Issue of health funding must be tackled

January 29, 2011 § Leave a comment

Yesterday, Aviva announced its plans to increase its health insurance charges. While we can all rail against this and the fact that people are being obliged to deal with increased charges at every hand’s turn, we must highlight the fact that it again points to a serious policy failure on the part of the outgoing Government with regard to the funding of health. The Government has flunked the test in respect of this matter on every occasion. The issue to which I refer was brought before both the High Court and the Supreme Court, where the Government lost. I was sorry it lost in the Supreme Court because the position it took in respect of risk equalisation was correct. However, the matter was then just abandoned and no action was taken. It must be two years ago since the decision of the Supreme Court was handed down. The Government applied a sticking plaster in successive Finance Acts in the context of tax relief.

The issues of health insurance and the funding of health must be tackled. The Labour Party will be publishing policies on these matters in the next couple of weeks. I accept this is a political matter which will be dealt with during the general election campaign. I will, however, be interested to discover the policy of the Fianna Fáil Party on health. That party has had nothing to say on this issue for many years. It left it to the former Minister for Health and Children, Deputy Harney, who has not been a member of Fianna Fáil for some years, to speak on the matter. What is the Fianna Fáil Party’s policy on health? Does it have a policy? We have not seen such a policy but we would be interested in seeing it in the coming weeks.

More questions for HSE on care of children

December 16, 2010 § Leave a comment

The conclusions of the HIQA report that some children are unsafe in Special Care Units makes for very sobering reading.

It seems that hardly a month goes by without some revelation or other relating to HSE care of children.

Just last week it was confirmed that some 200 children have died in the last decade while in state care.

In October we got the grim details of the Roscommon child care case and we also discovered that almost 800 children ended up homeless and in need of emergency accommodation last year

The system is badly flawed in a number of significant respects. For instance, while HIQA is responsible for inspecting the various centres, including High Support Units and Special Care Units, the number of inspectors is clearly inadequate. The work that HIQA does is very valuable, but their resources are stretched too thinly.

The failure of the HSE to ensure that all staff are properly qualified is a problem in special care units, just as it is in other areas. In Coovagh House for example, it was found that 20 of 109 staff were unqualified. In addition, thanks largely to the recruitment moratorium, these facilities are also forced to rely on agency staff, rather than recruit badly-needed care workers.

While I welcome the appointment this week of a national director for childen’s services, the outstanding HIQA recommendations such as the publication of a national strategy for special care; the appointment of a monitoring office for special care units; and a review of national governance of special care services, need immediate attention

The Child Care Amendment Bill which is making its way through the Oireachtas will provide for some protection to children in care. The Bill should be prioritised ahead of some of the more frivolous pieces of vanity project legislation that are in danger of clogging up the system in the lead up to the dissolution of the Dail.

Why must Ministers seek legal advice to deal with the HSE?

May 25, 2010 § Leave a comment

It is true that the accountability issue has been raised again in sharp relief in the investigations into the deaths of children in care. Given how often we are told that there is such a large amount of public resources devoted to the health services administered by the HSE, the blockage between those of us elected to these Houses and the people providing the services, which means it is not possible to establish precisely what is occurring, is incredible. Not even the Minister of State appears to be in a position to establish what is occurring.

The matter of different bodies arranging legal advice between themselves to establish their positions and whether they can move an issue forward is an extraordinary spectacle. Is it €16 billion per annum for the health Vote?

Members and, judging by what he has stated, the Minister of State cannot establish basic information without there being a competition between us and the HSE about legal advice. It is incredible that any democratic country is unable to have a proper debate or to establish information directly in the Houses. The HSE might have the best will in the world, but the manner in which it is configured and organised means it operates as a block to true democratic accountability in respect of child care and health services.

This matter is raised repeatedly in the House. How many more times will it be raised by practising, concerned politicians without anything seeming to happen? That people need to seek legal advice to establish whether they can do the jobs they are there to do is a spectacle.

HSE may not be fit-for-purpose to provide care to children

May 25, 2010 § Leave a comment

The inability of the HSE to clarify just how many children have died in their care in the last ten years is profoundly worrying.

The HSE was asked some months ago to compile figures on how many children in their care had passed away, but have STILL not been able to come up with a definitive number. This defies belief.

I appreciate that a portion of the period involved predates the establishment of the HSE. However, in a matter of such seriousness it is simply incredible that detailed records of the deaths of these children are not available, or that at the very least, that the number of such children is not known by senior HSE officials.

According to the CSO, excluding neo-natal deaths a total of about 300 children die each year, and the notion that as many as 20 of them are under HSE care hardly bears thinking about.

The further revelation today that the independent panel set up to look into the deaths of children in HSE care has still not received a single file on the individuals involved only adds to the picture of dysfunctionality and incompetence in the HSE.

Last week, the remains of Daniel McAnaspie were discovered in a field in Co Meath. The shocking murder of Daniel at a time when he was living in the care of the HSE is but the latest in a litany of scandals to beset the the organisation.

We now must ask the question as to whether the HSE is indeed fit-for-purpose when it comes to providing and managing child-care services.

Time to admit ‘implementation difficulties’ in children’s services are actually failings

May 20, 2010 § Leave a comment

Politics enters the equation when we come to discuss the requirement to allocate resources, expand provision and fund changes and improvements to children’s services. At its heart, politics relates to the allocation of public resources and the setting of priorities. As stated on previous occasions, I have never perceived debates of this nature as occasions on which to engage in party political contests. I certainly did not perceive the two to two and a half years the Joint Committee on the Constitutional Amendment on Children spent discussing this matter as an opportunity to engage in such a contest. However, that is not to state that politics does not enter the equation. As already indicated, it enters the equation in the most general sense when we discuss the level of priority we ascribe to this subject and the level of priority we are prepared to attach in respect of the requirement relating to the provision of additional resources.

We have debated matters of this nature with the Minister of State, Deputy Barry Andrews, on several occasions. I have no doubt that he is obliged to watch his p’s and q’s. I am not stating that he might misrepresent the position but he is obliged to defend the Government. He is not going to inform us that he is pressing for additional resources but that his requests have so far been refused. Nor is he going to state that attempts to employ the additional 265 social workers that are required will be accelerated or that these people should be recruited forthwith. I would be surprised if I was wrong in thinking that if it were left to the Minister of State, the recruitment of these social workers would be completed very quickly. However, action in this regard has been no more forthcoming than that required, in the context of additional funding and resources, in the area of child protection. Politics, therefore, enters the equation in that sense.

Opposition politicians are not only entitled to criticise the Government but are under a duty to do so, particularly where it makes commitments on which it fails to deliver. We would not be doing our job if we failed to engage in such a critique of the Government. However, I am not, as already stated, seeking to obtain a party political advantage in respect of this issue. I disagree with those who attempted to take such an approach to this matter in the past.

The debate on the report of the Ombudsman for Children provides us with a good opportunity to reflect on what we are doing. I accept we would not have time to do so but I believe we would be better served if we were to examine the report on a line-by-line basis. « Read the rest of this entry »

Lack of debate on HSE means answers to Tallaght Hospital Scandal scarce

March 11, 2010 § 2 Comments

Of course it is ludicrous to suggest that the Minister should be held responsible for not opening particular letters or envelopes in Tallaght hospital. It is nonsensical to suggest it and to the extent that it has been suggested I do not agree with it. However, there is a real issue for political representatives.

Because of all the changes that have occurred and the arrival of the HSE on the scene – many on the Government side have made this point – politicians and political representatives generally have been deprived of an opportunity to raise any serious issue or have serious debate, such as that which has been called for in the Seanad or in the Dáil. The Dáil is a Chamber to which the Government is accountable and responsible under the Constitution although it is not as directly responsible to this Chamber. However not even Deputies can get answers on these issues because Ministers habitually refuse to answer them, often because they are a matter for the HSE. However, when one approaches the HSE there is no serious procedure, basis or opportunity for public representatives to raise these issues and have them debated.

I do not blame people for mistakenly thinking that every issue must be laid directly at the feet of the Minister for Health and Children because the system has been changed in such a way as to render it impossible to get any answers other than calling for the Minister to come to the House. If the Leader of the Seanad has an alternative to propose to us on how we can have a serious and adult debate on this issue I would like to hear it. Otherwise, there is no alternative to people coming here day after day to call for the Minister for Health and Children to answer questions on issues which, in a normal democracy, she would not have to address in the same detail.

It was a complete spectacle to have the Minister of State, Deputy Conor Lenihan, state that something should be done about Tallaght Hospital. Is there a democracy in the world in which a Minister of State would state that something should be done? We are told that health spending is one of the biggest areas of public expenditure over which the Government and the Oireachtas presides. It beggars belief that there is not a serious basis upon which issues such as what went wrong at Tallaght hospital can be properly debated in the Houses of the Oireachtas.

Child Care Bill a case study on failures in public policy

February 5, 2010 § Leave a comment

The Child Care (Amendment) Bill 2009 was discussed in the Seanad this week.  The Bill provides a statutory scheme for the High Court to have exclusive jurisdiction to hear special care cases, abolishes the Children Act Advisory Board (CAAB), and makes a number of changes to the 1991 Child Care Act.

A number of other bodies took the trouble to brief Members on the Child Care (Amendment) Bill 2009. The information they provided has proven extremely useful to Members as they consider the Bill. It is always of assistance when interested bodies take the time to prepare briefings, meet Members and share with them their experiences and also the difficulties they perceive in respect of the practical, day-to-day operation of agencies, services of the State, etc. relating to children and also the problems they believe may arise in the context of legislation being brought forward.

Focus Ireland took the trouble to provide briefing information. To some extent, that organisation’s document provides an answer to the question posed by others in respect of the possible or potential cost to the State if aftercare services were to be placed on a statutory footing. It is not possible to make a direct analogy with Northern Ireland in this regard. However, the example of Northern Ireland was the best Focus Ireland could provide in estimating the ultimate cost. Focus Ireland indicates that the equivalent cost of providing the range of aftercare services available in Northern Ireland in the Republic of Ireland would be just under €11 million per annum. That figure is based on a total of 411 care leavers per annum. If it is possible for Focus Ireland to quantify the cost, it should also be possible for the Minister of State to do so. I agree with those who stated that it would be important to place aftercare services on a statutory footing in order that there might be some expectation among people of their being available. It is also important that proper controls, guidelines and supervision be put in place in respect of such services.

The Bill is welcome. However, it provides a curious case study in respect of failures in public policy. I do not lay all the blame for such failures at the door of the Minister for Children. These failures date back many years, perhaps even a number of decades. The Minister may wish to reflect on this and refer to it in his reply. « Read the rest of this entry »

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