Brian Stanley slams HSE bureaucracy and calls for transparency

I welcome the opportunity to speak on this bill. I have gone through the bill and I welcome a lot of what is in it. A service plan will be replaced with a performance delivery plan. That is very welcome. We can measure things. Your Minister for Health is to prepare a strategic direction statement in respect of health services priorities to guide the HSE in preparation of his corporate plan. I think that is very welcome that the Minister for Children and Disability is to prepare a similar strategic direction plan in respect of community-based disability services. I think that is very laudable. The Minister for Health will prepare an annual statement of health services priorities. That is really important. And the Minister for Children and Disability and Equality will do a similar task. The fact as well that the performance delivery plan will be due within 28 days of receipt of the termination of the maximum net non-capital expenditure that can be incurred. All good. And very importantly that the CEO must inform the Board, the Minister for Health and the Minister for Disability and Children and Equality if the HSE is likely to exceed the capital and non-capital budget allocation for the year. That is all fine. And as I said to you before, the substantial budget going in, I have no arguments with that, coming from a left Republican position, I welcome that. I think that, you know, the more we can point to it, the better. But outcomes are the whole thing. Now, could I just say to you, the HSE in their most recent, and this is the hard bit, the HSE in their most recent health sector employment report published in March showed that 18,851 staff in management and administration category. And that was in December 2019. And in March 2024, that number had increased to 25,477. So, you know, there is a substantial increase, 35%. The question there is, is that, and when we track this, we can see that those grades are expanding and increasing at a faster rate than the clinical staff and the care staff and the frontline staff. And that's one big issue I have with the HSE, that, well, you know, I'm not saying that all management in it are bad or anything like that. I know of managers in it who are doing their best. But what I'm saying here is, is that it has become very bureaucratic. There has been, there are several layers. I understand that it's a big shift to steer, that health systems are complicated. It's a big organisation, you know, 120,000 workers. It's very hard, can be hard to manage. I understand all of that and I get that. But I think what we have to keep an eye on is that we're seeing services in terms of budget going in. The situation that was highlighted recently with the clinical insourcing, and many of us have complained about outsourcing, but the insourcing, that one was interesting when that report came out, that surgeons were taking patients out of the public system who came to them during the week, for example, and doing the private work through a private company that they had established, so that they could do the work at weekends, and receive it on the, you know, and receive a different price for it, and let it become a cash cow for individuals and for those companies. But, you know, and the hospital, the bewildering thing about it was, the hospital's own facilities were being used, rather than if it's private, that's fair enough. If a private hospital wants to operate, let it operate. That's grand. I don't have any particular graph for privatised health services. But if a private hospital wants to operate, that's grand, and people want to pay for it privately. But we have to disentangle this from the public system, which we're supposed to be doing with Solanchik here. And it's clear that this was exploiting the use of public facilities and taxpayers' money, you know, scarce taxpayers' money that needs to be going into frontline services. So, you know, we have to move away from that. I welcome the fact that the department and the chief executive, Bernard Gloucester, has managed to get weekend work operation in hospitals. You're correct, they have to work seven days a week. You know, expensive equipment, we don't have enough equipment, we have a growing population. I get all of that. So, for now, you know, we need people to work at weekends, and I welcome the fact that that's happening. The consultant contract, I know that the numbers on the public-only contract, that's increasing. That needs to continue and needs to be accelerated. And again, that's nothing against people who want to work in private health. That's fine and dandy. But we do have to disentangle the two systems. This is a clear example of the public system and public facilities being exploited in terms of using them for private profit. The lack of transparency and outcome with delivery ministers, and you will remember the public accounts committee when I was the chairperson of it, and you were fairly good at drilling into things. I'll give you that in relation to disabilities, and you focused on that a lot, and health services, and you made a good contribution there, as indeed did a lot of members. But I remember you are particularly focusing on these issues, and this is something that we need to really give attention to. You know, the lack of transparency in outcomes and delivery, it damages the reputation of the healthcare system, and also can cause, obviously, long-term financial problems. It restricts the public information, and we must have full transparency in order to see how hospitals and how services are performing, and to get a better insight into waiting lists. And without that, public trust will be eroded. This morning, and I know you were inevitably absent, Minister Butler was here in your absence, but I hope that you get some chance to read some of what I said, and indeed other contributions that were made as well, because they were made sincerely. I raised the issue of dental, and particularly the public dental schemes. There are 230 million going into it per year. You know, it is clear that we are not achieving what we need to achieve in terms of the schemes. The DTSS scheme, the dental treatment services scheme for medically cared patients, it is clear that that is non-existent in many parts of the country, including in County Leash, where there are no dentists taking patients under it, except one on the edge of Carlow Town. The DTSS scheme, again, very limited, you know, up to 2009 you could have a range of services provided under it, now it is just cleaning and examination. And I proposed, or suggested, that maybe we should examine a voucher system for that, which is in operation in other countries, and to give a better service for workers who are paying PRSI, USC and PAYE. What I would say is that, and just to say what I said this morning, just to bring it home to yourself, we will have the opportunity, children and adults with special needs who need treatment or anaesthetic, there is a particular problem there, Minister. You know, there is over a two-year waiting list, and there are some awful examples of young people and adults in desperate need of dental care, and are on long waiting lists and going nowhere. And, you know, I have had family members come to me about it, and, you know, it is terrible, and they cannot be treated, and some of them are suffering with T-take, some of them are suffering with oral dental health problems. That will all cause further health problems down the line. And I just ask you to, if you can really take that one on board, because they are a very vulnerable group. On the issue of agency staff, and this is a, in some ways this is Noel Chestnut, but it is one that we have to deal with. And I know that Bernard Gloucester, when he took over, he said he was committed to trying to pare back that, and I know that is easier said than done, you know, but the over-reliance on agency staff is concerning. You know, 270 million in 2024, it is a lot of money in terms of spend on services and on recruitment agencies, etc. And the, if we could just say for a minute to you in relation to, and that was only for 11 months, 276 million, that was only for 11 months of last year, and the records show that this finance was spent on services such as administration, management, nursing, medical, dental, and paramedical services and supports, as well as maintenance and technical supports. And just in the Midland Regional Hospital in Portlaoise, there was almost 20 million, you know, a relatively small hospital, a very busy hospital, but there was almost 20 million spent there in 11 months last year. 19 million, 776 million, 19 million, 7, yeah, 19.7 million was spent there on agency staff in 11 months of last year. And that's, as you understand it, that has never been higher. Just to mention as well, you will be doing the capital development plan. I know that you will be swatting around the Cabinet table over the next few days with this, or the next week. I know there are hard decisions to be made. The cake has to be divided up. I would ask you to do what you can in terms of primary care centres and health centres, because we all know that if we catch people, if we're able to help people in the community, provide services at community level, it keeps them out of expensive hospital care. And particularly, I want to ask you in relation to the primary care centre for Portlaoise. It's promised, it's agreed that it's going to happen. Everybody's on board with it. It needs the cash, it needs a capital allocation. It's a town, Portlaoise town, is a population now in the region of 30,000. Huge catch material around it. It's one of the few towns, it's probably the only town of its size in the country, that doesn't have a primary care centre. Some of the smaller health centres, Mount Trath, Burris Nostry, Rathdowney and Grey Cullen, they need some upgrading as well. And I would ask for them not to be forgotten about. They need works as well. And just ambulance services, the dynamic deployment. And I've heard, we've had the ambulance services in before public accounts and we've had reports on them. But the dynamic deployment. I don't care what the ambulance service, the senior staff in the ambulance services says about dynamic deployment. Dynamic deployment where you have ambulances chasing from Portlaoise to Waterford or to Exford. And when they're within a mile or two or a couple of miles of where the accident or where the person, the patient is, the next thing they get a call or turn back, there's another ambulance after getting there before you. Meanwhile, back in Leish, there's somebody after having a heart attack and there's nobody to pick it up. You know, whether we like it or not. And I know there's no easy solution to it. There's nothing perfect. But we have to get to a system. The optimum, I think, is to keep the ambulances within a 45 or 50 kilometre area. You know, so Leish, you know, and by all means you should cross county boundaries. You know, Portlaoise ambulances should be able to go into South Kildare, go into West Carlow, North Tipperary, you know, East Offaly. Of course, you know, you have to be flexible there. But we can't have them chasing literally to Cork, which is happening and has happened. And that needs to change. Let me welcome the start of the Midlands Hospice. This has been going around since I came in here 15 years ago. And I would say before that, I want to welcome wholeheartedly the fact that now that that is going to be done. Okay, it's located in Tullamore, it's not in Leish, but that's people who live with that. Service in the Midlands is really, really important end of life care facility. And I want to just welcome that. So in conclusion, Minister, I would just say to you, I started off by saying it's a big ship to steer the health system. I understand that Bernard Gloucester has done a good job, I think, in terms of trying to... I know some changes he's made, he's brought some good changes to it. You know, I think we're taking a very hands-on approach to it. We may differ sometimes in ideology or other things, but it's important. What's really important is that we shorten the distance between budget and delivery. But also that we can see that it's a straight line, remove the diversions that people can talk around issues and sidestep and get around it. You know, in big organisations, we need to shorten the distance between the money going in and the top, and the actual top of the organisation and the service delivery on the ground. Remove all places for people to hide, keep it in a straight line. Let's make sure we get value for taxpayers' money and improve public services at the same time. Thank you, Les Cangola. Thank you.