishing or amending benefits. It is in respect of the rules applicable to those benefits that the Ombudsman’s office comes into play in terms of examining and applying them correctly. The fact that the Government generally accepts the Ombudsman’s decision saves people going to court to enforce their rights and also saves a great deal of time and money in that regard.

In the 1980s, my father, through his auctioneering business, had cause to take up a matter with the Ombudsman, namely, abolition of the first time buyer’s grant and the arbitrary cut-off point which applied in this regard, which was introduced by former Minister, Ray MacSharry. Some €10 million worth of grants was being abolished at that time. While one person made the complaint people all over Ireland benefited. While people had complied with the rules the Government had put an arbitrary time limit in place. My family has had much interaction with the Ombudsman down through the years, to the benefit of many people.

The decision in respect of the use of the word “Ombudsman” as proposed by the Minister and first proposed by the previous Government, is the correct one. There are a plethora of ombudsmen in place, including the Ombudsman for the Defence Forces, the Garda Síochána Ombudsman, the Insurance Ombudsman and Financial Services Ombudsman. We even have an ombudsmans’ association. It is a pity this was allowed to happen. However, we cannot turn back the clock. I note that there are students ombudsmans in our colleges. It detracts from the important function played by the Ombudsman in this country that this has been allowed to happen. There should be no further attempts by organisations to use the title “Ombudsman”.

I welcome section 7 which relates to citizens’ dealings with public services. However, I am not sure it goes far enough. Fianna Fáil put forward a Bill in the Dáil last year, the effect of which would have been to force local authorities to reply to a person within a particular time. I am not sure this section puts that obligation on a local authority, which obligation can be an administrative burden on local authorities, in particular if they receive a huge volume of vexatious correspondence. I met this morning with staff of Meath local authority who are very dedicated people. However, it can be frustrating for citizens who contact local authorities by telephone, e-mail or letter about a pothole and so on, which may be small issues in the overall scheme of things but affect their daily lives, if they do not get a response. Although I have not used the FixMyStreet.ie facility I understand some local authorities are doing great work through it, which is a positive development. If people know what to expect, it will be better.

The section is so general that it does not provide enough for the public. A local authority will be able to interpret it in a manner that gets around the legislation. I will have to discuss it with my group before we table an amendment to make it more specific. I am conscious of the resource issue because queries must be dealt with and local authorities do not have the staff they used to have. If people knew what to expect and knew that a complaint about a pothole did not go into a black hole in the office, they would be happy. If they knew there was a procedure in the office, they would be happy even if they never received a formal reply or a telephone call. Fianna Fáil is supporting the Bill and, on behalf of my colleagues, I pay tribute to the Ombuds- man. My party in government did not agree with the conclusions of the Ombudsman on one or two occasions but my dealings with her office have been excellent. Ms O’Reilly and her staff are excellent public servants and deserve our support. I hope they are not overwhelmed with work as a result of this Bill.

26/09/2012L00200Senator Cáit Keane: I welcome the Minister and the reintroduction of this Bill, which was reactivated by the last Government in 2008. It had another hearing in 2010. It has taken 212 26 September 2012 too long to get to this stage and it should not have taken so long because it is so important. The Government is only in office a while but when important Bills come along an explanation should be given for the reason they have not been enacted. I say that for the Government to note.

I raised a point on the Order of Business about women on boards. I find it difficult to call the Ombudsman an ombudswoman. Emily O’Reilly is universally respected and I would prefer to call her ombudsperson.

Deputy Brendan Howlin: Ombudsman is Swedish.

26/09/2012L00400Senator Cáit Keane: We are in Ireland. Táimid in Éirinn anois agus ba cheart dúinn a bheith ag cur in iúl-----

Deputy Brendan Howlin: As Gaeilge, Ombudsman atá ann chomh maith.

Senator Cáit Keane: We will have to get a right English word-----

Senator Trevor Ó Clochartaigh: Cad faoin Ghaeilge?

26/09/2012L00587Senator Cáit Keane: Sin é, aistrithe chomh maith agus focal ceart agus b’fhéidir go dtiocfaidh an Seanadóir Ó Clochartaigh suas leis an fhocal ceart le haghaidh ombudsperson.

26/09/2012L00600Senator Ivana Bacik: Tá an focal ceart agam, ombud.

26/09/2012L00700Acting Chairman (Senator Diarmuid Wilson): Senator Keane to continue, without interruption.

Senator Cáit Keane: I am starting with section 15(10)(a), which gives protection to the term “Ombudsman”. The Minister said he would accept amendments on Committee Stage and perhaps we will have a further discussion on the term. We are in Ireland and although we follow Sweden in many ways because it is way ahead of us in having introduced the Act in 1860-----

Deputy Brendan Howlin: It is an international term and is used everywhere else in the world. People understand what it is.

Senator Cáit Keane: I know.

26/09/2012L01100Senator Rónán Mullen: Is the Senator suggesting it should be changed to ombudsperson? That still ends in “son” and the Senator would still have a problem.

26/09/2012L01200Senator Cáit Keane: I would not have any problem with the word ending in “son”.

Senator Rónán Mullen: Ombudsperchild.

Senator Cáit Keane: The Minister has noted the point. I welcome the Government’s initiatives and, when the Bill is enacted, it will amend the Ombudsman Act 1980, which established the office to investigate complaints about the administrative actions of public bodies that adversely affected individuals or bodies corporate. We all know how important it is to individuals, some of whom are at the end of their tether. They wonder where they should turn to if they cannot get any satisfaction. The Minister mentioned the figures and I will deal with this later. The Office of the Ombudsman must be used and people should do so. Very often, the airwaves are used when the correct course of redress, which is readily available, is the Office of the Om- 213 Seanad Éireann budsman. The importance of the office cannot be overstated. When people are desperate and at the final hurdle, they will use it if they see no other road open to them.

The Legal Services Ombudsman is a separate entity. Can the Minister make a statement on the post of Legal Services Ombudsman to ensure we are all clear on its relationship to the Ombudsman? Momentum for reform in this area has been building for many years. It was first mooted in a publication by the Competition Authority in 2006, which pointed to a pressing need to introduce reform. The publication of the report on legal services provided an impetus for a debate on the topic and also, more generally, for a debate on the Ombudsman. The programme for Government committed to extending the role of the Ombudsman to ensure all statutory bodies and bodies significantly funded from the public purse are covered, as well as third level institutions. The Minister has outlined that it is proposed to enact the Bill but perhaps he can outline when it will be enacted. Perhaps he can give us a date when it will be finally passed by the Houses.

Deputy Brendan Howlin: I cannot enact it. That is up to the Oireachtas.

Senator Cáit Keane: I do not want to go back to 2008.

Acting Chairman (Senator Diarmuid Wilson): The Senator should leave the Minister alone.

26/09/2012L01800Senator Cáit Keane: I would like a timeline. The Minister for Public Expenditure and Re- form asked each Minister to review the public bodies falling under each Department’s remit. In surveying the inclusions and exclusions, the Minister has done considerable background work before introducing the Bill. It is based on the recommendations of each Department, so the consultation process has been inclusive of all Departments. The proposals in the Bill are made on foot of the consultation process. It is proposed that non-public bodies, funded in significant part or in whole by the State, will be included on a case-by-case basis by ministerial order. The Minister outlined some of the bodies to be included by ministerial order rather than by amending legislation. I welcome this step because we elect Ministers to have the power to do things. They consult the various interested bodies and we do not want to be in the Chamber changing legislation every day.

Has the Minister outlined who will be consulted and who will help the Minister make the decisions? Some 140 additional bodies were added, both public bodies and bodies that are not public but require public subvention. It is proposed that the Commission for Public Service Appointments will merge with the Office of the Ombudsman. We have spoken so much about the mergers of quangos. Perhaps these two bodies are similar and fulfil a similar role. The last paragraph of the Bill refers to the financial implications, which means more staff. Does merging offices involve more staff or change or taking personnel from elsewhere to the Office of the Ombudsman? I recommend the latter because the Ombudsman needs additional staff. The Minister referred to 80,000 complaints, of which 3,600 were judged valid, in one year. There were also 11,500 queries and I do not know how many e-mails the office receives. The Om- budsman is snowed under. The additional staffing provided for in the Bill is welcome but we want to ensure those staff are sufficient. Will the Minister make a statement on this?

The Minister stated the primary purpose of the Bill is to extend the Ombudsman’s remit. I acknowledge it represents the most significant extension of the Ombudsman’s powers in more than 25 years. I thank the Minister for this because the citizens need the Office of the Ombuds-

214 26 September 2012 man.

The Bill is to extend the remit of the office to a range of bodies, including higher education bodies. The Bill updates some of the provisions contained in the Ombudsman Act 1980 and affords to public bodies certain new powers and obligations. I will not say any more about this because the Minister referred to this in his speech.

There is a provision in the Bill stating powers must be consistent with resources. This ought to be written into every Bill because one cannot go wild and must always operate within resources. The Minister should have a good look at the resources of the Ombudsman’s office and ensure they are consistent with the provisions in the Bill. We must cut our cloth according to economic need.

A committee of the Houses of the Oireachtas is to have a role. Which committee has the Minister in mind? I refer to the provision to allow the office to make a general recommendation.

I commend the Minister who is bringing our legislation into line with the freedom of information legislation. It is welcomed by citizens. We hear a lot about openness, transparency and responsibility but this is giving great powers. The Ombudsman will now have the power to bring a case to the High Court if not given the required information. This is brilliant because the Ombudsman’s hands were tied behind her back previously. One hit a brick wall and went nowhere. The amendment in this regard is very welcome. I thank the Minister for introducing transparency and openness. A reference to transparency and openness is now a cliché but the Bill puts these principles into action.

26/09/2012M00200Senator Paschal Mooney: I welcome the Minister to the House. I welcome this key element of the programme for Government. It is interesting to note that this is the first extension of the powers of the Ombudsman in some 25 years. When the Ombudsman was appointed in the 1970s, the appointment was not met with universal enthusiasm, yet the office has proved to be very significant and effective.

I will not delay the House on the Bill. The Minister has outlined the various areas in which existing legislation will be improved. Recent cases dealt with by the Ombudsman give some indication of the effectiveness of her office. For example, the office challenged a HSE decision on nursing home charges, securing some 85,500 repayments for complainants. It intervened on behalf of parents who found out that their child who was being treated in a major hospital for a serious illness had been investigated for a non-accidental injury without their knowledge. The office reversed a decision on refusing carer’s allowance to the father of a woman with mental health problems and a suicidal history. In the first case of its kind, the Ombudsman upheld a whistleblower’s complaint about a flawed HSE investigation. The Bill is welcome in that it provides that, in making decisions on rights, benefits, etc., a public body covered by the Om- budsman must, consistent with the resources, deal with people fairly and in a timely manner.

Section 6 of the Bill updates section 4 of the existing legislation. The provision being introduced requiring bodies under the remit of the Ombudsman to give reasonable assistance and guidance in dealings with members of the public is important because there have been so many cases, for whatever reason, of members of the public not being treated by public officials with the respect they deserve. It is good to have the backstop. The Bill clarifies that the Ombuds- man may, in her general discretion, continue to investigate actions by bodies within her remit

215 Seanad Éireann on her own initiative and without formal complaints being made. This is also significant. The Ombudsman will no longer have to wait on the receipt of a complaint and can now initiate particular investigations across all the public bodies.

It is salutary to reflect on the fact that some 80,000 complaints have been handled by the Ombudsman’s office. An average of 46% of complaints have been upheld, as the Minister pointed out. This shows the public has enthusiastically embraced the concept of the Ombuds- man. Many public representatives who have been frustrated in their efforts to help constituents have referred many cases to the office of the Ombudsman. As stated, the success rate is pretty high.

We are now to extend the remit of the Ombudsman to some 140 bodies. This will obviously strengthen the accountability of the bodies because it has been proven that the coming into effect of the Office of the Ombudsman has improved the efficiency of public administration. The extension of the remit is bound to improve the quality of the service. It will also make public servants reflect more on how they initiate and implement policy in regard to their dealings with the public. I welcome this important legislation and wish the Minister well.

26/09/2012M00300Senator Ivana Bacik: I welcome the Minister to the House and the introduction of this Bill. As with all Members, I am grateful to the Minister for setting out the genesis of the Bill and the fact it was previously introduced in the Dáil under the previous Government. However, I understand it is the first time the Bill has been in this House. I am delighted we have the opportunity to speak on it now, essentially in a new period of its history. The Minister has outlined very clearly the proposals for amendment on Committee Stage.

Although the Bill was initiated under a previous Government, it clearly fits in with the current Government’s political reform agenda. It covers a number of different principles, including that of strengthening accountability of public bodies and improving the quality of services to the public. The latter is an important aspect, as the Minister stated. As Senator Keane emphasised, it is important in enhancing the transparency of public administration. The Bill comprises a positive set of measures to empower citizens and improve public services.

Like previous speakers, I pay tribute to the existing Ombudsman, Ms Emily O’Reilly, who has done a superb job and who is now halfway through her second term as Ombudsman. She has acquired a list of additional jobs and this Bill is adding to those.

With regard to Senator Keane’s question on whether the Title should refer to “Ombudsman” or “Ombudswoman”, I have grappled with the issue. I discovered literature suggesting the title “ombud” would be a useful compromise. It is non-gender specific and there is some backing for it, even in the Swedish language. Senator Harte pointed out to me that this is like a title used in Trinity College. Senator Barrett will be aware of fellows of the college. Women can be fellows, as can men.

Deputy Brendan Howlin: Jolly good fellows.

Senator Cáit Keane: There was a time when women were not allowed in.

Senator Ivana Bacik: There are now many women fellows. Perhaps we will move on. I will use the term “Ombudsman”. There has been discussion on the matter and alternatives proffered. Given that our Ombudsman is a woman and that the role is so closely and rightly associated with her, the title is interesting to use. 216 26 September 2012 A very extensive set of amendments is to be proposed to the Bill and the Minister has outlined them to us. They will make the Bill even more radical in terms of the reforms to be introduced. The Minister stated that more than 140 additional bodies will be brought within the Ombudsman’s remit. I very much welcome the extension of the remit to educational institutions and third level institutions, including Trinity College. There is to be a further extension, beyond 140, when significantly funded non-public bodies are added.

I am delighted the amendments are to be made in this House. It will give us a real opportunity to have a good debate on Committee Stage. Committee Stage debates in the Seanad comprise one of the strengths of the House. Any Senator may contribute and many will bring their expertise to the issue of the extension of the role.

The Minister referred to the role of the Ombudsman, to whom we pay tribute. She has dealt with an extraordinary number of complaints, some 80,000, with 3,600 valid complaints and more than 11,500 queries in 2011 alone. This indicates her office’s significant workload. It is important that she has been consulted on the proposed amendments. It was good to hear the Minister highlight her role in improving customer service in the context of the public service reform plan.

I now turn to the Bill’s provisions and the proposed Committee Stage amendments outlined by the Minister. Section 4 is critical in this regard, as the Minister will amend it to ensure automatic application of the Ombudsman’s remit to any new public body. The current section 4 requires governmental orders for any such extension.

Senator Keane raised the issue of criteria, particularly when it is proposed to extend the Act’s provisions to non-public bodies that are significantly funded. Will the amendment propose specific criteria? Once an organisation fits the definition of a public body, the automatic application is clear, but one can think of a range of different non-public entities that are significantly funded. Last week, we held a good debate on charities regulation. It was prompted by a Labour Party Private Members’ motion. We heard of the extensive reliance of many charities on State funding. Could they be included within the definition of non-public significantly funded bodies?

Quangos have been mentioned. I have read various references to, for example, Govern- ment-organised non-governmental organisations, gongos, which have become closely associated with Government funding. NGOs, or nongos, have no link to the Government----

26/09/2012N00200Senator Cáit Keane: Are there gondolas?

26/09/2012N00300Senator Ivana Bacik: ----- but might still be in receipt of significant public funding, for example, charities. We require greater clarity on the issue and should deal with it in more detail on Committee Stage.

The Minister stated that there would be an amendment to section 5 to provide for consultation with an Oireachtas committee. This is welcome. A committee would even be consulted in advance of the Ombudsman’s appointment. Committees are taking on such a role. Senator Keane asked which committee would be involved.

Yesterday, the justice committee held a useful hearing with the five members of the panel appointed by the Minister for Justice and Equality, Deputy Shatter, to select the new commissioners of the merged Irish Human Rights Commission, IHRC, and Equality Authority. The 217 Seanad Éireann panel’s five members, including the Ombudsman, commented on how it was a new experience for them to present their curricula vitae to a committee of Members. We replied that it was also a new experience for us. The meeting was a good exchange. The panellists were all persons of the highest integrity and there was no question about their curricula vitae, but the process was important for the democratic legitimacy of the merged commission.

The history of what happened is interesting. Having been appointed by the Minister for Justice and Equality this summer, they stood aside from the process over their concerns that their direct ministerial appointment meant they did not fulfil the Paris Principles, that is to say, the Parliament had not had an input. They sought to appear before us as a way to assert their accountability to the Parliament. I was struck by the Minister, Deputy Howlin’s intention to amend the Bill to clarify the Parliament’s role in this regard. It is a requirement under the Paris Principles and our various international obligations that we increase parliamentary scrutiny of appointments to what Transparency International calls Ireland’s national integrity systems, of which the merged commission will be one. I welcome the proposal.

In terms of section 7, I welcome the new provision on the rights of citizens and setting out entitlements to a high level of service. We have seen strong examples of improved services under the ongoing public service reform plan, which is being overseen by the Minister’s De- partment, as well as the Croke Park agreement. The latter has received much criticism in recent weeks, but we must recognise the fact that it has delivered many service improvements at a time of significant reductions in the number of public servants. For example, the Passport Office offers a considerably improved service when it was once the subject of much public criticism.

Schedule 2 lists the bodies not subject to the Ombudsman’s remit. Some obvious bodies are exempted, for example, the Law Reform Commission, the Director of Public Prosecutions and so on, the reasons for which the Minister has supplied. The Higher Education Authority has also been exempted. Serious criticisms were offered in the Seanad yesterday and today of the HEA’s recent commissioning of an international report that made the bizarre recommendation of merging UCD and Trinity College Dublin. Why should the HEA be excluded when third level institutions are included? Is the rationale that it has few interactions with the public? I presume that the merger of the human rights and equality institutions will need to be reflected in the Bill by way of an amendment.

I welcome the Bill and offer my strong support for it. That support is reflected on both sides of the House. The Ombudsman has been effective in her role. Transparency International has recognised this fact, as has every Senator. It is important and welcome that the Ombudsman for Children will follow automatically, in that her office will reform as well as the Ombuds- man’s. This is a radical proposal, but we can all support it as offering an improvement in public services.

Senator Sean D. Barrett: May I share time with Senator Quinn?

Acting Chairman (Senator Diarmuid Wilson): Will it be five minutes and five minutes?

Senator Sean D. Barrett: Yes.

Acting Chairman (Senator Diarmuid Wilson): Is that agreed? Agreed.

26/09/2012N00800Senator Sean D. Barrett: I thank the House. I strongly welcome the Bill. It is a part of a reform agenda that must be implemented as quickly as possible. Other issues have diverted us, 218 26 September 2012 but this is an important matter. Mildly put, Sir Humphrey is not a natural democratic. We must devise institutions to make him explain what he is doing and why.

I join other Senators in paying tribute to the previous holders of the post. I welcome the extension of its functions. The first holder, Mr. Michael Mills, learned his skills in the House, thereby disproving the quote cited by President Kennedy: “Leinster House does not inspire the brightest ideas”. The man who wrote it, Lord Edward FitzGerald, was in Carton House, which he preferred. I am glad that the Minister and his colleagues also took that step recently.

Senator Bacik queried the exemption of the HEA. It should be reconsidered. The first reference of the HEA to the Ombudsman will come from a certain Mr. R. Quinn of Sandymount, Dublin 4, who has something to say about how it performs its duties.

While I was a junior dean at Trinity College Dublin a long time ago, disputes between students and the college were appealable to Chancellor Mary Robinson, who subsequently became the Irish President, and Mr. Justice Henry Barron. This system ensured that we took our decisions seriously. The use of checks and balances improves the manner in which people conduct their business. Our society has needed checks, balances and scrutiny in the period since the Bill was first drafted.

I draw the attention of the House to the exemption list. The first body listed is Anglo Irish Bank. I do not know what was happening in 2008, but I cannot imagine an institution that has done more damage to this country. It should be the last body exempted. There are a number of other strange exemptions. I hope that the Minister will go through the list with a fine-tooth comb to explain why they have been exempted. It would probably make an interesting study of regulatory capture to learn who was using the back stairs to Ministers’ offices to be excluded from this legislation.

Why has the IHRC been exempted? One has no right to question a decision of the IHRC via the Ombudsman. It seems a contradiction in terms. I am sure the Minister will re-examine the issue. It is also strange that while one can make a complaint about faulty marmalade, one cannot make a complaint about the agency investigating it, the National Consumer Agency.

Pension trustees should be covered by the Ombudsman. A large number of private and public sector pension funds seem to be operating recklessly, financially speaking. It seems that trustees get together, award one another added years or so on and bankrupt their members.

Looking through the list of exemptions, one can see the commissioner for aviation regulation. At the behest of a former Minister, Noel Dempsey, airport charges increased by 41%, which seriously affected Irish tourism. The commissioner should not be exempt. People have also complained about the Competition Authority because it has so little success in promoting competition, particularly when part of court cases. With the Fire Services Council, if a fire be- falls a person, the issue should be dealt with in the best possible way. Essentially, everything on the list is worth checking. I would add Údarás na Gaeltachta to the list. I opposed very strongly in this House the removal of the elected representatives of Údarás na Gaeltachta, and that takes effect at the end of this month. There must be some other protection to provide checks and balances.

When reviewing Irish public administration approximately three or four years ago, the OECD referred to a problem of “agencification”, but that is what happened. When we set up quangos or distance bodies from the Minister, the Minister does not have to answer parliamen- 219 Seanad Éireann tary questions and the agencies quickly devolve themselves from any control by the so-called “parent” Department. As the McCarthy report noted, these bodies may have very large public relations budgets and become virtually independent republics. In a real republic like ours, that conduct is unacceptable; therefore, I am glad the Minister is reversing the process.

I disagree with my friend, Senator Keane. A dictionary definition taking in gender would indicate that “man” refers to women as well. “Personne”, on the other hand, is the French word for “nobody”, and I am sure “chairnobodies” would not be appointed to a committee.

26/09/2012O00400Senator Cáit Keane: The IMF has changed its outlook on that issue.

Senator Sean D. Barrett: I support the Minister and will be opposing Senator Keane’s amendment to change the Title of the Bill. It is an honour title.

Senator Cáit Keane: On a point of order, we hear much about the IMF, which has changed its term “ombudsman” to “ombudsperson”.

Acting Chairman (Senator Diarmuid Wilson): That is not a point of order.

Senator Cáit Keane: It is a point of information.

26/09/2012O00900Senator Sean D. Barrett: We are trying to get out from under the IMF, both in the verbal and financial sense. Regulators are not working in fields like aviation and transport. Represen- tatives of the National Transport Authority wrote to a man operating buses between Limerick and Dublin recently indicating that he could not have extra buses operating if they were being left standing in the rain. The energy regulator, which the Minister of State, Deputy O’Dowd, would rely on for regulating water, has given the ESB chief executive a salary approximately four times that of the Taoiseach. The regulators should be examined. The Central Bank is probably the world’s leading failed regulator as it caused the collapse of our banking system.

The Minister for Transport, Tourism and Sport, Deputy Varadkar, has indicated that the terms we signed with private operators to operate toll roads were disastrous from the taxpayers’ and road users’ perspective. A Minister of State, Deputy Shortall, drew attention last week to the fact that we have agreements with drug companies where we are getting perhaps 30% reductions in drug prices, while others were getting an 80% reduction. All public-private partnerships and agencies must be taken into consideration.

This is a splendid proposal and I wish it well. I apologise for using much of the time before handing over to Senator Quinn. I thank the Minister for coming to the House, which will support his efforts.

26/09/2012O01000Senator Feargal Quinn: I thank Senator Barrett for sharing his time. The Minister and this Bill are welcome, as it will bring more oversight. There are nonetheless a number of areas where we can go much further in order to improve democracy. For example, our democracy should look to countries like Sweden, which was mentioned today, which have very powerful freedom of information laws throughout levels of government. The main function of the Om- budsman’s office is to investigate complaints from members of the public who feel they have been unfairly treated by certain public bodies - we have heard about that today - but it should also ensure better governance. We must strengthen this and the public’s ability to access information.

In Sweden, all public sector documents are in the public domain in order that people can 220 26 September 2012 check them and hold the people in power accountable for their actions. Giving more presence to freedom of information in this country would enable groups and individuals outside government - ordinary citizens - to inform themselves on how the Government is managing our collective well-being. The current piecemeal system of freedom of information requests and parliamentary questions is just not working. We should include all public bodies in a simple, easily accessible public spending website. Senator Barrett mentioned some of the exclusions and I am sure the matter will be considered again.

A public sector spending website could be based on the American Federal Funding Ac- countability and Transparency Act 2006, which was introduced by President Obama when he was a Senator. This led to the creation of a website in which any expenditure over $25,000 by the federal Government in the United States, as well as a number of states, is open to the public. We have much information on-line but it is not collected in a central website, and I do not understand why that is so in a country of 4.5 million people. The state of Missouri is interesting as it created a website showing how every dollar was spent in a particular year, starting in 2007. It costs just $200,000 for this process in a state with a population bigger than Ireland at 5 million people.

In the United States, the federal Government publishes a vast array of data at data.gov, and at recovery.gov where citizens can track how stimulus funds are spent. At foia.gov, which was launched in March 2011, people can see if agencies are fulfilling their obligations to disclose information under the US freedom of information Act. We should name and shame the parts of the Government which do not release information or do not do so in a timely manner. Our ways of getting information, including getting Deputies in the Dáil to stand up and ask questions, is out of date compared with what could happen in an age of transparency. We can bring this about.

On a point related to access to information and transparency, could we allow easier access for patients to their records, possibly in an on-line way, in order that they could track health records and make educated decisions? We should do so. According to a study conducted for the European Commission, only 4% of European hospitals granted patients on-line access to their medical records but surely these should be available on-line in order that people can make better decisions about their future, including the effect of diseases like cancer. What is the HSE doing in this regard, considering it has a multi-million euro budget? The suggested action would surely demonstrate that the HSE is thinking of its customers, or patients, as referred to by Senator Bacik.

Under EU law, the right to access personal health data is guaranteed but patients often need to put in a formal request, and procedures can be long and complicated. How can we reduce red tape in that area? Information is power and having access to such information can allow people to make better decisions about their health. The UK Department of Health has pledged that patient records will all be on-line by 2015.

Will the Minister comment on the ideas from a 2011 paper by the Ombudsman, Ms Emily O’Reilly, that the remit of the Office of the Ombudsman should be extended to include prisons and all issues related to immigration, refugees, asylum seekers and naturalisation, possible constitutional status for the Ombudsman, and an improved reporting relationship with the Oireach- tas, including allowing the Oireachtas ask the Ombudsman to launch queries on its behalf?

There is much done in this Bill and the Minister has indicated he will make a number of 221 Seanad Éireann amendments on Committee Stage. It will strengthen what we are all trying to achieve and although I congratulate the Minister on how far he has gone, I believe we can go further.

26/09/2012O01100Senator Paul Bradford: I welcome the Minister and, like other Members, the legislation before us. It is impressive to learn that approximately 80,000 complaints have been handled by the Ombudsman since the office was put in place in the 1980s. The first Ombudsman, Mr. Michael Mills, set a very positive agenda for his office, and the outstanding work has been followed through right up to the current Ombudsman. We wish her well in her role.

I have listened with interest to what my colleagues have said, and we fully support every agency coming within the remit of the Ombudsman. I will not give a list of other agencies for which a case could be made for inclusion but the list could be expanded. Maybe the challenge to the Minister, in his role as Minister for Public Expenditure and Reform, is that if we had what I would call modern and good politics in this country, some of the questions to which answers cannot be given, some of the documents which lie hidden forever and some of the issues which we have tried to brush under the carpet, would have light shone on them and we would not go to the Ombudsman’s office but would deal directly with these issues in this House, in the Dáil or directly with the Departments to get answers.

Ireland has been a very secretive society. It has almost been a curse on the nation for gen- erations. We are now dealing with some of the aftermath of that by way of the children’s rights referendum and the Magdalene laundries which was debated in the other House last night. That sad endless tale will continue for some time. Many of those problems stem from our culture of secrecy. We must move beyond that and the Ombudsman’s office has played a very positive role in opening doors which would otherwise be closed and that work must continue.

The Minister and Members of both Houses must attempt to genuinely reform politics in order that every Member of the Oireachtas is almost a mini-Ombudsman to whom constituents can go and seek information and that when we make inquiries to Ministers, answers are given. It is a disgrace that Members of this House cannot ask Ministers parliamentary questions, although I know that is not the Minister’s fault. I often wonder how advantageous it is to ask Ministers parliamentary questions because of the quality of the answers. I was a Member of Dáil Éireann for ten or 12 years and different Ministers and different Governments, including Governments in which my party was involved, gave the same answers - generally minimalist in terms of information. It is part of the culture that one tells the Deputy, the Senator and the public as little as possible. We must move beyond that mindset. That is crucial to the concept of reforming democracy.

When the Minister brings proposals before us on the reform of politics, openness and transparency must be at the core of them. I recall when the rainbow Government was formed, the then Taoiseach, John Bruton, said on his first day in office - it was aspirational and he may not have reached the targets he set for himself through no fault of his own - he would like to govern behind a pane of glass. Everybody laughed because we thought that was kind of nonsensical. What Minister or Taoiseach would actually be transparent given the mentality we had that government must be secretive? That is an aspiration to which we should all aspire, namely, to govern and to conduct politics behind a pane of glass. That is what reform of politics is about.

I read a document recently about the reform of the Oireachtas which said that once a month, the Dáil sat on a Friday for approximately two hours, with no parliamentary questions, votes or otherwise. That is what passes in the Republic of Ireland as the reform of politics. As a long 222 26 September 2012 serving Member of the Oireachtas, the Minister knows we must go well beyond that if we want to give some credit to the word “reform”. I look forward to him coming to the House to debate the reform of politics into the future because that is very much part of the opening up of government and the lifting of veils of secrecy. If that is done, the Office of the Ombudsman may not have to deal with the thousands of queries each year which stem from the lack of information.

Notwithstanding the great work being done by the Ombudsman, which is the last resource of many people, and the fact that much to the satisfaction of Oireachtas Members who make representations on behalf of constitutions, almost 50% of complaints are dealt with satisfactori- ly, I want to highlight a special report by the Ombudsman. I think there have been three special reports in the history of the State. The Minister would not be the one with particular responsibility for this but it is an Ombudsman’s issue. The special report was on the sad and tragic saga of the lost at sea. It was debated at length in both Houses and at the committee. Who sits on what chairs has changed in the Dáil and in the Seanad but the subject matter and the lost at sea report have not gone away. I express my disappointment and my failure to understand why no progress has been made to date on implementing the request of the Ombudsman in regard to the lost at sea report. If reform, fairness, new politics and sincerity in politics are to mean anything and when the Ombudsman presents a special report to the Oireachtas with recommendations and the parties now in government rightly support that report, we must act on it if the Office of the Ombudsman is to have any credibility. Will the Minister take that request, which I know will be shared by many Members in both Houses, to the highest levels of government, that is, that the O’Reilly special report to the Oireachtas on the lost at sea tragedy be acted on?

26/09/2012P00200Senator Trevor Ó Clochartaigh: Cuirim céad fáilte roimh an Aire agus ba mhaith liom tréaslú leis as ucht an Bhille a thabhairt os comhair an Tí agus as ucht bunú an coiste nua form- haoirsiú seirbhíse poiblí agus iniúcháin, mar sílim gur céim an-tábhachtach é sin. Táim féin ag suí ar an gcoiste sin agus tuigtear dom gur ag an gcoiste sin a bheidh cuid mhaith den phlé á dhéanamh ar an mBille áirithe seo. Maidir leis an mBille, tá sé píosa fada ag teacht. Is dóigh gur fearr go deireanach ná go brách, ach is maith ann é. Ó thaobh na díospóireachta maidir le ainm an Ombudsman, feicim go bhfuil leagan deas Gaeilge le fáil don ainm sin in úsáid ó am go chéile - Fear an Phobail nó Bean an Phobail. B’fhéidir go mbeadh muid in ann breathnú ar sin.

Sinn Féin is supportive of the Bill’s intention to extend the remit of the Ombudsman to include a wider range of public bodies and believes, generally speaking, this is welcome. As was said, this is the first major expansion of the office’s remit in its 24-year history. Previously, it covered bodies such as the Civil Service, the HSE and An Post and this Bill will extend its remit to more than 100 additional State agencies, including the Courts Service, VECs, third level institutions, FÁS, the Irish Blood Transfusion Service and several other bodies.

Since the creation of the office, where previously many of the key functions had been the responsibility of Departments, numerous public bodies have since been set up to deliver services and for particular purposes. There is good and bad in this. Whatever about that, clearly the scope of the Ombudsman needs to be expanded to take account of that and to have remit over such bodies.

The Bill also provides for increased powers for the Ombudsman which we welcome. For example, where the requirement on a public body to provide information for the Ombudsman about a complaint is not being met, the Ombudsman can institute legal proceedings. However, we have some concerns and we will consider amendments on Committee Stage to that end.

223 Seanad Éireann I also note that we have some queries as to the timing of the legislation. To some extent, it may be putting the cart before the horse. The Minister is currently actively considering the modernisation of the Ombudsman legislation as a whole. We are not opposed to widening the scope of the Ombudsman’s office but surely it would be preferable to instigate the modernisation programme first and that the widening of the scope could follow on from that. Perhaps the Minister might comment on that.

I note the Minister does not have a heavy legislative programme in comparison with some of his Cabinet colleagues-----

26/09/2012P00300Deputy Brendan Howlin: The biggest in this session.

26/09/2012P00400Senator Trevor Ó Clochartaigh: I stand corrected.

26/09/2012P00500Acting Chairman (Senator Diarmuid Wilson): There seems to be a tendency to pick on the Minister here. I will not allow it.

26/09/2012P00600Senator Trevor Ó Clochartaigh: I stand corrected; we will not argue over it.

We question the proposition that publicly-funded, non-State bodies be added to the list of bodies under the Ombudsman’s office in anad hoc fashion. If this is to be done, then there is a need for detailed criteria, as mentioned by Senators Bacik and Keane, to determine their inclusion. There is a wide variety of these bodies and they serve many functions.

I welcome the decision by the Minister to send the Bill to the Joint Committee on Public Service Oversight and Petitions where it will be discussed this afternoon in private session. We note the Ombudsman’s statement that the petitions committee will provide a much-needed formal channel of consultation and collaboration between the Oireachtas and the Ombuds- man. I am a member of that committee and believe it has huge potential in supporting and complementing the work of the Ombudsman and it is highly necessary that the committee has the opportunity to discuss this matter. I agree with Senator Bradford on the reports by the various Ombudsman which have been made to date and the recommendations that have been laid before the Houses. That committee might be a very useful vehicle in trying to resolve those issues.

I further note the Ombudsman’s suggestion that there is a case for constitutional status for the office to keep it safe from political attack and partisanship. It has been argued that constitutional status would also further recognise the office as a viable alternative to the courts in securing access to justice and in an informal and a cost-free manner.

1 o’clock

This is an interesting suggestion which we believe is of value and we would welcome the Minister’s view on it. The Ombudsman has sought more transparent procedures for appoint- ing ombudsmen, adding that there is a strong case for having a prospective Ombudsman attend some kind of confirmation hearing before the Oireachtas committee charged with monitoring and supporting the work of the Ombudsman. Has the Minister responded to this query?

We are particularly concerned that there is a need for the remit of the Office of the Ombuds- man to be extended to the prisons and all issues relating to asylum, refugees and naturalisation. We have one of the few Ombudsman offices in Europe whose jurisdiction is restricted in this way. In her annual report in 2007 in advance of the initial publication of this legislation, the 224 26 September 2012 Ombudsman said: “However, it is my understanding that the Bill will not extend my remit to complaints regarding decisions in relation to immigration and asylum matters. I am most concerned about this.” She also said: “In my correspondence and submissions, I have stressed a number of points about this lacuna in my jurisdiction. I highlighted the fact that most Om- budsman Offices in Europe have jurisdiction in this area of administration.” That point was highlighted last week with the publication by the Irish Refugee Council of a report on the conditions in the direct provision centres, which I raised in this House. It shows that the Minister should consider including those agencies in respect of the amendments being brought forward. If he does not, we will certainly think about tabling amendments to have that done because it is extremely important.

The Ombudsman’s 2007 annual report stated:

It is an area of administration which impacts very significantly on the lives of a very vulnerable group of people, many of whom face significant challenges in dealing with or- gans of state and complex administrative processes which they know little about, while also being faced by barriers such as a lack of resources, a lack of legal expertise and language barriers. This makes it all the more important that they have full access to an independent statutory complaints system. As things stand, my Office can only be of assistance to people with complaints in relation to issues such as the quality of accommodation for asylum seekers or complaints about delays, whereas I am unable to scrutinise complaints in relation to actions such as decisions to refuse family re-unification applications, decisions to refuse leave to remain resident in the country, etc.

We agree that these restrictions are unwarranted and should be subject to investigation by her office in accordance with the terms of the Ombudsman Act. We will also seek an amendment to ensure the Office of the Ombudsman has the capability to conduct its business through Irish. Tugaim faoi deara go bhfuil Oifig an Ombudsman faillíoch maidir le hAcht na dTeanga- cha Oifigiúla, cé go bhfuilimid ar fad an-mholtach faoin obair a dhéanann sí. Níl scéim daing- nithe aici faoin Acht sin go fóill, in ainneoin go bhfuil comhráite ar siúl aici le ceithre bliana agus ba chóir go mbeadh Oifig an Ombudsman ábalta freastal ar shaoránaigh le Gaeilge chomh maith le haon saoránach eile agus dhéanfaí sin ach go mbeadh na hacmhainní cuí ar fáil chuige sin. Beimid ag moladh leasaithe ar an mbunús sin.

In general, we support this legislation, but this area needs to be considered in light of any modernisation programmes rather than being rushed through and that in widening the scope of the legislation, the Ombudsman needs more scope over justice issues. It is also very important for the Minister to make a statement about the increased workload on the office given the extra bodies under its remit and the resources available to her office to enable her to do her work. I share the concerns of some Senators about some of the organisations that are exempt. It strikes me that any agency that receives public funding should be open to question and a complaint to the office of the Ombudsman. I note that agencies such as the Irish Bank Resolution Corpora- tion, An Bord Pleanála, Bord Gáis Éireann, Bord na Móna, Bus Átha Cliath, Bus Éireann, Coras Iompair Éireann, the Dublin Airport Authority, the ESB, the National Tourism and Develop- ment Authority, the IDA, the Irish Film Board, Iarnród Éireann and the National Concert Hall are exempt.

Deputy Brendan Howlin: They are commercial semi-State agencies.

Senator Trevor Ó Clochartaigh: Many of those organisations are subject to questions in 225 Seanad Éireann this House on many occasions.

Senator Ivana Bacik: That is not the test.

26/09/2012Q00500Senator Trevor Ó Clochartaigh: If they are receiving Government funding, it is extremely important that if there is an issue with their dealings, it should be reviewed. If they have nothing to hide, why should we exempt them from this legislation? Mholfainn gur cheart iad a chur san áireamh. We want full public oversight and transparency. State funding is going into these organisations and we are accountable to the electorate and the State as to how these moneys are spent. The role of the Ombudsman is extremely important in fulfilling those criteria. Beimid ag tacú leis an mBille ach beimid ag moladh leasaithe áirithe ar Chéim an Choiste. B’fhéidir, áfach, go dtabharfadh an tAire féin na leasuithe sin chun cinn agus nach mbeadh gá dúinn iad a bhrú.

26/09/2012Q00700Senator Jimmy Harte: I welcome the Minister to the House. The Office of the Ombuds- man is probably one of the most respected offices in the country. In response to Senator Byrne, I do not think there have been any complaints about the office itself, which is a testament to the work of the Ombudsman. Obviously, some people are disappointed in their dealings with the office but there is never bad publicity about it. It is a very well respected office. It reminds slightly of the old television advertisement for Carlsberg when the employee goes to the room, finds it covered in dust, hears a telephone ringing in the distance, eventually discovers a dusty telephone in a dusty office and rubs down a sign on the door which says “Carlsberg Complaints Office”. If the Office of the Ombudsman was in that advertisement, we would have achieved perfection but we do not have perfection in any walk of life.

It all boils down to customer relations, as one calls it in commercial life, or simply how one deals with the public. The nature of the Civil Service is such that it does not have the cut and thrust of commercial business which involves word of mouth. If somebody in a commercial business messes up, word of mouth means that he or she goes out of business. That does not happen in the public service, which is a good thing in some respects. An area with which I am most familiar is local authorities. They are sometimes an easy target for the public to hammer, be it over potholes, water, sewerage or housing. It probably all boils down to a HR issue when staff join a company or public body in terms of how they are asked to deal with complaints. Perhaps the Ombudsman is clearing up issues that should not have happened in the first place in many cases, but the Civil Service is such a big organisation. I remember speaking to a senior director of TNT Express, which is one of the biggest haulage and courier companies in the world based in Australia. Its policy was that when one rang the top guy in the company, one was put directly through and if he did not answer his telephone, he rang one back. The feeling at TNT was that if someone had to ring the head of the company, the complaint was serious and it was dealt with at that level. That feeling permeated the company. We have all experienced ringing Ministers’, Senators’ and Deputies’ offices, as well as local authority and HSE offices, and being told somebody is at a meeting when we all know he or she is not at a meeting but sitting at the other end of the desk and does not have time to speak to us. It is an overall problem in society.

The remit of the Ombudsman must be extended to cover all public bodies because there is cynicism that there might be some public bodies that are not answering questions they are asked. The HSE is one example, and I have had experience of this with the HSE’s Regional Forum West. Getting an answer out of it was like getting the third secret of Fatima. It was sent around the room and back again. Someone must be answerable and the buck must stop 226 26 September 2012 somewhere. The work of the Ombudsman has been very effective but it is worrying that 150 complaints are upheld per month, which equals 35 complaints per week and seven complaints per day. There is a fair bit of work involved in that. They are valid complaints and the figure of 3,600 complaints per year is worrying. If they related to a private company, it would not last too long.

The previous Government initiated this legislation and it is only coming to completion now. It is important in the current climate where the public treats politics and public life in a cynical way. It strengthens the power of the public to know that someone is fighting on its behalf. Rather than closing doors, the Ombudsman can open one. The experience the Ombudsman gives back to the public in rapping public bodies on the knuckles is important. Otherwise the public service will be treated with contempt. The Ombudsman has increased people’s ability to get through the system. She has good powers. I welcome any extension of the powers. Obvi- ously there are other organisations that should be included but that issue will be discussed on Committee Stage.

26/09/2012R00200Minister for Public Expenditure and Reform (Deputy Brendan Howlin): I thank all Members who participated in what was a good debate. I thank Members for the welcome I received. I enjoy coming in as the debates are more calm than some of the debates in the other House. I will not deal with all the points made because that is not possible in the time available.

The legislation is part of an elaborate suite of reform legislation that I will have the privilege of piloting through the Houses. Many of the comments made by Senators overlap on legislation that I will bring forward, for example, detailed comments on the Freedom of Information Act. As Members are aware, the programme for Government has committed to a significant extension of the Freedom of Information Act and much work has been done in that area. Members have talked about whistleblowers legislation. I have published the heads of a Bill which is being considered by a committee. We had a good seminar on the issue. The heads of the register of lobbyists Bill have been published and referred to a committee. The general Dáil reform area is beyond my purview but I shall deal with the points made by Senator Bradford. Much more is needed in terms of the reform agenda to make public business more transparent and more relevant and to restore confidence in the institutions of State which is important, starting with the Oireachtas where there is a broken confidence. I used a phrase recently that, perhaps, I should not have used about simple commentators. There is a simplicity about some of the analysis about the complexity of public business, on which there is a need for an open debate, to see how we can deal with it.

Senator Byrne welcomed the Bill but why not given that his party was the progenitor of it. I acknowledge that. He underscored a theme replicated in every contribution, namely, the respect the Office of the Ombudsman, and the three holders of the office since its inception, had brought to that office, which is not common in all public institutions.

Senator Keane referred to the title “ombudsman”. Ombudsman is from the Swedish concept. I hope I am progressive in all these matters but I do not go along with the notion that because the word “man” is at the end, it is gender specific. Ombudsman is a gender neutral comment, which in Swedish simply means “agent of the people”. Given that it is internation- ally known, whether in Hong Kong, Sweden or Ireland, there is no need to craft it into something that is unique. Whether one is a migrant or a visitor one knows what the ombudsman is. I would not get caught up on the title. The objective of part of the legislation is to protect the title, in order that the word “ombudsman” is not so widely used, so profligate, that the high respect it 227 Seanad Éireann has earned, through usage, is not diminished.

The Senator also mentioned resources. The reason for the mergers is back office supports. That is the idea I am trying to drive across the public service in order that the core business of each agency be maintained, as far as practicable, where it is needed. However, there would be a sharing of resources in order to avoid duplication of back office supports, either in office buildings, technology, or people to answer telephones, and all the things that can be done on a common basis but which do not compromise the effectiveness of the important role given to specific agencies, agents or authorities, under law.

Senator Mooney also mentioned resources. Of course, where there is additional staff, a strong redeployment process is ongoing within the public service, as mentioned by Senator Bacik. Where there is not the advance in public sector reform that people would wish, it gets an extraordinary amount of media attention and that is understandable. However, the transfor- mational work does not get the same attention, it is taken as a given such as the reform of Garda rosters, an issue that had been talked about before I became a Member. It has happened and the Garda Commissioner has said that there is a 25% increase in Garda visibility on the streets. We transformed the sick leave arrangement by halving it, something which was supposed to be impossible. That is done, pocketed and forgotten. Likewise, absenteeism and common leave arrangements have been pocketed. There is a need to acknowledge the fundamental changes taking place in the public service. We are driving a very big agenda involving more than 200 timelined objectives. I have put this before the committees of the House and Members should engage with it. At the end of the process there will be a different public service. I am digress- ing from the issue.

Senator Bacik referred to the role of the Ombudsman and, specifically, Committee Stage amendments. I have indicated that we are replacing the Schedules attached to the 2008 Act on Committee Stage. The bodies which will be within or outside its remit is still a matter that is under consideration with individual line Departments. The general principle we are working on is that there must be a compelling reason to exclude them, rather than the reverse. I note the point made by Senator Quinn that the Office of the Ombudsman should be consulted on all these issues, including in respect of bodies which should be within or outside its remit. I undertake to do that, to ensure that dialogue and communication is clear.

The legal services ombudsman, which was mentioned, was established under the Legal Services Ombudsman Act but is being abolished as the Government has decided to introduce significant legislation to provide for the regulation of the legal profession. That legislation is being advanced by the Minister for Justice and Equality, Deputy Alan Shatter. I have decided to include the Higher Education Authority in the remit.

Senator Ivana Bacik: I am delighted to hear that.

Deputy Brendan Howlin: I received strong representations from one of the Ministers of State who was anxious that be done. The Higher Education Authority will be included in my amendment on Committee Stage. If Members have strong views on the issue I would be happy to hear them between now and Committee Stage where there will be a full debate.

Senator Ivana Bacik: I welcome that announcement.

Deputy Brendan Howlin: There are two points I wish to make before getting to issues raised by Senator Barrett. There is a misunderstanding of the role of the Ombudsman. The 228 26 September 2012 Ombudsman is not a court of appeal for a regulator’s decision. Landing charges at Dublin Airport cannot be appealed to the Ombudsman. The regulatory authority should be subject to a different appeals mechanism. The role of the Ombudsman is in the interaction of State agencies who have statutory roles to perform and the general public to ensure every citizen is dealt with fairly, well and in a timely fashion. That is not saying landing fees are too high at Dublin Airport or that there should be different bus routes or that the tolling regime is wrong or too expensive. The Committee of Public Accounts and a variety of other bodies deal with those issues. In a similar vein, the same applies to semi-State companies, an issue raised by Senator Ó Clochartaigh. Semi-States act as commercial companies. One cannot complain about an individual company. They are not all in receipt of moneys from the State. Many of the semi-State companies are profit-making and remit a profit to the State. I do not think that the Senator can make fish of one and fowl of another. In other words, that Bord na Móna should be included because it is losing money this year but somebody else should be omitted. They operate on a commercial criterion and are subject to oversight in a different way.

I am very taken by Senator Barrett’s comment on “agencification”. I am not sure that I have heard it before but it is a good word. Agencification has happened and the biggest agent, or manifestation of agencification, has been the creation of the HSE which, to put it bluntly, was established to shield a Minister and a Department from questioning. We need to pull that back and get access and accountability in a real way and I am determined to do that.

I mentioned Senator Quinn’s comments on freedom of legislation which is subject to extensive separate legislation. He mentioned that some countries have a great deal on their FOI websites in order to reduce the need for parliamentary questions. I invite Senators to look at my Department’s website at per.ie. They will find a database that shows the current public expenditure for every Vote and a comparator - in graphic and monetary value formats - that displays changes in the past ten years. The staffing ratio is also displayed and members can see where ratios have increased or decreased over time. I invite Senators to examine it.

Since early this year I have instigated in my Department the publication of all tenders above €20,000 on their websites. I have asked other Departments to follow suit before the end of the year. My Department publishes the data as a matter of routine every quarter. It allows people to see who tendered and what we spend our money on. The database will be expanded but it is quite extensive now. I formally launched it and I invite people who were not aware of it to take a look.

I have invited my Department to explore the potential for Ireland’s participation in the Open Government Partnership. It is a new global, multilateral initiative that aims to secure concrete commitments from governments across the globe to promote open government, and openness and transparency in administrative processes, including a proactive publication of as much official data as is possible. I have outlined the guiding principles that we will promote.

Senator Bradford mentioned a profound issue which I have made many speeches about in the past, that is the role of Parliament. I confess that there is always a view that the Opposition argues for the primacy of Parliament and accountability but as soon as it becomes a government that commitment is somewhat lessened. I am doing my best to hold on to the oppositional view that we need to strengthen Parliament. I shall probably stray off the reservation and get myself into bother by saying the following. It is like when I created the original reform plan for government called Better Local Government. When it was published I travelled around the country as part of a road show to promote it. I remember that at every information forum with 229 Seanad Éireann councillors there was a general demand for more powers to be devolved to local government. Without doubt that is what happened everywhere I went. Later, after a cup of tea, a councillor would whisper in my ear that the programme should have nothing to do with Travellers, the sit- ing of dumps and that he or she did not want the power to raise money. That was not a uniform response and I am not suggesting that it was. However, on examination of the existing powers one will discover that people often do not know that they have them.

Senator Thomas Byrne: True.

26/09/2012S00500Deputy Brendan Howlin: Seldom are some of the powers utilised and there is an extraordinary potential for the Oireachtas to do more. Let me give an instance, and one that I shall give to the Committee of Public Accounts when I appear before it. We have changed the budgetary system here at my instigation last year. We produced a three year envelope of expenditure, in terms of the ceilings for every Department, in order that what we need to achieve is known for the next three years. We also published all of the comprehensive review of expenditure data in order that all of the options for cuts and modifications are available. On 1 January I wrote to the Chair of every committee asking him or her not to wait until the budget but to call in Secre- taries General to debate ideas, examine the Comprehensive Review of Expenditure, CRE, and determine recommendations to Government for what should or should not be done. I have not been overwhelmed-----

Senator Thomas Byrne: The Minister will not be.

26/09/2012S00700Deputy Brendan Howlin: -----by Parliament saying that we want to make the budget because the blunt view is that it is my job. One cannot have it both ways. One cannot say make Parliament responsible but, like good holy men of old, not yet. We need to be proactive.

I noted Senator Bradford’s comment on working as if behind a pane of glass when I waited in the Visitors Gallery. He was right and many people said he made an interesting comment. To be blunt not everything in government can be done behind a pane of glass. We would not have reached our conclusions on Northern Ireland if everything had been done behind a pane of glass. There are necessary interactions. If people know that certain people are talking then negotiations would not happen. That must be understood and every company works like that. The principle behind the Senator’s comment is right.

Senator Bradford also made an important point on the Lost at Sea report. Senator Ó Clo- chartaigh made an important intervention stating that the report might be an appropriate job for the Joint Committee on Public Service Oversight and Petitions. The Senator asked about the role of the committee. The measure is a new innovation in this Oireachtas. My initial hope and intention for the committee was predicated on a referendum being passed that would allow it to be a clearing house for investigations. I still intend to introduce legislation as soon as I can and hope to have the heads of a Bill before the Government in the next couple of weeks. They will relate to the framework of investigations that can be done that is consistent with the Constitution as is. I shall introduce it to this House as soon as I can. In the meanwhile there is an important job of work to be done by the committee. First, it must link into the Ombudsman and follow through on recommendations that have not had enough focus in the House. Second, it needs to replicate - it is a matter for itself how it structures it - the petitions committee in the European Parliament which takes direct petitions from citizens that is followed by a hearing. I am interested to see how our committee will develop that aspect.

230 26 September 2012 There was a point made about having constitutional status for the Ombudsman but I have not considered the idea. Perhaps - thinking off the top of my head - it might be a suitable issue for the constitutional convention.

I have mentioned the commercial semi-State companies. A number of Senators also talked about the justice area in terms of prisons and decision-making bodies for asylum applications, etc., and I will reflect further on the matter between now and Committee Stage which is not far away. I assume - I do not want to presume - that this House will vote on the Bill. Since nobody has opposed it then are we due to take Committee Stage on 4 October?

26/09/2012S00800Senator Ivana Bacik: Yes, 4 October

26/09/2012S00900Deputy Brendan Howlin: That does not give much time for Senators to consider their amendments but I will examine the matter.

I thank Senator Harte for his contribution and take his point that it is very important to ensure that the public has confidence in the way that State agencies conduct their business. The Ombudsman can play a compelling and important role in ensuring that the objective is achieved.

I hope that I have at least touched on the variety of issues raised by Members and look forward to returning here in the near future for an extensive debate on Committee Stage.

Question put and agreed to.

Acting Chairman (Senator Marie Moloney): When it is proposed to take Committee Stage?

Senator Cáit Keane: Next week, 4 October.

Committee Stage ordered for Thursday, 4 October 2012.

Sitting suspended at 1.30 p.m. and resumed at 2 p.m.

2 o’clock

Health Service Executive (Governance) Bill 2012: Order for Second Stage

Bill entitled an Act to amend the Health Act 2004 and to provide for related matters.

26/09/2012U00300Senator Colm Burke: I move: “That Second Stage be taken now.”

Question put and agreed to.

Health Service Executive (Governance) Bill 2012: Second Stage

Question proposed: “That the Bill be now read a Second Time.”

26/09/2012U00700Minister for Health (Deputy James Reilly): I welcome the opportunity to bring this Bill into the Seanad. It is an important Bill which, as the title, the Health Service Executive (Gov- 231 Seanad Éireann ernance) Bill 2012, suggests, provides for a new governance structure for the HSE.

Senators will know that, in line with the programme for Government commitments, a series of legislative changes are planned to bring about radical reform of the health services which will see the introduction of universal health insurance. The programme for Government also envisages the HSE will eventually no longer exist as its functions move elsewhere under the health reform programme. This will take careful planning and sequencing, and further legislation. The Bill is intended, therefore, as a transitional measure, building on earlier changes to the composition of the board last year, and is designed to help prepare the health system for the changes ahead.

Under the Health Act 2004 which established the HSE, the HSE board is the governing body of the HSE. In 2011, I made changes to the composition of the board designed to facilitate greater co-ordination and integration between the senior management teams in my Department and the HSE. Since that time, the interim board has provided a basis on which to make early progress on the health reform agenda, facilitating a greater unity of purpose. However, when making changes to the board, I signalled that I would be bringing forward legislation to abolish the board structure and establish new governance arrangements for the HSE, pending its eventual dissolution. These changes are in the Bill now before the House.

The Bill abolishes the board structure of the HSE under the Health Act 2004 and provides for a directorate, headed by a director general, to be the new governing body in place of the board. This new structure is designed to help prepare the service delivery for the next phase of the health reform programme. The Bill’s other purpose is to provide for further accountability arrangements for the HSE. In line with health reform policy, the Bill is intended to make the HSE more directly accountable to the Minister for Health, who in turn is accountable to the people through the Oireachtas. A number of technical amendments are also being made to the Health Act 2004 to take account of the replacement of the board structure by the directorate structure.

The HSE has legislative responsibility for the organisation and delivery of health services. Under the Bill, as the governing body, the directorate has authority to perform the HSE’s functions. The directorate will consist of a director general and other directors. To offer flexibility and allow the size of the governing structure to adapt to changing circumstances, the Bill does not specify a fixed number of members for the directorate but instead provides for a maximum of seven and a minimum of three members, including the director general, who is automatically a member and chairperson of the directorate. The Bill provides that other members of the directorate must be HSE employees in the senior grade of national director. In support of the new directorate structure and to reflect a shift in focus to services, it is intended to recruit national directors in the areas of health and well-being, hospitals, primary care, mental health and social care. My intention is that the other directorate members will be drawn from these senior managers of services.

The HSE will continue to have operational responsibility for running the health service, but the Bill sets out parameters for the HSE. It provides that the directorate is accountable to the Minister for the performance of the HSE’s functions and its own functions as the governing authority of the HSE. The process will be that the director general accounts on behalf of the directorate to the Minister through the Secretary General of the Department. In this way, the HSE will be required to account for its actions and decisions. The new provisions build on existing accountability arrangements under the Health Act 2004 which are being retained, for 232 26 September 2012 example, in relation to service plans, annual reports, codes of governance and the provision of information to the Minister.

The Bill also builds on accountability arrangements in the 2004 Act by allowing the Minis- ter to issue directions to the HSE on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes the HSE is not having sufficient regard to such objectives or policies in performing its functions. The Minister will also now be empowered to specify priorities for the HSE to which the HSE must have regard in preparing its service plan. The Minister may establish performance targets for the HSE in regard to these priorities. However, directions, priorities and targets may not be specified for individual patients or service users.

As is the case with the CEO, the Bill provides that the director general will be the Account- ing Officer for the HSE. This is a temporary arrangement as my intention is to return the Vote to the Department of Health from 1 January 2014. At that point, the director general will no longer be the Accounting Officer. This will require further legislation to disestablish the HSE Vote and fund the HSE through the Vote of the Office of the Minister for Health. In the meantime, the Health Service Executive (Governance) Bill has new provisions for a statutory audit committee to advise the director general on financial matters relating to his or her functions and other related matters. This committee will report in writing to the director general and will provide a copy of that report to the Minister.

I will now deal with the details of the Bill. Part 1 has the standard provisions dealing with the Short Title of the Bill, commencement and definitions. It also provides for the repeal of those parts of the Health Act 2004 providing for the board and CEO structure.

Part 2, sections 4 to 22, contains provisions to amend the Health Act 2004 to reflect the new directorate structure and accountability arrangements. Some of the key elements are sections 5, 6, 7, 12, 14 and 17.

Section 5 amends section 10, on directions from Minister, of the Health Act 2004. Section 10 of the Health Act 2004 allows the Minister to give general written directions to the HSE in respect of the Act and to give specific directions on the submission by the HSE to the Minis- ter of reports and information with regard to the performance of its functions. Section 10 is amended to provide also for ministerial directions on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes the HSE is not having sufficient regard to such objectives or policies in performing its functions. As I stated earlier, directions may not be made with regard to individual patients or service users. Section 6 inserts two new sections into the Health Act 2004, namely, section 10A on setting of priorities by the Minister and section 10B on limitation as to exercise of power under sections 10 and 10A. Under section 10A, the Minister will be empowered to determine priorities to which the HSE must have regard in preparing its service plan and to establish performance targets for the HSE. Before specifying priorities or performance targets under this section, the Minister must have regard to best practice as respects the service, the subject of the priority or performance target, outcomes for patients and recipients of services likely to be affected by the priority or performance target which the Minister is considering specifying and the effect that specifying the priority or performance target concerned would be likely to have on other services provided by or on behalf of the executive. Again, priorities and targets will not apply to individual patients.

233 Seanad Éireann Section 7 inserts a new part in the 2004 Act to provide for the establishment of the new governing authority for the HSE, namely, the directorate. This new part will form sections 16A to 16M of the Health Act 2004. Section 16A provides that the directorate will consist of a director general and other persons referred to in the Bill as appointed directors. Section 16B sets out the detail regarding the term of office of an appointed director. The term of office for a member appointed to the directorate is three years and he or she may be re-appointed by the Minister for a second or subsequent term. As I outlined, appointed directors will be drawn from employees in the grade of national director in the HSE. An appointed director will cease to be a member of the directorate if they cease to be a national director in the HSE. Section 16C sets out the role of the directorate, which will have collective responsibility as the governing authority for the HSE and the authority to perform the HSE’s functions. Subject to any directions of the Minister, the directorate may delegate HSE functions to the director general. This section also sets out the accountability arrangements to the Minister about which I spoke. Section 16D sets out eligibility for appointment and reasons for removal from office of persons appointed to the directorate. These are similar to the provisions in other legislation in respect of board appointments and removals. Section 16E provides for the appointment by the Minister of the director general. It is my intention, subject to the Bill being passed by the Oireachtas, to appoint Mr. Tony O’Brien, who is currently deputy chief executive officer of the executive, to be the first director general, as permitted by section 16E(4). Subsequent directors general will be appointed by the Minister following a recruitment process under the Public Service Manage- ment (Recruitment and Appointments) Act 2004. The appointment of the director general will be made on terms and conditions as determined by the Minister, with the consent of the Minister for Public Expenditure and Reform.

Section 16F sets out the eligibility requirements for appointment as director general, as well as circumstances in which the director general may be removed from office. Section 16G provides for the general functions and role of director general. These include managing and controlling the business of the HSE. In the operational aspects of his or her role, the director general is answerable to the directorate, as the governing authority of the HSE. On a day-to-day basis, national directors, even if appointed as members of the directorate, will be accountable to the director general for the performance of their functions as employees of the HSE. Section 16H sets out the arrangements for the delegation of functions by the director general. A key objective of the new HSE governance arrangements is to facilitate a system whereby authority to make operational decisions is delegated as closely as possible to the point of service delivery. Delegated functions may be subdelegated by the director general to HSE employees. This will be subject to any directions from the directorate. Section 16I provides for the attendance by the director general before Oireachtas committees. Other aspects of section 7 deal with procedural and related matters for the directorate.

I will now turn to section 12 which amends provisions in the 2004 Act in regard to service planning. Currently, the HSE prepares a service plan in line with certain requirements, adopts the plan and submits it to the Minister for approval. The Minister must either approve the service plan or issue a direction to amend the plan if requirements are not met. The 2004 Act is now amended to provide for the HSE to prepare a plan in line with current criteria, while also taking account of priorities determined and targets set by the Minister. While the Minister may direct the HSE to amend the plan if requirements are not met, the Minister may now also amend the plan, following consultation with the HSE. Section 14 provides for the 2004 Act to be amended in order that the Minister may direct the HSE to take specified measures with regard to the implementation of the plan. I have already spoken about section 17, which provides 234 26 September 2012 for the director general to be the Accounting Officer and sets out provisions for a new statutory audit committee. Other sections in Part 2 of the Bill deal with technical amendments to the Health Act 2004 consequential to the establishment of the directorate. Part 3 of the Bill has the standard provision for savers following on from the repeal of sections relating to the board and the chief executive officer.

I will conclude by stating the reform programme is about the patient. While this Bill is only one element of a legislative and administrative reform process aimed at ensuring a better health service for patients, it is an important one. Accountability and service delivery are fundamental tenets of the health reform programme. I believe this Bill, together with the new management arrangements, will help bring greater focus on service delivery and ensure more accountability during the time the HSE continues to exist. I also believe it will help to make sure the patient is at the centre of the service and the service is reminded continually of its obligation to serve the patient. The HSE is an experiment that has not worked. The Bill is doing what I promised to do when I stated last year that I would change the governance structure for the HSE. This is a step towards the overall reform of the health service that will see the eventual dissolution of the HSE as an entity and will facilitate the introduction of universal health insurance as included in the programme for Government. The new structures will improve patient care and will lead to sustainable performance improvement by the HSE. It will give better control of financial and clinical systems. It will lead to more integrated care and integrated governance, crucially with a clear line of accountability from the HSE to the Minister. As stated previously, it is an important step on the way to universal health insurance.

26/09/2012V00200Senator Marc MacSharry: I welcome the Minister to the House. The Fianna Fáil Party will support this legislation but remains unconvinced about what it can contribute to the improvement of services and, in this context, I wish to make a few points. When I sat on the Government side of the House, I was highly critical of the establishment of the HSE in 2004. Moreover, even while on the Government side, Senator Cummins and others can confirm I thought it was wrong that such a large proportion of the State’s budget and of taxpayers’ money effectively would be under the control of a third-party organisation. In that context, I support the Minister’s actions in bringing the budget back in, as is appropriate as it never should have left.

The origins of the HSE go back through quite a few Administrations. The initial idea may be traced as far back as the then Minister for Health, Barry Desmond. I agree that subcontract- ing the running of the health service to a third party organisation constitutes an abdication of the State’s responsibilities in the interest of what was wrongly dressed up as this thought of political interference. It is vital for public representatives to have the power to do work on behalf of the people. If they abuse that, there needs to be appropriate enforcement to deal with that. How- ever, our automatic reaction should not be too subcontract the power and ensure we operate at arm’s length. I would be critical of the Minister in some of his actions in that regard.

I look forward to more detail being provided on the legislation. I think of Titanic and ask myself if it were called Olympic would it have stayed afloat? If the captain were known as the skipper, if the engineer were known as the navigator or if the master at arms were simply known as the head of security, would the ship have stayed afloat? I doubt it would have. That is why I am concerned this legislation is just the relabeling of the existing structure, albeit with the potential to be under more control by the Minister, as should be the case. Will the same individuals go from being the head of a particular directorate as it is now, to having a different title? What are the service areas that each directorate will deal with specifically? What budget 235 Seanad Éireann will be available for this transition? In an agency as large as the HSE as we know it, I hate to think of the cost of relabelling the doors where people’s names are, just to name a very small and insignificant part of it.

I know it is envisaged that this legislation will have no impact on budgets, but I disagree. What budget has been earmarked for these changes? Will there be any job losses as a result of these changes? To what service areas will the new directorates apply? It seems we are cutting down to six or seven from 12. Will there be salary increases for the new heads of these directorates? Who is earmarked for them? Will there be a public procurement process to put these people in place? Will it simply be that the person who used to be called the skipper will now be called the captain resulting in the Minister now having full responsibility and being able to tell the individual to review particular area because the service plan does not include X or Y?

Is this legislation that was thrown together based on a promise made 17 months ago about how we would transform the health service? There is no plan or blueprint for how we will implement this and how it will change. All politics is local. The HSE, the Department of Health and the Government - past and present - would point to the national cancer control programme and the approach to cardiac care and cardiac categorisation as being highly successful. I ask myself what this new structure will do to undo the discrimination in an entire region, the north west. Statistically it can be pointed out that the people are looked after with 80% of them getting stents inserted within the two-hour best international practice period, and we have our specialist cancer centres of excellence. The approach seems to be that the 20% of the people living in the north west can either move closer or die as I have often said, including to previous Ministers.

In opposition the Minister was the foremost Member in the House at highlighting these dis- crepancies and inequalities in our health systems. When I was on the other side of the House some of my colleagues would not speak to me because I was so vociferous at saying similar things. Now that he is in government and in command why are those things not forthcoming? The people on the street do not care whether it is called Olympic or Titanic. They just want to know how the Minister will keep it afloat because the reality is that it is sinking and all we are seeing is a haphazard approach to management. I do not doubt the Minister’s capabilities medically or in business. The previous Government was rightly criticised for poor communications but, by God, the communications of the Government and the Department of Health in recent months have been shambolic in the extreme. If I were captain of a football club and the vice- captain could not express confidence in me, that person would be gone. If a fellow manager in a club used language along the lines of stroke politics in describing something I did in carrying out my duties, that person would have to go or I would be gone. That is what the people are seeing.

What do people in the north west see? They see cuts to home help and discrimination in what are supposedly the successful clinical programmes, but that is down to where in the country one lives. Some months ago this House saw the breaking of the story about Creagh House. We were assured by a Minister that there would be no cut to the services and yet today, having been warned by me and many others, the unions have announced there is a problem and the Government needs to intervene. What is the legislation doing for them? The reality is that it is doing nothing for them.

We constantly hear the rhetoric that the cupboard was bare when the Government came into office and there was no money to implement the plans it wanted to implement. The Minister 236 26 September 2012 when in opposition met representatives of the troika as I did. When I participate in the Fianna Fáil delegation meeting the troika, I get to question it on what we can and cannot do. The Min- ister and his party colleagues, including the Minister for Finance, Deputy Noonan, did so when in opposition. However, they prepared a manifesto to buy the people by lying to them about what would be done in the north west, including the provision of centres of excellence and the retention of the accident and emergency unit in Roscommon. That is just my part of the country. Every parish has a story to tell and it was disgraceful and deeply cynical.

We are now passing legislation to change the name of the fleet. While we support it, I see nothing to give the people the confidence to which they are entitled in the management of our health service. However, the reality is that free GP care is nowhere to be seen. We have cost overruns of €500 million. Mr. Cathal Magee has resigned as head of the HSE having back in February told the Minister - based on freedom of information requests - that this would happen. The Minister’s Cabinet colleagues are running for cover in the context of expressing confidence at one level and then half-heartedly doing so in the House. There is a Minister of State who openly flaunts her feelings and undermines his authority.

Where are sections 10 and 12 of the Bill in terms of the Minister’s input into selecting primary care centres? I have no doubt that Swords and Balbriggan are as entitled to have those primary care centres as are Sligo town, Ballymote or other places in my area. However, we must have rules. Those on the outside looking in see poor management and a lack of management. Everybody knows the Minister needs to find savings and cuts will be required. However, all they see are a lack of communication and haphazard management - the headless chicken approach as I called it last week. If any good news is to be announced, the Minister and his senior colleagues are wheeled out to announce it while, if there is any semblance of bad news, Mr. Tony O’Brien is wheeled out to say the Minister had nothing to do with it. However, 18 months ago he claimed to be fully in control. Who is in control? Whether it is Titanic or Olym- pic, who is in charge and calling the shots? Is it the Minister on this, Mr. Tony O’Brien on that and the Minister of State, Deputy Shortall, on the other? In these difficult times people need to be able to say, “You know what? Reilly is a good one. He’s a medical professional with business experience and in these difficult times he’s in command.” They are entitled not to see the vice-captain question him or a senior Minister saying that he is involved in stroke politics. While I know we will be in opposition for some time, in the interest of the country the Minister has my full support in giving himself a good shake, bucking up and giving the people the confidence they require in their health service. This legislation does not do much to give me that confidence at this point.

26/09/2012W00200Senator Colm Burke: I welcome the Minister to the House and thank him for introducing this legislation. We need to consider where we are in health care and think about the very negative message given out on health care. We need to consider why we need reform and need to create efficiencies. Currently, 27% of all Government spending is on health care. This means 27 cent of every euro paid in income tax goes towards health care services. The €13.588 billion provided for in this area in last year’s budget was greater than the total amount collected in income tax. This means all other taxes collected were utilised to operate the remaining 14 Departments. There are huge inefficiencies in terms of health spend, in particular in the cost of drugs. In 2000, the cost of drugs in the health care sector was €576 million. By 2010, this had increased to more than €1.9 billion, which is a 230% increase, with little or no control during the intervening time over who or what was paid for drugs. In comparison with other countries, Ireland is one of the most expensive not alone in Europe, but in the world in terms of the cost of

237 Seanad Éireann drugs. In terms of governance of the health sector, how did this happen and who is responsible for it? This Bill seeks to bring control of this sector back within the remit of the Department of Health.

The reform which took place in 2004 was supposed to bring about necessary changes. How- ever, the cost overruns occurred after 2004 when the Health Service Executive was established. This will continue unless necessary reforms are put in place. The Brennan and Prospectus reports of 2003 recommended the establishment of one national entity to manage health services. Following the establishment of the HSE, the Minister frequently referred Deputies’ parliamentary questions on health services for answer by the HSE, as a result of which a huge number of issues arose.

At the time of the 2003 report of the national task force on medical staffing there were 1,731 approved permanent consultants posts within the health boards. The task force predicted in that report that owing to the European working time directive there would be a need to appoint more consultants and that by August 2009 there would be in the region of 3,100 permanent consultants appointed. It was also stated that, by 2012, we would have 3,600 permanent consultants. Currently, there are 2,500 consultants in the system, which is 1,100 short of the target.

Last week Opposition spokespersons complained about waiting lists for appointments with senior consultants. However, these have occurred because policy, in terms of appointment of the planned number of consultants as set out in the 2003 report, was not implemented. The Op- position is not entitled to be critical of waiting lists given they are the result of the failure of the previous Administration to appoint the number of consultants promised. It is difficult now to address this issue owing to a tightening of budgetary provision.

This legislation puts in place a new structure of governance and seeks to provide for that promised in the programme for Government, namely, that money should follow the patient. This is just another step in that process. As outlined by the Minister, the legislation introduces a temporary transitional structure, which is but one of the steps needed to be taken in this area. While the Bill abolishes the board of the HSE, it does not change the legal status of the HSE. It also, as outlined in detail by the Minister, provides for accountability and establishment of the directorates.

Section 5 amends section 10 of the 2004 Act and allows the Minister to issue directions to the HSE on implementation of ministerial and Government policy. In other words, it gives back the power to the Minister to issue directions. Section 6 determines the priorities to which the HSE must have regard in preparing its service plan. The Bill also establishes performance targets for the HSE. It is important clear targets in this regard are set out. It is also important the terms of any plan and the targets set in each area are implemented.

Section 12 introduces changes to how the service plan is prepared and amends section 31 of the 2004 Act. The HSE must take into account the priorities and targets set by the Minister. It is important if we want to move forward with reform that the plan prepared each year takes into account the Government’s long-term programme. The Minister has dealt with the various amendments to the 2004 Act that are required to be put in place.

A particular issue about which I am concerned - this relates to the task force report of 2003 in regard to reform of the health service - is front-line staff. In this regard I would like to outline to the Minister one issue which I believe needs to be tackled, namely, the appointment of locum

238 26 September 2012 consultants following the retirement of consultants. A number of instances in this regard have been brought to my attention. In one case, a consultant retired and an interview was held in November, following which the interview board agreed on the candidate to be appointed. As of today, the locum consultant remains in place and the selected candidate has not been informed of his or her selection for appointment. This is disappointing from the point of view that the HSE would incur no additional cost as a result of replacing a locum consultant with a permanent consultant. Perhaps the Minister would address this issue. We do not want a return to the situation whereby we are relying more on junior doctors. If the policy as I have just outlined continues, that is what will happen.

Another issue of concern is that of junior doctors. It is important I raise this matter with the Minister, as I have done consistently since becoming a Member of this House. One of the problems with which the Minister had to deal when he took up office approximately two years was the lack of planning in regard to the appointment of junior doctors. In April 2011, the Minister had to, on short notice, ensure recruitment of a huge number of junior doctors. In this regard, a number of people from India and Pakistan were recruited and given two year contracts. Those contracts will expire in June 2013. I want to ensure the necessary procedures are being put in place to ensure replacement of those doctors in June-July 2013. The planning for this needs to be in place now. I am raising it because of a survey of final year medical graduates I carried out in April, May and June. Over 50% of those interviewed said they will not be working in Ireland after June 2013. Only 35% intended staying in the Irish hospital service in 2013. That is a concern and we must start planning for it because we are eight or nine months from 30 June.

The Bill brings the power back into the Department, while working with very good staff in the HSE. It is easy to criticise HSE staff but there are good and dedicated people in the HSE. It is important the cost of drugs is dealt with in a comprehensive manner. We are paying far in excess of what is required. It is one area where we can replace services.

We must work hard on the reconfiguration of services, which is being dealt with professionally in Cork. We used to have three or four hospitals doing a bit of everything at huge cost whereas reconfiguration assigns certain categories of treatment to certain hospitals so there is no duplication. It is a welcome development and the Minister has been very much involved in it. We need to do this throughout the country to ensure we are getting value for the money we put into hospitals and to provide the best possible level of care.

Despite media comment on the health care area, much progress has been made on outpatient care. The media will not cover the fact that the number of outpatient appointments has increased from 2 million to 3.5 million per year in the past ten years. The number of day case procedures has increased dramatically and there are more day case procedures now than ever before. This increase has taken place because of reform and reorganisation in health services. These changes can make the service more efficient but it is a question of how we manage it.

A HSE financial management issue raised recently concerns the small number of people dealing with financial management who have financial qualifications. The legislation refers to setting up an audit structure. That is very important. As financial management is about getting value for money, we need people with expertise. I am not convinced we have a sufficient number of people in the HSE to deal with financial management. I ask the Minister to give priority to this point over the coming 12 months. We need to get value for money but this requires people with the necessary financial qualifications to ensure we get the maximum out of every euro we spend in order that the patient is the beneficiary. The theme of the Minister is that the 239 Seanad Éireann patient comes first and it is pertinent that the taxpayer also gets value for money. The level of cover for the patient should not be diminished. I look forward to working with the Minister in the implementation of the Bill.

26/09/2012Y00200Senator John Gilroy: I welcome this important legislation. No one could argue it is overdue. It offers hope that at last, and without prevarication, the Government is trying to get to grips with something often charitably described as a monolith. The Minister promised he would take this step and it demonstrates the determination of the Minister and the Government to have a working health service at last. Many local and national politicians have made a career out of criticising the HSE. Much of the criticism is well merited. It is remarkable that the previous Government, with such apparently innocuous legislation entitled the Health Act and acting out of the best motivation, managed to create something so unwieldy that we must take down the entire edifice after a mere eight years in existence. If it is remarkable, it is not particularly surprising when we reflect on the words of a former Minister for Health and Children who referred to the Department as Angola. It gives us a glimpse into the thinking that informed the decision to establish the HSE. The decision to create the HSE was driven as much by a desire to insulate the Government, which lacked political vision, from the inevitable criticism that would arise from an unreformed organisation as much as it was motivated to achieve reform. We have seen problem following problem and crisis following crisis in the HSE. The responses seem only to paper over the cracks without achieving real reform. It should not surprise us and we should not profess surprise.

The HSE was established on a premise guaranteeing that it could not succeed. In abolishing the old health boards and creating the HSE, all that was achieved was to lay down another layer of administration and management on top of a dysfunctional management structure. For good measure, we removed any trace of political accountability or transparency. We can cite a number of examples, such as the number of grade 8 administrators, a senior managerial post. The number of positions, which was in single figures under the old health board system, increased to 700 after the creation of the HSE. After the massive increase in managers, there was no discern- ible improvement in the delivery of health care. Matters became steadily worse until, despite spending up to 27% of the entire tax take, we have inherited a system that is not fit for purpose.

Although it is an interim measure, the Bill goes a long way to delivering on the health reform agenda set out in the programme for Government. Another example is the removal of local representation from the old health board system. This was heralded as a step into modern Ireland, where the fingerprints of local lobby groups could be found all over the map of the health service. It was a good idea and one that went some way to removing the overbearing nature of local interest at the expense of the national interest. However, like many things done by the previous Government, in making one reform and failing to replace it with the alternative, we fell into the double misfortune of having no political representation and no oversight.

When the HSE was established, one of its grand sounding platforms was the regional health service consultative forum, comprising local representatives, which met at quarterly intervals. Elected representatives had the opportunity to question officials on the operation of the service but without any input into policy decisions. This became a farce and remains so, but it served a useful political purpose to insulate the Government from any political fall-out that would in- evitably arise from the unreformed service. I was a political representative on one of the fora and I was told in 2007 that, despite a projected €18 million overrun in September, no single person was accountable for the multi-billion euro budget. Therefore, there was no financial officer available to appear before the board to explain how the circumstances could have arisen. 240 26 September 2012 This is what the HSE and previous Government have bequeathed us. We have taken away political transparency at local level and added in, for good measure, a diminution of accountability at national level. With this, one could hardly be surprised to hear politicians of all parties, local and national, and service users complain that they cannot obtain even relatively insignificant information about the operation of services. We have even heard the Minister complain from time to time that the service is unbelievable.

It is very good that this Bill is appearing before us now. It strengthens the ability of the Minister to give policy directions to the HSE. We need to reflect for a moment on the ability of the Minister to give policy directions to the agency responsible for the highest expenditure, in excess of €13 billion in taxpayers’ money. That the Minister has taken this on board demonstrates clearly what was wrong with policy-making measures of previous Administrations. It beggars belief that we must include such a provision at all. We must examine what the design- ers of the Health Act 2004 were thinking when they omitted to include such a critical provision in the legislation. That the Minister is taking upon himself direct accountability for the health service is a move that contradicts directly the policy initiatives of previous Governments, and it will be seen as politically courageous and demanding. It is a vital step in ensuring that the Government’s policy decisions and commitments are properly implemented.

There will be criticism, of course. The health service problems will not be cured overnight and I suspect the Minister will fall in for much criticism during the period of transition. It is right to expect the Minister to be criticised if there are developments that are contrary to his plan.

Political generosity will be required from our political opponents. When I hear Senator MacSharry’s mixed metaphors, I am not hopeful about gaining such support or even generosity. I will not labour the point-----

26/09/2012Z00200Senator Marc MacSharry: The previous Minister did not get it either.

26/09/2012Z00300Senator John Gilroy: -----suffice it to say that following eight years during which the delivery of health services was at best inconsistent and lacking integration, we cannot expect an instant panacea.

The reorganisation of the health service in line with the programme for Government, with the ultimate aim of providing universal health insurance, as outlined by the Labour Party as early as 2006, and perhaps a little before it, is ambitious and will require patience and forbear- ance. It is a plan that is long overdue and the Government has moved quickly such that the massively complex reorganisation of the HSE is well under way.

We look forward to working with the Minister in securing the badly needed change. This Bill is an important first step in delivering this change. We look forward to having a robust discussion on its separate and various provisions on Committee Stage. We look forward to working with the Minister on his ambitious plan to deliver real reform in the health service.

Senator John Crown: I was asked in public last week whether I would have voted to express confidence in the Minister last weekend had I had the opportunity to do so; I state unam- biguously that I would have done so.

Senator Martin Conway: Well said.

241 Seanad Éireann

26/09/2012Z00600Senator John Crown: The Minister inherited a very difficult job in very difficult circumstances. He set his face into the wind with the reform agenda, which will be difficult to implement. He has and continues to enjoy my confidence.

It is appropriate to point out at this stage that the Minister is the fifth, or possibly sixth, Min- ister under whom I have worked as a doctor in Ireland since 1996. Of the last four, the current Minister exhibits an extraordinary difference, namely, that his aggregate workplace experience, not just in health care, compares favourably with that of his three predecessors, whose aggregate workplace experience before becoming Members was four years. It was quite extraordinary in that two had worked for less than one academic year as teachers and one had worked for several years in a very reputable legal practice. That was the total life and work experience they brought to the job. We can see the difference in somebody who has not just worked in any workplace but in the health system. It brings understanding to the problems we face.

My one small concern is that the Minister may have been taken captive by the bureaucracy. I came back to Ireland in 1993 to work in a voluntary hospital that answered to the Eastern Health Board, which in turn answered to the Department of Health. After the first of many re- jigs, I worked for a voluntary hospital that answered to a regional health authority that answered to the Department of Health. Subsequently, I worked for a voluntary hospital that answered to the HSE and the Department of Health, and then for a HSE hospital that answered to the HSE itself, which was somehow quasi-independent from the Department of Health. More recently, the proposals are such that I will be working in a HSE hospital under a structure that is ultimately, I am thankful, to be prorogued and absorbed into another body.

Twenty years ago, I worked in a country that had the worst doctor-patient ratios and waiting lists of any country in western Europe. This is still certainly the case in respect of doctor–patient ratios. In the case of waiting lists, we are still close to the bottom. The most recent figures I saw, dating from two years ago, show we are still ranked way below the norm in terms of access to care.

Recent figures have shown that the waiting period for treatment has shortened, which is welcome, but the time taken to gain access to consultants to get the treatment has lengthened. I would love to know the aggregate waiting time from a GP decision that one needs hospital treatment to one’s actually obtaining hospital treatment. I suspect it is not very different.

Twenty years ago, I came back to work in a system that was bureaucratised, centralised, undemocratic and corporatised. Regretfully, I still do. Some 20 years ago, new consultants could be appointed only by an entity called Comhairle na nOspidéal. In examining this organisation, one can only assume it was set up in the manner that dogcatchers were appointed in Tipperary after the Second World War to ensure there were no greenshirts or blueshirts being appointed in excessive numbers. The idea that the appointment of a radiologist in Macroom required the approval of a central committee somewhere in Dublin made no sense. The committee now has a different name and is called the HSE; it still makes no sense. As the senior Senator from Cork stated, there are still huge inconsistencies and illogical aspects associated with the appointment of consultants. I hope we can get this fixed.

When I first started speaking about health issues approximately ten years ago, I stated the central problems of the health service could be summed up in three broad silos. I have always believed the health service was of mediocre quality and I never bought into the hysteria suggesting we had a Third World health system. I worked in a Third World system and realise we 242 26 September 2012 have never had such a system here. We had a health system that was and sadly is still close to the bottom of the table of western OECD health systems in terms of access, specialist care, etc.

The system is characterised by extraordinary inefficiency. This is a product of our amaz- ingly inefficient system of funding. We basically put in place structural incentives for hospital CEOs to close beds. When the money runs short towards the end of the year, they react by closing beds and operating theatres. This is why I am a little sceptical about the potential impact of some of the nuanced differences proposed for consultant working practices. As I said to my colleagues, they should accept everything they are asked to accept because they will not be doing any more work. The proposal will make no difference. If they sign up to do operations on Saturdays, there will be no theatre or nurses. The beds will be closed and the ambulance drivers will not bring the patients in. I said that if they are going to sign up to the agreement for the sake of industrial peace, they should do so, but that it will actually make no difference.

The third major issue with the health system, the third great pillar of dysfunction, is inequal- ity. It is a case of the Paris Hilton health care system. Paris Hilton said that when she gets on an aeroplane, she wants to turn left and not right. This is the kind of system we have inherited, unfortunately. It is not of the Minister’s making and it is one he intends to reform with the move towards universal and negotiable insurance. However, it is the system we have and it needs to be tackled.

There is a great scene in “Father Ted” in which Father Ted receives the Golden Cleric award and has the opportunity to be on the podium for a few minutes, where he vents his views, resulting in a form of group psychotherapy. Bearing this in mind, pardon me if I unburden myself of one or two anecdotes that I believe are illustrative of some of the dysfunctions.

When I came back in 1993, I discovered I was one of only four oncologists in the entire country, which was ludicrous. There was an unbelievable lack of access and patients were dying from treatable cancers. Women were having mastectomies because they could not gain access to radiotherapy for geographical reasons.

3 o’clock

Women in County Donegal were more likely to have a mastectomy than women in south County Dublin because they were further away from radiotherapy centres. For approximately six months, I tried to go through the bureaucratic channels to highlight the fact that we needed a fundamental reinvestment in oncology services. I got nowhere, lost my temper and went public. For a year, I became something of a nuisance of a young man making public statements and pointing out grotesque deficiencies.

The reaction of the bureaucracy was not all that strange - it was probably internally consistent. In the first instance, we were called into a meeting. I will not name names, but a senior official at the Department of Health told us that the Minister of the time was unhappy to be reading accounts in newspapers about cancer service deficiencies and asked us to be quiet about them while he thought about what to do. That did not quite sit with me. I was then hauled in by my hospital and told that there had been a serious and credible threat to the effect that a proposed investment in the hospital would be withdrawn if it could not control me. I was told that, only for the fact that I had passed the one-year probationary period on the old consultants’ common contract, I would certainly have been fired. It was not because I was an alcoholic or moral reprobate or doing anything illegal, but because I was not toeing the line or being quiet

243 Seanad Éireann about deficiencies in the system.

I am not satisfied that the current provisions give any more protection than I would have had if I had not passed my one-year initial phase as a consultant. The central problem in our system is that it is undemocratic and bureaucratic. Until we have a truly democratised, liber- alised and socially responsive health system with the elimination of most of the bureaucratic middle levels, we will continue to have these problems.

Early on, I heard the argument that I was only a clinician, what was a type of technician, that I did not know the situation and that the only people capable of acting in a self-disinterested fashion were health bureaucrats, civil servants and hospital administrators. Everyone but them had a vested interest. I became so tired of hearing this that I decided to enrol in a relatively ar- duous two-year MBA programme to study health policy and health management at the Smurfit school. It has been one of my best decisions. The first lesson we were taught on the first day was the difference between management and leadership. I fear that what we are seeing in the health system is layer upon layer of management and a failure of leadership.

The model that is best loved by the permanent government and the hospital administration class has a professional managerialist at the centre surrounded by a group of technicians who do technical jobs - the person who fixes the hospital boiler, the person who is in charge of the kitchen, the person who looks after the laundry, the person who does brain surgeries, the nurse and the radiologist. We need to move to a fundamentally different model. At the core of all of the world’s great hospitals are clinical leaders - sometimes nursing rather than medical - who are surrounded by wonderful, technical managerial competence. The people in the latter group provide human resources, corporate governance, compliance, physical plant, etc. However, I do not see that model emerging in Ireland. Instead, a kind of tokenism is creeping into clinical involvement through the notion of clinical directors.

Thankfully, I have had the privilege of working in some of the finest hospitals in the world. The people who rose to their leadership positions did so because they were great leaders, not because they were acceptable to the bureaucrat who wanted to elevate a doctor to that position. Some doctors decide relatively early in their careers to become bureaucrats because they do not like practising medicine. They are scattered liberally across Ireland’s health system. Dispro- portionately, the people who are allegedly the senior decision making doctors in our system are not the ones who have been forged in the fires of peer review or climbed the heights of quality, brilliance and achievement. Instead, they are felt to be the safest hands from the bureaucrats’ point of view. This is what I fear is emerging in the development of the clinical directorship model.

My final points relate to what one might call guerilla health economics. Spending money on health care is no worse for an economy than is spending money on cars, white goods or holidays. Why is it that Bloomberg News or CNBC tells us that an increase in consumer spending on cars or holidays in February or an increase in house prices is good news whereas spending more money on health care is bad news? It is always bad to waste money. We need to understand that if we move to a model of reformed health care, we may end up spending more, but we will spend it more efficiently.

The next time the Minister meets any of the Germans, he should tell them, his friends and colleagues, that they can lecture us on how to run our economy and that Ireland will adopt their health system immediately. The synthesis that has emerged between the Minister’s pre- 244 26 September 2012 election health policy and Labour’s health policy is more correctly called the Deutsche model. Germany’s model is the most successful of the large countries’ health systems in terms of equity, equality and access. In summary, everybody is mandated to have occupation-based health insurance and society pays the premia of those who do not have it. This provides a freely negotiable insurance instrument. One may take it to any doctor or hospital one wishes. One may choose to attend a hospital run by the state, the Red Cross, a Catholic religious order or a university. One also picks one’s doctor. Doctors deal with one directly and bill one’s insurance. Such a system has risks. Doctors can overdo testing, in that there is a health economic concept called supplier-induced demand. However, there are ways to police that situation.

This is something like the system we have in our socialised health insurance model, namely, VHI, which is a community-rated form of slightly selective social insurance that is open to approximately 45% to 50% of the population.

The big bang that we need to reform the existing system is not that big. We have already gone half way with approximately one half of the population.

26/09/2012AA00200Acting Chairman (Senator Terry Leyden): I do not want to interrupt the Senator, but his time has concluded. I must hand over to the Cathaoirleach.

26/09/2012AA00300Senator John Crown: I thank the Minister for his attention and wish him well in the rest of this work. If I have referred to deckchairs on Titanic, this has not been a speech on maritime safety. My remarks last week about a ten-month waiting list for abortions seemed to make people believe that I was actually discussing abortion.

26/09/2012AA00600Senator Deirdre Clune: The Cathaoirleach cannot ask me to follow that.

I welcome the opportunity to speak in support of the Bill. What it sets out to do is clear. The Minister called it a transitional measure that builds on changes he has already made to the composition of the HSE board. I wish him well as he prepares to move towards a system of universal health care, which is a central plank of the programme for Government. He will have my support in that work.

For many Senators, the Bill will focus our minds on the Health Act 2004, under which the State has been operating. Other Senators have outlined the situation that has since evolved. Oireachtas Members submit questions to the Minister only to be told that the matters involved are not for him, but for the HSE. I hope that those days will vanish with the passage of this legislation.

If money is being allocated from central resources to the provision of health services in hospitals and communities, it makes sense that Government policy be reflected in its expenditure. The Bill develops structures whereby the Minister will have an input into service plans and accountability measures will be introduced. The Minister will be in a position to issue directions to the HSE on the expenditure of funding and the provision of services. It is right that the HSE’s priorities will be stated by the Minister. I was concerned this week that services were not being provided for children who needed community speech and language therapy or occupational therapy. I contacted the Minister and the HSE, for which it is a matter, as funding has been provided. There must be an avenue whereby public representatives and members of the public can bring to the Minister’s attention an issue where Government policy is not being reflected on the ground. This legislation would facilitate that.

245 Seanad Éireann I particularly welcome the proposed new structures and directorates. Primary care is extremely important and I know from working with people and their families how vital the service is. Senator Crown, who spoke before me, discussed the hospital issue. Primary care involves services in the community, including nurse specialists and public health nurses, that play a very important part in delivering primary care services. It also involves registered nurses, physiotherapists, and occupational and speech and language therapists. The primary care provisions have, to date, had an enormous impact on community services. They provide services locally and in the community, particularly for older people and people who may have children with learning disabilities. This ensures elderly people and the disabled can remain in their own house and community, and we all know the social and long-term economic benefits of that. This is an extremely important plank of Government policy, as it was with the previous Government, and it must be continued and expanded. I know the Minister is completely committed in that regard.

I will also mention the mental health directorate and the fact that this new section will over- see reform in this area. Money has been allocated in the provision of services, and A Vision for Change has been a long time in the making. There is a ten-year strategy that will facilitate a transfer from old psychiatric services to community-based services for those with mental health difficulties. It is a very important plank of the policy. The proposal to set up this directorate has been welcomed by interest groups, and it is particularly welcome that a director will now be responsible for driving forward change in this area and ensuring funding is spent where it is meant to be. It will guarantee that provisions will be available in the local community. With regard to social care, child and family services will also come under a directorate, and there will be clarity in how services will be provided within the HSE structure.

This is an important first step towards a system with universal health insurance and where the money will follow the patient. In such a system, services will be provided based on medical need rather than whether an individual has private health insurance. I wish the Minister well in his quest to get to that point, as I know this is an important first step for him.

26/09/2012BB00200Senator Thomas Byrne: I support the Bill, although it is more a case of letting it pass. The Minister has promised something good will come from it and we must wait and see. The Minister has given himself two Dáil terms to implement his health policy, which is longer than he gave the HSE to sort itself out.

Senator John Gilroy: That is one term shorter than the time it took for the Senator’s party to destroy the country.

Senator Thomas Byrne: Many Members on the opposite side were members of defunct parties, including some in ministerial ranks. The Minister has argued that this is all the fault of the last Government; nevertheless, the people saying this and the staff representing the Minister are the same people who were in the last Government. It is a bit much to hear it repeatedly explained that it is the fault of the last Government as we are talking about the same staff. The only difference is the Minister is at the top, and it is annoying to hear his spokesperson make such comments.

The Minister has given himself more power with this legislation to direct the health service in any way he sees fit, which is a retrograde step. We will now see the politicisation of the health service.

Senator Martin Conway: There was politicisation of the HSE.

246 26 September 2012 Senator Thomas Byrne: The politicisation of the health service led to ruin.

Senator John Gilroy: Fianna Fáil led us to ruin.

Senator Martin Conway: Politicisation without accountability.

26/09/2012BB00900An Cathaoirleach: Senator Byrne to continue, without interruption.

Senator Thomas Byrne: The director general of the HSE will be in the same position as the current chief executive in that he or she will be accountable to an Oireachtas committee. There is little change. This Bill is supposedly the first stage in the introduction of universal health insurance but we do not have much detail in that respect. The board of the HSE was abolished well over a year ago and nothing much has happened except that a gap has formed in accountability and direction. Officials on the ground do not know which way the Minister wishes them to go or how the political wind is blowing. There is a total lack of leadership and accountability, which is wrong, as the officials on the ground are taking the flak which the Min- ister is refusing to take.

The Minister is examining structures rather than people’s health care. He is replacing a system with a very similar model but he will be able to say, in public relations terms, that we are making progress. The HSE has been in place for seven years and the Minister is giving himself longer to sort out these problems, and he will be able to say that the process was always going to take two Dáil terms. The Minister should have given the non-political public health service a bit more time, as there have been significant improvements in the past number of years, despite some faults.

Many of the Minister’s promises remain unfulfilled. Fine Gael Deputies in my area are going around with leaflets boasting about the new GP card for long-term illness but nothing has happened in that regard. There were promises relating to a regional hospital before the last general election but nothing has happened in that regard either. Direct promises have been broken, and it is of great concern that power is being handed back to the Minister. I would personally oppose the Bill on that basis, as it is utterly wrong.

This has nothing to do with accountability. The Bill provides for the director general to be accountable, which will reduce the accountability of the Minister. Ministers were always good at taking credit while avoiding the bad news, and the current Minister, Deputy Reilly, is the same. There is not much change in that respect. He is putting in place many of the old health board structures that failed us when there was political interference leading, for example, to cancer services being kept in places when they should not have been. The national cancer strategy was rejected in the last Dáil, and a current Minister of State, Deputy Perry, disgracefully promised sick women that there would be a cancer service in Sligo. I do not know how people can sleep at night when they tell cancer patients-----

Senator John Gilroy: The Senator’s party members resisted that strategy.

26/09/2012BB01200Senator Thomas Byrne: I speak for myself on this issue. I absolutely and wholeheartedly supported the national cancer strategy because cancer experts and the professor from Canada recommended it to us. I know not everybody, including Senator Crown, may have agreed but it was seen as the way forward. Fine Gael were unbelievably cynical in sinfully opposing that strategy, as it literally dealt with the lives of women, in particular. It was a terrible act.

247 Seanad Éireann Senator John Gilroy: The Senator’s party members opposed it.

Senator Thomas Byrne: My party did not oppose it. I supported it.

Senator John Gilroy: Members of his party resigned over it.

Senator Thomas Byrne: I completely and utterly disagreed with them but they did not make a promise that they knew was false, like the Minister of State, Deputy Perry, and Fine Gael. The Fine Gael organisation indicated that services would be restored after the election. My colleagues resigned because they disagreed with the decision but they were also realistic in that they did not promise that a decision would be changed. There was a very specific promise made to ill people, which was a sick act.

I am opposed to more ministerial involvement and the private health care system proposed by the Minister. He recommended the case of the Netherlands but costs there have increased over the years.

Deputy James Reilly: It is an excellent system.

26/09/2012BB02000Senator Thomas Byrne: It is not the excellent system which the Minister purports. We should be cultivating and supporting the public health service, which is the best way to provide health care to the public. The biggest mistake made by Fianna Fáil and the Progressive Democrats with the Health Service Executive was giving it an awful name. Why is the National Health Service in Britain beloved?

It is a public health service which even the Tories would not dare to touch. It is beloved because there is a history there and a principle that everybody will be looked after regardless of his or her means, or lack of means. That is a principle we need to support. We need to gradually move way from the two-tier system, which has been in place under all Governments. I am not convinced in regard to private health insurance.

We cannot allow a Minister to make directions because there will be motions before the Dáil asking the Minister to direct the Health Service Executive or the director general to do different things which would not be the Minister’s responsibility. However, the power would be there for the Minister to do so because it is a very general power and there is very little in the Bill as to the type of directions the Minister may make.

I can certainly see Members of Dáil Éireann tabling parliamentary questions asking that the Minister make directions in certain instances and I can see motions being put down on such directions. That is no way to run the health service. The health service should be run on the basis of medical need and medical priorities. I do not agree with the Minister interfering in that because Fine Gael has not shown it is able to manage health care and that it understood the health system before the election because if it did, it would not have made the rash promises it made around the country. In Roscommon the promise was completely broken, in Navan it was not kept and in Monaghan, it was completely broken. The Minister said in Monaghan that if he did not keep his promise, he would resign. That was a very dangerous promise to make and he has broken it but I would not ask him to resign over things like that.

A motion in the Dáil expressed confidence in the Minister and we must accept that but I appeal to him to work with the Minister of State, Deputy Shortall, on the primary health care centres. I want to see a primary health care centre built in Kells but I was very disappointed

248 26 September 2012 with the answer given last night by the Minister of State, Deputy Cannon, on the Minister’s behalf. It was very vague on whether that health centre would be built. Negotiations were taking place with a preferred bidder who a number of years ago told the Department it could not afford to build it. I would like an update from the Minister on that because I will certainly do what I can to support that particular project, notwithstanding all the cynics out there. This Bill is an abomination and it is a pity my party is supporting it.

26/09/2012CC00200Senator Marie Moloney: I welcome the amendments to the Health Act 2004 through the Health Service Executive (Governance) Bill 2012. Any effort made to improve accountability and to make our health service more transparent is vital and this Bill will bring that about. The HSE can no longer hide in the long grass, not be accountable to the Minister and not give answers.

26/09/2012CC00300Senator Thomas Byrne: It is the only one giving answers; the Minister is not.

26/09/2012CC00400Senator Marie Moloney: We are dealing with people’s lives and the use of taxpayers’ money. At the end of the day, the buck stops with the Minister. Those opposite will hold the Minister to account for whatever happens in the HSE; therefore, it should be accountable to the Minister. I do not know how this accountability was taken away from the Minister in the first place and what people were thinking when they did that but we are trying to improve the situation. What worries me gravely is what Senator Crown said that people who are in the system and who are trying to highlight the deficiencies and inefficiencies in it are being muzzled. That is not good enough. He was one of those who was strong enough to stand up and speak about it. What about all the others who tried to do so but who were shot down and whose jobs were threatened if they spoke out about the system?

I had reason to attend a consultant in the past year and we spoke about the health service. He told me he was the only consultant in the hospital - I will not name the man or the hospital because he would be identifiable - with one registrar under him. He told me he took the job in that hospital because he thought he could make a difference. He said he worked hard but that he had not been able to make a difference because the system was pulling him down. Anything which can ensure accountability is most welcome.

Earlier we debated the Ombudsman (Amendment) Bill 2008, the Ombudsman’s office and accountability. This is all about accountability. We must be accountable. Today Senator Bar- rett introduced a new word “agencification” in the House. That is exactly what we have been getting - agency after agency. We need to pare this back, throw open the curtain and have accountability.

I have been led to believe there are between seven and eight layers of management between the front line services and the Minister. Why do we need all those layers of management? Nobody is arguing that we do not need management. Every agency needs to be managed properly but do we need so many managers answering to each other? I do not believe that is good enough and we could do away with many of those layers.

For several years replies to parliamentary questions submitted to the Minister or representations made to him have stated that it is a matter for the HSE. I do not expect the Minister to have all the answers at his fingertips because no Minister could possibly have them. However, if the Minister asks the HSE to report back to him, it should do so and we should get the answer eventually. For 12 months, I have been trying to get an answer from the HSE. I wrote to the

249 Seanad Éireann Minister who forwarded my letter on to the HSE. God only knows where it went because I have been chasing it from pillar to post but cannot find it. I wrote to the Minister last November and it is nearly October but I still do not have an answer to that issue. It is not good enough. We should be able to get answers.

The HSE has operational responsibility but with this responsibility, there seems to be no accountability. With the abolition of the board of the HSE and the introduction of the directorate headed by the director general, I hope a speedy transition is forthcoming so that we can progress with our health reform programmes for the betterment of the public. One gets sick of political parties arguing about whose fault it is. We should forget about that and work with what we have and for the betterment of the people. We tried the HSE and the boards of the HSE and they did not work. Let us change the system. If it is not working, let us fix it.

26/09/2012CC00500Senator Sean D. Barrett: I welcome the Minister. As I said the last time he was here, he occupies probably the most demanding post in Irish public life. Perhaps “disagencification” might be the word for this in that we are trying to get rid of agencies and restore ministerial responsibility which, as the previous speaker said, we were discussing with the Minister for Public Expenditure and Reform earlier.

Looking at the numbers employed in the health service, between 1980 and 2011, it went from 55,000 to 104,000. The rate of increase in the administration was to an index of 295 and the total staff was to an index of 187. We have a bureaucracy problem. With Senator Crown, I fear Sir Humphrey has had more of a say in this Bill than we would want him to have. That is where the expenditure has gone. In 1980, the number of non-doctors employed in the health service was 51,000 and it is now 96,000. We have to remove these layers.

I wonder if what we might call the “J Crown” model of hospitals, financially standing alone with their own management, preferably very little, and their own accountant, might not be a much better idea. I realise what is before us today is an interim measure to get rid of the layers of bureaucracy from the HSE but I put that forward for the Minister’s thoughts when he is preparing for the next stage. When we are sick, we want to see a doctor and not the 15,500 bureaucrats who are employed in the system.

I was a member of the Brennan commission. Maurice Tempany was also a member. He was seriously concerned about the number of people with financial and accounting titles in the health services but with no qualifications, a point raised by Senator Burke. The Comptroller and Auditor General has also had that problem. It took some time to get the management letters from outside accountants commenting on what was going on. We really must be aware of all of that.

On page 67 of Health in Ireland: Key Trends 2011, one can see that the German health system - praise for which I am mindful of - spends 11.5% of gross national income and we spend 11.4%. Therefore, we are entitled to expect that kind of service and are duty bound to support the Minister in any measures he has to remedy that situation. The report also shows that our spend of €3,781 per capita is not that far short of Belgium, is bigger than Finland and Italy and about the same as France. Therefore, we are spending a lot of money and are entitled to ask why the service is not being delivered. The Minister deserves the support of the House for tackling issues related to very short working hours and restrictive practices in the health service under the Croke Park agreement and on his own initiative.

250 26 September 2012 I am concerned about some sections, namely, section 16A(4), which states: “A person may not be appointed as an appointed director unless he or she is a person who is an employee of the Executive holding the grade of national director in the Executive.” In the Brennan report, we were critical of that common recruitment pool. Why can other people not come in and help in this important task? Is that a restrictive practice? Like other Senators, I will see whether we will table amendments in respect of this. Section 16D concerns qualifications, which could help the Minister develop those points, but most of the qualifications are disqualifications as listed. One cannot be a Member of the Seanad or the European Parliament. What can one be to assist the Minister in this important task? Much the same is true of eligibility for appointment to the post of director general. We need to think outside the box in the same way as Senators Crown and Burke have spoken about. We have spoken about reform of governance and there has been reflection on why the Brennan report failed. In the other House, the Tanáiste said that no econo- mies were achieved. One had a Health Service Executive into which every single person in the health boards was absorbed. That must be looked at because we have problems.

This debate must take place openly. I am concerned about section 16I(2), which states: “The Director General is not required to give an account before any Oireachtas Committee of any matter relating to the general administration of the Executive that is, or is likely to be, the subject of proceedings before a court or tribunal in the State.” We know there is a sub judice rule but we now have the potential sub judice rule in order that they can refuse to participate in anything, which could happen in the future. This gets more draconian in section 16I(9) where it states that: “In carrying out his or her duties under this section, the Director General shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy.” We are all doing it but under that section, this person will be the only person in the country who does not engage in active debate with the Minister on these issues, much of it supporting him in the reforms he seeks to make.

Section 16J(1) states: “Notwithstanding his or her functions as an appointed director, an appointed director shall be accountable to the Director General for the performance of his or her functions as an employee of the Executive.” Does that make for a board of people who all think the same way and demonstrate the herd instinct? We have had to investigate the problems caused by and deal with the consequences of this herd instinct in so many other areas of Irish life as we attempt to retrieve ourselves from the IMF and others. Section 16K(9) states: “A meeting of the Directorate shall not be quorate unless at least half of the persons who for the time being are members of the Directorate are in attendance at the meeting.” That should be up around 90%. These people must attend board meetings and participate in these discussions. They have been let off far too lightly in section 16K(9). I became confirmed in my fears about the Sir Humphrey factor because under section 16M(8) the director will be called the director general, not the chief executive officer. I worry about people always looking for fancier titles. If they would just do the job, that would satisfy us much more.

In respect of the first step towards universal health insurance, I hope we will not continue the mistakes we have made in this area. We have lost in the Supreme Court, the European Court of Justice-----

An Cathaoirleach: The Senator has one minute left.

26/09/2012DD00300Senator Sean D. Barrett: I have had discussions with the Minister in the House on this issue and I am glad to conclude in the time limit. Milliman pointed out - I know the Minister sent 251 Seanad Éireann it back into VHI - that people were being kept in hospital for 11.6 days when the average length of stay according to best practice was 3.7. We will end up with a hugely expensive system if we keep people in hospitals for an unnecessarily long time. Reforming our health service is a long road, as Senators Crown and Burke and others have said. This is a good first step. I think we will all table amendments in a helpful capacity when it comes to Committee Stage. We wish the Minister well but he has inherited a system that is highly inefficient, very expensive and, in many cases, not serving the patient.

26/09/2012DD00600Senator Martin Conway: I welcome the Minister to the House. He is a frequent visitor at this stage and enters into debate and discussion with us in a very healthy, open and useful manner.

I commend the last speaker for his contribution. He was very positive, as always, and I look forward to helpful amendments. It will be interesting to see what they are. I particularly commend Senator Crown for his contribution. It is very telling that he stated that had he the opportunity to provide a vote of confidence in the Minister, he would have happily done so. I believe Senator Crown has credibility in this area as a distinguished consultant who has specialised in the treatment of cancer over the years in this country. He knows the health system and what the Minister has inherited and is trying to do and is somewhat in unison with the Minister’s vision.

This legislation is important when it comes to implementing that vision and I welcome and support it. For too long, the HSE was too much at arm’s length from the Minister. When difficult decisions were being made and correct and incorrect decisions were being made, the previous Minister regularly stated that the HSE was effectively not accountable to the Minister for Health. In any political democracy I know, the line Minister takes ultimate responsibility for his or her Department and does not kick to touch. No disrespect to anybody but that is what happened for the past number of years. There was an awful lot of kicking to touch. What I would describe as an extremely right-wing philosophy saw the whole disaster that was co- location. That philosophy is what would often be regarded as the Boston-type philosophy. One often heard the phrase “Boston or Berlin”. Based on what Senator Crown said earlier, I would be much more comfortable in the Berlin model. Most elements of Irish society would support that concept and did so in the last general election when the two coalition parties had broadly similar philosophies on health. They involved universal health insurance and a fair and accessible health system for all - effectively a public health system where no matter who one is as a citizen, what one’s resources were and whether one had or did not have resources, one would have access to the same high quality health care.

Unfortunately, implementing that policy is not easy, especially when one is taking over the monster which was and, to a large extent, still is the health service. The Minister must effectively dismantle a health system that is not working and incrementally reassemble a working health system which has at its core the principle of patient care and safety, what is correct for patients and, most importantly, accessible, quality and safe health care. Trying to achieve that will not be easy. The Minister will make enemies because there are vested interests. When one is trying to manage vested interests and do the right thing, one will upset people. This Minister is not interested in the perception of change, rather he is interested in change. Unfortunately, for too long in politics we have had too much of people spinning and trying to create a perception that change is afoot when in real terms no change is afoot. When dealing with the health service, perception is very dangerous because people’s lives are at risk. Every citizen should be entitled to good quality health care. Unfortunately, for too many citizens that is not happening. The Minister is making a genuine effort and he has a vision. The legislation will enable him to 252 26 September 2012 penetrate that vision throughout the system by introducing the necessary changes.

Staff costs will have to be examined. While we are still within the terms of the Croke Park agreement it will be reviewed. Given that 70% of the budget goes on staff costs, it is difficult to implement change. However, genuine efforts to reduce costs are being made with the remaining 30%. There is an old saying, “Rome was not built in a day”, but in this scenario change will take time. There was a mention of two terms of office. I would be delighted if I could say to citizens in my area and elsewhere that in ten years time we will have a high quality health service. The majority of people are buying into that.

I attended a HSE briefing at 8 a.m. on Friday last with Anne Doherty, chief executive of the HSE in the mid-west region which is considering the joining up of Ennis hospital, the Mid- Western Regional Hospital, Dooradoyle in Limerick, St. John’s Hospital, Limerick and Nenagh hospital. The concept is that they should be looked at as one campus although there are four sites. The idea of creating specialist areas in various hospitals is the correct approach where risk assessment and quality care is assured. Therefore, when a patient from County Clare is referred by a general practitioner, it may be more appropriate for him or her to go to Nenagh hospital because that is where the particular specialty is located, or it may be more appropriate for a person from Nenagh to go to Ennis hospital. This is a small country with limited resources which is part of a troika programme. We have a responsibility to do things efficiently and in the best interest of citizens.

I believe in primary care and in keeping people in their homes for as long as possible. I sub- scribe to the notion of primary care centres. While I am not a medical expert, I am a reasonable observer of such things. If injuries can be treated at local level, without referral to accident and emergency departments, that is a more desirable prospect. I would like to think there will be advances in primary care in the lifetime of the Government and, by the end of the next term of Government, a blossoming of primary health care throughout the country.

A value for money audit was carried out on the provision of services for people with disabilities, whether personal assistant hours or a conglomerate of services, because money was being thrown at services and we were not getting value. Certain recommendations within the value for money audit show that a better service can be provided at a cheaper rate to those in need. Difficult decisions will have to be made. In terms of the body that nominated me for the Seanad, People with Disabilities in Ireland, 92% of its funding was going on office space and administration. It was inappropriate that it should receive €1 million of Government money when €920,000 was being spent on office space and administration. I had to support the decision because it was the right decision.

I call on all representatives of the Houses, in opposition and in government, to work together to ensure the people have a quality health system. Politics will have to be put aside. Unfortunately, party politics is necessary but, when it comes to the health service, there should be a national approach for the betterment of the people.

26/09/2012EE00200Senator Marc MacSharry: The Senator should tell that to the Minister of State, Deputy Shortall.

26/09/2012EE00300Senator David Cullinane: I welcome the Minister to the House. When I hear politicians say that we should put politics aside, it is always politicians in government. The reality is that, when the Minister for Health was in opposition, he was a robust spokesperson for health, rightly

253 Seanad Éireann so. Our job is to hold the Government to account. We will work constructively with it if it makes the right decisions, but in many areas it is not making the right decisions.

Many previous speakers referred to Titanic. This is the centenary of the sinking of Titanic. It is apt for those Senators to raise that analogy in terms of where the health services and the Bill are at. We support the Bill only because it is an improvement, not because we believe it will deal fundamentally with the real problems in the health service. Essentially, this is rearranging the deckchairs on Titanic.

Public health services are struggling from day to day. Those who work in the health service are under extreme pressure. Hospitals are suffering and many are reeling from the latest round of cuts of €130 million and cuts to home care packages, in addition to the €750 million taken out of the health budget in 2012 and €1 billion in 2011. Fianna Fáil was also responsible for taking large amounts of money out of the health service and not properly reforming it. It, too, has to take responsibility for that.

26/09/2012EE00400Senator Darragh O’Brien: Sinn Féin put many people into the health services.

26/09/2012EE00500An Cathaoirleach: Senator Cullinane to continue, without interruption.

26/09/2012EE00600Senator David Cullinane: There is also the recruitment ban, restrictions on overtime and the hiring of agency staff, all of which are having a real impact on health services.

Senator Crown mentioned the deal with consultants. It may be a good deal but we will have to wait and see how it works. If there are fewer staff, fewer nurses, fewer doctors and less capacity in the surgical theatres, the deal will not amount to much. I come from the south east. This year, owing to cutbacks which the Government, the Minister for Health in particular, put in place, the regional hospital in the south east lost three of its surgical theatres, going from eight to five, 25 inpatient beds, six paediatric beds and front-line staff, all of which is having an impact on patient care. The Minister will have seen the reports of increased waiting times for outpatient activity and orthopaedic waiting times in Waterford Regional Hospital. He can shake his head but that is the reality. The clinical director at the hospital was on local radio this week confirming that is the case. In some areas waiting times have increased.

What we are trying to achieve is accountability in the health service. Pontius Pilate could not have arrived at a better system than the one in place. The major problem in the health service for far too long has been that no one takes responsibility, and that goes back to previous governments as well. How are we in a new era of responsibility when cuts of €130 million are announced, yet the Minister did not make those announcements, rather a senior civil servant? How is the buck stopping with the Minister and how is that taking responsibility for what is happening in the health service? It is not. The buck has to stop with the Minister and if there is to be accountability, he must take control. He made a big deal of saying he would take the reins of the Health Service Executive and he would take control, yet when the announcement of cuts of €130 million had to be made, he was nowhere to be seen. That is the reality. He was forced into a humiliating climbdown on the cuts to personal assistants for people with disabilities only because those unfortunate people camped outside Government Buildings to get the Minister to do what was right.

Mr. Cathal Magee resigned owing to problems in the health service and a lack of movement. There is no doubt the Bill provides for a slight improvement in services but it still creates a layer of bureaucracy. It is about management. Senator Crown is correct. What we want is a genuine 254 26 September 2012 health partnership. What about the voice of patient groups? What about the voice of advocate groups? What about democratising the health service? That is something the Minister and his party spoke about when in opposition. They were critical of the previous Government, which abolished the health boards. What about local democracy and accountability? Why is it always bureaucrats and technocrats who are responsible for what is happening in the health service? What about people who represent real people such as people with disabilities? What about people who represent older people? What about local politicians who represent people who are elected? Surely they too should be part of how the health service is run.

The Minister’s White Paper on universal health insurance is not going to be delivered as promised. It will be delayed, yet we still do not know how the scheme will be rolled out. I have heard a lot about the Boston, Berlin, Dutch and Deutsche models but I want one that is based on equality. We need a health model where a patient’s treatment is based on need, and need alone, and not on their ability to pay. The system should be free at the point of delivery and funded through general taxation. That is what I want to see and it is the type of model that we should see.

The Government has shelved the scheme for free GP care to long-term illness patients. The measure has been placed on the backburner.

I wish to refer to an important issue raised by Mental Health Reform regarding the Bill. The organisation welcomes the Government’s intention to improve the HSE’s accountability through the Bill but it states: “[T]he current draft of the Bill does not ensure that a Director for Mental Health who has the competence to drive implementation of the Government’s mental health policy will be appointed.” That important point needs to be taken on board.

I draw the Minister’s attention to another important issue faced by patients and the people of the south east. I listened to the clinical director of Waterford Regional Hospital and I have listened to all of its consultants. They are concerned about a review of the hospital network in the region, the possible break-up of the clinical network in the south east and the potential for Waterford Regional Hospital to be networked with Cork. There is a fear that the region could lose services and that its regional hospital would be downgraded as a consequence. It is a real concern for the people in the region and I know that they have raised the matter with the Min- ister because they sent him their submission. They want to ensure that there are proper health services for people and that geography is not an issue when it comes to the type of treatment that one receives.

The Minister must do much better than this Bill if we are to deliver the type of public health service that the citizens of this country need. He must do better if we are to truly democratise the health service and ensure that patients and citizens get the treatment that they need as a right and is not based on their ability to pay or where they come from. The State has a responsibility to vindicate their right and deliver the best health services to the people of the State.

26/09/2012FF00200Senator Catherine Noone: Like other Senators, I support the Bill. It is a positive and necessary stepping stone that will bring us closer to the ultimate goal of the dissolution of the HSE. The Minister has intended to dissolve the HSE since we came to government.

The programme for Government clearly spelled out the intended future of the health service and the continued existence of the HSE was not part of it. The HSE is simply an organisation that has managers managing managers. A manager should at least have a budget and without

255 Seanad Éireann one they should not be a manager. The situation that has prevailed to date is out of control. It was Senator Moloney who said that there are seven or eight layers of bureaucracy between the Minister and front line staff. That says it all.

The Bill provides for the abolition of the HSE board, which was established under the Health Act 2004, and for a new governing structure to fill its place. The board will be replaced by a directorate which will ensure further oversight and accountability for the HSE. The directorate structure is an interim measure intended to help put in place a more direct line of accountability between the HSE and the Minister. From a policy point of view, as well as every other point of view, the structure is welcome and necessary.

The HSE will face many significant challenges in the year ahead given the resources that are available and the dual constraints of both the national recovery plan and the Croke Park agreement. The health sector - like all other sectors - has experienced a reduction in financial resources over the past three consecutive years. During the period we have also seen a steady improvement in service and effectiveness which we hope will increase in the coming years.

The improvements are clear and must be acknowledged but there is more to come during this transitory period. I welcome the overhaul of the HSE’s governance structure. The organisation has had eight years to prove its effectiveness but Senator Byrne has suggested that it should be allowed to continue for another few years to see if it could work. It is that type of Fianna Fáil logic that has led to the property sector going from boom to bust. There is an ex- pression that “if it ain’t broke then don’t fix it” but I believe that if it is broken then one should fix it. In that respect it is good that we can control the health service and that sense will prevail.

With resources tighter than before we need to ensure that one hand talks to the other at all times and that the Minister has full, complete, accurate and timely information when making decisions that are crucial to the future of services both nationally and regionally. As the Minis- ter has said, the new HSE directorate structure will allow us to redesign the system and to put the needs of the patient front and centre. The Bill will bring us closer to that happening and will allow us to take another crucial step in unwinding the years of damage. It will also make the health service more dynamic, agile, flexible, efficient, less expensive and more patient centred. I have belief in the Bill and the positive agenda that has been set regarding HSE reform. I commend the Minister and his officials on their work.

Senator Darragh O’Brien: I welcome the Minister. I have listened to the debate - particularly the last two contributors - and watched the television monitor earlier. Some of us on this side of the House have a degree of sympathy for the Minister. I talked to my health spokesperson and colleague, Senator MacSharry, and he too has had occasion to cross swords with the Minister of State, Deputy Shortall. I wish the Minister well with the mediation process. I would not take a bet on it but for his sake I hope that they can work things out.

Senator MacSharry has outlined my party’s position on the Bill and we gave it a broad welcome. Without question the HSE, its structure and how it is governed needs to be changed and that is all fine, well and good. From my time in the last Dáil when the Minister was the Opposition spokesperson on health one was given the impression that the only problem with the health service was that he was not in charge. The same impression was given around the country when he promised many things to people in Monaghan and Roscommon. How are the plans for a new hospital in our area of the north east going?

256 26 September 2012 The job of a Minister for Health is serious and I have acknowledged that before here. Re- cently, I watched the speech he gave in Monaghan where he gave an assurance that he would resign if it was seen that he did not keep his word. I ask him to watch his speech and to listen to what he and the Taoiseach told the people of Roscommon. More importantly the Minister should examine what was done. Does he have a clear conscious?

Last week we read that there are 340,000 outpatients on waiting lists. Successive governments have failed to deal with waiting lists. Before the Minister replies with the old mantra of what did or did not happen under the old regime I must state that advances were made, particularly in cancer services.

I consider the Minister to be a good constituency colleague. I have listened to him speak at various meetings where he talked about the importance of children. I agree that we must ensure that children and the most vulnerable in our society receive the services that they deserve. However, the aim must be explained to people in the context of managing a reduced budget and real choices must be outlined. The Minister should not leave it up to HSE officials to deliver serious announcements like those made three weeks ago. We do not have an unlimited pot of money and he should be upfront about telling people that. I acknowledge that he has a difficult job to do but we must give people choices because a lot of promises were made.

I have a question on governance. When will there be free GP care for long-term illnesses? I have written to the Minister and his office about various cases, particularly on behalf of people with diabetes and I would like to know how they are proceeding. I have heard a lot from the Minister for Transport, Tourism and Sport, Deputy Varadkar recently but I will not go into it. He has told me that he deems such free GP care to be unaffordable. The scheme formed an important plank of the proposals by the Minister for Health when he was Opposition spokesperson and I am interested to hear how the matter is proceeding.

I have a couple of serious matters that I wish to raise with the Minister on paediatrics and children. I raised the issue twice here and I wrote to him a couple of weeks ago.

4 o’clock

I have yet to receive a response. I am sure it is in the Minister’s office.

Senator John Gilroy: What does that have to do with the legislation before us?

26/09/2012GG00300Senator Darragh O’Brien: Is the Senator finished?

26/09/2012GG00400Senator John Gilroy: I am.

26/09/2012GG00500An Cathaoirleach: Senator O’Brien to continuie, without interruption.

26/09/2012GG00600Senator Darragh O’Brien: It is related to governance of the HSE. In fairness, the Min- ister is taking notes and I am sure he will do his best to answer the questions. If you are ever a Minister, which is highly unlikely-----

26/09/2012GG00700Senator John Gilroy: It is as unlikely as you being one.

26/09/2012GG00800Senator Darragh O’Brien: If you do not think it is important that matters relating to cystic fibrosis-----

An Cathaoirleach: Senator O’Brien must speak through the Chair. 257 Seanad Éireann Senator Darragh O’Brien: You might ask Senator Gilroy to control himself, although it is a difficult thing for him to do.

26/09/2012GG01300An Cathaoirleach: Senator O’Brien to continue, without interruption.

26/09/2012GG01400Senator Darragh O’Brien: This is very important. The Bill relates to the structure of the HSE and its various directorates. The question of the vacant paediatric cystic fibrosis post for physiotherapy in Temple Street Children’s University Hospital, which looks after 94 children, is crucial. This Bill formally provides that the HSE is officially and under law required to report to the Minister, and I am asking the Minister to intervene in this matter. This post has been vacant for four weeks but it was flagged about six months ago that this retirement would take place. However, the human resources, HR, section in the HSE will not respond to the parents of these 94 children. The Minister, being a medical doctor, will understand the importance of physiotherapy for children with cystic fibrosis. I urge the Minister to check with the HSE as to when it will give its sanction to filling that post. I hope Senator Gilroy considers this an important enough issue to raise in the House.

With regard to our budgets and how the HSE manages its budget, we saw the figures last week which show that the overruns continue. We were given assurances by the Minister and the Government that front-line services would not be affected. However, I can offer an example from our constituency and north Leinster where there have been cuts to the HSE paramedic ambulance service in the north Leinster area and specifically in Swords and north County Dublin. Every Tuesday, between 7 a.m. and 7 p.m., there is no ambulance cover for 250,000 people. Last Tuesday they were covered by Loughlinstown hospital, but on the weekend before last there was no HSE ambulance on the Friday and Saturday nights in the north County Dublin area because the HSE would not cover sick leave and would not put in non-rostered staff. The Minister is aware of this issue. He campaigned in the previous election on the platform that Dublin North needs a Minister. Perhaps we did, but I believe we still do. I ask the Minister to deal with this issue as well. This is about governance of the HSE and examples of the front-line services which have been affected, such as the cystic fibrosis post in Temple Street Children’s University Hospital and the north-east and north Leinster region having to wonder when it will have cardiac and advanced paramedic ambulances available to it.

Last week Loughlinstown hospital was covering Swords, but last weekend there was no ambulance in the north-east area. Why do the people of our area not deserve 24 hour, seven day per week advanced paramedic cover when other areas of the country do? This is about management and I wonder how this new structure of governance will make that change. The Minister might explain with regard to the different directorates being set up - I agree with the structure - how regularly they will report to him. How hands-on will the Minister be? When there are further cuts, will it be the case that the Minister will send out some poor official in the HSE to make the announcements for him? I believe there is an opportunity here for the Minister. It is not up to him to take my advice - I am sure he would not - but people realise that he has a difficult job and that the budget has diminished. However, if the Minister told people that he would keep his promise of protecting the front-line services, people would have more respect for his and the Department’s approach. Consider the cut in home care hours and the welcome U-turn the Minister made regarding the personal assistants, which other Members have mentioned today. We must be much clearer about these matters.

If the Minister is to save €750 million next year, I believe a proper public debate must take place on how he will achieve that. On a personal level, I wish the Minister well in that endea- 258 26 September 2012 vour. This is an area that is close to the Minister’s heart and he has experience in it. However, many mistakes have been made over recent months in the management of the Department and the HSE. Is the Minister recommitting now to ensuring front-line services will not be affected? Is he recommitting to building a new hospital in the north east? Is he recommitting to ensuring the ambulance cover in the north Leinster area, lest I be accused of being parochial on this, will be reinstated? Will he give a commitment to ensuring the cystic fibrosis post in Temple Street Children’s University Hospital is filled without further delay? I await with interest the Minis- ter’s responses to those questions.

26/09/2012GG01500Senator John Kelly: I will be as brief as possible. I welcome the Minister and support the Bill. However, like other Members, I will move swiftly along and raise a couple of issues with the Minister.

One of the issues relates to Government policy on co-sharing of services. I spoke to the Minister a number of months ago about the possible use of fire stations for the co-location of ambulances and ambulance personnel. The Minister and the Minister for the Environment, Community and Local Government, Deputy Phil Hogan, were supportive of the idea. Follow- ing that, a chief ambulance officer for the western region and a chief fire officer for my county agreed a policy document which would bring this about. However, the entire process was eventually frustrated by one official in the county council who said it simply cannot happen. Per- haps the Minister would get involved with the Minister, Deputy Hogan, and let these councils know that where these possible developments might take place, it is Government policy that they should. We talk about saving money and this is a way of doing that. There is no capital investment and only minor overheads.

The second issue I wish to raise is also about saving money. It relates to the home help service, which was mentioned by some Senators, and I have mentioned it to the Minister previously. I have carried out a costing of this proposal. I think the figure for the amount of money saved by taking 600,000 hours out of the home help service is approximately €8 million. I am not sure whether it is €6 million or €8 million. I have suggested previously that if we took on people who are unemployed and put them on community employment schemes - they are already receiving a social welfare payment - for the increase of €25 per week they would receive, we could provide the 600,000 hours that were removed from the service at a cost of €750,000. The 600,000 hours could be put back into the system for €750,000. Therefore, instead of saving €8 million, we could save €7.25 million if the Minister did things my way. I realise there are issues surrounding taking on community employment applicants and so forth, but they do this under the rural social scheme. It is important that this be considered. It is a way of delivering a quality service at the right price.

An issue arose today and I believe this is the second time I have dealt with such a situation. It relates to people who have poor circulation problems. The Minister will be familiar with this. When there are poor circulation problems there is always a possibility that the patient might have one or both legs amputated. The only machine available for dealing with this is the ArtAs- sist. I am sure the Minister has heard of it. It is available through the private sector but not in the public system. It is not available free. It is being made available, for example, in University College Hospital Galway, UCHG, to people who have serious circulation problems. I do not know what company has developed this machine but it charges for its use. The cost for a 90 day course of treatment using this machine is approximately €1,400, but people simply do not have the money to pay for it. They are medical card holders. A consultant in Galway has written an article about this. He stated in his article that if this machine was made available for free to 259 Seanad Éireann people who cannot afford to pay for it, they would save money through avoiding the need for amputations and follow-on care. Those are three ideas that would save money and improve the health service and I would appreciate the Minister’s thoughts on them.

26/09/2012HH00200Minister for Health (Deputy James Reilly): I am genuinely pleased to have been here today. The quality of the contributions has been excellent in the main and the debate has been stimulating and thought provoking and I am being genuine when I say that because some of the comments I have heard have re-energised me and made me glad that I have taken this job. When I conclude, I will do so in a forceful fashion.

A number of Senators have raised issues that have nothing to do with the Bill but they are important issues nonetheless and I will deal with them even though the Senators in question may have left the Chamber. In fairness they may have left because they did not think we would finish so quickly and I appreciate that.

Senator MacSharry asked if the same personnel would be involved and if there would be job losses. There will be job savings, although the Senator can call them job losses if he wishes. Will the same personnel be involved? Certainly not, we now have a new head of the HSE and a new person at the head of the Department of Health, with a new CEO of VHI. The Senator asked if there would be an increase in salaries. The previous incumbent in the HSE was on €320,000 per year plus a car allowance, the current incumbent is on €195,000 with no car allowance. The previous incumbent in the CEO position in VHI was on in excess of €400,000, the current incumbent is on €230,000 to €250,000. Not alone have we changed personnel, we have saved the taxpayer money.

The Senator said there is no plan but that is utterly untrue; there is a very clear plan. Time does not allow me today to go through the plan in its entirety but I will be happy to do so at another time. This Bill is an important step along the road.

The north-west region is an area of concern for me, particularly for 24 hour cardiac stent- ing. Today we are discussing the issue, and I will come to the hospital groups later, because I have been discussing those as well with Professor Higgins, who is carrying on his work as expeditiously as he can and he will come to me with a report later next month. I am glad to say, however, that I have been in contact with the Minister in the Northern Ireland Executive, Edwin Poots MLA, by phone on a number of occasions and that he issued a statement saying that rather than looking to Britain, which one report on cardiac surgery for paediatrics recommended, he wishes to have an all-island approach and that we should plan our services together with that in mind. I am happy to do that. I have also discussed with him the issues around air ambulance cover for the Border area and the issue of cardiac catheterisation. We will both tour the facilities along the Border in the near future so we can familiarise ourselves with the situation. Both Departments have been examining the issue, not just the big ticket issues like the hospitals but the small items such as ambulances crossing the Border, GPs accepting patients from either side of the Border and GPs having different rotations. If there is a man in Blacklion who is miles from his colleagues but close to people across the Border, why would he not be part of that cooperative or on-call service?

The Senator asked why changes are not coming but I challenge him and say they are coming, they are here already. Despite the fact €1.75 billion has gone out of the health service in the last two years, and another €700 million will go this year, with 6,000 fewer staff, and despite certain political parties saying there would be calamity and catastrophe at the end of February 260 26 September 2012 when people left, there was no such calamity. We not alone maintained a safe service, but we improved it. We have done so in a way that is measurable and verifiable. There are 22% fewer people on trolleys so far this year in comparison with last year, despite those challenges. The number is 13,450 people, a figure verified by the Irish Nurses and Midwives Organisation. There has been an 85% reduction in those waiting longer than one year for an in-patient procedure, a 63% reduction for those waiting longer than six months, and an 18% reduction for those waiting longer than three months. That is real, measurable and verifiable. There are 800 fewer children on waiting lists this year than at this point last year. I remind Senators there have not been any cuts to home helps or reduction in personal assistant hours.

I am happy to acknowledge when I make mistakes and I will make more because, as the ad- age goes, the man who made no mistakes made nothing. I had the 55 top managers of the HSE and Department of Health in a room in Dr. Steevens’s Hospital two weeks ago and that was the first time it had happened since the HSE was formed. I said to them that I want to empower them to go out and try new things and when they try them and they work, I will laud them and if they do not work, I will support them in order that they can go out and try something new again. I will not castigate people or operate in an atmosphere of fear. I want people to be innovative and think outside the box, which is what Irish people are good at. I will return to that issue.

I am sorry to say it to Senator MacSharry but to have to listen to talk of cynicism from Fi- anna Fáil, I will not even comment on it.

Senator Marc MacSharry: Please.

Deputy James Reilly: The Senator asked when free GP care will be introduced. It will be introduced in this quarter, in this Dáil session, as promised. I accept it is a bit late, but I have explained before it is an extremely complex area. It is much more complex than I ever understood and the Attorney General is working with this to move from a system that is eligibility-based on means to a system that is based on disease entities. The work is nearly done and we hope to move on it shortly. We will introduce that legislation.

Senator Darragh O’Brien: Which areas will be in the Bill? The Minister said it will happen this quarter.

Senator Marc MacSharry: Swords and Balbriggan first no doubt.

Senator Darragh O’Brien: I was only looking for clarification.

Deputy James Reilly: I said it would be introduced in this Dáil session.

Senator Darragh O’Brien: Will it be available to people this quarter?

26/09/2012HH01000Deputy James Reilly: Is this a debate now? I will release the Ogden report in the next couple of weeks and the PA Consulting report and they will address many of the concerns expressed here by others, including Senator Barrett, and on this side by Senator Gilroy, on the lack of financial expertise in the system. It was asked who is in charge and I will make that clear. I am in charge and I will take responsibility for decisions I make that are good and for those that are bad.

There was a metaphorical discussion about changing the name of Titanic to Olympic and so on. The reality is that Titanic, like the HSE, did not have the necessary navigation systems on it.

261 Seanad Éireann Senator Darragh O’Brien: Or the right captain. Is that what the Minister is saying?

Deputy James Reilly: We did not even have headlights in the HSE, we could not see what was happening. Now we have the headlights, we have a much more sophisticated system.

I wish to refer to emergency departments. We were forever hearing the situation would be treated as a national emergency and everything would be done to correct the problems, with ten point plans in place but none of it worked, particularly at a time when the Government threw money at it. I will come back to the whole emphasis Fianna Fáil had on inputs - more doctors, more nurses, more money - with no focus on outcomes for patients.

Senator Darragh O’Brien: Not true.

Deputy James Reilly: What resulted from the investment?

Senator Darragh O’Brien: What about cancer care?

Acting Chairman (Senator Diarmuid Wilson): Senator O’Brien already had an opportunity to contribute during the debate.

26/09/2012HH01700Deputy James Reilly: With the best will in the world, the Senator asked me questions and I will answer them but he has had his time and I ask him to please keep quiet.

Senator Darragh O’Brien: That is what the Chair is for.

Acting Chairman (Senator Diarmuid Wilson): I thank the Minister for his assistance.

26/09/2012HH02000Deputy James Reilly: I thank the Chair and will be grateful for his protection.

Now we do not just measure the number of patients on trolleys at 8 a.m. with the INMO, we measure the number again at 2 p.m. and again at 8 p.m. in order that we can now predict a pattern and know at 8 p.m. the night before if we will be in trouble the next morning and can take corrective action. That is why, although many people had their hearts in their mouths when I said it, there will never be 569 people again on trolleys. I can never say that absolutely because there could be a catastrophe that might result in that but in the ordinary run of things that does not happen. Today there are 100 fewer people on trolleys than this time last year. We now have put in place a system that can predict. For example, we have put in place a system for inpatient procedures whereby people are prioritised, once the urgent and cancer cases are looked after, on the basis of the duration of time they have been waiting. Moreover, in respect of outpatient figures, it is utterly disingenuous to state they have increased since last April. They were never counted before in this country and the figures never were available. Last April, we only had to hand half the figures and while we now have nearly all of them, they still are not complete. The current figure is 340,000, which ultimately may rise to 360,000.

However, I wish to assure Members about a matter that must be put into perspective. I have been told the outpatient services see approximately 200,000 people each month. If one is to believe some figures that have been given to me today to the effect that 3.5 million people were seen last year as outpatients, that monthly figure obviously is higher at 300,000 people. It is a problem that, when one first looks at it, is quite shocking. However, it can be addressed and the Government is determined to address it. I have stated in the past and repeat that I will put my neck on the block whereby my aim is that by the end of next year, 2013, no one will be waiting longer than a year for an outpatient appointment. Some 16,800 people have been waiting 262 26 September 2012 longer than four years for an outpatient appointment. This is an absolute disgrace and a cause of considerable concern to me.

Senator Colm Burke mentioned an instance of the non-appointment of a consultant. If he provides me with the details, I certainly will investigate it. The issue concerning non-consultant hospital doctor, NCHD, planning is ongoing. The Senator is dead right that many excellent people work in the HSE and I have always made that point. However, I always have complained about the lack of proper management, transparency, accountability and fairness. One must start at the beginning in that one must have transparency and one then can have accountability. When one has accountability, one may get fairness. Senator Burke mentioned the cost of drugs and this issue must be addressed. I am happy to state we are well advanced with our negotiations with the Irish Pharmaceutical Healthcare Association, IPHA, and hope to conclude them by the end of this week. I hate to say they will conclude because one never knows what could happen in negotiations. However, we are making good progress and I am quite confident that I will have good news on that deal in the short term. Another issue that arises with regard to the cost of drugs is drug reference pricing and the cost of generic drugs in this country. One need only go up the road to Newry, where one can buy some drugs generically at one tenth of the price we pay down here. Drug reference pricing will address this issue and as Members are aware the Health (Pricing and Supply of Medical Goods) Bill 2012 received support in this House just before the summer break, from where it will pass into the Dáil and become law very quickly. I already have mentioned how significant numbers in respect of financial expertise will be put into the system and I will have a definitive announcement in this regard in a couple of weeks time.

Senator Gilroy made the valid point that before the HSE was formed, there were approximately 13 grade eight staff in the system but by the time the Government came to power, there were more than 700 such posts. An explosion is not the word for it. I thank Senator Crown for his supportive comments. I can tell him I have no intention of being captured by the bureaucracy. I could not agree with him more regarding the employment of consultants by Comhairle na nOspidéal. I wish to devolve down to the managers of the hospital groups control over their budgets and control over recruitment of doctors and nurses. This must be their decision. There is very little point in giving them responsibility unless they are given authority and they know what they need by consulting on the ground where they are delivering care. I must refer to the example of Mr. Bill Maher in Galway. When he took over the hospital, had they not started to attack the waiting list, there would have been 9,901 people waiting for longer than one year for treatment. When I last spoke to him two weeks ago, that figure was down to 720 and he stated it would be 500 by last Thursday. This is a hell of an achievement and shows what can be done. However, Bill Maher did not do that on his own. He acknowledges he did this with the co-operation of the clinical directors, the nursing directors, the front line staff and everyone with a focus to put the patient first and to be fair.

Senator Crown spoke about the current funding system and I agree it is utterly bonkers and made that point in opposition. I refer to the idea that one gives a block budget to a hospital and that when the money is all gone, everything stops and the only people who suffer are the patients. Furthermore, there is a perverse incentive to leave lying on a bed a patient who has finished his or her acute phase of treatment because he or she only costs one grand a day, as opposed to taking in an acutely ill patient who could cost five grand a day. On a fixed budget, one simply does not do it. However, under a money-follows-the-patient system, one will do it because if there is no patient, one will not get paid. The new arrangements with consultants

263 Seanad Éireann will mean they are available 24 hours a day, seven days a week, 365 days a year on five-day rosters, including night work. This means there will be a senior clinician in the hospital at all times. Senior clinicians are known to make more decisions more quickly with fewer tests. Consequently, this will save money and will put people through the system much more quickly. When I referred to the clinical programmes last year saving 70,000 days at a putative saving of €63 million, the point is not about the €63 million but about how more patients were treated more quickly and that is what it must be about, namely, the patient.

I do not want Senator Crown to preside over a system in which any man or woman working therein is afraid to speak out. However, neither will I preside over a system in which people can use their professional status to give a skewed version of what is happening to speak to their own vested interest. While I will encourage people to speak out, I will have others who would be prepared to speak against them from the same area of expertise. If they are telling the truth, the truth will be seen by the people but if they are telling a little yarn simply to further their own agenda, so be it as that will be found out too. I believe that to be fair and I hope Members agree. I want doctors to talk to doctors and nurses to talk to nurses. Senator Crown spoke of new management and clinical leaders and I believe that is of critical importance. It is hugely important to have clinical leaders with management responsibility and authority. As I stated previously, the success of the special delivery unit, SDU, is based on the fact that for the first time, those on the front line believe they are being listened to. Their ideas are assessed and if they look good, and make sense from a financial point of view, they are implemented and if they do not, they are not. In the case where there is a doubt about the idea, one should go back and revisit it. The Dutch model has been much talked about. I always have made clear that we take certain things from the Dutch model. However, we take ideas from Denmark on patient safety, from the United Kingdom on the trust model for hospital groups and from Northern Ireland the example of the SDU.

I take, in particular, the point Senator Crown made, also made by Senator Barrett, about doctors over-doctoring VHI. VHI now has new leadership in the form of a new chairman and a new chief executive officer with a remit to reduce costs and to bring in proper audit. I am sure all Members have heard anecdotal stories about people who were billed for procedures they had never had carried out or certainly were not aware they had carried out but for which the company would pay anyway. In addition, they have a remit for something that never was undertaken previously in VHI, namely, clinical audit. A cardiologist will ask the relevant cardiologist the reason he or she did something and if it was not necessary or clinically indicated, the company will not pay for it.

Acting Chairman (Senator Diarmuid Wilson): I apologise for interrupting the Minister but-----

Deputy James Reilly: I have yet to respond to many Members. Must I conclude at 4.30 p.m.?

Acting Chairman (Senator Diarmuid Wilson): Perhaps we can be lenient with the Min- ister.

Debate adjourned.

Business of Seanad

264 26 September 2012

26/09/2012JJ00600Senator Maurice Cummins: I propose an amendment to the Order of Business that the debate conclude no later than 4.40 p.m. to allow the Minister to complete his response to the Second Stage debate.

Acting Chairman (Senator Diarmuid Wilson): Is that agreed? Agreed.

Health Service Executive (Governance) Bill 2012: Second Stage (Resumed)

Question again proposed: “That the Bill be now read a Second Time.”

26/09/2012JJ01000Minister for Health (Deputy James Reilly): I appreciate the intervention.

Senator Byrne referred to the same staff being in place but I already have made clear the staff has changed considerably. Many have made the point that the board of the HSE was abolished last year. However, it was not abolished - its membership changed - but this governance Bill will abolish the board.

As for talking about two terms to implement the reform, I believe that for the first time both parties in government had the political courage to state before an election that it would take two terms to carry this out and that they could not promise what they could not deliver. However, the Government will deliver it within two terms. Someone also mentioned the Dutch system, how the costs have risen and how the entire system is unaffordable. I happened to be in contact with the Dutch permanent secretary fairly recently at an informal meeting in Cyprus and he explained how the costs of course have risen because they have begun to cover dental care. Senator Moloney spoke about the muzzling of health workers and I have covered that point. It is not something with which I agree. Senator Barrett referred to the increase in the number of non-doctors in the health system from 56,000 to 96,000. We also need to include among those non-doctors nurses, health care assistants, physiotherapists, occupational therapists and others. This brings me to a key principle in which I believe, which is treating the patient at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. I do not want consultants seeing patients whom GPs should be seeing and I do not want GPs treating patients whom their practice nurses or physiotherapists should be treating. I do not want nurses looking after patients whom the health care assistants should be looking after. Why is it that one of our major hospitals has nine nurses to one health care assistant and another hospital other similar size has three nurses per health care assistant? Through the HSE and SDU we will transpose uniformity across the system and where we find excellence of care or really efficient methodologies being used that are safe, we spread them across the system.

I often quote the example of the physiotherapists who, when screening orthopaedic refer- rals, found that 50% of the patients did not need to see the surgeon at all. Some of it might be because they could treat them and some of it could be because it was the only way the GP could get the patient the physiotherapy service. The same thing is happening in psychiatry with counselling services. There is considerable dysfunctionality in how our systems are organised.

A colleague of mine recently turned up at an outpatients department along with 35 other patients at 9 a.m. I find that a disgrace. That is a system that is self-serving and shows disdain for citizens and patients. There is no reason for that - it must stop and it will stop. I have asked Mr. Tony O’Brien to ensure it stops and people are given appointments. I accept we need to allow for those patients who do not arrive. Large numbers of people are not arriving and that could be 265 Seanad Éireann a factor. If they have had to wait for a year they may have got sorted out somewhere else. There are simple things we can do and will do such as sending text messages 48 hours beforehand and asking them to reply indicating whether they are coming. We will also send a text message again on the morning of the appointment reminding them to come. Equally if those people do not reply by text, the next time they seek the appointment it will cost €10 or €20.

I wish to refer to the money being spent. Many of the things I said when in opposition have been quoted, but here is something else I said frequently when in opposition. I said we should not put another bob into the black hole that is the HSE until I find were the leak is and we are getting there. Like most things I have found out that it is like a bloody colander - pardon the language.

26/09/2012KK00200Acting Chairman (Senator Diarmuid Wilson): The Chair did not hear that.

26/09/2012KK00300Deputy James Reilly: The Senator raised an issue about section 16 and the national directors. I have reservations about that and I would be happy to take amendments on Committee Stage. The rationale is as follows. The jobs for national directors can be advertised and then they become eligible to go on the directorate. As this is a temporary arrangement we made a decision to limit it to the wider health family as opposed to outside. We do not want a long process of tendering, appointments and all the rest of it. If the Senator is worried about section 16 we can review that on Committee Stage. It concerns the issue of the director general not giving evidence to the committee on an issue that is being dealt with by the courts. Perhaps the Attorney General has a view on that matter and I will need to revert to the Senator. However, I remind him that it is a temporary measure.

Senator Darragh O’Brien mentioned VHI. The clinical audit is one thing and there is the other audit. We will also now do a deal with VHI and I have informed it of this. I believe it should be doing this on the private side but public patients should not be charged per day any more but per procedure. If the hospital is efficient the procedure will be done efficiently and the patient will be in and out quickly. If it is inefficient then the hospital will lose money. That is the only fair way to do it.

Senator Conway spoke about vested interests. As we challenge and change the status quo the noise will grow to a deafening din - it is getting a bit loud already. We are not afraid of that. We said we would change things and we will do so. As I said on a radio programme, we were elected by the people to do it. They did not say they would like us for the way we did it or that they would like us for having done it, but we will do it.

The value for money audit was mentioned. I have said we are focused on outcomes for patients and not inputs, which formed the main focus of the previous Government. We can measure hospital outcomes in many ways, but we still do not have the measures of outcomes in primary care we need.

Senator Cullinane spoke about rearranging the deckchairs on Titanic - I have dealt with that issue. I have spoken to his obsession with inputs rather than outputs. I have spoken about the consultant talks at the LRC. I thank the consultants’ leadership for bringing this to a ballot of their membership. They are leaders in the health service and where they lead others will follow. Senator Crown mentioned nurses and said that there would not be anybody in the theatre to support the consultants - there will be. Nurses are already well used to working different shifts as are others. We will get the efficiency and care citizens need in a much better way. I believe

266 26 September 2012 consultants will also have much better job satisfaction.

I am not sure of the accuracy of whether there is an increase in the waiting list for outpatient appointments in Waterford Regional Hospital. The Senator spoke about the announcement of €130 million by civil servants - they were not civil servants, but public servants. I appeared on the radio and television the following day to reassure the people that they would not lose their service. Just as increasing inputs does not necessarily improve outcomes, reducing them does not necessarily mean a cut in outcomes for patients. From what the Senator has said I know he agrees with the model of care we are proposing and universal health insurance. If there are real concerns in Waterford Regional Hospital about the new hospital groups we will review it and consult further. The Senator concluded his speech by saying it was not a bad idea but I must do better. I have not heard any better idea from him.

26/09/2012KK00400Senator David Cullinane: I mentioned community health partnerships. The Minister was not listening.

26/09/2012KK00500Acting Chairman (Senator Diarmuid Wilson): The Minister to continue, without interruption, please.

26/09/2012KK00600Deputy James Reilly: I agree that we need to flatten the pyramid of management and devolve more authority to the local level to which I have alluded. I want more power locally the people who do the job locally.

Senator Darragh O’Brien talked about the OPD figures. I spoke about this issue in his ab- sence. He is back now. He asked when GP care would be provided. I have covered that issue. It was suggested that it might not be affordable but I believe it is and it will be delivered. The physiotherapy issue in Temple Street Hospital, while nothing to do with the Bill, is important. No moratorium will be applied to critical such posts. That will not happen. I am informed that patients who need it are being given physiotherapy.

Senator Darragh O’Brien: Not in Temple Street Hospital.

Deputy James Reilly: However, I agree with the Senator that we need a permanent physiotherapist in situ there. I will need to check the situation regarding ambulance cover.

Senator John Gilroy: Perhaps Senator O’Brien can drop into the Minister’s clinic on Sat- urday.

Acting Chairman (Senator Diarmuid Wilson): No interruptions, please. The Minister has limited time.

26/09/2012KK01100Deputy James Reilly: I am nearly finished. I am very grateful to Senators for their for- bearance.

Senator Kelly made a number of excellent suggestions. It is eminently sensible to share facilities to give services in areas, particularly where the populations are small. We would need to examine the suggestion regarding community employment schemes. While it is a great suggestion, there are issues that would require negotiation. I will certainly inquire about ArtAssist for peripheral vascular disease.

I thank all the Senators who contributed. We have had a very good debate and I am looking forward to further debate during the remaining Stages of the Bill in the Seanad. I am more 267 Seanad Éireann determined and committed than ever to introduce these changes and to fix the health service. However, I am more convinced than ever because of the new leadership that is emerging at the top of the HSE, in the Department and hospitals. I am sure Senators join me in thanking them and those who work on the front line for the excellence of the work they do.

Question put and agreed to.

Committee Stage ordered for Tuesday, 2 October 2012.

School Transport: Statements

26/09/2012LL00187Acting Chairman (Senator Susan O’Keeffe): I welcome the Minister of State at the De- partment of Education and Skills, Deputy Ciarán Cannon, to the House.

26/09/2012LL00300Minister of State at the Department of Education and Skills (Deputy Ciarán Can- non): I thank my former colleagues of the Seanad for affording me the opportunity to address them on the issue of school transport.

School transport is a significant logistical operation managed by Bus Éireann on behalf of the Department of Education and Skills. In the region of 114,000 children, including more than 8,000 children with special educational needs, were, on a daily basis last year, transported to schools throughout the country. This network involves approximately 4,000 vehicles covering over 82 million kilometres annually. Members will appreciate it is a serious and logistical operation.

I am aware that this scheme has been the subject of much comment and debate recently in various parts of the country as a consequence of changes this year to the post-primary school transport scheme in particular. Essentially, the changes implemented last year and this year derive from a value for money review of the school transport scheme which was finalised in 2010 and from decisions of the previous Fianna Fáil-Green Party Government to implement a number of recommendations in that report. Before I outline the changes in more detail for the benefit of Members, I would like to stress again today that these changes are being implemented at a time of serious, long-term economic challenges. It has been, in the period since we assumed office, and will continue to be necessary for this Government to make tough and unpopular decisions. The reality also is that we have little or no scope to reverse earlier Gov- ernment decisions.

This year’s school transport budget of €170 million is €1 million less than that provided in 2011. Under the four year national recovery plan, this figure will be further reduced to €167 million in 2013 and €164 million in 2014. These are minimum required levels of savings and are like every other area of expenditure liable to revision. The reality is that in the 1997 to 2011 period, the budget for school transport increased from €50 million to almost €180 million, an increase of 260%. This massive increase in the school transport budget, while was heavily influenced by factors such as safety and transport provision for children with special educational needs, is significantly greater than the inflation rate or the rate of increase in the overall education budget during the same period. Given current circumstances and the fact that this is a significant expenditure area, it was simply not possible to exclude such an area from serious evaluation and from the impact of essential reviews in expenditure. The aggregation of the primary measures implemented in 2011 and 2012 and the post primary transport measures 268 26 September 2012 now being implemented arising from the value for money review will be an important element in achieving these savings.

On a positive note, the changes to the operation of the scheme also aim to ensure a mod- ernised and streamlined application and administration system managed by Bus Éireann, which will be simpler and more transparent for families and schools. I accept that, because of the rural nature of the school transport scheme - which this year will again provide transport for approximately 13% of the overall primary and post-primary school-going population of some 840,000 children - the impact of the changes will obviously be significantly more visible in some rural communities.

In essence, the changes to school transport are in line with the general approach of the Department in relation to the planning of school infrastructure, which is based on children attending their nearest primary school and, in turn, attending their nearest post-primary school. At primary level, the “closed school rule” has ceased. While children who were attending this school of amalgamation retain their eligibility, from this school year all new primary children applying for school transport are assessed for eligibility based on their attendance at their nearest school, having regard to ethos and language. Similarly at post-primary level, the use of the catchment area system as a means of determining eligibility ceased for all new pupils entering a post-primary school this year. From the commencement of this school year, school transport eligibility for all new pupils entering a post-primary school is being determined by reference to the distance they reside from their nearest post-primary school or education centre, having regard to ethos and language.

As at primary level, children who were eligible under the former catchment boundary area system will retain their transport eligibility for the duration of their post-primary education cycle, provided there is no change to their current circumstances. In other words pupils in first, second, third, fourth or fifth year last year may complete their education in the school they are attending and may retain transport eligibility to that school for the duration of their time in that school. Siblings of these children and other children who are not attending their nearest school, be it at primary or post-primary level, may apply for school transport on a concessionary basis only in accordance with the terms of the relevant school transport scheme. Senators may recall that from the 2011-12 school year the distance criterion was also applied at primary level and that a number of children who were availing of school transport under the closed school rule, CSR, had been deemed eligible, although they resided less than 3.2 km from their school of attendance. From the beginning of the 2011-12 school year, therefore, the distance criterion of 3.2 km applied to all pupils availing of transport under the primary school transport scheme.

It remains the position that eligible primary and post-primary children holding valid medical cards and children with special educational needs will be exempt from paying the school transport charge. In addition, this year, to support families affected by the ceasing of the closed school rule, the primary concessionary charge of €200 was reduced and equalised with the new primary transport charge of €100. I attended a number of meetings last year in Listowel, Gal- way, Donegal and other locations at which I met with parents of primary school children, some of whom were anxious to access transport on a concessionary basis. They were being asked to pay €200 while children accessing the service on a non-concessionary or eligibility were being charged €50. I committed at that time to those parents to exploring the opportunity of equalising that charge. I committed at the time to exploring the opportunity of equalising that charge and, thankfully, in last year’s budget year we were able to do that. This means that ineligible children, those who do not meet the requisite primary distance or those who may not be attend- 269 Seanad Éireann ing their nearest school, may now get a concessionary seat at a cost of €100 per annum, rather than the cost of €200 that applied in the past, where there is spare capacity on buses once all eligible children have been catered for. I wish to emphasise that the changes to school transport at primary and post primary level are, and will continue to be, applied equitably and fairly on a national basis.

Given the very difficult fiscal position facing the country, it is imperative that parents, schools and the general public recognise that the main objective of the school transport scheme is to support the safe transport to and from school of children who would have difficulty travelling, for reasons of distance, to their nearest school if transport is not supported. While it is, always has been and always will be, the prerogative of parents to send their children to the school of their choice, it is simply not reasonable in these difficult times, or at any time I argue, to expect that the State would be available to provide transport on a school of choice basis.

26/09/2012MM00200Acting Chairman (Senator Susan O’Keeffe): I remind Senators that group spokespersons have eight minutes, other Senators have five minutes and I will ask the Minister of State to conclude not later than 5.50 p.m.

Senator Ned O’Sullivan: I wish to share my time with Senator MacSharry.

Acting Chairman (Senator Susan O’Keeffe): Is that agreed? Agreed.

26/09/2012MM00500Senator Ned O’Sullivan: This is a timely debate and I welcome the Minister of State back to the House. We were colleagues together during the last Government term and I wish him well in his endeavours.

The school transport budget is a big ticket item, even though it has been reduced as the Min- ister of State has accepted, and unfortunately it appears set that there will be further reductions in it in the years ahead. It is a big operation. As the Minister of State said, 110,000 plus students, including 8,000 special needs students, avail of the service and there are 4,000 vehicles on the road which clock up 82 million km every year.

This scheme was the brainchild of a previous Fianna Fáil Government in line with our party’s commitment to equality and cherishing all the children of the nation equally. Without it, there would not be access to second level education, particularly at current levels. I compliment everybody involved in the operation of the service from the administrators to the bus drivers who in many cases are the friendly face of the system for the pupils.

The value for money report recommended certain changes which it is accepted were en- shrined in the national recovery plan. The then Fianna Fáil Minister, Mary Coughlan, prepared that and proposed a gradual phased changeover to the new system. This Government, as in many other instances, has implemented fully, almost slavishly, Fianna Fáil policy even though it berated that policy in opposition. It is on record that the current Minister, Deputy Quinn, was highly indignant about the then Minister, Mary Coughlan’s, proposals even though the ones that are now being implemented are far more stringent.

It is interesting that we are having this debate now given that the schools started back in September and we are starting to witness teething problems with the changeover, of which the Minister of State will be aware, and every Member present will have some case on hand of families and communities that are upset about the operation of the system under the new regime, and that is the way it will be. There is a commitment that the operation of the system will 270 26 September 2012 be reviewed this side of Christmas. The Minister of State might clarify that in order that we can assess the level of the problems.

A key change is the move from the catchment area system at second level, which has been in place for a long time. No more than any other system, the system in place was not perfect and there were a number of anomalies in it which caused problems for families and communities and this system will probably prove to be the same. There will be problems and anomalies in it as no system is perfect.

The idea of attending the nearest school in theory is the right one. However, it will create problems for people on a number of levels, the detail of which I will not go into. I want the Minister of State to be as flexible as he can be in the way in which the programme will be implemented, particularly in areas where county boundaries are being broken and where families are being forced to send their children out of the county for the sake of a kilometre or two. That is a problem in many respects, whether it be in the area of one’s cultural identity, county loyalty or the colour jersey one wears. People are more comfortable in their own county. Therefore, that is an aspect that needs to be examined.

The idea of siblings not being able in the future to attend the same school as their brothers and sisters will be upsetting for families. There may be a tradition of the children in a family attending a certain school and in most cases parents will dig deep into their pockets and pay for their children to attend the same school rather than attend a different one. There is also the question of subject choice. The nearest school may not necessarily be the most suitable school for a pupil. One pupil might be particularly gifted academically and the nearest school might be one where the main ethos is focused on technical subjects and so on and vice versa. These are all areas that will have to be examined.

I noted on reading a Dáil debate on this area that a Fine Gael Deputy raised an interesting point. A particular bus could be passing a student’s door but it would be the wrong bus for that student and he or she would have to travel a considerable distance in a rural isolated area on winter days and nights to avail of the proper bus. I hope in the promised review that these matters can be ironed out.

The minimum number of students required to run a school bus service has increased from seven to ten. There should be flexibility around that requirement, especially in the more rural areas because essentially this is a rural problem. I do not think school transport is a major issue in Dublin city, although it may be, but the correspondence I receive on this issue is all from people in rural areas throughout the country.

The cost of school transport is increasing. This is happening when people are facing increased charges in terms of septic tanks and property taxation and increases in PRSI have been mooted. The Government effectively has doubled primary school transport costs. That was not envisaged in the previous Government’s programme. The costs are sizable. The maximum cost for one family has increased from €110 to €220, which is a significant ask for parents. There is a €50 increase in the second level transport costs which brings the cost up to €350. The only way it can be paid is in one lump sum or in two instalments. I ask the Minister of State to reconsider this. Could the payment of two instalments of €175, which is a significant cost if it applies to more than one or two children in a family, be phased in over a 12-month period to give people an opportunity to meet the cost, bearing in mind the cost of school books and other costs.

271 Seanad Éireann I have heard reports that the administration of special needs transport is getting blocked up. There is a blockage in the pipeline. A number of colleagues on both sides of this House and in the other House have told me that the processing of applications for school transport for students with special needs is taking an inordinate amount of time. The Minister might examine that area.

I agree with the Minister of State that traffic safety must be paramount. We read horror stories every year of accidents involving young children stepping off buses where there is in- adequate lighting and there are other such problems. The buses must be safe and must be run properly. That is the most important issue. I appeal to all parents to make sure that their children stringently observe all the rules of the road.

26/09/2012MM00600Senator Marc MacSharry: I thank Senator O’Sullivan for sharing a little of his time. As a former business person and one who knows business, I know the Minister of State appreciates the need for common sense. I have written to him about a case, that of the Gilgarrow family in Sligo, concerning school transport. A child in that family attends Coola school even though the closest school is Ballymote but because historically the family attended that school, that child can continue to do so. A sibling of that child is travelling in the same direction but it will not be possible for that child to do so without paying €350 despite the fact that the family has a medical card and that there is a spare seat on the bus. Effectively, the Government is saying to that family that one child can travel on the bus to school but that a parent will have to transport the other child by car in that direction, even though there is a spare seat, the person has a medical card and there is also a scenario where there is another child at home with diabetes who requires a routine to be followed in terms of medication.

5 o’clock

I ask the Minister of State to examine that case; I know he has details on it. I appreciate that there must be rules and a threshold. However, for Government to work effectively, there must be some element of common sense and discretion. As a former businessperson, the Minister of State will appreciate that and perhaps he can examine the case. There are many similar to it. Taking a literal interpretation of the rules means that needy cases are overlooked. As well as a literal interpretation, there is an interpretation of the spirit of the rules. In the case of the Gilgarrow family in Castlebaldwin, County Sligo, discretion is warranted.

On a matter not related to school transport, I ask the Minister of State to investigate reports that Bus Éireann is adjusting services to rural areas. I refer specifically to the north west of the country, where the Dublin route calls on Rooskey, County Roscommon, and Dromod, County Leitrim, and the reports that the service will no longer call to those villages. This move will further marginalise the north west, rural Ireland and the communities dependent on these services. The route between Sligo and Dublin is crucial to community life in these smaller villages and connects them to employment and services of the larger centres. I do not recall the route numbers but I ask the Minister of State to examine the matter. While everyone appreciates that savings are necessary, we must be conscious of preserving the soul of Ireland, which is rural Ireland and parts of the country that do not have the critical mass for services. If services must be pared back to make savings, we must do so where there is a critical mass of other services such as in Dublin, Galway and the larger cities.

26/09/2012NN00200Senator John Whelan: I propose to share time with Senator John Kelly. I appreciate the courtesy of Senator Jim D’Arcy, who allowed me to speak first as I have to attend another meet- 272 26 September 2012 ing at 5 p.m. I welcome the Minister of State again after a previous discussion on this matter on the Adjournment, responding to Senator Pat O’Neill and me in July.

I welcome the thoroughness of the policy as set out by the Minister of State. Senator Ned O’Sullivan made a constructive and fair-minded assessment. No one wants to tear up the rule book or put policy in the bin. It is well intended and has been introduced to good purpose. We must have planning and cost control and I do not seek favouritism or ducking and diving around the rules. This is primarily an issue that affects rural Ireland. If people cannot get the school bus, there may be no alternative. There is no 46A bus going down boreens. An increasing number of families are finding it difficult to keep a car on the road, never mind two cars. The husband or wife may have to head off to work in the car and there may be no option to get the child to school. The buses are going by the door and the brother and sister can get the bus but another child may have to get a lift ten miles in the opposite direction. There may be no alternative school bus route or service. There is no saving to the taxpayer or the Department. If the purpose is planning, cost saving and value for money, proximity to the school cannot be the only metric underpinning the policy. Other factors must be taken into account. It would be foolhardy to have a single measure of eligibility. It is an absurdity that two children from the same household can get on a bus with empty seats while another child must be driven to school in the opposite direction. That is the first problem that needs to be addressed in the review.

The Government will ask schools to consider amalgamation and rationalisation in the interest of the best use of resources. Heywood community school is the amalgamation of four secondary schools. They merged in good faith and the parents, encouraged by the Department, bought into the project. Now they are being told it is no longer the nearest school. Children from the Swan national school, Newtown national school, Wolfhill and Raheen are being told to go to Castlecomer and Portlaoise, which are ten miles and eight miles, respectively, in the opposite direction. There is no school bus to these locations. It is not the intention of the Depart- ment to undermine the enrolment policy of a perfectly good, popular and well run viable school, but persisting with this policy will strip out 30 to 50 children annually. One does not need to be a rocket scientist to do the maths on that point. Within a number of years, the viability of the school and the enrolment process from primary schools will be undermined. How can the principal and board of management go to primary schools in the catchment area of Heywood community school in November for the traditional information and enrolment evenings without being able to assure the parents that eligible children will have access to the school bus? The concessionary ticket is not the answer because it leads to travelling on a wing and a prayer. If there is a seat, the child might get one. I ask the Minister of State to exercise his political prerogative to examine and review the policy and its operation on the ground. While it might be working for the majority of people, it is affecting hundreds, if not thousands, of families nationwide. It puts undue distress and hardship on rural families.

26/09/2012NN00300Senator John Kelly: I welcome the Minister of State to the House. Senator Ned O’Sullivan called this a timely debate and it is only now we are seeing the repercussions of the blunt instrument introduced. I contacted the Minister of State about a number of cases. One involves a woman who came from Galway to a rural part of Roscommon and enrolled her twins in a school in Glenamaddy. She did not have children in secondary school before and was not aware of the rule that children must go to the nearest school. She was not told of the rule when she enrolled the children and, at the eleventh hour, when she required a bus ticket, she was told that, even though she has a medical card, she would be charged because she was not sending her children to the nearest school. She accepted that it was not the nearest school but her endeavours with

273 Seanad Éireann Bus Éireann to get some discretion brought into the equation led to nothing. An official from Bus Éireann phoned her and offered to call down and hear her story. When he called down, she was not there and he returned to Galway. When she subsequently spoke to him on the phone two days later, his answer was that the child was not going to the school nearest to the family. She explained she was aware of this, yet the official from Bus Éireann came from Galway, 60 miles each way, to measure the distance. That is pure nonsense, where one arm of the State can be milking it for travel expenses while this woman is expected to pay €600 that she does not have.

Another case involves a distance of a few hundred metres and a child with special needs. The child is going to a school and the psychologist has written to the special educational needs organiser suggesting the child is in the most appropriate school, but the letter seems to carry no weight. I have other examples also. There are still empty seats on buses that could facilitate the children in question.

There is no mechanism in place to deal with discretionary cases; that is my biggest problem. From my dealings with legislation in my previous day job down through the years, I noted discretion was always provided for in social welfare legislation. There was always provision for a ministerial decision if all else failed. There is a need for ministerial intervention on this issue, just for this year. I ask for a moratorium on the heavy-handed approach that applies this year. Families should be fully informed for next year. This certainly did not happen this year. I sympathise with those families who were caught in a trap and did not realise what they were doing when they bought uniforms for children and enrolled them in a certain school only to be told that the school is a meter farther away than another. I would like to hear the Minister’s response.

26/09/2012OO00200Senator Sean D. Barrett: I welcome the Minister. I note from his speech that the cost of the school transport scheme is €170 million per annum and that some 114,000 pupils are availing of it. If my arithmetic is correct, this amounts to an individual cost of €1,400 per year. I know schemes other than that of the Department with a different limit and in respect of which the catchment area is half suburban and half rural but I do not believe anybody pays €1,400 per year per pupil.

When we discussed this issue last year, it was said that special disability cases are included, thus increasing the average. However, I would have believed that in an open market, parents who want to send their children to school would not even pay half that sum. It is the subject of a court case in which it has been argued the service should have been put out to tender. There is no verdict in that case, if I recall correctly. Irrespective of the law courts, it would be interesting for the Department to ask whether there would have been savings had there been competitive tendering. Some two thirds of the contracts are passed on in any case – it may be an even higher proportion at this stage - to the independent operators. Given the high cost, we must ask whether there are alternative ways in which the service should or could have been provided.

I note Bus Éireann is suing a rival in court on foot of an allegedly libellous document sent to Senator Norris. Senator Norris is not present today. Is the case a good use of public funds given that CIE itself needed an extra €36 million the week after the Dáil and Seanad went into recess in July? Mysteriously, it discovered it was short of the money. One has a constitutional right to criticise public policy. One must also bear in mind the rights of Members of the Oireachtas and that the director of the company being sued chose to communicate with a Senator, Senator Norris, on the matter. I am sure Senator Norris will be in contact himself. 274 26 September 2012 The service is valuable. It operates in a society that now has far more cars per household than when it began. It has increased in cost dramatically, from €50 million to €180 million. There was an increase of 260% between 1997 and 2011. Can the Minister enlighten us on what the value-for-money study stated on the potential to continue serving the children of the nation in a lower cost way?

The Minister of State referred to not diverting money that should be invested in schools to school transport. The Minister of State and Minister face the consequences of a very rapidly rising birthrate. To be spending money on buses when we actually need school places and tu- ition for the increased numbers that will be in our schools in four or five years is ill advised. We need buildings and teachers for the pupils. This should be the emphasis.

In all times of economic crisis, people say, “Never waste a good crisis”. Is this the time to do a root-and-branch analysis of the school bus service? Since 1932, the Department responsible for transport has tried to stop a large, independent bus service from getting into operation. After 80 years of trying, the wrong people own 80% of the buses. There must be a message there for those responsible for transport policy in general and for a major customer in the transport sector such as the Department, which must purchase school bus services. We will be in a better position when we know the result of the court case. We will know whether the proceedings indicate that there should be competitive tendering for the service. I would be concerned about the cost.

Senator Jim D’Arcy: I wish to share my time Senator Brennan. Cuirim fáilte roimh an Aire Stáit ar ais go dtí an Seanad. I thank him for outlining once again in detail the application of the school transport scheme.

The last sighting of the dodo was in the 1660s in Mauritius. We know nothing about the national recovery plan to which Senator Ned O’Sullivan referred; it, too, is in the ether. It had all the tactical nous of Trapattoni in the European championships. We will leave it at that.

Since the scheme was introduced, it has been of great benefit to hundreds of thousands of children and this has enabled them to attend school regularly. Mr. Neil Kinnock said he was the first member of his family to attend university. The US Vice President, Joe Biden, or someone else stole this line. I was the first member of my family to avail of the school transport scheme. We had to walk before the scheme, in our bare feet. The scheme is of immense importance and we need to maintain it.

As the Minister has outlined, the allocation for the scheme in 2012 was €169,693,000. In 2013, the allocation is to be €167,435,000. In 2014, the allocation is expected to be €163,751,000. This is a huge envelope and the money is not in the system to add to it.

Is it possible to have greater value for money through management, for example? There is a virtual monopoly in the management of the school transport system although much of the work is done by private operators. I refer to the monopoly of Bus Éireann. I would like the Minister to consider this.

All Senators should congratulate the Minister on succeeding in protecting so much of the school transport budget in the current financial circumstances. If I am correct – I believe I am – there was a serious proposal at official level to do away with the school scheme. The Minister of State is to be richly congratulated. I have heard him speak passionately, both in public and in private, on the school transport scheme and his commitment thereto.

275 Seanad Éireann Nevertheless, the financial circumstances require some savings to be made. Most are gained by tightening the criteria. For example, children are only eligible for school transport to their nearest school. This will cause problems.

I know of a family of four or five children who live on a hill within a hen’s throw of a school. They pass it on their way to a school miles away. Tá dhá thaobh leis an scéal. We must be bal- anced. There will always be difficult cases and I do not know how they will be handled. That is up to the Minister of State. I do not know whether many of them can be handled. For the sake of efficiencies in the pot of money available to us, we must encourage families to attend their nearest schools. This is the new reality.

I am delighted that we have been able to reduce the concessionary charge to €100 from €200. It had been coming for a long time and a great deal of work was done. It is a good move forward.

I do not envy the Minister of State his task. I almost supported Senator MacSharry in respect of the Sligo situation that he outlined until he stated that there were many like it, at which point he lost me. If the Minister uses his discretion to look after one situation, it will be the old stroke politics. We are long past that.

Senator Ned O’Sullivan: Did I hear the name of the Minister for Health, Deputy Reilly, mentioned in terms of stroke politics?

26/09/2012PP00300Senator Jim D’Arcy: This is payback time for the Senator who I slagged about the national recovery plan. The Taoiseach addressed the other issue perfectly well. The criteria were open and transparent.

26/09/2012PP00400Senator Ned O’Sullivan: I believe the Senator.

26/09/2012PP00500Senator Jim D’Arcy: I thank the Minister of State for attending the House and congratulate him on his handling of the school transport service.

Senator Terry Brennan: Ba mhaith liomsa freisin fáilte a chur roimh an Aire ar ais go dtí an Seanad. I acknowledge and welcome the decision that eligible primary and post-primary children who hold valid medical cards and pupils with special educational needs will continue to be exempt from paying the school transport charge. Some 140,000 children were transported to and from school by bus last year. The figure might increase this year. The figure included 8,000 children with special educational needs. This was a major transportation of children, as is acknowledged by many families.

Does the Minister of State believe that the service is as effective and efficient as it should be? What changes can be made to improve the service, if possible? Gabhaim comhghairdeas leis an Aire as an obair iontach atá á dhéanamh aige do scoláirí óga ar fud na tíre.

26/09/2012PP00700Senator David Cullinane: Cuirim fáilte roimh an tAire Stáit. We must accept that providing school transport for 130,000 children every day is a large logistical challenge for the State and requires a significant investment. However, I cannot join one of my republican colleagues in the Seanad, Senator Jim D’Arcy, in commending the Minister of State for cutting the budget for school transport by €17 million. Such a cut will have an impact on some people’s ability to avail of school transport. We are discussing children.

Senator Jim D’Arcy: One could cut €17 million and still have €3 million left. 276 26 September 2012 Senator David Cullinane: The republic with which I want to be associated, a republic that cherishes all children equally, has a free education system. An element of this involves ensuring that children can get to school by funding a transport service through progressive taxation. If there is no money, as Senator Jim D’Arcy stated, we must consider raising the necessary amount through increased taxes on those who can afford to pay more. In a republic, one would end the practice of subsidising private education to the tune of €30 million per year and use that money to ensure equity and access in the system. Philosophically and politically, we must approach this situation from the point of view of equality. We must recognise it as a children’s rights issue and ensure that those rights are vindicated by the State.

Not unlike other Senators, I corresponded with the Minister of State prior to and during the summer, in my case because of a number of issues that arose in Waterford following changes to post-primary school transport. The changes were introduced by the previous Government but one change, the abolition of catchment areas that resulted in a child being required to attend the closest education centre, only came into effect this year, leading to significant confusion. Fami- lies were unaware of what was happening. They enrolled their children in schools and applied for transport, yet no one had informed them of the changes. This was a critical fault. Someone dropped the ball. I do not know whether it was Bus Éireann, the Department or someone else. Surely there should have been communication following the making of applications, particularly when people in the Department and Bus Éireann knew that the scheme was going to be changed. It might have solved the problem for some of the families affected.

Many families received letters stating that their children would not be eligible for post- primary school transport. Like many Senators, I was inundated by calls and representations from parents. I downloaded the eligibility criteria from the Department’s website. According to that information, the Department will measure the distance from a child’s home to the nearest education centre, yet the letters to some families claimed that the measurement was from the nearest post office to the school. That measure was not mentioned anywhere on the website. If it is the case and if there is a rationale, the information should be included in the eligibility criteria to which people have public access on the website.

The Minister of State might correct me if I am wrong, but he stated that only 1% of the students who applied for concessionary transport were denied. The fact remains, some people were denied school transport. For those people who availed of concessionary transport, there was an obvious difficulty with people using medical cards, for example. Ordinarily, if such people qualified for school transport, it would be free, but they were being asked to pay because they were availing of concessionary transport. Although the Minister of State may be considering changes, if a person has a medical card, he or she should be entitled to free transport whether a place is availed of in the first instance or there is a concessionary transport place.

I accept there are challenges and it is a big logistical project to be delivered by the State. I also accept that in a republic we must ensure that children have access to school transport in a fair system. I agree with previous Senators about the lack of flexibility and discretion in the scheme. In certain circumstances, there are only a few metres in the difference and a child may want to attend the same school as siblings. In my county there is a short distance between Port- law in County Waterford, the nearest education centre in Carrick on Suir and the centre which most people would have attended in Kilmacthomas. That does not make sense and people should be able to attend school in their own county rather than the neighbouring county. Pupils should be able to attend a school with their siblings and friends and where their parents had attended. A bit of discretion in the scheme would go a long way and solve many of the anomalies 277 Seanad Éireann which surfaced this year and caused problems for many parents.

26/09/2012QQ00200Senator Pat O’Neill: The Minister of State is welcome to the Seanad. As the Senator who raised the matter on the Order of Business, I have a few points, although most of the Senators have dealt with the issues. The changes to the scheme are too blunt and there is not much of a humanitarian or practical aspect to them. There will always be difficulties in change.

I gave examples before and do not wish to repeat them but the nub of the matter concerns people with medical cards. Some 8% of people on the school transport scheme were receiving benefit under the medical card scheme, and as Senator Cullinane noted, perhaps 1% are affected in having to pay €350. I have given examples where people live on a road where a bus to Kilkenny city passes the door. When a child applied for a ticket for the bus, the parents were told he could not go on the bus with his sister and that the nearest school was in Thomastown. The parents in question would have to drive the child two miles every morning in order to get a second bus. That is impractical, and if a bus stops outside a house to collect one child, another child should be allowed on the bus, whether the cost is €350. That is why the scheme should be reviewed.

This also limits parents’ choice of schools. There are six educational centres at secondary level in Kilkenny city, and there is a large catchment area in the adjoining villages within five or six miles. If somebody lives just outside the criteria for Kilkenny city, the children are instruct- ed to go to places like Thomastown, Castlecomer or Ballyhale. There is nothing wrong with those education centres but if a pupil’s brothers or sisters are attending Kilkenny city schools, and the parents have attended schools there, there should be a choice in schools.

I accept that savings had to be made in the Department but a blunt instrument has been used. Departmental officials did not really consider the humanitarian side of this. The 1% of people in question do not have much of a voice and will not be on the street protesting, and I do not support protests at any stage. The only avenue available for these people is lobbying Members like Senators or Deputies or county councillors.

I know the Minister of State knows his brief well and may review the system next year. The savings could be found in other areas in the Department. The action in this area was not properly thought out, although I am not blaming the Minister of State. There are people in middle Ireland who do not receive any entitlements from the State and they are trying to educate their children the best they can. Those people may have children in university, meaning they are liable for registration fees. They may have a child going to secondary school and if they do not have a medical card, they may not have free transport and have to pay for a concessionary ticket. As Senator Whelan pointed out, the concessionary ticket process is hit and miss because if a bus is full, the pupil will still not get to the school.

I ask the Minister of State to review the scheme. I know the departmental officials formulated the process with savings in mind but we could reconsider this scheme. Perhaps we should include people’s past records, including where siblings went to school, as well as a free choice in education. I thank the Minister of State for his attention.

26/09/2012QQ00300Senator Mary Moran: I was not listed to speak in the debate but as I have raised the topic several times on the Order of Business and the Adjournment, I felt I should contribute. I concur with Senator O’Neill’s call for a review of the scheme. Other Senators have argued that there can be no discretion but in the special needs area, we must show a little discretion. The Minis-

278 26 September 2012 ter of State would be well aware of cases I brought to him. Department officials must consider special needs children cases, as all children do not fit in the same criteria.

I have mentioned the case of one child on several occasions. That child attends a special school in Dundalk and because the child lives 2.6 km from a pick-up point, the child’s mother now has to drive the child. The child wears a back brace, suffers from dreadful epilepsy and has severe problems with attention deficit hyperactivity disorder and concentration. The child is almost asleep before getting to school. Nevertheless, nothing has been done about the case and the mother this year has had to drive the child to a pick-up point on the roadside. I may be seeking some discretion but if the child could go normally on a secondary school bus, there would be no problem. As the mother noted, she has a concessionary ticket which is being paid for. She has said she would pay anything for proper transport.

The mother in question is a nurse and the father also works, meaning very often they have no means of arranging for somebody to stand at the side of the road to pick up the child on the way home. I ask that the Minister of State consider this case again. Last week, on the second day at school, the child was brought home and dropped on the side of the road. The bus driver informed the mother that the child could not be taken on the bus any more because there was no insurance cover for the child. The mother rang me in tears on the Wednesday and I contacted the Department straightaway. The child is being picked up for school again but the mother cannot let her colleagues in the health service down when there are cutbacks in the north east. The woman is distracted and upset, and this is unnecessary.

One of the reasons I stood for election in 2011, having never been involved in politics before, is to mention the case of my own son, who required wheelchair transport to go to school in Drumcar in County Louth. This was in the time of the previous Government and our circumstances demonstrated the completely nonsensical way in which people determine school transport. He required wheelchair transport and a bus with a wheelchair space drove past our house every day; however, when we tried to get him a place on it we were told that we could not get one and instead we had to drive him to school, with the Department reimbursing us at a rate of 33 cent per mile. That was the limit. We had to pay the €158 a week to get him to and from school while he was in a wheelchair. It would have cost the Department nothing - not 33 cent a mile - to examine the details, see there was a space on a bus and put the child on it. It is argued that one cannot be concessionary and if the Minister of State makes a concession for one person he will have to make it for everybody. This is not the case with regard to disability. When one has a child with special needs and it takes one half an hour to dress him or her and another ten minutes to walk out and put him or her on a bus, no money would pay for the time in an extra half an hour in the morning. On behalf of the mother of the child with special needs I mentioned, and on behalf of all those with special needs, I appeal to the Minister of State to examine cases individually.

26/09/2012RR00200Senator Catherine Noone: I welcome the Minister of State to the House and commend him and his officials for their work. I was interested to note that in recent years Bus Éireann’s accounts have shown the cost per student has increased annually. In effect, it costs more to transport fewer children. The cost in 2009 was €1,266 per student, in 2010 it cost €1,392 per student, and in 2011 the cost was €1,526 per student. The number of students availing of bus transport has decreased by 20%, yet the cost has increased. I understand the counterpoint, that this figure includes 8,000 children with special needs who incur a greater cost because of their special needs and the special transport needed to be provided for them. It is great that this number of children with special needs is transported every day but the State has a responsibility to 279 Seanad Éireann all children, and while I am not aware of specific instances such as that spoken about by Senator Moran, it is clear the service is not provided in all instances, which is very unsatisfactory. If savings were made elsewhere in the system, surely the average cost per pupil would stay level rather than rising overall. I am not sure that 8,000 children with special needs would result in an average rise of €300 per child nationally if the number of children using the service nationally is reducing by 20%.

As many of my colleagues know well, recent changes have been made to the school transport system and I will not go through the points already made by my colleagues as we are somewhat tied for time. Regrettably, as other Senators alluded to, the revised scheme may mean siblings of pupils enrolled in the same school for this school year may not be eligible for school transport, and these siblings could apply for transport on a concessionary basis. As many parents are now aware, changes in the post-primary school transport scheme were announced in the budget in 2011. One of the changes, which took effect this month, means the use of the catchment area system as a means of determining eligibility will cease for all pupils newly entering a post-primary school. Under the new system, school transport eligibility for all new pupils entering a post-primary school will be determined by reference to the distance they reside from their nearest post-primary education centre, and will take into account ethos and language. This will be applied in an equal way nationally.

It is clear that if this were opened up to a tendering process which invited Bus Éireann and private companies to tender for the school transport contract, we might see potential synergies emerge which are unavailable to us, such as between school and hospital transport or with regard to the cost of maintenance for a company with an international fleet as opposed to an indigenous or regional bus company. There are many possibilities. Bus Éireann is doing a reasonable job but there is room for imagination and greater use of resources. We need to open up this sector to competition. Bus Éireann has done a decent job but it can be done better. Given that we will spend €170 million on school transport this year, perhaps we should strive for greater savings and synergies across the board. This could be achieved by having an open and competitive tendering process.

I do not want to touch on the legal aspect of the court case concerning this issue, but regardless of whether there was a contract to provide school transportation for Bus Éireann, there should be no question as to there being an open, fair and competitive tendering process in the future. I do not know who would win such a tendering process, but this is precisely the point. Each player should be given a chance to offer innovative ideas, some of which I have heard in dispatches, which could be applied to the school transport system.

While there has been a fair bit of disruption to parents and pupils this year, with the changes made in the budget in 2010 now being realised for the first full year with some regrettable consequences, I hope we do not shy away from further changes. The biggest and most effective change we can make is in how we handle future school transport contracts. I am interested to hear the views of the Minister of State.

26/09/2012RR00300Senator Martin Conway: Like the Minister of State, I come from a rural constituency and we are contacted regularly by parents of children who use the school transport system. Funnily enough, this year has not been too bad and we have not had the same level of communication as we did last year. This means the Minister of State must be doing something right. The budget of €170 million was reduced by €1 million. Being realistic, this is less than 1% and is more like 0.5%. School transport has not suffered in the same way as other sectors in society. 280 26 September 2012 The measures proposed are innovative but we could be even more innovative. We need to foster and encourage car pooling, especially in rural Ireland. One way to make this happen is by offering a tax incentive whereby parents would receive a small deduction in tax or a tax allowance if they can prove they car pool or sign up to a car pooling scheme which could be run by volunteers. Many retired teachers have contacted me to say they want to do something to help. They want to work a day or two a week to help get the country back in action. They have pensions and they are quite willing to give of their time. They are able, competent and professional retired public servants. I suggest a national car pooling scheme to bring young people to school could be co-ordinated and operated entirely by retired schoolteachers, initially on a pilot basis and, if successful, rolled out nationally. This would get people back to work, save money and reduce the budget of €170 million. Substantial reductions to the budget could be made if people were prepared to think outside the box.

26/09/2012RR00600Minister of State at the Department of Education and Skills (Deputy Ciarán Can- non): As a former Member of the House, at times I was disappointed when a Minister would come in, deliver a speech, listen intently to arguments made for and against a particular issue, then deliver another speech and walk out the door. I will endeavour as best I can to respond to each presentation and apologise if my delivery stalls every now and again. Certain themes recurred throughout the contributions and I will deal with these once.

To respond to Senator O Sullivan, no case can be made that this Administration is in any way more stringent than the previous one in its application of the terms of the scheme which arose from the budgetary decision in 2010. We have been as flexible as we possibly could. The Senator mentioned conducting a review. My officials and I and Bus Éireann engage and communicate weekly as anomalous situations arise during the transitionary phase. I will explain what I mean by this. The review is happening as we speak. There is no need for us to state publicly we are having a review. It is ongoing and changes will be made if any issue needs to be tweaked or amended to make the scheme more flexible or equitable. Last year I committed to thousands of parents that I would reduce the concessionary charge on primary school transport from €200 to €100, and I did so in the most recent budget.

The issue which has arisen most often in the past number of weeks in the post-primary sector is the €350 charge that applies on a concessionary basis to families with medical cards whose children, if attending their nearest school, would be paying nothing. I am looking again - I am not making any commitments here - at perhaps being able to reduce that €350 down to a smaller figure. If I do so I will have to find that saving elsewhere in the school transport budget which may mean adding on an equal amount to the charge across the rest of the system. I sup- pose I am bringing a degree of social solidarity into the system.

I do not agree with the supposition that we should endeavour at all times to transport children within their own county. This is a small island of 4.5 million people on the edge of Europe. We can get a bit sensitive at times about our county loyalties. When children go on to third level education, nobody suggests his or her child should only go to university in Clare and not in Galway, for example. One cannot argue, in particular at a time of severe economic difficulty, that there is a more rational or logical approach to take than simply transporting children to their nearest school. It is fair, equitable and transparent. Everybody understands this is the case. With regard to the complaint by the schools that they were unaware of this, they were notified twice in the past year that this change was happening. It was on the Department’s website since the middle of 2011, so principals and boards of management of all of our schools had ample notification that this change was about to occur. 281 Seanad Éireann Senator MacSharry raised the issue of those unable to accompany siblings to a particular school. There was an option in the value for money report. However, we made the system flexible by allowing children already in it to work their way through the post-primary school system and by allowing them to retain that eligibility to the end of their education. What we could have done was to say that as and from September 2012, every child in the post-primary system shall attend their nearest school. From a logistical point of view, that would have been far easier to do because there would not be this anomalous situation where a bus passes by a house to pick up a child’s sibling but that child has to get into a car with his or her mother or father and travel in a different direction. That is happening but not to the extent people would argue, and I will deal with that statistic. The flexibility we have in the system, where we are allowing children to finish their post-primary schooling, is causing anomalous situations to arise. Once that phase is over and those children have worked their way through the system, those anomalies will disappear and from then on children will be transported to their nearest primary school and post-primary school in a fair and equitable manner.

In early January or February, parents will be able to log on to their computer, access a website, click on a map where their house is located and they will be automatically told what is the nearest school. They will be able to make a payment and the bus ticket will arrive in the post. We want to make it as simple, seamless, fair and as easy to understand as that.

Senator MacSharry mentioned the fact there are significant synergies and savings to be achieved in combining various elements of public transport in rural Ireland. He is correct; there possibly are. They are not as significant as some people might argue but there are savings to be made. The Minister of State, Deputy Kelly, has convened a group of experts from my De- partment, his Department and from the HSE to look at publicly provided transport across rural Ireland and the different entities which provide public transport for which we the taxpayers are paying to see if there are any synergies and saving which can be achieved. For example, in my community of rural east Galway, the school bus drops children every morning at school, as in most rural communities. On a Friday morning, the school bus returns to its base and a half an hour later another bus arrives and travels around the community bringing about ten elderly people into the local town to collect their pension and so on. There is no reason that school bus, having dropped off the children at 9 a.m., could not do that run. That is just one instance of savings. There are savings to be achieved and the Minister of State, Deputy Kelly, is working very closely with my Department and the HSE to see if we can achieve those savings.

Senator Whelan mentioned that principals did not have the opportunity to plan. I argue they did in that they were notified twice in the past year and it has been on our website since the middle of 2011. He mentioned a review, which is ongoing.

Senators Kelly and Moran raised the issue of special needs with which I will deal as best I can. There are very straightforward and compassionate procedures in place through the Na- tional Council for Special Education and our SENO system. SENOs play a major role in determining the school transport eligibility of children with special needs. An individual assessment is carried out. A blanket approach is not taken nor is there insensitivity or inflexibility. An individual assessment is carried out on every special needs child who uses school transport by a SENO who is professionally qualified to make a determination as to what school can be best resourced to care for the child’s needs. The SENO will determined the nearest school which is resourced or can be resourced to care for that child’s needs. Once the SENO makes that determination - I do not have any professional expertise to make that determination nor do any of my officials - we will then provide transport to that school for that child free of charge. That is the 282 26 September 2012 way it has been and the way it shall remain.

Senators Barrett and Noone and a number of others asked why we do not tender school transport out to a number of different entities. I do not have any ideological hang-ups about who should provide school transport in this country. I am responsible for safely transporting 114,000 children to school on a daily basis. If I may use the simile, I have an aeroplane in the sky every day with 114,000 people on it and I am not about to allow any entity to take the controls of that aeroplane unless I can be certain it has the logistical capacity and experience to be able to do so. Every report published on school transport in recent decades, including the value for money report in 2009, has arrived at one conclusion. I stress that at this point in time no other entity in this country is capable of delivering the school transport system, although there may be at some point in the future.

I have said to a number of operators in the private sector that my door is always open. If they come to me with a rational suggestion or plan which I can trust will get these children to school safely every day, my officials and I will spend a considerable amount of time looking at it. Nobody has come to me with such a plan and if they do, I assure Senators Barrett and Noone, I will listen intently to them.

Senator Catherine Noone: How can they as long as the court case is active?

Deputy Ciarán Cannon: I will not discuss the intricacies of the court because the judge has yet to make a determination-----

Senator Catherine Noone: I do not want the Minister of State to do so.

26/09/2012SS00500Deputy Ciarán Cannon: -----but following the court case and irrespective of the outcome, my door will remain open to anyone who wants to make such a suggestion.

One should bear in mind that this is a huge logistical operation which takes place approximately 180 days per year. At this point in time, I trust nobody but Bus Éireann to do this. I am not saying that somebody will not come up with an alternative system in the future.

Some 85% of the children who are transported to school are transported by private operators. That is put out to tender every year by Bus Éireann. Last year Bus Éireann began a rolling tendering process of some routes because, as Senators will appreciate, there are 4,000 routes; therefore, it was not able to put out to tender every route. That tender produced a saving €2.8 million last year. It is not that we are not trying to extract the maximum possible saving from the system.

A former colleague of mine once said there is only one thing worse than a public monopoly and that is a private one. We need what we call a provider of last resort - in other words, a publicly provided transport system to which we can revert. If we are being taken for a ride by a private operator which we have contracted in to provide all of the school transport and slowly but surely its prices start to go up, we need to be able to revert back to some publicly supported system which might be able to intervene and perhaps convince the private operator that it is not the only show in town. We need to be very careful in this regard. However, I will say once again that my door will remain open and that I have no ideological hang-ups whatsoever in this area. It may be Bus Éireann in ten years time but it may be somebody else.

6 o’clock

283 Seanad Éireann No one has presented an alternative to Bus Éireann to me or my officials or the Department in recent decades.

Like many of his colleagues on the extreme left of society, Senator Cullinane argues that there is a great golden pot of wealthy people waiting to bail us out of our difficult economic situation. That is not the case. Only last week, the OECD produced a study stating that Ireland has the most progressive taxation system in the EU; therefore, I am afraid the great golden calf that is supposed to exist is not there. We must provide a fair and equitable school transport system and find €17 million in savings. Senator Cullinane mentioned that it was €17 million this year. That is not the case. It is €17 million between 2010 and 2014.

Senator O’Neill mentioned the word “humanitarian”. From dealing with my officials and Bus Éireann on a weekly basis, especially in the run-up to the school year, I guarantee there is no approach more humanitarian than that taken in that Department and section in Tullamore. These are people who interact every day with families who find themselves in very difficult situations. We always strive to accommodate any family we can within the terms of the scheme.

We are trying to devise a system that is easily understood, transparent, fair and equitable. Once we put that system in place and build good policy around it, what else do we do other than implement the terms and conditions of that system fairly and equitably throughout the country? At this point or any point in time, no one can argue that it is not fair and equitable to transport children to their nearest school. I do not accept the argument for transporting them to any school other than their nearest school. If parents decide for their own best reasons to send the child to another school, we cannot support that decision by providing transport. We could never afford it and we cannot afford it at this point.

Life-Limiting Health Conditions in Children: Motion

26/09/2012TT00300Senator Mary Ann O’Brien: I move:

That Seanad Éireann:

- recognises that there are 1,400 children in Ireland with life-limiting conditions, who have complex needs throughout life and additional needs as they near death, with 350 such child deaths each year;

- commends the tremendous work being done by organisations such as the Jack and Jill Children’s Foundation and the Irish Hospice Foundation on behalf of many of these children by providing nursing care and support, as well as offering some respite to parents and families;

- notes with grave concern that there is no national home nursing care programme or budget for children with life-limiting conditions, which in many instances contravenes the best interests of the child, places an excessive burden on acute services, and imposes a hidden cost on the taxpayer;

- notes that putting in place a dedicated national home nursing care budget for children with life-limiting conditions is in line with the programme for Government commitment to a personal budget model ‘so that people with disabilities or their families have the flexibility to make choices that suit their needs best’, with the policy, Palliative 284 26 September 2012 Care for Children with Life-Limiting Conditions in Ireland — A National Policy 2010, and with Ireland’s international obligations under the UN Convention on the Rights of the Child;

- recognises the economic advantage of putting the right supports in place for parents to care for their children with life-limiting conditions at home, as set out in the report, ‘There’s No Place Like Home — A Cost and Outcomes Analysis of Alternative Models of Care for Young Children with Severe Disabilities in Ireland’ 2010, which found that at €147,365 per year for hospital care as compared to €16,422 per child for Jack and Jill home nursing care, the average annual cost for hospital care for a severely disabled child is nine times more expensive, which means, therefore, that the Jack and Jill Children’s Foundation has saved the State up to €235 million since 1997, when multiplied by the 1,600 families supported at the cost of hospital care;

- appreciates that, over the past 15 years, the Jack and Jill Children’s Foundation has raised €36 million privately to fund its nationwide service, while the HSE grant during this same period was €4 million;

- acknowledges the recommendations of the value for money and policy review of disability services in Ireland published July 2012, which emphasises keeping the child- patient at home and the money following the patient principle;

- recalls with approval Ireland’s ratification of the United Nations Convention on the Rights of the Child on 28 September 1992 and welcomes the explicit recognition of the family as the ‘fundamental group of society and the natural environment for the growth and well-being of all its members and particularly children’; and

- maintains, in keeping with Article 9 of the United Nations Convention on the Rights of the Child (Separation from Parents), that where there is no overriding medical necessity to the contrary, it is in the best interests of children with life-limiting conditions to be cared for at home.

Calls on the Minister for Health to:

1. recognise the impact of not having a dedicated budget for a national home nursing care programme for children with life-limiting conditions in place, which results in: inconsistent supports between regions; ad hoc funding for home nursing care for children with life-limiting conditions; tremendous stress and unacceptable pressure on parents, whose energies are diverted to trying to secure resources to support their child at home; and

2. as a matter of urgency to commit to putting in place a national home nursing care programme for children with life-limiting conditions with a dedicated and trackable budget which will immediately result in savings for the State and uphold the best interests of the child.

I stand before the House as a mother who struggled for 24 months, day and night, with my husband Jonathan to nurse a child about whom the State, at the time, took the view that babies cry anyway, they gets lots of colic and some of them are up every night for months. However, when one has a child who is tube fed, has epileptic fits every 20 or 30 minutes and it takes 22 hours per day to get through if one is lucky, that child will break down the family and possibly 285 Seanad Éireann break up one’s marriage. It is an horrific experience.

I also stand before the House as a person. My experience was in 1997 to 1998 and while it was a long time ago, I still have the pain and passion in my heart. I visited a family on Roscom- mon last week as part of the Jack and Jill Children’s Foundation. I went to see the mother and father of a little boy who has reached his fourth birthday and it is time for the HSE to take over the Jack and Jill Children’s Foundation nursing hours and look after him. The father has lost his job, is beyond the edge of coping and I am very worried about him. The parents are looking after the little boy as best they can. They are fighting as best they can to give the child a dignified life and look after him at home. It was through all of this and going back to my own experience, when we found out and it became clear to us there was no help in the State, that we founded the Jack and Jill Children’s Foundation back in 1998.

The good news is that this motion is very simple, measurable, achievable, realistic and timely given the forthcoming referendum on the rights of the child. I assure the number crunch- ers that we are not seeking additional money. I really want to stress that point. We know the economy is broke and we want to reallocate resources from one or other of the many budgets the HSE supports and that are meant to support these children. However, we must remember these children are usually not well enough to leave hospital or their homes to go to a special needs developmental school or weekend respite care. It is just not possible. These children get a chest infection at a drop of a hat. An organisation such as the Brothers of Charity, for example, is just not geared for such children. The little boy in Roscommon managed to attend his Brothers of Charity service on three days out of most of last year, which is not much good.

I want to ring-fence the existing budget to underpin a national home nursing care service that would save millions of euro every year by keeping children out of crowded and expensive hospital beds that are meant for acute patients. I am talking about using our existing budget in a more cost-effective way while recognising and serving the needs of our young vulnerable patients. Again, I remind my fellow Senators that hospital care is eight to nine times more expensive than home care. We know we are broke and need to save money. This is a great way if we can drive the HSE forward to save this money.

The 1,400 children with life-limiting conditions and their families are depending on us to prioritise and fund a national home nursing care programme by ring-fencing the money. We are not talking about a lot of money according to Professor Charles Normand of Trinity College Dublin - in or around €15 million. This is about putting the patient – the child - and the health needs of that child first. I believe that when the Minister does the cost-benefit analysis, he will surely know that this is the right thing to do. Sleep-deprived parents throughout the country are being forced into battle to keep their children at home. They are forced as a last resort to take their stories to the media, something no family wants to do. Nurses are being strangled by red tape, wasting their nursing time and skills making telephone calls and writing letters lobbying on behalf of families. There are too many families on the brink of not coping and I have been there. I would like those present to imagine what it is like when one’s child is having a fit every hour and being fed through a tube and the tube comes out. It is unimaginable.

As a businesswoman, I know that if something does not have a budget, it does not happen, no matter how much lip service it is given. To give them their due, up to now HSE personnel have robbed Peter to pay Paul when it comes to finding the budget for home care plans for precious, vulnerable children. They have dipped into geriatric budgets or equipment budgets or wherever they could find it. However, as the budget noose has been tightened increasingly 286 26 September 2012 within the battered and broken HSE system, the so-called no-budget barrier is being shoved in the faces of desperate parents, and that is what was shoved in the face of the parents in Roscom- mon last week. The mother and father started to cry quietly in front of me. The HSE and Brothers of Charity personnel looked at me and I looked at them and we put our hands up and thought what we could do.

There are brilliant people in the HSE but it is up to us to make the difficult change to reallocate and ring-fence budgets.

The inconsistencies of practices around the country are shocking. It appears that the HSE in Cork can ring-fence budgets for children but it cannot do so in Roscommon and Tipperary. A child born with severe brain damage and in need of 24-7 care has a much better chance of being nursed at home if he or she is born in Donegal, Louth, Cavan or Dublin. I gathered that information by telephoning all the Jack and Jill Children’s Foundation nurses, as well as several special liaison hospice nurses in the last two days to ask them some simple questions. The HSE’s inability to take over care plans of children under the wing of the Jack and Jill Children’s Foundation is an alarming trend. As the foundation never wanted to take on more than it could deal with, we care for children under the age of four. Some 69 of our children will soon reach that age. It is approximately a year since the HSE was informed of this yet it states it simply does not have the budget. However, we know the budget is available.

The little boy in Roscommon has just turned four years old. He receives ten precious hours from the HSE and the Jack and Jill Children’s Foundation has been giving him 12 hours. On a good night this little boy wakes on three occasions but on a bad night neither he nor his parents get any sleep. He is a perfect test case for us to try to put home care nursing in place. The Brothers of Charity, which also attended the meeting about the Roscommon baby, do amazing work but many of the main pillars in the disability group are getting enormous sums of money. The Brothers of Charity has a budget of €164 million. Could we not take €1.8 million? Could I even mention the unmentionable? The HSE gives Dóchas and some other foreign aid charities a couple of million euro. Could we not take €250,000 from one, €200,000 from another? We are broke and we are speaking about the most vulnerable, sick and desperate children, as well as their parents and siblings. The family is affected and breaks down.

It is ironic that we still do not have a budget for the vital service of home care for severely disabled children even though they have the right to that service under the UN Convention on the Rights of the Child, which was ratified by Ireland on 28 September 1992. My colleague, Senator van Turnhout, will expand on this argument.

We must recognise the economic advantage of putting the right supports in place for parents to care for their sick children at home. This argument is set out in the 2010 report, No Place Like Home, which conducted a cost and outcome analysis of alternative models of care for young children with severe disabilities in Ireland. The report found that hospital care for a severely disabled child cost €147,000 per year compared to approximately €18,000 for home nursing care by the Jack and Jill Children’s Foundation. I am not here to speak solely about the Jack and Jill Children’s Foundation but we happen to have a system which allows me to outline our figures. It is eight to nine times more expensive to put a child in hospital. There will be the occasional child who is in such need of intensive care that the family would prefer him or her to die in a hospice environment but 98% of families want to keep their children at home in his or her own room and around familiar smells, colours and toys. We have to get back to business. We do not have the money but we know it is eight to nine times cheaper. 287 Seanad Éireann A dedicated national home nursing care budget for children is in line with the commitment in the programme for Government to a personal budget model. As I have stated previously, the concept of client focused services does not appear to be part of the culture of the HSE. It does not seem willing to embrace such a model despite the best efforts of the Minister for Health to implement it. Approximately €1.5 billion is spent in the area of disability but the people affected have no say over the services they receive, where they receive them or who provides them. At the end of the day disabled people are consumers like the rest of us, and they deserve the power of choice.

The good news is that what we seek in this motion is achievable. A little bit of change and manoeuvring will be required but we can achieve our objective by working together as a group. Individualised funding is the Minister’s vision, with a focus on giving the individual the right to support the life he or she wants to lead. In a child’s case, the parent gives the child a little voice that says, “Please keep me at home where I can be surrounded by my family and friends”. We should not speak about out of home respite care when a child does not travel comfortably, or pre-school services when he or she is not well enough to attend developmental pre-school. Give children a choice by giving their parents the funding for and choice of home care plans. Give them some dignity and respect. They are also citizens.

The decision is up to my fellow Senators. Will they shrug their shoulders and leave this evening saying the situation is terrible and that while acknowledging I was passionate about the subject there is nothing to be done about it, or will we all grab this opportunity to carefully examine the cost-benefit analysis and urge the Government to make this investment? We could thereby achieve the great goal of putting in place a national home nursing programme for the 1,400 children in Ireland with life limiting conditions, with a dedicated and trackable budget. That would be a smart move which would result in savings for the State and uphold the best interests and rights of children. The timing is right for this initiative, and it is realistic and measurable.

26/09/2012UU00200Senator Jillian van Turnhout: It is my honour and privilege to second this motion on behalf of the 1,400 children in Ireland with life-limiting conditions, their parents and their families. I am disappointed that the Minister for Health, Deputy Reilly, is not here for the debate but we are in good hands with the Minister of State at the Department, Deputy Kathleen Lynch, and she will report back to the Minister. I welcome the representatives of the Jack and Jill Children’s Foundation and the Irish Hospice Foundation who are following the debate in the Visitors Gallery.

I have carried out a three-pronged analysis of the current arrangements for the care of children with life-limiting conditions and I am convinced that what we propose in our motion is child centred, in line with Government policy and makes financial sense. I will now outline my three-pronged analysis.

As we celebrate national children’s day this Friday, it is appropriate that I draw from the United Nations Conventions on the Rights of the Child and, in particular, article 9 on separation from parents. Article 9 states: “States Parties shall ensure that a child shall not be separated from his or her parents against their will, except when ... such separation is necessary for the best interests of the child”. Unless there is some overriding medical necessity to the contrary, it is in the best interest of a child with a life limiting condition to be cared for at home with his or her parents, siblings and extended family. It is also in the best interest of parents and the family, which are recognised by the Convention on the Rights of the Child as being the “fundamental 288 26 September 2012 group of society and the natural environment for the growth and well-being of all its members and particularly children”, that they be allowed to focus their energy on caring for their sick and dying children at home rather than fighting the system.

We are debating the Thirty-First Amendment of the Constitution (Children) Bill to strengthen children’s rights in Ireland. The motion before us goes to the core of children’s rights and the interplay between parents and children. In the vast majority of cases, parents are the best advocates for their children’s rights. Parents in many different parts of this country are today arguing with local health officials to get minimal supports to provide home nursing care for their children. We only need to look at today’s edition of the Evening Herald to see the human story behind what we are debating. A report in this newspaper highlights the case of four month old baby Saoirse, who was born with Treacher Collins syndrome and has spent her entire young life in the Children’s University Hospital, Temple Street. Despite being told by doctors that she can be taken home, she is stuck there indefinitely because the HSE cannot find the funding required to provide a night nurse. Is that the future for baby Saoirse?

Just before we went on holiday in July we received copies of the value for money reports and policy review of disabilities and services. I had really high hopes about the value of this report for guiding disability services in Ireland into the future, but I am disappointed by its outcome. Ultimately, it is a policy review. There is no number crunching and no scrutiny about on whom and how the money is being spent or the value it is yielding, either directly or indirectly. That said, I wholeheartedly support its emphasis on keeping the child or patient at home and the money following the patient principle, which is echoed in the programme for Government and Palliative Care for Children with Life-Limiting Conditions in Ireland - A National Policy, 2010.

Let us look at the financial analysis. As is stated in the Government’s motion, it costs more to provide hospital care. Nobody disputes that. We have never suggested that the services and supports provided in the two settings in question are the same. What we are saying is that children with life-limiting conditions should not by default be cared for in hospital over home, especially when this is not the parents’ preference. There are many parents who, with the best interests of their child in mind, want to care for their child at home, and it is in these cases that the State can save a significant amount of money. This is not rocket science. I genuinely find it hard to fathom why we are actually debating this. We are in a terrible recession and the State must save money. We are proposing a way for the State to do so, with the unusual bonus that the knock-on effect is in the best interests of children and parents. However, in 90 minutes the Government might vote on an amendment to defeat this. What are we doing here? It is completely nonsensical.

While we are discussing finances, the Irish Hospice Foundation, through public fund-raising and the generosity of the public, has raised €3.5 million to guarantee to fund five of the eight children’s outreach nurses required throughout the country. The funding has been available since 2010. However, due to unacceptable delays by the HSE in making these appointments, unrelated to finance, only three of the eight nurses are in place. Therefore, four regions have no children’s outreach nurse. This situation must be remedied immediately.

This brings me to the Government’s amendment. As I said today on the Order of Business, it was a body blow when I read it. In fact, not to trivialise it, when I read it the character from “Little Britain”, Vicky Pollard, sprung to mind: “Yes, but no, but yes, but no, but yes.” Is this what we are debating? The Government’s amendment is inaccurate. It states that the Govern- ment “acknowledges the valuable work being done by many organisations including the Jack 289 Seanad Éireann and Jill Foundation and the Irish Hospice Foundation as part of wider Health Service Executive funded delivery of services to people with disabilities”. However, the Irish Hospice Foundation does not receive any funding from the HSE. It might have projects but in this area it receives zero funding. My colleague, Senator Mary Ann O’Brien, has outlined the minimal funding provided for the Jack and Jill Children’s Foundation by the HSE. The Irish Hospice Founda- tion is funding the only children’s palliative medicine consultant in the country. It has provided funding for five of the eight children’s outreach nurses, as I have mentioned.

The Government amendment asks us to applaud the HSE but this statement in the amendment is factually incorrect. It is an insult. The amendment fails to acknowledge the financial contribution of the voluntary sector to the provision of these essential services, which is really a testimony to the generosity of the people and, given the nature of these organisations’ work, demonstrates clearly just how close this issue is to people’s hearts. Senator Mary Ann O’Brien and I have provided conclusive proof that the proposals set out in our motion make sense. The motion is child centred, it is Government policy and makes financial sense. If we do not act on this immediately, we are telling parents and children with life-limiting conditions to sit in a corner and simply wait. The problem is that these children do not have the luxury of time.

Patients, not inputs or money, are the priority. What happens to patients is what really matters. I have often said that regardless of how elegant the design is or how eloquently it is delivered, if it does not improve patient outcomes, it is for naught. The Minister for Health, Deputy James Reilly, said exactly that in the Dáil not ten days ago.

26/09/2012VV00200Senator Imelda Henry: I move amendment No. 1:

To delete all words after ‘‘Seanad Éireann’’ and substitute the following:

‘‘acknowledges the valuable work being done by many organisations, including the Jack and Jill Children’s Foundation and the Irish Hospice Foundation as part of wider Health Service Executive funded delivery of services to people with disabilities;

welcomes progress so far under Palliative Care for Children with Life Limiting Con- ditions in Ireland — A National Policy (2009);

commends developments beyond palliative care needs by both statutory and non- statutory agencies to progress services generally for such children;

notes the complex and multi-disciplinary nature of such services, which has placed emphasis on developing home-based supports, and respite care, on a more uniform basis nationally for such children and their families;

notes ongoing discussions between the Health Service Executive and relevant non- statutory organisations to further promote where possible services for children with life- limiting conditions;

notes that the Health Service Executive has consistently funded the Jack and Jill Children’s Foundation, subject only to the general estimates reductions applied evenly to all agencies in the disability and palliative care sectors in recent years;

notes that the recommendations contained in the value for money and policy review of disability services relate to the full range of residential, day, respite and other support services delivered by and on behalf of the Health Service Executive; 290 26 September 2012 recognises that the preference for keeping the child-client at home must take account of the availability of resources across all types of service delivery funded under the disability and palliative care programmes;

acknowledges the difference in the cost of hospital versus home-based services, but points out that the costs relating to a 24-hour acute medical service will always show an unfavourable cost when compared to a home-based support service, which is entirely different to the type of service provided to families for a specified number of hours;

notes that the Minister for Health and the Minister for Children and Youth Affairs are satisfied that the broad principles as outlined in the United Nations Convention on the rights of the child in terms of the provision of appropriate health services to children are reflected in current policies being pursued by the Health Service Executive;

acknowledges the Minister for Health on the various services in place for children with life-limiting conditions, ranging from acute hospital-based to home-care supports, the progress that has been made or is planned in line with the programme for Govern- ment and under health reforms, for such care needs, and the need to maximise service delivery in this area in line with resource availability;

acknowledges, however, that recent economic circumstances will regrettably have a bearing in terms of the availability of wider resources to ensure the expansion of that provision and best possible outcomes for children, and notes that within this context, the Health Service Executive is working to ensure that the best possible level of service for children and young people are maintained; and

notes that the Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single-tier health system, supported by universal health insurance, and guided by the principle of money follows the patient and care for all persons, including children with life-limiting conditions, as close to the home as possible, within available resources.’’.

I welcome the Minister and also take the opportunity to welcome Jonathan Irwin from the Jack and Jill Children’s Foundation. I commend the work the foundation does in caring for children with life-limiting conditions. Without the support of this organisation life would be very difficult for the children and families concerned.

I have no problem supporting the ethos of this motion. It is a pity that during the good times, when we had money, previous Governments did not address this issue. Many children availing of services provided by the Jack and Jill Children’s Foundation also avail of other specialist health supports and disability services, both hospital based and community based. The aim of the HSE is to ensure that all children with life-limiting conditions would receive services on an equitable basis and through a standardised approach. A paediatric palliative care consultant was appointed in May 2011 and is based in Our Lady’s Children’s Hospital, Crumlin, with additional sessions in the Coombe hospital. Four nursing posts have been filled in Temple Street Children’s University Hospital, Our Lady of Lourdes Hospital, Drogheda, Waterford Regional Hospital and Limerick Regional Hospital. Pending approval from the HSE control group on recruitment, additional nurses will be placed in Galway, Cork, Crumlin and Mullingar.

A needs assessment report, Respite Services for Children with Life-limiting Conditions and their Families, was undertaken in Dublin, mid-Leinster and Dublin North East in 2012. It is 291 Seanad Éireann hoped to have the needs assessment for HSE South and West completed before the end of 2012. Funding for paediatric palliative care is incorporated in the overall palliative care provision in the agreed HSE service plan. A total of €78 million was allocated this year for palliative care. As we are now in a situation where we must make cuts of €3.5 billion everywhere, it will be difficult to expand the health budget.

Palliative care for children is delivered differently from the palliative care services for adults. Many children requiring palliative care have life-limiting conditions, as opposed to advanced terminal conditions, and children may survive for many years with these life-limiting conditions. Where children need palliative care it is usually provided at home. In the home, the family is supported by their family doctor, public health nurse and the specialist palliative care team, where it is available. The medical and nursing care of children in hospital is the responsibility of paediatric trained medical and nursing staff, with support from the specialist palliative care service.

A national policy was launched in March 2010. Ultimately, this policy aims to ensure that all children with life-limiting conditions will have the choice and opportunity to be cared for at home. In line with the key findings of the palliative care needs assessment for children, this policy prioritises community-based care for children who need palliative care. I commend the Minister for the various services in place for children with life-limiting conditions, ranging from acute hospital based to home care supports. Progress has been made or is planned for such care needs, in line with the programme for Government and under health reforms.

The Government has embarked on a major reform programme for the health system, the aim of which is to deliver a single tier health system supported by universal health insurance and guided by the principle that money follows the patient and providing care for all persons, including children with life-limiting conditions, as close to the home as possible, within available resources. The HSE remains committed to working with all voluntary disability service providers, including the Jack and Jill Children’s Foundation, to ensure that all of the resources available for specialist disability services are used in the most efficient and effective manner possible. The Minister for Health was in the Chamber today and after hearing his lengthy speech I have the utmost trust and faith in him in the very difficult job he must undertake in the next few years.

We are committed to children’s issues. We have set a date for the children’s rights referendum, we are going to build a new children’s hospital and we are committed to supporting agencies that deal with children. Children’s rights are at the forefront in this House. We are lucky to have Senators Mary Ann O’Brien and Jillian van Turnout, who have an in-depth knowledge of and deep commitment to children’s issues. I hope we will be in a position to revisit this issue again very soon.

26/09/2012VV00300Senator Terry Leyden: I express my admiration for Senators Mary Ann O’Brien and Jil- lian van Turnhout who tabled this well formulated motion. They have a brought a new dimen- sion to the Seanad and it is commendable that they tabled a motion of this nature.

I welcome the Minister of State, Deputy Kathleen Lynch. I also welcome the representatives from the Irish Hospice Foundation and Mr. Jonathan Irwin of the Jack and Jill Children’s Foundation, who played such a role in setting up that organisation because of the needs of the time and which has proved to be very satisfactory.

292 26 September 2012 I was particularly struck by the details of the case in Roscommon outlined by Senator Mary Ann O’Brien. She recognised the work of the Brothers of Charity and the organisation County Roscommon Association for People with Special Needs. This is a very important funding organisation that was established some years ago and it invited the Brothers of Charity to take on the running of services in County Roscommon. They have proved to be very successful in that, providing extremely good conditions for their clients over those years. I commend them for their work and hope that Senator Mary Ann O’Brien will be successful in the case she outlined of the four year old boy in County Roscommon who is need of particular care, and not in an institution. I note the hours given by the HSE and the Jack and Jill Children’s Foundation, which are welcome, although not adequate in the circumstances.

I am surprised the Government tabled an amendment to the motion; I thought the motion would be put forward as a recommendation. This is not legislation; it is a very good recommendation that outlines in detail the benefits of care in the home provided by families. The amendment patronises the organisation and is not very helpful. The line is that there is nothing that can be done. I appeal to the Minister of State because I am sure she would have the power to allow the motion to be a recommendation to the Government, “that the House calls upon the Minister for Health”. It will not compel him or make any difference to the legal situation but it would be more helpful than accepting the amended motion outlining the usual stuff that comes in from the Department.

I was in that Department for a number of years and understand the situation in Hawkins House. It was not the most pleasant ministerial experience I ever had; I was glad to get out of it. I made a case to former Taoiseach Charlie Haughey when he was drawing up a new Govern- ment, telling him I wanted to get out of there. He asked me how I knew he would give me any job but I replied I wanted to get out of the Department of Health because it is a very difficult Department, with a crisis a day. The delegation of responsibility is very important and there is a tendency in the Department for the line Minister to take control of everything but there must be a balancing of power because this is a very big Department and there has been a tradition in it of difficulties in this regard. That was certainly highlighted by the Minister of State, Deputy Shortall. When Ministers of State are delegated responsibilities, there should be a clear line of demarcation.

The Fianna Fáil Members see this motion as children’s rights in action and it is particularly timely in the context of the current referendum proposal. We support the concept that the State should dedicate money to set up a national programme to provide home nursing care for terminally ill children. Such a measure would be cost effective because it is estimated to be nine times more expensive to keep a child in hospital than at home. That has been clearly outlined in the statement here. It would also be consistent with the Government’s own stated policy on caring for people in their own homes.

The sad reality is that approximately 490 children die in Ireland every year and an estimated 1,100 are living with a life-limiting condition. Of the 350 children who die as a result of those conditions, the majority pass away in the first year of life. The main difference between adult and paediatric palliative care is the vast majority of adults are cancer patients while children can be born with a number of congenital diseases and abnormalities that are known as life-limiting conditions. This means the child is not expected to survive to adulthood, with some only surviving for a number of weeks or months after birth. Children with palliative care needs in Ireland receive excellent treatment in paediatric hospitals but an acute setting is not always the most appropriate place for some of these children, as Senator O’Brien outlined from personal 293 Seanad Éireann experience. She could bring that to the family in Roscommon. They want their child to come home and it is the least that could be offered to them in this regard. It is an experience no parent would ever wish for but the best one in the circumstances.

I appeal again for consensus and that the Minister of State accept the principle in the motion. If there is a vote, however, we will vote against the amendment and for the motion.

26/09/2012WW00200Senator Aideen Hayden: I second the Government amendment. The issue before us concerns the care of children with life-limiting conditions, particularly those in end of life scenar- ios, and I thank my Seanad colleagues for bringing this matter before us. I thank the Jack and Jill Children’s Foundation and the Irish Hospice Foundation, which have played a major role in highlighting the needs of children with life-limiting conditions, particularly children who are approaching the end of life. No one in this Chamber is unaware of the grief felt by a parent who has lost a child or who does not understand the fear we all face as parents of losing a child. When my children were small, I would go into their bedroom at night just to hear them breath- ing and make sure they were still alive. I know the anxiety of parents facing life with a child who is terminally ill, when they fear any local children getting the measles, flu or a temperature.

We are being asked today, however, to decide if what we do is good enough for children who face the end of life. This is not about the Jack and Jill Children’s Foundation or the Irish Hospice Foundation, but about what our national health system is doing to support parents and children with life-limiting conditions. One of the difficulties I have is with the NGO model is knowing where the charitable model ends and State responsibility begins. I note in the background documentation I obtained for this debate that families supported by the Jack and Jill Children’s Foundation were worried about what would happen to their support structure once their children reached four years of age and beyond. Children with life-threatening illnesses do not cease to have those needs when they go beyond four, seven, eight or even 17 years.

While we can recognise the contribution of a particular group, this issue goes beyond children with severe disabilities and extends to children with cancer and other long-term acute illnesses. In reality what has happened here is that the NGO has stepped into the breach and done what the health system should have been doing with little State support when overall costs are taken into account. The Jack and Jill Children’s Foundation raised €35 million in charitable donations as against €4.5 million it received from the HSE since 1997. As Senator van Turnhout said, in the implementation of Government policy on palliative care for children with life-limiting conditions, phase one calls for the appointment of a children’s palliative care consultant and eight outreach nurses to support care at home, of which the cost of the consultant post is to be fully funded for five years and five of the nursing positions for three years by the Irish Hospice Foundation. The HSE is to fund only three of the nursing positions. It is clear that while official documents talk about a spirit of partnership, public generosity allows the State to abdicate its obligations.

One may argue about the methodologies but the reality is clear. It is far better for a child to be cared for in his or her own home for as long as possible in most circumstances. The evidence also is clear that it is cheaper for the public purse. For example, the report published in 2010, There’s No Place Like Home – A Cost and Outcomes Analysis of Alternative Models of Care for Young Children with Severe Disabilities in Ireland, estimates there is a saving to the public purse of approximately €120,000 if a child is cared for at home. Obviously, there is some disagreement with this figure and the HSE estimates that a service similar to that provided by the Jack and Jill Children’s foundation would cost €23 per hour if delivered through the executive. 294 26 September 2012 What really is important is what is in the best interests of the child, his or her immediate family and, in particular, a group that is often forgotten, namely, the siblings.

Many NGOs save the State money and, unfortunately, that is the nature of the job. What is also unfortunate is that where an NGO has demonstrated the need for a service, the State does not act to mainstream that service, being content instead to let the voluntary effort lead the way. The role for voluntary effort is to show by example in setting up new services and exploring new ways of meeting public needs. The Irish Hospice Foundation and the Jack and Jill Children’s Foundation have done this but as a society, we must go further as the charitable model is not enough. Children deserve to live and die with their families around them and this service should be fully funded through public taxation and, while I mean no disrespect by this comment, not by recycling mobile phones or drinking coffee.

I support the Government amendment because I believe a properly funded public health system is what is needed, not a piecemeal system that addresses particular needs at particular times. Again, I mean no disrespect to Senator Mary Ann O’Brien when I state that social solidarity is not helped by proposing the removal of funding from one organisation dealing with overseas funding, such as Dóchas, in favour of supporting vulnerable children. The bottom line is that services to children, vulnerable young people and all of society should be properly funded by public taxes and any support to the charitable model should be for extras, rather than for fundamentals within the system.

26/09/2012XX00200Senator Sean D. Barrett: I support the motion and regret the terms of the Government amendment to it. Less than a couple of hours ago, the Minister for Health was impressing Members hugely in this Chamber. It was a great debate in which he thanked Members, they thanked him and a spirit of camaraderie, friendship and so on obtained. He proposed to abolish the Health Service Executive, is working to this end and Members wished him the best of luck.

However, the Government amendment to the motion mentions the Health Service Executive in its first, fifth, seventh and 12th paragraphs. Obviously, whoever wrote this amendment did not listen in to what the Minister, Deputy Reilly, was saying. The many issues the Minister will address include the weakness of financial controls in the health service, which he is reforming. For example, I refer to those people who are called financial officers and accountants who have no qualifications. He is working on such issues and is not relying on the continuation of the Health Service Executive to deliver the health service. Consequently, I do not know the reason the Government amendment relies on it so heavily to dispute the motion tabled by Senators Mary Ann O’Brien and van Turnhout.

I commend the Minister of State for the manner in which she always has thought outside the box when in this Chamber because this is an area Members agree unanimously requires huge reform. A Government economic service is needed for a range of things to ascertain what these numbers look like. As was mentioned, some reports have no numbers and it is necessary to establish the real numbers. This applies regardless of the issue. One might be considering water charges, what the cost of the meter might be or whether it is worth charging some people at all given one would save so little water. Alternatively, one might be ascertaining what is the basis of the household charge, given so many houses are in negative equity, there are so many ghost estates nationwide and so many people remain in houses because banks are trying to hold up the prices. Consequently, such an economic service would be useful throughout the material introduced to this House by the Government. I gather that the Minister for Public Expenditure and Reform, Deputy Howlin, who also came into the House today, is considering that. 295 Seanad Éireann There is a lot of literature to the effect that people should not be in hospital. As the motion noted, it is extremely expensive and unhealthy and there is an entire literature on iatrogenic diseases. As stated previously, it weakens the relationship between parents and their children. Members also have referred to the findings of the Milliman report that Irish society is hospital- fixated. The aforementioned report on VHI found we keep people in hospital for 10.6 days, whereas best practice worldwide would be 3.7 days. This is eating up money and probably is not doing people much good in terms of health services. If these children can be minded, looked after and loved by their parents, as this motion suggests, let us run with that. Before dealing with some other points, I suggest Members should consider whether the motion tabled by their colleagues meets the spirit of the comments made earlier today by the Minister for Health. I think it does and they should not be sent away rebuked on the basis of a policy that is already changing in the Minister’s mind.

When this issue was discussed briefly on the Order of Business, the wish on all sides of the House was to avoid running the debate as a Punch and Judy show after which the newspapers could report, “ashen faced Minister left the House on foot of Government defeat”. Members are not doing this and no one wants to do that. They seek to improve policy in a country where so much has gone wrong. While Friday was mentioned as being international children’s day, it also will be the fourth anniversary of when bankers walked out of the Department of Finance with €64 billion in their pockets. This is the situation with which Members are trying to deal.

During the health debate earlier, Members also pointed out the fastest growing category since 1980, I put the precise numbers on record during that debate, has been the growth of bureaucracy. It has been growing far faster than the number of staff as a whole. This is money that is wasted and which hopefully will be put towards patients in the new Department of Health. The Minister strongly expressed the view that patients be put first. While I support and will be voting for the motion, I echo the point made by Senator Leyden and ask the Government to take on board the sentiments, rather than hitting the motion for six out of the Chamber. Some compromise should be found because all Members are agreed that such children in very great need should be looked after by society. They are much more deserving candidates than running up huge hospital bills or than the bankers who took €64 billion from us four years ago or than the rapid expansion of the bureaucracy of the Irish health service. Given her performances in this Chamber and the spirit she brings to debates, I cannot envisage how the Minister of State would vote for the Government amendment.

26/09/2012XX00300Senator Colm Burke: I welcome the Minister of State to the House. I am a little surprised as to how business is conducted in this House in respect of certain matters. While I may be stepping on toes by making this point, I am not at all sure that tabling an amendment is the best way to deal with this matter. I am a little surprised that some form of joint agreement on the matter has not been reached in this House. I make no apologies for making this point because this is a highly emotive issue. Those involved in it are hugely dedicated and committed to giving support to their children when the State has been unable to provide that support.

This situation has persisted for many years as if one considers the background, the national advisory committee on palliative care was established back in 2001 and an assessment was carried out between the Irish Hospice Foundation and the Department of Health and Children back in 2005. However, seven years later, we are still trying to put together the long-term direction. While there must be compromise on all aspects, particularly at present given the financial constraints, I believe we must be somewhat more proactive in respect of how we deal with such issues. This pertains to an organisation that has raised more than €35 million. No one is entitled 296 26 September 2012 to criticise it for the service it has provided over many years in giving support to families. The question now is how one can assist to make sure this is not considered on a year-to-year basis but in respect of where one wants to be in five years time when dealing with this issue.

7 o’clock

While I accept there are budgetary constraints, we need long-term planning to deal with this very difficult issue. We already had a long discussion today on the Department’s budgetary constraints during which I mentioned that in 2011 an amount equivalent to all the income tax collected went into health care. How do we now fit this area into existing budgets? While people might say I am stepping outside the Government line in this, it is an area that needs more thought. We also need to give more thought to the proposal before the House tonight. The Min- ister of State might have something constructive to say as she always does when she comes to the House. Once we have listened to her we might work out how best to deal with the motion and what is required in order to put in place a long-term structured approach to the problem.

The earlier speakers, including the proposer and seconder of the motion have outlined the difficulties parents face when dealing with this problem, and the support and commitment they must give. People are spending a considerable amount of time on fund-raising to provide those services. We need more long-term planning in the area. It is disappointing that it has taken 11 years to reach this stage. Do we need to wait another 11 years or can we do something more positive from now on despite the existing budgetary restrictions? In replying to the motion, I ask the Minister of State to deal with not just the here and now but also how we can deal with this in a long-term way. We need to ask where we want to be in five years on the issue. Will we have another similar debate in five years or can we put something concrete and definite in place?

26/09/2012YY00200Senator Fiach Mac Conghail: I welcome the Minister of State. I have always been im- pressed with her engagement with us whenever we have brought a motion. I like the Seanad and participating in its debates. Senator Zappone spoke on radio this morning and outlined ways that the Seanad could and should improve its business. The Independent Senators put considerable time into preparing our motions. The Taoiseach has bestowed responsibility upon us and it is part of our democratic duty to bring issues to the floor of the Seanad for discussion. This allows us to tease out with the Minister present the intricacies and nuances, but also to share stories. To my shame I was not aware of the work of all these charities, including the Jack and Jill Children’s Foundation and the Irish Hospice Foundation. It allows me to gain more knowledge as a citizen but also as a parliamentarian and legislator to try to improve my own understanding and how I might contribute better to the work in the Seanad.

We have heard very moving stories about the family in Roscommon and Senator Mary Ann O’Brien’s passionate contribution in moving the motion. I fully agree with Senator Hayden’s enlightened overview. That is what is great about the Seanad - that this debate can go to and fro and with regard to the perspective one might have. I have nothing but admiration for Senator Hayden, who is very active in the area of homelessness, which is of particular interest to me. There is nothing she said with which I would disagree.

While this is not a criticism of the Minister of State, there is a pattern of a mildly aggressive approach in the Government amendments to Private Members’ motions. Senator Colm Burke in his polite and erudite way hinted at that. We find there is no effort to address the issues highlighted in Private Members’ motions. We all have very busy lives - some of us work outside 297 Seanad Éireann the Seanad. We spend considerable time on wording motions, researching issues and briefing fellow Senators. This is not the first time we have been faced with a lazy and inaccurate Gov- ernment amendment. Part of the wording of this evening’s Government amendment is not true. Regardless of whether we accept the spirit of the amendment, we cannot vote for something that is fundamentally untrue. More effort should be put in and more consideration should be given by Government Senators when dealing with issues we and other parties and groups raise.

While I do not want to be bombastic or aggressive, there are ways to be innovative on the issue. There is no real disagreement on the facts, although there may be on some of the figures. One of my former lecturers, Senator Barrett, could very quickly on the back of an envelope look at the financial comparators. Could we have a sub-committee? Should we move it to the Oireachtas Joint Committee on Health and Children where we could have a very limited discussion on the various contradictions on figures or is there a different way? I would loath having to bring this to a vote, but we might have to. We feel we are introducing a very good idea. If the Minister of State agrees, we would be willing to withdraw our motion. Having listened to the contributions from Senators Hayden, Colm Burke and Barrett, we would withdraw it as a recommendation if the Government withdraws its amendment, otherwise we would need to take it to a vote. We should continue to pursue the issue and my fellow Senators know our form in pressing votes. We have a good track record in that regard but would not like to do so in this instance. More effort on the Government’s part in engaging with Private Members’ motions in terms of language, respect and a more nuanced approach would be helpful. That is why we spend our time in tabling motions. We do not do this to annoy the Minister of State. We feel it gives rise to greater citizen awareness and improves the work we do in this House.

26/09/2012YY00300Senator Mary Moran: I echo Senator Mac Conghail’s sentiments. While he was speaking I glanced around the House and it was clear that Senators from all parties were in agreement. All Senators only have the best interests of children at heart, whether they be terminally ill or have a life-threatening condition, or are in the whole of their health. We all agree on that. I echo the sentiments expressed by Senator Mac Conghail and find the situation to which he alluded very unfortunate. I read the motion tabled by the Independent Senators and initially agreed. However, I also agree with Senator Hayden in that we need to look forward.

7 o’clock

The HSE must take a more active role in the provision of health and care for children who are terminally ill in order that people do not to have to collect mobile phones and hold coffee mornings for years on end to raise funds.

Like other speakers, I know from personal meetings I have had with the Minister of State, Deputy Lynch, whom I welcome to the House, how much she cares and how good a job she is doing. I do not envy her having to speak against this motion.

I pay tribute to the excellent work done by the Jack and Jill Children’s foundation, the Irish Cancer Society and all other groups in terms of their provision down the years of nursing care and support to children with life limiting conditions. It is a fact of life in Ireland today that many families are faced with the awful reality of coming to terms with having a child who is terminally ill. The thought of this is not something anyone, in particular those of us who are parents, would want to countenance. Having to take sick children to accident and emergency departments or hospital can be a traumatic experience for children and parents. A child with a life limiting condition needs and deserves the best possible care we can provide, as do their 298 26 September 2012 families. I am glad so many speakers have in their contributions recognised the siblings involved rather than only the children who are ill.

In the “Wizard of Oz”, Dorothy was able to get back home to Kansas by clicking together her red shoes and saying, “There’s no place like home”. When we are sick or upset we all long for our own bed and the familiar surroundings of home. It must surely be an added strain and stress for children and their parents to be in hospital far away from home. Many of us will have experienced the journey of visiting children in hospital far from home and all that brings with it, including having to find additional childminders, having to get time off work and so on. Being able to spend precious time at home with one’s terminally ill child in the secure knowledge that all his or her needs are being met is a firm goal for everybody. It is good to know that many children are being looked after by the Jack and Jill Children’s Foundation and through a range of services provided by statutory and non-statutory providers.

The Government is committed to the implementation of the policy, palliative care for children with life-limiting conditions, which was launched in 2010 and recognises that there must be an alternative to inpatient care for children who have been appropriately assessed and for whom a detailed care plan has been established, with the input of the children, where appropriate, and their parents. I agree with Senator Mac Conghail, that many interesting debates have taken place in this House since we became Members, on which there have been many views offered. It is important all viewpoints are listened to. The Seanad provides a forum for debate on important issues, which is one of the reasons we need to retain it.

Representatives of the LauraLynn House made a presentation to Joint Committee on Health and Children prior to the summer recess. One of representatives was the mother of a beautiful child who was terminally ill and in LauraLynn House. I spoke with her following that meeting. When I heard at the end of June that the little baby girl had died, I wrote to Sharon, the child’s mother. I was delighted to receive a beautiful reply from her last week, which gives some indication of what parents of terminally ill children go through. I am sure she will not mind if I read a little of her letter which states:

Victoria fills every day with positivity. There is always some work to do for fundraising, someone calls or phones. She ensures that each day we have reasons to get out of bed and carry on.

While it is great that Victoria’s mother and father continue to fund-raise, I do not believe care of terminally ill children should be dependent on fund-raising all the time. It is important the necessary supports are put in place. The letter goes on to say that LauraLynn House was most definitely sent by the angels to protect and care for Victoria, that she was most peaceful there and so well cared for medically, that she was also loved and that they the parents were also looked after and are still in close contact with the team. It further states that Victoria has been working her magic and fund-raising has been astonishingly successful, which makes them proud, and that they want to be there for LauraLynn as it was there for them.

Victoria was Sharon’s only child. The family lived in Donegal. Her husband, who had a farm, had to give up work and sell everything in order for them to travel up and down on a daily basis from Donegal to Dublin to look after Victoria for the few months that they had her. They had to do this because the hospital in Letterkenny was not equipped to cope with Victoria. The parents also had great support from grandparents and so on. If we had in place a structure which ensured all terminally ill children were looked after all the time it would be great. 299 Seanad Éireann

26/09/2012ZZ00200Senator Paschal Mooney: This is a difficult motion to debate. The sensitivities surrounding it are such that anybody who contributes must be aware of the human suffering and heart- break behind it. I suggest it not only applies to those parents with terminally ill children but to any parent, such as myself, who has a special needs child. It is an area where such parents do not want to go.

I am disappointed the Government has tabled an amendment to the motion which so com- prehensively challenges of the original motion. Were I a Senator on the Government side I would probably be defending an amendment to the motion because that is the way the system works. Motions such as this are an opportunity for the Government to set out its stall, which is what it has done. However, this takes away to a large extent from the reasons the motion was tabled. The amendment is disappointing, not alone in terms of the manner in which it is worded but in that it does not offer much hope.

The Minister of State, Deputy Lynch, and I are old friends. I have great respect and admiration for what she is doing. In trying to get some context on this issue, I came across the executive summary, which is based on the 2010 report, which refers to the report of the national advisory committee on palliative care published in 2001. This highlighted the need for a review of children’s palliative care services. A palliative care needs assessment for children was undertaken and the results published in 2005. The findings of the needs assessment in Ireland were consistent with those undertaken in other countries.

I then undertook a search for anything the Government had said on this issue during the past 12 to 18 months and came across a parliamentary question tabled by Deputy Pádraig Mac Lochlainn and responded to by the Minister of State, Deputy Lynch, in June this year. The response of the Minister of State was exactly as I have just outlined. It offered nothing else. I cannot find anything else that indicates what the Government has done so far in terms of the recommendations made. I understand that the Minister of State, Deputy Lynch, as in the case of all Ministers, did not write the reply. However, the reply goes on to state in the second paragraph that the policy recommends that there should be hospital based specialist palliative care teams led by a consultant paediatrician with a special interest in palliative care and that palliative care services should move to the new paediatric hospital. It further states that primary care services need to be developed, including the provision of a consultant paediatrician with a special interest in palliative care, outreach nursing posts, therapy posts, hospice in the home and respite care, both at home and away from home, in each of the HSE regions and that these developments would be in line with primary care network developments. In order to plan and develop services, data collection is required and it is envisaged that the Health Service Executive will collect information on children living with and dying from life-limiting conditions. Has the data collection process been undertaken? It would not cost anything and it would be helpful. There are figures on the approximate number of children but the executive summary in the report calls for a data collection process. Perhaps the Minister of State has a view on this issue.

I will cherry-pick some of the many recommendations in the report. A key point is that there should be locally-based children’s palliative care support available at the network level. Each HSE area should develop a plan for respite facilities for children with life-limiting conditions and their families. I could not see anything to do with children on the HSE website. Maybe I was looking in the wrong place. It only referred to palliative care provision but did not specify the unique nature and needs of children with life-limiting diseases and their families. I could not find it on the website, although the Minister may respond by saying it is there. Is the HSE developing a plan for respite facilities? Is there any co-ordination in the area? 300 26 September 2012 Another recommendation is that all relevant hospital and community staff should be facilitated to partake in education and training on children’s palliative care. Is that being undertaken? It is in-house training and does not cost anything. Another recommendation is that all health care professionals working in palliative care should have the opportunity to engage in research. Is that happening? Is research being undertaken? It should not cost too much under current structures.

The final recommendation I will address is one to ensure that palliative care conforms to best practice, and that protocols and standards in respect of palliative care for children should be developed and should be overseen by the national development committee for children’s palliative care. The national development committee could provide a national forum for the cohesive, integrated development of children’s palliative care services and would address the regional administrative area variations in service provision to children with life-limiting conditions and their families. The ad hoc approach has been referred to by other speakers. Is there any progress on the provision and establishment of a national development committee for children’s palliative care?

26/09/2012AAA00200Senator Tony Mulcahy: Although it sits uneasily with me, I cannot but fully support the motion. Perhaps I cannot support it in its entirety but I can empathise with the proposers of the motion. When we table amendments, I wonder whether we examine what we are writing and how we are presenting it. To give the impression that we have matters under control in the delivery of services in palliative care or disability is a complete misrepresentation. We are not quite there yet. The value for money report is the key to many of the questions asked. My views on this area have been very well expressed and I also communicated them to the Minister of State in conversation. The quicker we get to a model whereby the money follows the patient, the better. That is the only line in the reply that interests me.

Two weeks ago, the Rehab care awards were broadcast on television. At the end of the night, the CEO made the final presentation and my stomach nearly turned. When we are looking at people drawing salaries in excess of €300,000, we have a problem. We justify it by our presence. One can name any of the disability services organisations. Some of them operate on very limited budgets but I have attended presentations in the audiovisual room in Leinster House and when I see a CEO, I am looking at €125,000. The quickest thing we could do is to implement the value for money report and apply the principle that the money follows the client. The client can determine how to get the services and who is delivering the services.

We must also consider the representative bodies who purport to represent the needs of those with intellectual disabilities and other disabilities. I am talking about the representative bodies, not those who deliver services. We should immediately stop all funding to representative bodies as we did with the People with Disabilities in Ireland, PwDI, and transfer the money to service delivery. The money should follow the client so that the client can buy the service. I do not need any representative group to represent me or my child, nor do many other people, but we do need a service. I do not need a CEO to be paid €300,000. If the Jack and Jill Children’s Foundation had that lump of money tomorrow morning, it would make good use of it judging by what the organisation delivers from its budget. The same is true of many service providers within the HSE.

I was at a meeting in Limerick six or seven years ago and spoke to a finance officer who told me she gave a cheque to the Daughters of Charity, the Brothers of Charity and Enable Ireland for €74 million. She did not even receive a set of accounts for that sum and had no control over 301 Seanad Éireann where the money went. The sum of €74 million was for services in Clare, Limerick and Tip- perary. She did not know what the organisations wanted to do with it. That has changed but not to the extent we want. If we could make the determination on where the money was spent, I am sure the Minister of State would be inundated with people seeking a service because they would recognise the quality of the service.

The Minister of State has done much work and I trust her implicitly to deliver it. The Min- ister of State knows my form on this topic. We need to get to this new model immediately. In fairness to the Brothers of Charity, it tried to stop paying increments to staff. The matter was taken to the Labour Court and to the High Court. It was determined that because the organisation received funding from the Government, it was covered by the Croke Park agreement. I do not generally have a problem with the Croke Park agreement because it provides service delivery. When we hand over State money to private bodies, they are covered by the Croke Park agreement as a result of receiving that money. The organisation was doing the right thing. Let us not get mixed up by the charitable status because the organisations are damn well paid for the job they do. Voluntary body service providers are not voluntary, they are damn well paid. The quicker we get the money to follow the client, the quicker we will get a value for money service. We will get more respite hours, more palliative care and better quality support for our children and the next generation.

26/09/2012AAA00300Senator Trevor Ó Clochartaigh: Tá sé an-suimiúil a bheith anseo ag éisteacht leis an díospóireacht anocht. Listening to the debate, I am appalled by the cynical politics of the Gov- ernment amendment. Sinn Féin fully supports the motion and I call on the Government Sena- tors to do likewise, notwithstanding the offer made by Senator Mac Conghail, to withdraw the amendment.

I do not disagree with the analysis of the health system by Senators Mulcahy and Hayden. The motion may be wordy but it is simple and can be reduced to the last paragraph. It seeks “to put in place a national home nursing care programme for children with life limiting conditions with a dedicated and trackable budget which will immediately result in savings for the State and uphold the best interests of the child”. It is very simple and I do not see how the Government Senators can oppose it. It will save us money and treat children with the dignity they deserve at the end of their lives. The reference to recognising “that the preference for keeping the child/ client at home must take account of the availability of resources across all types of service delivery funded under the Disability and Palliative Care programmes” sums up the amendment. That shows the fundamental philosophy of the Government is about pounds, shillings and pence, even if we are saving money. The economics of the HSE are upside down and do not make sense.

There is a similar example in Galway West. A surgeon does vascular surgery for people whose legs need to be amputated. He needs a pump to be made available to people who have issues with their legs. If it is made available for three weeks, it costs €3,000. If it is not made available, he must amputate their legs. They must be sent to hospital in that case, must remain in hospital and afterwards their houses must be refurbished at a cost of approximately €30,000. Where is the economics in that? It is indicative of the way the HSE and health service are being run.

These are the economics of austerity. It is the kind of messed-up economic thinking that occurs when one ends up paying so much money for the bank bailout. It was very interesting to read the recent report of the UN Committee on Trade and Development. It stated the austerity 302 26 September 2012 programme is not working and that it is not turning the economy around. When we cannot even allow for the quite modest budget I desire for children who are dying – let us be honest in that regard – and their families, we must ask what kind of country we are living in. The Government has not tackled this issue.

While I respect the Senators on the Government side, I believe they are all at sea on this motion. I cannot find anyone who supports the counter-motion brought forward by the Govern- ment. Therefore, the Government Senators should vote with their hearts and minds and support the Independent Senators’ motion, as is right.

The Government has not got to grips with consultants’ pay or tackled the issue of special ad- visers. The CEOs of semi-State bodies are still being paid more than the President of America. The allowances in the public service and the tax breaks made available to private investors for their pension funds have not been tackled. The Government cannot find time to tackle these but it can find time to put forward an amendment to a motion that makes complete sense.

I agree with Senator Hayden on her vision for a health system but do not believe the health system advocated by the Minister and Department is the one she dreams of, nor is it the one I dream of. We have a two-tier health system and there is privatisation of home care and nursing services. There are cutbacks to dental services in rural areas and there is centralisation. This is not of what we dream.

While I agree with Senator Mulcahy’s analysis of the disability sector, if we had a properly serviced and funded universal health service, there would be no need for the charitable organisations the Senator outlined to deliver services that should be essential and which people, disabled or otherwise, deserve as of right.

We support the excellent motion brought forward by the Taoiseach’s nominees and will oppose the Government’s amendment.

The history of the State is littered with examples of its abdicating its responsibility to provide services and support the ordinary citizen, thus leaving the job to the voluntary sector. In this motion, there is a particularly good example of the type of service offloaded by the State onto the charitable and voluntary sector. The motion notes correctly that one charitable foundation “has saved the State up to €235 million since 1997, when multiplied by the 1,600 families supported at the cost of hospital care”. The HSE grant during the same period to fund such services was €4 million, a fraction of what was needed.

Services such as essential nursing homes for the unwell are provided by most developed states. To fail to provide for such care, which can often be done indirectly, would constitute a breach of someone’s right to health care. Our system of health care provision allows for such failures daily, and it is worse still when vulnerable children are the ones who are adversely affected by the failure. It is clear that the State is failing, and it is for that reason that organisations such as the Jack and Jill Children’s Foundation and the Irish Hospice Foundation have had to step in. They deserve great credit for their work but this does not absolve the State.

Let me refer briefly to the related issue of rare diseases. There is very limited support for children with rare diseases. On foot of Deputy Ó Caoláin’s proposal, the Joint Committee on Health and Children held a special hearing on International Rare Diseases Day on 29 February last. Members heard from families affected. I understand this was a very useful discussion, and many of the children availing of services such as those provided by the Jack and Jill Children’s 303 Seanad Éireann Foundation have life-limiting conditions. When a person is diagnosed with a rare condition, the impact on the entire family is enormous. It is important when considering putting in place a national centre for rare diseases with access to information and looking at pathways to health care and access to services that the patient be put at the centre of the process.

The Government Members should stop the hand-wringing, do the right thing, withdraw the amendment and support the Independent Senators, who have tabled a motion in good faith. There is no great commitment on the Government side to put in place the national nursing home care programme that has been requested. The Government should think of the children and their families and do the right thing. Caithfidh na Seanadóirí an rud ceart a dhéanamh agus tacaíocht a thabhairt do na Seanadóirí Neamhspleácha.

26/09/2012BBB00200Minister of State at the Department of Health (Deputy Kathleen Lynch): I always appreciate the debates in the Seanad. I have said this on several occasions and I am not just saying it because I am present. The Seanad has a character of its own that we do not see in the other House.

I will deal with the last speaker first. I come in here quite genuinely and my approach to all these issues has always been on the basis that we need to find a solution to the difficulties that face us all. I have always taken that approach in politics. To challenge people in the way Sena- tor Ó Clochartaigh challenged Senators to stop the hand-wringing is inappropriate. We ought to challenge Senator Ó Clochartaigh to stop making politics out of something that is clearly non-political. The benefit of having a cohort of Independent Senators is that it affords the opportunity to have a debate along non-political lines.

26/09/2012BBB00300Senator Trevor Ó Clochartaigh: Let us hope they vote non-politically in that case.

26/09/2012BBB00400Deputy Kathleen Lynch: The Senator needs to keep that in mind. The benefit of having a cohort of Independent Senators is that we are afforded the ability to have this type of approach. It is never overtly political.

I spent my afternoon trying to find a compromise on this issue. Ultimately, I realised I could not achieve one, but this is not the fault of anybody in this room. It appears that once there is a resource issue in respect of any motion, it is not possible to allow that motion to pass as it places an imposition on the Government to deliver virtually immediately. This is why the counter-motion was tabled. It is legitimate to state the drafter of a counter-motion always seeks to defend and present the opposite view to the motion, as put. Perhaps we need to examine seriously how we conduct business in this regard. We should consider trying to have more compromise and, therefore, more solutions to the difficulties that face us.

When coming here today, I knew I could not win the moral argument. How could one possibly do so? One does not have to be a mother to understand the difficulties and awfulness of the circumstances in which people find themselves. What struck me most about the contribution of Senator Mary Ann O’Brien was the reference to the smells and sounds of the family home. It is not something we always think of but it is clearly part and parcel of what we are.

The Senators on the Government side are, as Senator Mooney stated, obliged to support the Government’s motion and they do so in the knowledge that they too could not win the moral argument. That is a position people find themselves in and it is no fault of theirs. Technically, it is my fault. If this debate proceeds to a vote, so be it, but I would prefer if there was none. Outside the budgetary process, there is nothing we can do in regard to the funding. I have spo- 304 26 September 2012 ken on two separate occasions, once today and once last week, to the Minister for Health about funding for palliative care for children. We did not reach an agreement. However, I was encouraged by his statement that he wants to sit down with the organisations involved to discuss how to resolve the issue. It is not for me to say “Yes” or “No” on the organisations’ behalf, but the invitation has been made. It is probably the first step in the process of coming to terms with an issue that needs to be addressed.

We could talk all night about who delivers the service. As we all know, several organisations deliver it in a caring and compassionate way. One of the organisations is the HSE, which we need to keep reminding ourselves is the health deliverer. Often, I meet people from the HSE who are quite demoralised by the continual undermining of their position. Specialist groups beyond the HSE also deliver health services that, in some cases, the State would find difficult to provide for the same type of money.

The value for money review tells us a great deal. I am convinced that we need to know much more. I am never certain where children with life-limiting conditions fit into the policy, for example, primary care, a patient-centred health service or disability services. Our spend on disability services will not just be €1.4 billion. That amount is a fraction of our overall spend and does not take into account what the State is spending in this regard on social welfare, education, transport, etc. We need an in-depth examination of how we are spending that money and the choices that people do not have.

The Senator and I have had long discussions. Could any Member imagine having a disability and spending his or her entire adult life attending a day centre every day? I could not. Perhaps people would like to go to a pub, a match or a park. These are the choices that we make every day. Perhaps parents would make different decisions for their children if we provided them with different choices. An option will not always be cheaper; some options will be more expensive because they will be delivered in different settings by different people. In the main, this is a question of choice and allowing people to live worthwhile lives. Be one a young child or an adult, the right to choose the life one lives is fundamental.

As to dividing on this motion, there is not much between us. The Government faces a resourcing difficulty, for which reason we cannot withdraw the motion if it is put to a vote. I apologise for putting people in a position in which they must take these decisions. I hope that the invitation will be accepted and that we can start the process.

26/09/2012CCC00200Senator Fidelma Healy Eames: I was hoping to contribute before the Minister of State because I wanted to appeal to her to try to find a way through this situation in order that we would not need to push the motion to a vote. I appreciate the efforts that she outlined. The motion has stilled the House and I compliment its proposer and seconder. It has challenged the way we do our business politically, and not a minute too soon. It is ridiculous that, too often, there are two sides on matters like this.

The Minister of State concluded on the basic point, that is, we should have the right to choose how we live our lives. I understand the motion to mean a right to choose a care model that would suit the family and child in question. According to Senator Mary Ann O’Brien’s proposal, the home care model saves the State nine times the cost. If we reject this motion, there must be a fundamental difficulty within the Government. Could we validate the figures? It is interesting that the Minister of State has spoken with the Minister, Deputy Reilly, who has offered the relevant organisations an invitation to talks. Before the House divides, that invita- 305 Seanad Éireann tion is worthy of consideration.

A number of months ago, the House’s discussion with the Minister for Justice and Equality, Deputy Shatter, on the issue of prostitution met with some success. The Independents tabled that motion. As was our request, the Minister reverted to the House within six months. I do not know whether Senator Mary Ann O’Brien is in a position to hear me.

Senator Mary Ann O’Brien: I beg the Senator’s pardon.

Senator Fidelma Healy Eames: Would she and the other Independent Senators consider a stay of execution for a number of months?

Senator Mary Ann O’Brien: We do not have that long.

Senator Fidelma Healy Eames: This is September. Can I take it that the Minister, Deputy Reilly, is willing to sit down with the organisations within one month?

Deputy Kathleen Lynch: To clarify, the difficulty lies with the fact that this cannot be done outside the budgetary process.

Acting Chairman (Senator Jillian van Turnhout): Other Senators will be pressed for time.

Senator Fidelma Healy Eames: I appreciate that and will conclude. I do not fully understand what the Minister of State means. An urgent meeting between the Independent Senators and the Minister should be held to address this issue. If we support Senator Mary Ann O’Brien in ensuring that the meeting is held in October at least, will she consider not pushing the matter to a vote? If she ever needed to retable the proposal as it is or in another guise, she would have my support in a vote. I am making a difficult request, as the Senator knows what is at stake. We are lucky to have parents who want to take care of their children at home. Some 1,500 children are in foster homes and institutional care. Their parents have neglected them. In some cases, their parents abused them. This is one of the key issues in the children’s referendum. This debate is concerned with what type of nation we are.

Perhaps I have said enough. I had not planned to contribute or submitted my name for time. The issue challenges us on our value system.

Senator Rónán Mullen: Cuirim fáilte roimh an Aire Stáit. Ba bhreá liom tréaslú leis na Seanadóirí Mary Ann O’Brien and Jillian van Turnhout as ucht an méid atá ráite acu. Chuala mé an díospóireacht ón tús. Bhí mé tógtha go mór le cé chomh praiticiúil is a bhí an méid a dúirt siad. Is léir nach ceist acmhainne atá anseo. Is ceist bainistiú acmhainne atá anseo. Is trua mór é nach bhfuil sé de shamhlaíocht ag an Rialtas breathnú ar an gceist i gcomhthéacs bainistíochta, seachas acmhainní.

I wanted to welcome the Minister of State to the House but she is leaving. We are speaking as one Minister of State has resigned - I presume on principle - because of her disquiet at the way certain decisions are being taken or the lack of communication. This is exactly the kind of issue that should prompt those kinds of consideration. The Government has clearly been deaf today, despite a really eloquent and touching case being presented - I mean that in no patronis- ing sense - by Senators Mary Ann O’Brien and van Turnhout. They speak with different areas of expertise and a deep knowledge and experience of the subject at hand. All we have got from the Government is some blasé promise of a meeting. It is as if we are speaking about some 306 26 September 2012 much less important topic than the care of children with life-limiting conditions.

Only last year a report launched jointly by the Children’s Sunshine Home and the Irish Hospice Foundation indicated that, in 11 counties, respite care is not available to all families of children with life-limiting conditions. The report at the time was based on information from the HSE in Dublin mid Leinster and Dublin north-east and indicated that only limited respite services were provided. Access depended on such factors as a child’s age, the nature of the diagnosis, the prognosis and the child’s home location.

The importance of respite services has been recognised by the Department of Health, which launched a new national policy for children’s palliative care in March 2010. What is the point of policy documents if there is not even enough imagination to consider problems that are not, as has been noted, fundamentally about extra resources but rather the management of existing resources? One wonders about the commitment to human dignity that allows such an unthink- ing response as we heard today. It was mentioned in the Seanad that there are certain motions that simply should be unopposed, and this is one of them. I am very disappointed at the easpa samhlaíochta, or lack of imagination, from the Government.

I am grateful to Senator Mary Ann O’Brien and others for their interest in jointly hosting a briefing on a related but separate matter some months ago, which dealt with families which received a diagnosis of a fatal foetal abnormality. On that occasion we heard about the importance of perinatal hospice care, and there is a commitment from the Government that we will have a debate on this in due course. Similar issues arise whenever we speak of real stories of young children who, as Senator Mary Ann O’Brien noted, cannot really be expected to make it to out-of-home respite or preschool care when they are simply not well enough. It is quite clear that the context for care should be in the home.

Great credit is due to the Jack and Jill Children’s Foundation for all the work it has done. It is sad to think that as a child approaches age four, it can be a point of fear for parents that the State is not in a position or willing to do the needful in terms of ongoing care. The case has been made clearly about how much financial sense this makes. It is a remarkable figure that it is eight or nine times less expensive to provide home care than to provide care in a hospital. Senator Mary Ann O’Brien mentioned what a relatively small sum of money is at issue, with €15 million being sufficient. I am sure it is possible, despite the constrained circumstances, to examine our expenditure and ask whether we should prioritise our resources in such a fashion in order that children with life-limiting conditions can be put closer to the top.

I will not go on any further as the case has been made by the Independent Senators on the Government side of the House better than I could ever possibly make it. I commend them for doing so. I ask the Government to rethink its position, even at this stage, rather than fobbing people off with promises of meetings. It should take the proposal seriously and consider the issue with fresh and compassionate eyes and with appropriate prioritisation.

26/09/2012DDD00200Senator Martin Conway: I do not propose to go over the ground covered, as most Mem- bers on both sides of the House would understand my commitment to the issue. I welcome to the Gallery Mr. Jonathan Irwin, for whom I have a huge regard, with Senator Mary Ann O’Brien. I notice our colleague from the other House, Deputy Mattie McGrath, is also in the Seanad, keeping an eye on proceedings. Perhaps he has an ambition to join us at some stage. Either way, this issue is of such importance that I would regret a division of the House on it. I do not doubt the integrity or intentions of the Minister of State, Deputy Kathleen Lynch, and 307 Seanad Éireann the Government.

It can be said about this House that issues pertaining to people with disabilities have received considerable attention during the short period of the 24th Seanad. We have had numerous discussions and a couple of well worded Private Members’ motions, with the Minister of State, Deputy Kathleen Lynch, in the House on a number of occasions. Senator Mooney may have been present when I credited the work done by a former Minister of State, Mr. John Mo- loney, during his short period responsible for disability services. He established a value for money audit published last July. The recommendations of that audit were fairly well figured out by many people involved in the disability area. The simple concept was that money should follow the client. That approach should percolate through the various disability areas.

I have spoken on numerous occasions about what I would describe as the obscene salaries of some chief executives. Senator Mulcahy may have referred to this in previous discourse. Some chief executives on this small island of ours are paid in excess of €300,000 per year. They are in charge of non-governmental organisations providing support to people with disabilities. On the other hand, people like Mr. Irwin commit their lives to bettering the position of people and infants with disabilities. It is a crying shame that during the course of the Celtic tiger, the type of provision being discussed in this debate was not dealt with and that we threw money at problems without identifying solutions.

I am convinced that the €1.5 billion mentioned by the Minister of State for providing support for people with disabilities is the start. That funding is adequate to provide all the support mechanisms in the State for people and children with disabilities but the problem is that it is channelled inappropriately. It is most likely that 70% to 80% of the money is spent on administration, renting buildings and paying inflated salaries that are protected by various mechanisms. We must get real about these resources. We are effectively a broke country in a programme, and even today we are still spending €1.5 billion on support services for people with disabilities. Where is at all going? That should be an ample amount to provide quality care for infants, young adults and people in general with disabilities. We will not go over the recent personal assistant debacle but it is worth noting that one personal assistant hour costs €28 or €29, with €12.50 being paid to the person doing the work. There is something fundamentally wrong with a system where that practice is allowed prevail. Everything must be put on the table in a mature, realistic and determined approach to improve this process. I do not want to see a vote on this motion but we are in a democracy. Senator Mary Ann O’Brien is very passionate and committed to the work she has done and she has proved this in action, not just words. It is her call. I appeal to people to realise that there is a genuine sense of sincerity in all quarters, including the Government. They are dealing with a very difficult and precarious situation. The Minister of State spoke about the budgetary process. Unfortunately, Governments must abide by systems and bureaucracy. There is little choice because if one breaks the budgetary process, myriad people will criticise one for doing so and one is brought before the Committee of Public Accounts and so on. There is a process. We might not like it but if the intentions are there and if the door is open to meaningful dialogue while this budgetary process maxes itself out ahead of the next one, I hope the well meaning invitation will be taken up not only by the Senators but by the NGOs whose chief executives are not on the €4,000 and €5,000 per week pay scales.

I want to see sincere and genuine engagement where realism is the name of the game but, unfortunately, not all the NGOs are like the Clare Crusaders, the Jack and Jill Children’s Foun- dation or the other organisations which do fantastic work. They will have to start to look at their systems and into their hearts and realise that money, which has been wasted, could be put to far 308 26 September 2012 better use by creating schemes, such as that proposed.

26/09/2012EEE00200Senator Mary Ann O’Brien: I thank the Minister of State for coming to the House. Ear- lier somebody alluded to the fact that I am not a politician. I am definitely not a politician because I am so confused and so comforted by all of the Senators words this evening. I know we all feel the same. There are 1,400 families, of which we know, who are depending on what we do this evening but I am also hearing about this terribly frightening budgetary process. I am shaking in my boots already.

I had a quick chat with the Minister of State. She gave me her word and said she would arrange a meeting with the organisations within a week. I am very comforted by that fact but she said there was the budgetary process. Before this evening, I wanted to be able to come in here with a commitment that we could work together. I must have called the Minister for Health and his Department on seven different occasions and I e-mailed him three times but I could not get him to call me back or meet me.

26/09/2012EEE00300Senator Maurice Cummins: He was here all day.

26/09/2012EEE00400Senator Mary Ann O’Brien: I know he was here all day but he was not here to deal with this business. Why would he not answer me back and give me five minutes? I did not want a long meeting; I just wanted a huddle-type meeting. The last time the Jack and Jill Children’s Foundation met the Minister he said he admired the quality and the excellence of its service and the way it served the whole country but that he was stuck between a rock and a hard place and that he could not find this money.

Let us just take a business approach to this issue. I have the HSE annual financial report and the list of the different agencies throughout the country and how the €3.5 billion is divided out. Senators Mulcahy and Conway said many interesting things about the different organisations. I think Senators Hayden and van Turnhout talked about the policy and the value for money report which came out in June. The only problem is that it was just a policy report; there was nothing in it about value for money. Laurence Crowley, who is a brilliant man, spent three years doing that report but I would say to Senators Conway and Mulcahy that the problem is value for money within the €3.5 billion.

I know for certain that the Minister is between a rock and a hard place but he must get HSE management to sit down and sort out the issue of value for money. We only want to extract €15 million out of the €3.5 billion. It is there. I listened to Senator Hayden and would have the same vision.

In a meeting with the Minister of State, Deputy Lynch, and her senior HSE officials, I was accompanied by the nurse of a family who had taken a little child out of Crumlin hospital. The family was looking for a new buggy. Sandra apologised and said she did not want to raise individual cases but she said Crumlin hospital was looking for the buggy it lent this family in Wicklow last February. This was eight months later. The HSE could not get the €1,600 for a buggy. I looked into this recently and I will tell Senators about value for money. This buggy is for a special needs child and the buggy company could give me the buggy in three weeks but the HSE said it would be three months. We have to look at the value for money the HSE is giving.

At that meeting, the HSE said that it saw that the Minister of State, the Jack and Jill Chil- dren’s Foundation and the hospice wanted to follow the patient. That is what we all agree on. The HSE management said it wanted to do that in the short to medium term, which I thought 309 Seanad Éireann was fantastic. In my world, short to medium term means in the next month but the HSE manager said that to him short to medium term meant five to eight years. I do not have five to eight years because our children and our families do not have five to eight years.

I do not know what to do this evening. I should push this to a vote but I really trust the Min- ister of State and feel her heart is in the right place. However, we will have to break budgetary processes because the money is available, as Senators know. I need a promise to go in, fight for these families and take the money out. It is only taking €250,000 from one area, pushing it around and reallocating it.

26/09/2012EEE00500Acting Chairman (Senator Jillian van Turnhout): Is the Senator withdrawing the motion?

26/09/2012EEE00600Senator Mary Ann O’Brien: I am withdrawing the motion for this evening but if I do not get somewhere next week with the organisations, I will be back because I know I will be given time and will push this to a vote.

Amendment No. 1 lapsed.

Motion, by leave, withdrawn.

26/09/2012EEE00900Acting Chairman (Senator Jillian van Turnhout): When is it proposed to sit again?

26/09/2012EEE01000Senator Maurice Cummins: Ar 10.30 maidin amárach.

The Seanad adjourned at 8 p.m. until 10.30 a.m. on Thursday, 27 September 2012.

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