Other Questions.

Departmental Funding.

Liam Twomey


7 Dr. Twomey asked the Minister for Health and Children if he will make a statement on the number of projects which received funding since May 2002 and the number of projects expected to receive funding for specific projects in the acute hospital sector (details supplied). [10700/04]

I understand that my Department has clarified the Deputy's specific requirements with regard to the question raised. Following this clarification, the Deputy requires information only in respect of those projects in excess of €10 million — this cuts out a lot — which had contractual commitments in May 2002 or which have received funding since that date.

The Deputy will be aware that the national development plan, which commenced in 2000, sought to provide investment in the acute and non-acute hospital sector on an equal basis over the life of the plan. It is my intention that this policy be carried forward into the new five year capital investment framework for 2004 to 2008 being established by my Department.

In response to the request for the information required by the Deputy, I can confirm that the number of separate projects in the acute hospital sector being funded since May 2002 is 22 in 16 different major hospitals and at an estimated total cost of €1.667 billion. As the Deputy will appreciate, this funding is being spread over the life of these major projects and, in most cases, it will be over a period of several years. The projects include: St. Vincent's University Hospital — this will cost about €212 million; Mater and Children's Hospital Development — this will ultimately cost approximately €431 million; Naas General Hospital — this will cost up to €119 million; James Connolly Memorial Hospital; Our Lady's Hospital for Sick Children, Crumlin — this project involves operating theatres and further developments and will cost up to €30 million; St. James's Hospital — €40 million; Beaumont Hospital; Coombe Women's Hospital; Incorporated Orthopaedic Hospital, Clontarf; Tullamore General Hospital — €141 million; Portlaoise General Hospital — €32 million; Longford-Westmeath General Hospital — €74 million; St. Joseph's Hospital, Clonmel — maternity unit; Cork University Hospital — this project includes radiotherapy-oncology, accident and cardiac-renal units; University College Hospital Galway; and Mayo General Hospital, Castlebar.

In light of our having discussed the Hanly report, the purpose of my questions is to second-guess what the Department is planning. This question ties in with Question No. 42 which asks whether there is radical reorganisation of acute hospital services inside and outside the Dublin region, whether the Minister is planning to transfer the tertiary services to one hospital, whether he plans to transform one hospital in the Dublin region into a major acute emergency service hospital doing emergency work only, and if there are plans to designate one or more of the five major Dublin hospitals as a general hospital which will only do major elective work in the Dublin region. Are there such plans for the south east where I am involved? Will Waterford Regional Hospital remain the regional centre? Is Kilkenny General Hospital, which would seem to be the more logical choice, being considered?

Patients in the south east are losing out in some respects regarding the development of their acute hospital services. There is an increased level of activity in the south eastern hospitals but no progress is being made in reforming the services. Nobody seems to know the direction in which we are going. My obtaining figures from the Minister is to try ascertain what the Department of Health and Children thinks about acute hospital services.

The Minister is saying the plan is for the next five years. Will he expand further on his reply in response to my point about the Dublin hospitals and those in the south east? Is something happening or something we should know? I know the Hanly report ties into this issue to a large extent.

There is no joint conspiracy, if that is what the Deputy is indicating.

I am not saying there is a conspiracy.

It is fair to say that, in the decades prior to 2000 when the national development plan was announced, the health care system did not receive the capital investment it required. Therefore, many of the hospitals had no serious investment for up to 20 or 30 years. In this respect, I include hospitals such as St. Vincent's Hospital, the Mater, and the Cork and Galway hospitals. The first task was to prioritise between acute and non-acute categories. We were endeavouring to obtain a 50:50 split in the national development plan so that the non-acute category would cover day care centres, health care, primary care, community care and continuing care. As the design teams worked on these major projects and dug deeper, the costs increased in some instances. However, we had to modernise the hospitals. This was agreed to by all owing to the condition of some of the hospitals prior to the developments in question. Some of them had no serious investment.

A range of projects are taking place that cost less than €10 million. There has been significant investment in Waterford Regional Hospital, as the Deputy knows, and in Kilkenny hospital. I was in Kilkenny recently and noted that the hospital has up to ten or 11 new facilities. Significant investment has been made in Wexford General Hospital even prior to the plan, and design teams have been appointed in respect of projects at that hospital. Many of the initiatives predated the Hanly report.

The projects in the major teaching hospitals are of a significant level given the scale of those hospitals in any event. Galway will serve the entire western seaboard for tertiary items, such as radiotherapy and heart surgery, which means people from the west will no longer have to go to Dublin for heart surgery and radiotherapy in the future and for a range of other services such as renal services, some areas of orthopaedics and other specialities. As a result of the investment in Galway, we will now be able to provide services in the regions.

I again remind the House that supplementary questions and answers are limited to one minute. If Members abided by that, we could accommodate more Members on supplementary questions.

Medical Council Report.

Willie Penrose


8 Mr. Penrose asked the Minister for Health and Children if the terms of reference of the inquiry, to be chaired by Judge Maureen Harding Clark, into the activities of a person (details supplied) have been finalised; when the inquiry will begin; the form it will take; when he expects it to be completed; and if he will make a statement on the matter. [10788/04]

Arising from the Medical Council's report of an investigation into the professional conduct of Dr. Neary, Judge Maureen Harding Clark has been selected to chair an inquiry into the issues raised in it.

Following the appointment of the chairperson, a premises has been secured and fitted out for the inquiry. In addition, Judge Clark has conducted an extensive examination of relevant documentation, including the transcript of the proceedings before the council's fitness to practise committee. The inquiry has as its principal purpose the objective of seeking to determine the reasons certain practices at the hospital were performed, and continued for so long, as well as seeking to ensure that all necessary measures are put in place to prevent a repeat of these events at the hospital in question, or elsewhere in the hospital system.

I have had a number of meetings with Patient Focus, the group representing former patients of Dr. Neary, and have discussed the proposed terms of reference and format of the inquiry. I met this group again yesterday in this regard. I indicated to it that I will revert to Government in regard to some outstanding issues it raised with me. It is my intention that the inquiry commence as soon as possible.

The Minister will accept he has the support of everybody in this House in ensuring this inquiry is up and running, is comprehensive and is as broadly based as the Medical Council has sought and as the unfortunate women who suffered at the hands of Dr. Neary have been seeking through Patient Focus.

I wish to ask about points at issue which are serious and which, if not addressed, a good inquiry will not result. In regard to the date of the start of the inquiry, will the Minister ensure it goes back as far as events in 1974? Will he ensure it is truly broadly based in the sense that it does not just look at caesarean hysterectomies but also at injurious procedures, such as the removal of ovaries? Will the Minister deal with the compellability issue so that witnesses are compelled to appear before the inquiry? If that issue is not addressed, the inquiry will not meet the needs of those seeking it. I understand Patient Focus has put forward proposals for compellability using the 1970 Health Act as a means of ensuring this happens.

I am looking at the issue of compellability and will respond to Patient Focus via another meeting shortly on the issues the Deputy outlined. The judge is anxious to concentrate on and to take as accepted fact the report of the Medical Council having gone through all its procedures, taking of evidence and declaring professional misconduct arose in the instances investigated by the Medical Council. It falls to this inquiry to establish how that professional misconduct was allowed to continue for so long. That was one of the original core requests of Patient Focus. An answer to that basic question would benefit all of us because it would help to inform policy in other hospitals.

The judge is anxious to facilitate persons who wish to come before the inquiry to bring forward evidence or to tell their own story on issues outside caesarean hysterectomy. Patient Focus has said — I hope I am faithfully interpreting what it said — it accepts the judge cannot go into every case which would arise in such a circumstance and make judgments on each case. There is an issue of clinically having to examine each case which may now emerge subsequent to the Medical Council report. Those issues have been raised with us. We are reflecting on them to see how we can accommodate them. We indicated that the inquiry team and the judge are willing to accommodate people to bring forward their stories to the inquiry.

The Medical Council report gives a clear template of professional misconduct which is now accepted. There is no argument but that Dr. Neary was guilty of professional misconduct in regard to the cases that came before the Medical Council. The key issue for the inquiry is to establish why this was allowed to happen for so long. We are looking at the compellability issue to see if we can accommodate the concerns of the group in that regard.

I do not think anybody is disputing the importance of the Medical Council's fitness to practise committee's report but what is sought by the Medical Council and Patient Focus is a broadly based inquiry which was understood would take place with the appointment of this judge. I am not clear whether the Minister is saying he is willing to extend the terms of reference back to 1974 and beyond the specific issue of caesarean hysterectomies to other unjustified and injurious procedures. Will he also ensure compellability to make this inquiry effective?

On broadening the inquiry to cover different procedures, I am still not clear what is requested from the discussions I have had——

There are only 130 women; it is not a large population.

——in the context of different cases and so on. The group has said it does not expect the judge to reach conclusions in each case that would come forward.

They want to be able to give their evidence.

The judge has indicated that she is willing to hear what people have to say on those specific issues.

Why not extend the terms of reference?

I think we will have further meetings with the group. We will see what emerges from them.

Fluoridation Forum.

Ciarán Cuffe


9 Mr. Cuffe asked the Minister for Health and Children the person he intends to appoint to the expert group on water fluoridation; when he expects it to report to him; and if he will make a statement on the matter. [10817/04]

As the Deputy is aware, I established the Forum on Fluoridation to review the fluoridation of public piped water supplies in Ireland. The forum report's main conclusion was that the fluoridation of public piped water supplies should continue as a public health measure.

The forum also concluded that water fluoridation has been very effective in improving the oral health of the Irish population, especially of children, but also of adults and the elderly; the best available and most reliable scientific evidence indicates that at the maximum permitted level of fluoride in drinking water at one part per million, human health is not adversely affected; and dental fluorosis is a well-recognised condition and an indicator of overall fluoride absorption, whether from natural sources, fluoridated water or from the inappropriate use of fluoride toothpaste at a young age. There is evidence that the prevalence of dental fluorosis is increasing in Ireland.

In all, the report of the fluoridation forum made 33 recommendations covering a broad range of topics such as research, public awareness, and policy and technical aspects of fluoridation. The establishment of the expert body recommended by the forum is now well under way. I am pleased to announce that the chairperson of the expert body is Dr. Seamus O'Hickey, former chief dental officer with my Department. Dr. Hickey's mix of scientific knowledge, awareness of fluoridation issues and experience of administrative issues leaves him well placed to chair the body. The expert body is to be known as the Irish expert body on fluorides and health. It will meet at the end of this month.

The terms of reference of the expert body are: to oversee the implementation of the recommendations of the forum on fluoridation; to advise the Minister and evaluate ongoing research, including new emerging issues, on all aspects of fluoride and its delivery methods as an established health technology; and, as required, to report to the Minister on matters of concern at his or her request or on own initiative. It has broad representation, including from the areas of dentistry, public health medicine, toxicology, engineering, management, environment and the public, as identified within the forum on fluoridation report. Letters of invitation have been issued to prospective members of the body. It will have a strong consumer input in terms of members of the public and representatives of consumer interests, in addition to the necessary scientific, managerial and public health inputs.

The secretariat of the body will be provided by the Irish Dental Health Foundation, an independent charitable trust which has been very much to the fore in securing co-operation between private and public dentistry and the oral health care industry in regard to joint oral heath promotion initiatives. The foundation's stature and expertise place it in an excellent position to support the work of the forum in its initial stage.

The forum's report envisages that the work of the expert body may be subsumed into the health information quality authority, HIQA, in due course. The support of the foundation allows us to press ahead with the establishment of the expert body in advance of the establishment of HIQA.

I am here on behalf of my colleague, Deputy Gormley, our party's health spokesperson. I am grateful for the opportunity to speak on the Peamount Hospital issue.

Deputy Gormley would welcome the appointment of Dr. Hickey, regardless of whether he would agree with him on all issues. It is some progress. The Minister will be aware that it has taken 18 months to put together the expert body. The Green Party has questioned the status and impartiality of the Dental Health Foundation as the group to push things forward. However, I can say no more in my capacity other than that Deputy Gormley looks forward to raising issues in regard to any reports the expert group may draw up on the matter.

I accept the Deputy's points.

Hospital Services.

Gerard Murphy


10 Mr. Murphy asked the Minister for Health and Children the efforts he is making to reduce waiting lists and the lengths of periods for patients on waiting lists to see consultant endocrinologists; and if he will make a statement on the matter. [10866/04]

Paul Connaughton


34 Mr. Connaughton asked the Minister for Health and Children the paediatric care services available in the health system for children with diabetes; and if he will make a statement on the matter. [10850/04]

Joe Costello


70 Mr. Costello asked the Minister for Health and Children if his attention has been drawn to comments made by a consultant (details supplied) which described the state of services for children with diabetes as a scandal and medically indefensible; the steps he is taking to ensure that adequate services are available to children with diabetes; and if he will make a statement on the matter. [10803/04]

I propose to take Questions Nos. 10, 34 and 70 together.

There are two main types of diabetes mellitus. Type 1, or insulin dependent diabetes mellitus, accounts for approximately 10% of patients and affects mainly young people. Type 2, or non-insulin dependent diabetes mellitus, accounts for 90% of all cases and affects mainly middle-aged or elderly people.

Patients with diabetes mellitus are diagnosed and treated in a number of different settings within the health services. The majority of patients, particularly those with type 2 diabetes, receive their treatment at primary care level. Other patients, particularly those with type 1 diabetes, receive their care primarily in the hospital setting, usually from a physician with a special interest in diabetes or, in rarer situations, from an endocrinologist who specialises in the treatment of diabetes.

Children diagnosed with diabetes usually require hospital admission for the medical management of their acute condition and the commencement of their diabetes education. Acute centres that provide diabetes care for infants, children and adolescents are outlined in the following table:

Health Board/Authority


Eastern Regional Health Authority

Beaumont Hospital; Mater Hospital; St. Columcille’s Hospital, Loughlinstown; St. James’s Hospital; St. Vincent’s University Hospital; Adelaide and Meath Hospital, incorporating the National Childrens Hospital at Tallaght; Children’s University Hospital, Temple Street.

Midland Health Board

Midland Regional Hospital at Portlaoise; Midland Regional Hospital at Mullingar.

North Eastern Health Board

Our Lady of Lourdes Hospital, Drogheda; Cavan General Hospital.

North Western Health Board

Letterkenny General Hospital; Sligo General Hospital.

South Eastern Health Board

St. Joseph’s Hospital, Clonmel; St. Luke’s Hospital, Kilkenny; Waterford Regional Hospital; Wexford Regional Hospital.

Southern Health Board

Bon Secours Hospital, Cork; Cork University Hospital; South Infirmary Hospital, Cork; Tralee General Hospital.

Western Health Board

University College Hospital, Galway; Mayo General Hospital.

Mid-Western Health Board

Limerick Regional Hospital.

I recognise there is a need to expand and improve service provision to meet increasing demand. After detailed consideration and having had a series of meetings with the Diabetes Federation of Ireland to consider its strategy document, Diabetes Care: Securing the Future, I have asked the chief medical officer of my Department to chair a working group on diabetes. This group is charged with formulating a national framework for the future development and delivery of services for the increasing number of diabetics, including children, who require treatment. The group has been asked to examine the current and predicted epidemiology of diabetes, health promotion and preventative initiatives, including screening, current service provision, including the need to achieve better integration of care using current resources and facilities and the expansion of shared care programmes and future needs in terms of service provision and staffing.

Future planning in the care of diabetic patients will be informed by the recommendations of the working group which has been asked to report this year.

Given that the working group has not met since the end of January, the Minister might advise us why this is the case. Will he accept that people diagnosed with diabetes must wait up to 15 months for a hospital appointment to see a diabetes specialist and that there is a danger of developing complications over that period? The Diabetes Federation of Ireland, which recently attended the Oireachtas Joint Committee on Health and Children, pointed out that complications can arise during that period. It was also pointed out to the committee that the recommendation is for one consultant endocrinologist per 50,000 of the population. Currently there is one consultant endocrinologist per 150,000 of the population. Will the Minister agree that one consultant endocrinologist per 150,000 of the population cannot give the required service?

One paediatric endocrinologist per 200,000 of the population is recommended. There are currently just four part-time paediatric endocrinologists for a population of 1.4 million under the age of 18. We require one per 200,000 and we have one per 285,000. Will the Minister agree that an adequate service cannot be delivered with that level of expertise?

I agree that we need further concentration and expansion of services in the diabetes area. It did not come under the cardiovascular strategy. While many of the issues covered by the cardiovascular health strategy overlap with the diabetes issue in the preventative area, diabetes lost out as a by-product of that, even though not intentionally.

On consultant numbers, we are back to the fundamental issue facing the Irish health care service. We depend far too much on doctors in training. We need consultants to provide a service, plus a new consultants' contract. I accept there are not sufficient senior consultants in a range of specialties, yet we tend to become fixated about other aspects of the health care debate. In essence, this is the key issue. If we can resolve the consultant contract issue this year — this envisages a significant industrial relations process — and get agreement on the ratio between consultants and junior doctors, it will open up a significant potential dividend for the Irish health care system and the public in terms of wider access to a range of other specialties where we are historically below the levels that obtain in other European countries.

What effort is the Minister making to reduce hospital waiting lists? Is he aware that 2,026 patients had their procedures deferred at University College Hospital last year and 865 had their procedures deferred more than once for various reasons, including lack of beds and so on? Is he aware there is a four-year waiting list in the Western Health Board area for rheumatology? What is he doing about the serious issue of reducing waiting lists? Obviously the waiting lists are getting longer. In reply to my parliamentary question yesterday, he said it is a matter for the Western Health Board whether it appoints a second rheumatologist. It had €15 million left over in the last two years but it has not appointed a rheumatologist. Is the Minister or the health boards responsible for the substantial increase in waiting times? For example, in University College Hospital, Galway, 985 patients had their admissions deferred last year because there was no bed available. Some 406 admissions were deferred by the consultant, 275 were deferred by the hospital and so on. I do not think the Minister is aware of these figures. When I tabled a question on the matter, it was referred to the Western Health Board for answer. What is the Minister doing about reducing hospital waiting lists, which is the essence of this question? It appears he is doing very little because hospital waiting lists are increasing. Can we get some information on the appointment of a second rheumatologist in the Western Health Board area?

When this issue arose in the context of the Hanly debate, we made the point that the model we want to bring forward ultimately offers the best guarantee in terms of regional self-sufficiency in specialties such as endocrinology, rheumatology and so on.

The facts do not support it.

This is the ultimate gain to be derived from the blueprint we are trying to put forward, without undermining the basic hospital infrastructure in a particular region. There are some macro issues that must be resolved.

On the individual cases referred to by the Deputy, it is the responsibility of the health boards within their own resource constraints to prioritise what specialties they will concentrate on and so on.

Can the Minister not correct the health boards?

This is why we are reforming the health structures. I made the point at the launch of the health service reform programme that there has been patchy development of specialties in different health boards throughout the country, depending on which got priority in the hospital or which priority in the region, following which the health boards make submissions further up the line. This underlines the case for a national hospitals agency that would examine the need for specialties and would have the power not just to analyse and advise, but to execute and reduce the plethora of waiting lists.

What has the Minister done to reduce the waiting lists? He has been in office for a long time.

We have done a great deal about them.

The Minister refused a second rheumatology post in Galway.

I do not refuse posts.

In my constituency there is a young girl who cannot find a place in a rehabilitation centre in Dublin. Can such a person be treated outside the State under the treatment purchase scheme? It is an emergency.

I do not know the specific case the Deputy has mentioned but the treatment purchase scheme has done a great deal to reduce the numbers who have been on waiting lists for a long time. It is getting through the lists quickly and nearly all hospitals are co-operating with it. The Deputy or the person's GP is free to contact the treatment purchase fund to see if the person can be treated abroad or elsewhere in the State through the fund. If we can make significant progress on waiting lists, the fund can be broadened to include lengthy out-patient lists.

Diabetes services in the Mid-Western Health Board are in dire straits. Children presenting with type one diabetes do not receive specialist medical care and are being looked after by a physician or they are recommended to attend diabetes centres in Dublin. This is serious and these children will run into problems later in life because they are not being dealt with now, creating burdens for the system in future. Does the Minister have plans to deal with the crisis in services in the mid-west?

Work is under way to develop a national approach to diabetes service provision and prevention. The early identification and diagnosis of children with type one diabetes is essential and much can be done with early intervention to ensure the quality of life of young people in that situation.

On the future of the shared care scheme for diabetics in the north Dublin area, does the Minister accept the importance of undertaking diabetes care, as far as possible, at primary care level? This makes for more effective use of resources and staff. The future of the shared care scheme is now in jeopardy.

I will see if anything can be done about the scheme but I cannot give any commitments. It was a private scheme funded from private sources but I will investigate it. The Deputy is right, the multi-disciplinary approach, with primary care and effective specialist nursing for children and young people, has been effective. If we can develop multi-disciplinary teams on a shared care basis with primary and secondary care providers, we can improve the situation for those with diabetes.

The Minister pointed out that the appointment of a second rheumatologist is a matter for the Western Health Board. Will the Minister ask the board to spend the €15 million surplus it has on the appointment of another rheumatologist to reduce the waiting time from four years to a reasonable period so that people are not suffering while appointments are cancelled?

The Western Health Board will prioritise its appointments within the resources it is given. We sanction posts and they then go to Comhairle na nOspidéal for approval.

Who is responsible for the appointments? The Minister should not fudge the matter.

Does the Minister have any control over the matter?

Written Answers follow Adjournment Debate.