Vol. 745 Tuesday, No. 4 8 November 2011 DÍOSPÓIREACHTAÍ PARLAIMINTE PARLIAMENTARY DEBATES DÁIL ÉIREANN TUAIRISC OIFIGIÚIL—Neamhcheartaithe (OFFICIAL REPORT—Unrevised) Dé Máirt, 8 Samhain 2011. Ceisteanna — Questions Minister for Health Priority Questions …………………………… 673 Visit of Haitian Delegation …………………………… 682 Ceisteanna — Questions (resumed) Minister for Health Other Questions …………………………… 682 Leaders’ Questions ……………………………… 694 Ceisteanna — Questions (resumed) Taoiseach ………………………………… 700 Order of Business ……………………………… 717 Topical Issue Matters ……………………………… 730 Topical Issue Debate Cross-Border Projects …………………………… 731 Fuel Laundering ……………………………… 732 Community Employment Schemes ……………………… 735 Hospice Services ……………………………… 738 Access to Central Treasury Funds (Commission for Energy Regulation) Bill 2011 [Seanad] Second Stage ……………………………… 740 Referral to Select Committee ………………………… 744 Competition (Amendment) Bill 2011: Order for Second Stage …………………………… 744 Second Stage ……………………………… 745 Private Members’ Business Promissory Notes: Motion ………………………… 759 Questions: Written Answers …………………………… 787 DÁIL ÉIREANN ———— Dé Máirt, 8 Samhain 2011. Tuesday, 8 November 2011. ———— Chuaigh an Ceann Comhairle i gceannas ar 2.00 p.m. ———— Paidir. Prayer. ———— Ceisteanna — Questions Priority Questions ———— Hospital Services 38. Deputy Billy Kelleher asked the Minister for Health the public hospitals that he considers suitable to be turned into hospital trusts; if the introduction of external management consultants represents the beginning of that process; if the move is permissible under the Croke Park agreement; and if he will make a statement on the matter. [33230/11] Minister for Health (Deputy James Reilly): The health service requires strong management capacity to deliver on service targets in an effective and efficient way within available resources, and also to lead change in a complex environment. Over a period the HSE has identified a need to develop management capacity, especially in certain hospitals. In June 2011, the executive invited tenders from potential service providers for a four-year framework agreement for personnel placement and supply services. Under this agreement, service providers can be asked to source and supply senior interim managers or more long- term senior management candidates. Following from this tender process, five companies were invited last month to participate in a mini-competition to source and propose candidates for an interim management support structure for HSE west. The competition has closed and the proposals are being evaluated. Under these arrangements, it is planned to recruit a chief executive officer for the Galway university hospitals group. It is also intended to strengthen management capacity in the HSE mid-western region by putting in place other interim management supports. The successful provider will also be expected to assist in developing management capacity for the longer term. The HSE is engaged in discussions with the IMPACT trade union regarding these plans and does not regard them as conflicting with the public service agreement. As stated in the programme for Government, in conjunction with the introduction of univer- sal health insurance, public hospitals will become independent, not-for-profit trusts. This will require the development of the necessary corporate governance, management and clinical capa- city to ensure these hospitals are equipped to function efficiently and effectively, once estab- 673 Priority 8 November 2011. Questions [Deputy James Reilly.] lished as independent service providers. Under these arrangements, it is planned to recruit a chief executive officer for the Galway University Hospitals Group. It is also intended to strengthen management capacity in the HSE mid-western region by putting in place other interim management supports. The successful provider will also be expected to assist in developing management capacity in the longer term. The HSE is engaged in discussions with the IMPACT trade union on these plans and does not regard them as conflicting with the public service agreement. As stated in the programme for Government, in conjunction with the introduction of univer- sal health insurance, public hospitals will become independent, not-for-profit trusts. This will require the development of the necessary corporate governance, management and clinical capa- city to ensure these hospitals are equipped to function efficiently and effectively, once estab- lished as independent service providers. Deputy Billy Kelleher: In the context of the introduction of universal health insurance and the establishment of independent trusts, by now the stated position of the Government, nine months after taking office, given what was said prior to the general election and the time the Minister has had to prepare policy documents on his own vision of what the health service should look like in the years ahead, should at least offer a blueprint for us to analyse in the near future. We are awaiting the establishment of the implementation body in respect of univer- sal health insurance, but it is imperative that we see the criteria laid down, with the instructions and parameters for the commission when making proposals on universal health insurance. In tandem, if we are to meet the commitments given in the programme for Government, in the near future hospitals must be identified that would be suitable for removal from the HSE, or whatever structure is left after the legislation is passed, to become independent trusts managed by a local board completely separate from the national body which will manage the health service. None of this has yet happened. Does the Minister know which hospitals will be involved? Will they be large hospitals, or the smaller hospitals which are being downgraded? Deputy James Reilly: We are not of the view that hospitals are being downgraded; they are changing the emphasis on the care they provide. Our primary concern is that hospitals are safe. Decisions are still in the process of being assessed; therefore, no final decisions have been made. We are evaluating the matter. All of the hospitals are different and the universal health insurance implementation commission will examine the issue. It would be premature, therefore, to outline exactly what each hospital will do or which hospitals will be connected to which. There are different possibilities and there may be interim arrangements prior to final arrange- ments being made for connectivity between hospitals. There are considerations related to con- nectivity by road infrastructure and the complementary positions hospitals offer when in part- nership with others; we do not want hospitals to duplicate services unnecessarily. This work is ongoing. It is a massive task that we are intent on completing and there has been a lot of activity to date. As soon as the implementation body produces its report, it will be brought before the Dáil. Deputy Billy Kelleher: Who will make decisions on the hospitals in which there will be further capital investment while we await the establishment of independent trust hospitals and the amalgamation of other hospitals? Who is going to make these decisions in the interim? Deputy James Reilly: Each Minister receives a capital budget and it is his or her responsibility and that of his or her Department to make the relevant decisions in respect of that budget. That has always been and remains the case. 674 Priority 8 November 2011. Questions 39. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will put in place a programme to restore services to hospitals in the north east and, with immediate effect, main- tain and sustain the minor injury unit at Monaghan General Hospital as a 9 a.m. to 9 p.m., seven days a week service, proceed with the medical assessment unit at the same hospital site and restore the rapid response vehicle to the ambulance service covering County Monaghan and north County Louth [33229/11] Deputy James Reilly: I am committed to ensuring acute hospital services at national, regional and local level will be provided in a clinically appropriate and efficient manner. In particular, I want to ensure that as many services as possible can be provided safely in smaller hospitals. To this end, the Government will publish a framework for the development of smaller hospitals to set out how their future will be secured. The framework will give clear information on the role of smaller hospitals and address any safety issues arising from HIQA’s reports. Consul- tation covering all the key stakeholders, including patients and public representatives, will be an integral part of the process. In addition to the framework, the organisation of hospital services will be informed by the clinical programmes being developed and implemented by the HSE. These interrelated programmes aim to improve service quality, effectiveness and patient access and ensure patient care is provided in the service setting most appropriate to people’s individual needs. In the context of the specific questions raised by the Deputy, the minor injuries unit at Monaghan General Hospital provides an eight hour service, from 9 a.m. to 5 p.m. This service came into effect on 1 November. The change in opening times is the direct result of the current budgetary and financial position facing the health system. The HSE has reviewed other possible options to save money or increase revenue but concluded that they would not generate sufficient savings in the short term. Following a