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Dáil Éireann debate -
Thursday, 1 Jun 2006

Vol. 620 No. 6

Priority Questions.

Nursing Homes Inspectorate.

Liam Twomey

Question:

1 Dr. Twomey asked the Tánaiste and Minister for Health and Children the efforts she has made to introduce an independent nursing home inspectorate; and if she will make a statement on the matter. [21492/06]

On 7 April 2006, in line with commitments I gave during the debate on the Health Act 2004, I published, for consultation purposes, the draft heads and general scheme of a Bill providing for the establishment of the health information and quality authority, HIQA. Included in the scheme is provision for the establishment of the office of the chief inspector of social services within HIQA. The office of the chief inspector will be assigned responsibility for the inspection of residential services for older people, including private nursing homes.

The public consultation on the draft heads concluded last Friday and I intend to seek Government approval as soon as possible to commence drafting the full Bill. It is my intention to publish the Bill during the autumn session.

This is a difficult point for many on this side of the House because the Tánaiste is doing nothing to protect patients in nursing homes. On this date last year, during Leaders' Questions, the Taoiseach stated: "The legislation will not be ready before the summer but will be introduced in the autumn". That was to be the autumn of 2005, not 2006.

Does legislation prevent elderly patients being tied to chairs or beds? Will it stop staff shouting at patients? Would it have kept alive Peter McKenna and many other elderly patients in similar circumstances? That is a question we and the Tánaiste should ask.

The Tánaiste has a terrible record with regard to legislation. She has a sense that the public does not understand legislation and, therefore, she does not have to care about what it means, which is an important point. The Minister for Justice, Equality and Law Reform has shown the public how important legislation is in the past week. The Tánaiste should give a much clearer answer as to why she has failed to deliver this legislation in the past 12 months.

We are in the House as legislators, which is our official title. However, we have failed to deliver the most basic legislation to protect vulnerable elderly people in nursing homes. It has been discussed and the Government included it in its election manifesto in 2001, otherwise known as the health strategy. It included it in its programme for Government when the Government was re-elected, promising to protect patients. When the Leas Cross scandal broke last year, the Tánaiste and the Taoiseach said all the right things when in front of the television cameras but in the past 12 months they failed miserably to deliver the type of legislation the House is supposed to deliver to protect elderly people.

It is not good enough to tell the House the social services inspectorate will be part of the health information and quality authority, when or if the authority sees the light of day during this Administration. The issue of the health information and quality authority Bill is currently out for public consultation. It may be back by September but it is also possible it will not see the light of day. We are not moving quickly enough in this regard.

In the past 12 months we have come back to the House with emergency legislation on at least two if not three occasions, and we will do so again tomorrow. It is a damning indictment that we are officially described as legislators yet this is the sort of carry-on we must put up with. The two-line response of the Tánaiste to my question is not good enough. I would prefer to know why she and the Department failed to introduce the Bill in the past year. What excuses are they giving each other? They need to fully comprehend the importance of this legislation and what it means. It is just another Bill lying around the Department for God knows how long, just as reports which the Tánaiste is afraid to publish are lying around. Where is the O'Neill report, which we have heard nothing about? We have Question Time to get proper answers.

The Deputy misunderstands the situation. I have been in the House for 25 years and was in the Seanad for four years before that. I mention that because there has never been a time when more legislation in the area of health was passed or in the pipeline than in the past couple of years. Legislation in the Department of Health and Children is getting much greater attention and priority because the focus and role of the Department is clearer as a result of the division of responsibilities between the Department and the HSE.

We published the health information and quality authority Bill but it was decided to pursue the social services inspectorate in a different way than had first been suggested. Instead of having fragmentation in the health services, given that we spent the past year bringing things together, we do not want to establish a host of new organisations and then at some future point try to bring them together, with all the associated cost and inefficiency. The decision has been taken to make the social services inspectorate, which will among other things inspect nursing homes, not just in the private sector which is the norm at present but also in the public sector, part of the body that has responsibility for setting standards for health service delivery. That is a sensible suggestion which has been well received.

I decided for good reasons to put the Bill out to public consultation. The consultation process closed last Friday. I am not sure if the Deputy made a submission but, whether he did, a number of submissions were made. I have not yet had an opportunity to study the submissions but I hope to do so soon. I want to take on board the good opinions and advice that will come from the consultation process.

The important point with regard to legislation, which I am sure the Deputy will acknowledge, is to have correct legislation. I will not suggest to the Deputy that legislation by itself will stop awful things happening to old people, whether in their homes or elsewhere. However, we will have legislation that will be enforced, we will have statutory backing for standards, we will have a multidisciplinary team of inspectors and those nursing homes in the public or private sector that do not meet the high standards will not be registered and, therefore, will not be in a position to operate as nursing homes. This is a radical departure from the current situation, where the inspection process is part of the organisation that must deliver services, which is the way it has always been in this country but which is not appropriate. We will have robust legislation. A number of questions will be dealt with later, including one on Leas Cross.

I am not withholding any report. I have not seen Professor O'Neill's report or received it from the HSE, which commissioned it so I am not in a position to publish anything. Reports, whether we like it, must follow a legal process — it is a cumbersome process at times — or an injunction can be made against us to prevent us from publishing them, which would not be satisfactory. I have not seen the O'Neill report nor am I in a position to publish it. As soon as it has cleared the legal issues, it will be published, as it should be. Concealing information is not on my agenda, which is why in recent days we extended freedom of information to a host of health organisations, which will be helpful.

The Tánaiste must have watched the programme on the disgraceful situation at Leas Cross. The health information and quality authority Bill was proposed as long ago as 2003. At what stage did she decide she would include the social services inspectorate in the Bill? Why are there so many delays? This should have become a priority. It was already well known that the Tánaiste wanted to introduce the Bill before the Leas Cross scandal. It became a priority for the Tánaiste, the Taoiseach and the Minister of State, Deputy Seán Power, this day last year. Only the public consultation aspect has finished. I did not make a submission to the Tánaiste because I consider it more appropriate to make my submission here where everybody is supposed to be held to account. I know the Tánaiste is inclined to take matters out of the House to take away democratic accountability but that is not right. What is the reason for the hold up? Why can we not move quickly and have the legislation by the end of October or November?

I said in my response that I hope to have the legislation in the autumn session but I want to have robust legislation. We have spent some considerable time during the past year working on appropriate standards and looking at best international practice in this area. We want appropriate standards that can be enforced so that when inspectors inspect places where older people and others reside, including children, they will know what to look for and that those units that do not comply with the standards will not be in a position to remain as a registered residential unit for older people.

Seán Ryan

Question:

2 Mr. S. Ryan asked the Tánaiste and Minister for Health and Children if she will report on the type of problems being identified in respect of the present unsatisfactory inspectorate system of private nursing homes; and the action which is being taken to address these problems. [21482/06]

The inspection of private nursing homes is the responsibility of the Health Service Executive under the Health (Nursing Homes) Act 1990. The 1990 Act provides for the registration and procedures for attaching conditions to the registration of private nursing homes and for de-registering homes. The Nursing Homes (Care and Welfare) Regulations 1993 set out the standards to which private nursing homes must adhere to remain as private nursing homes.

In accordance with the regulations, the Health Service Executive carries out inspections of private nursing homes. The HSE has inspection teams in each area. Each team comprises a senior area medical officer, a director or assistant director of public health nursing and a principal or senior environmental health officer.

Each nursing home receives an integrated report following inspection which contains recommendations on best practice, which are required for continued registration. Under the 1990 Health (Nursing Homes) Act and the 1993 regulations, the Health Service Executive can attach particular conditions to registration. Any deviation from these conditions can be subject to sanction. The type of breaches identified during inspection by the HSE include contracts of care with relevance to detail of fees and updating of fees, undertaking regular fire drills and maintenance of fire fighting equipment, hygiene levels, care levels, accident prevention policies, drug record maintenance systems, accuracy of staff rotas and appropriate stimulation-entertainment activities for clients to engage in.

Two inspections per year of every nursing home are required in accordance with article 44 of the regulations. In addition, the inspection teams carry out follow-up inspections as required and also conduct advice visits for prospective nursing homes. The HSE is committed to publishing inspections reports on nursing homes and this will happen from mid-July onwards.

That is the theory but, in practice, the position is completely different. Does the Tánaiste accept that older people in need of care, especially those who must leave their homes and go into long-stay institutional care, are among the most vulnerable in society? Does she accept we do not have a fair and equitable system of financing care? Does she accept we do not have clear and transparent rights and entitlements for older people in nursing homes? We do not have a system that ensures quality care is delivered. Does the Tánaiste accept we have allowed care facilities to develop in response to tax laws rather than to the real needs of older people?

Is the Tánaiste aware — this is some of the information sought in the question that I did not get — that as far back as 2004 and earlier, problems in nursing homes, such as staff shortages, nursing policy issues, maintenance and accommodation standards, hygiene, lack of activities for residents and lack of equipment, were known to her Department and officially recognised as such? Does the Tánaiste accept that nothing has been done? Does she accept that the lack of care of older people as well as the neglect of younger people, as witnessed in recent days, is the hallmark of the Government? Rather than speak about the issue, when will the Tánaiste deal with the issue?

I do not accept the Deputy's assertion. In Ireland, the majority of nursing homes in the public and private sector are of the highest possible standards. Those that have and cause problems are a tiny minority but, even if it is only one, that is not good enough. I share the Deputy's view that older frail people are among the most vulnerable in society, many of whom suffer from illnesses of the mind and may not be in a position to understand what is happening and may not have family members or others who can care for their needs. That is the reason they are entitled to look to the State for the highest standard of protection and care. We have laws in place. They are deficient and that is the reason we are changing them. We want to move to a position where the inspectorate is independent of the service provider and where the regulation and inspection is so robust that if nursing homes do not meet the requirements, they will not be in a position to continue to care for patients.

Leas Cross nursing home has been closed. I do not know if somebody else will acquire the property and open it as a residential care centre. One of the lessons everybody must learn if they care for elderly people is that it is not acceptable to society or to the authorities to have a level of care that does not meet the highest possible standards. I do not accept we have left the provision of care to mainly tax-based schemes. In this year's budget, the largest ever package for care of the elderly of €150 million in a full year was provided. That by a huge margin is the largest package ever provided.

My priority and that of the Government is to try to support as many older people as possible to remain in their homes. Some 28% of those in residential care have either a low or medium level of dependency and may not, in different circumstances, have required residential care if there had been home supports. We are seeking to put in place home supports. This year, approximately 3,000 are being supported at home through home care packages in addition to those who have home help and other supports. In the coming years, we may need to move to support approximately 7,000 to 10,000 or, perhaps, 10,000, 12,000 or 15,000 as the population ages. Clearly that will take time. When that support is in place, many more will be able to remain in their homes. Whether it is at home, which is usually the desire of every older person and their family, or in institutional care, we want to ensure that as a society we provide the resources, the services and the statutory framework to enforce high standards in order that older people can expect to live out their lives in dignity, with respect and with high standards of care.

What happens to older people who need care but for whom it is not provided in the community and who cannot get a health board place and cannot afford a private nursing home? That is a fundamental question posed by thousands of older people. Can the Tánaiste give me the answer?

We have provided €110 million this year, which is €150 million in a full year, towards additional supports for the elderly, including the provision of specific services in the community, because community services are not just about home care packages but putting in place therapists and others who can support people living in the community. Chiropody is an important service for diabetics. Physiotherapy and so on is also important.

In Ireland there are 20,000 people over 65 years of age in long-term care. That is approximately 4.5% of that age group. That is the international average for people over the age of 65. In different circumstances, perhaps 28% could be at home. The State has contracted beds in certain places where it has not been in a position to provide publicly funded beds. Nobody gets a bed for free. Some 90% of the cost is paid for in the public nursing home and people are expected to pay only 80% of their old age pension. In a private nursing home the position is different. It is inequitable and there are proposals relating to the funding of long-term care before the Cabinet which have been included in the social partnership talks. It is a major issue for society. How will we assess who is entitled to it? We all accept that everyone could not possibly be entitled to fully publicly-funded care in their older years, because that would not be affordable and would not be fair to those who are very well off. I want to see low and medium-income earners getting greater support, and the same support whether the State is in a position to provide a public nursing home bed or whether the individual must try to acquire one in the private sector. There has to be equality of support. I hope those policies will be finalised this month.

What the Tánaiste said gives no joy to the thousands of people waiting twelve and a half years on a waiting list for public nursing homes, and who will die before they get public beds.

What people are concerned about is a bed, whether it be publicly funded or privately provided. They want high-quality care in a residential setting regardless of who provides it. That is the challenge for us, to ensure we support that.

Hospital Services.

Caoimhghín Ó Caoláin

Question:

3 Caoimhghín Ó Caoláin asked the Tánaiste and Minister for Health and Children if she has received the report of the investigation into the death of a person (details supplied) at Monaghan General Hospital; and if she will make a statement on the matter. [21374/06]

Following the death of Mr. Patrick Walsh in Monaghan hospital on 14 October 2005, the Health Service Executive commissioned Mr. Declan Carey, a consultant surgeon at Belfast City Hospital, and an honorary senior lecturer at Queen's University, and Professor John Monson, professor of surgery, University of Hull, to carry out an independent and external review.

The HSE has advised my Department that a report has been prepared by the consultants and is now going through a necessary legal process prior to completion. This is normal procedure. My Department is advised by the HSE that it has been in touch with the family of Mr. Walsh and briefed them fully on the current situation. I have not received the report and it would be inappropriate for me to speculate on its contents.

Did the Tánaiste say she has received the report?

No, I have not received it.

When does the Tánaiste expect to receive the report, and why has she not yet received it? Can she say when it was concluded, and to whom it has been presented? Has it been given to the Walsh family, or has the family seen it?

In the wake of the tragic and unavoidable death of Pat Joe Walsh, the Tánaiste said:

Regardless of what policy operates in any particular hospital, there is no excuse for anybody dying unnecessarily because they cannot get access to appropriate medical care.

Does the Tánaiste accept that what is at issue here is not the policy in Monaghan General Hospital? Does she accept that the issue is the policy she and her Department have been pursuing, and the HSE embargo on acute surgical emergencies being dealt with at Monaghan General Hospital? Those are the underlying contributory factors. The embargo meant that members of staff at Monaghan General Hospital were prevented from performing a life-saving operation on Pat Joe Walsh. Does the Tánaiste accept that the members of staff at the hospital want to be able to deal with emergencies, that they want accident and emergency services restored to the hospital, and that they have the wholehearted support for the community?

Does the Tánaiste remember that in September 2005, the month prior to the tragic death of Pat Joe Walsh, all the consultant surgeons at the Cavan and Monaghan hospital sites made a public appeal for Monaghan General Hospital to be allowed to go back on call for surgical emergencies? After all that has happened, will the Tánaiste now, belatedly, listen to that appeal and help to avoid further tragedies being visited on our families in County Monaghan, so many of whom have now suffered the avoidable loss of one of their number?

I confirm I have not received the report. I understand it has been completed in recent weeks. The process is that if one is drawing any adverse conclusions about any individual, individuals or institution, they must be given an opportunity to respond, and that response has to be included before the report can be given to anybody, under natural justice and so on. For example, with regard to the Our Lady of Lourdes Hospital inquiry, the response of the Medical Missionaries of Mary was included in the report. That has to happen.

That is the process which I understand is under way regarding the report of which we are talking. I think the report has been given either to individuals or institutions — I do not know who they are — against whom findings have been made. They are then given the opportunity to respond.

In a very different situation, the Minister for Arts, Sport and Tourism recently commissioned a report into the activities of Bord na gCon, and the Attorney General advised him and the Cabinet that before the report could be published, the people mentioned in it, or identifiable though not mentioned by name, had to be given a period of time to consider what was said about them and respond. I think the period was 15 working days or something of that kind. That is fairly normal practice in these situations.

I presume that with regard to the report we are discussing, that period of time will shortly be up, and the Walsh family will then get the report, and it will be published. There would be no reason for the report if one were not to learn from what happened and make sure it cannot happen again.

In her response, the Tánaiste talks of the report making adverse conclusions about any individual or institution. With respect, I am accordingly surprised she has not yet seen the report. Has Professor Brendan Drumm had sight of it yet?

The Walsh family, and certainly the people of County Monaghan and the staff at Monaghan General Hospital, will not tolerate scapegoating in this situation. We are very clear on the underlying reasons for the tragic death of Pat Joe Walsh. I am concerned that the Tánaiste says that a fortnight after its publication, while others are having an input, or have been appraised, the Tánaiste has not been appraised.

What is the Tánaiste's proposed course of action now that the report has been published? Has she spoken with the Walsh family, or has the family an understanding of how soon the report will be made available to them?

On a related matter, what can the Tánaiste say to the people of County Monaghan to follow the HSE statement that it cannot guarantee the future of emergency services at Monaghan General Hospital now that we have lost emergency surgery? This is the ongoing drip, drip, drip loss of every crucial element which makes up an acute hospital site, and is a serious matter. What answer has the Tánaiste to the collective appeal of the entire surgical department, all the consultant surgeons in Cavan and Monaghan hospitals in the month prior to the tragic death of Pat Joe Walsh? If that appeal of September 2005 had been acted on and we had the restoration of emergency surgery at Monaghan General Hospital, Pat Joe Walsh could very well be alive today and his family would not have had to suffer the terrible grief visited on it. It is surely time to recognise what is needed. Will the Tánaiste act in the full information now at her disposal? Nobody can be blind to what is now needed.

Where stands the latest of the many reports on hospital services in the north-east commissioned by the HSE? What can the Tánaiste tell us of that?

If we all knew why the late Pat Joe Walsh died, we would not have needed a report in the first place. The report was written by two very eminent independent clinicians, one from Northern Ireland and one from the UK. We sought people from outside the jurisdiction to get an objective assessment of what happened on that famous night. If we had known all the answers we would not have needed to do that.

Clearly there is no adverse impact on the late Pat Joe Walsh or his family, so the issue of sending the family a copy of the report in advance for their comments does not arise. We have to follow due process so that we can have a report which is publishable, which is what everybody would like to see and it is what is on the way. I have not seen the report, have not discussed it with anybody and have not a notion what is in it. I wish we could have had the report sooner. I am advised by the HSE that the Walsh family had been briefed on the matter. There have been ongoing problems with the HSE north-eastern area. There are five hospitals for a small population base.

It does not have a small population base. That argument should not be pedalled.

It does.

That is not the truth.

It does. To provide the range of acute services at the level of development——

It has an expanding population.

The Deputy knows what happened in Northern Ireland when his party colleague had responsibility for health services. Let us be fair on this matter. The HSE commissioned an independent report into acute hospital services in the north east. The report is to hand and it will be published in due course.

Mental Health Services.

Dan Neville

Question:

4 Mr. Neville asked the Tánaiste and Minister for Health and Children her plans to increase the number of child and adolescent psychiatric inpatient beds; the number of such beds; and their location. [21373/06]

Most children with mental health problems are supported in the community. However, a small percentage of children and adolescents with mental health problems require inpatient treatment. Specialist public inpatient psychiatric services for children and adolescents are provided at Warrenstown House, Dublin and St. Anne's, Taylor's Hill, Galway, with capacity for the treatment of 20 inpatients.

A Vision for Change, the report of the working group on mental health policy, was published in January this year. The report addresses the future direction and delivery of all aspects of mental health services, including child and adolescent psychiatry. The Government has accepted the report and €25 million in additional funding has been provided this year for the further enhancement of mental health services. This brings the total funding for mental health services in 2006 to approximately €835 million.

A Vision for Change acknowledges the gaps in the current provision of child and adolescent mental health services and makes ten recommendations for the improvement of these services. In particular, the report recognises the need for additional child and adolescent inpatient beds. It recommends that urgent attention be given to the completion of four child and adolescent psychiatric inpatient units and that multidisciplinary teams should be provided for these units.

Project teams have been established by the HSE to develop four additional child and adolescent inpatient psychiatric units. The exact location of the units and the number of beds to be provided in each unit is being considered by the HSE. The recommendation is that there will be one in Limerick, Cork, Galway and Dublin. The approximate size of each unit will be 20 but there will be discrepancies in areas with larger populations. The aim is to ensure the units are located in the areas of greatest need and provide the most appropriate care setting for children and adolescents with mental health problems. Both the range of ages and the variety of disorders requiring inpatient treatment must be given careful consideration when planning child and adolescent inpatient services.

The mental health needs of children and adolescents are also being addressed by the appointment of additional child and adolescent psychiatrists, the enhancement of existing consultant-led multidisciplinary teams and the establishment of further teams. The number of child and adolescent psychiatrists' posts has increased considerably from 56 in 2005 to 70 in May 2006. Hopefully, this will have a knock-on effect in reducing waiting lists and the further provision for mental health services for children and adolescents.

The Minister of State has had a report for several years that claims the number of child inpatient beds needed is 148. With the rise in population, it has been calculated that the number now is 156. However he is proposing to establish only 80, 50% of the required beds. Some 16 and 17 year olds are inappropriately placed in adult psychiatric beds. How does he propose to tackle this problem? The Irish College of Psychiatrists has come out strongly on the need for proper care for this age group. Although the budget for psychiatric services has increased this year, will the Minister of State accept that since 1997 the percentage of the health budget allocated to the services has actually fallen from 11% to 7%? Is this not an indication of the Government's lack of attention to the development of the psychiatric services?

Will the Minister of State accept there is a deficit in the area of general psychiatric services? As a result there has been an increase in suicide. A vital approach to dealing with these issues is the provision of proper child and adolescent psychiatric services. Young children are not being treated for their difficulties. Due to the lack of resources, the service concentrates on the 12, 13 and 14 years old age groups. However, children in crisis at seven, eight and nine years of age are not being treated, leading to their difficulties becoming chronic.

In a recent reply to a parliamentary question on waiting lists for child and adolescent psychiatric services I was informed waiting periods are two years. This is inappropriate and unacceptable. Sexual abuse creates severe emotional problems for children and adolescents. Children abused by paedophiles have had to wait two years for counselling. Has the Minister of State any proposals to improve this situation?

Waiting two years for mental health services is unacceptable. That is why the Government and the HSE has increased child and adolescent psychiatrists by 20%. That should have a notable improvement in waiting lists. The Irish College of Psychiatrists argues there should be a full cohort of services for this age group. Opinion is divided on this. The working group did not accept that recommendation. It was of the view that all children up to 18 years of age should be treated by child and adolescent psychiatrists. Those over 18 years of age should be treated by the adult mental health services. Opinion is divided between psychiatrists, the HSE and the Department of Health and Children.

What is the opinion of the Minister of State?

In my opinion, children and adolescents should be treated up to the age of 18 years by the child and adolescent services. Otherwise, a situation could arise where an individual develops a psychiatric episode at the age of 14 years and is treated by one consultant up to the age of 16 years, then he or she would be treated by another consultant until 18 years and then transferred. This is not best practice and that is accepted by the expert group which examined the issue. I agree opinion is divided among psychiatrists.

The HSE and the Department of Health and Children are supporting the DETECT model of early diagnosis of psychosis. It is being rolled out in the Dublin area. It is proposed to roll out another model in a different environment, such as a rural area. I am considering this and seeking funding for it.

I am also consulting with general practitioners. The opinion of those in the medical profession such as general practitioners is that if the proper funding was given in the primary care area, there could be quicker diagnosis and treatment for young people with psychosis who need treatment. As I stated in my reply, the vast majority of people can be treated in the community. I am meeting a group of general practitioners soon to roll out a counselling and cognitive therapy service for people, especially young people, with requirements in this area. That is one of the recommendations of the expert group, that not all children or adults with psychosis should necessarily have to be referred directly to a psychiatrist and a multidisciplinary team. The feeling is that services need to be changed so people with psychosis and psychiatric problems should be sent directly to counselling or psychotherapists where the general practitioner is of that opinion.

Would the Minister of State accept that the number of psychotherapists is totally inadequate and that the Department and the HSE have not made any effort to increase the support systems to the psychiatric services?

In March 2005 the Minister of State announced the sale of lands to fund this properly. I understand, from his reply to a parliamentary question, that no movement whatsoever has been made on that. Not one piece of property has been identified which will go for sale. Recently, I asked for an inventory of properties that would be sold. Fourteen months after the announcement there is no inventory and no movement whatsoever.

My priority and that of the Government in the sale of any lands is based on the premise that first we must look after the clinical needs of any patients who are in these institutions. It is not simply a process of merely selling properties.

What of an inventory, so that we would know?

There is much work being done on it at present but the priority is to ensure the services are put in place in the community. That is being done at present.

It is not.

It is hidden work and is obviously not in the public arena.

Health Services.

Paddy McHugh

Question:

5 Mr. McHugh asked the Tánaiste and Minister for Health and Children her views on the development of the Tuam health campus; her further views on whether the project should proceed incorporating all the elements proposed in the Health Service Executive planning brief forwarded to her Department in 2002; and if she will report on her discussions and communications with the Health Service Executive on this project. [21354/06]

I am aware of the development proposals of the former Western Health Board for new and refurbished health facilities on the site of the former Grove Hospital in Tuam. This project has become known as the Tuam health campus. This site was acquired from the Bon Secours Order some years back and while a development control plan was prepared, this has not yet been advanced due to more urgent capital investment priorities.

In November 2005, I visited the east Galway area and, in a meeting with local management, was appraised of the HSE's development plans for the Tuam area, including a community hospital, an ambulance base, a primary care centre, mental health services and administrative facilities. I urged that these plans be advanced in accordance with its service plan and capital programme. My staff have maintained ongoing informal contact with the HSE since then.

The capital plan of the executive for 2006 has been agreed by me and provision has been made for the phased development of the Tuam health campus. I am advised the HSE has commenced the process of recruiting a project manager for the development. The immediate task of the project manager will be to review the current pattern of service provision in the area in respect of all existing and planned services. This will update the planning brief previously prepared for the site in 2002.

In addition to maximising the integration of all health and social services on the site, the HSE will explore possibilities for inter-agency and inter-sectoral co-operation for the benefit of the town and the people of Tuam.

The HSE believes that a significant opportunity now exists to develop a model integrated primary and continuing care facility on the Grove Hospital site and I fully support this perspective. The funding required to complete such a facility will be significant and it is a matter for the HSE to determine the priorities for investment in line with the resources available to it over the coming years.

I thank the Tánaiste and Minister for Health and Children, Deputy Harney, for her reply. I thank her for accepting the case put forward for Tuam Hospital, sanctioning phase one and making that initial allocation available.

She mentioned in her reply that a project manager was appointed. Is that person from inside or outside the HSE, and what is that person's function?

There are three basic elements in the Tuam health campus: a community hospital, a primary care unit and an ambulance base. There is an urgent need for the immediate provision of an ambulance base. I note €1.8 million is set aside for ambulance services. Can we take it this will be expended on providing an ambulance base in Tuam immediately and that this can proceed while consideration of the community hospital is ongoing? Can we also take it that X-ray facilities will be provided in the town to serve that region of north-east Galway, south Mayo and west Roscommon, and that we need not wait for those services while the community hospital plans are being developed?

I assume the project manager is someone from within the HSE. That would be normal.

Deputy McHugh asked about the function of the project manager. As he will be aware because he is familiar with this, it is an eight acre site and the original plan in 2002 was to use all of the site. We believe it will not be necessary to use all the site and I hope some of the site can be disposed of to leverage the funding to complete the investment, but that matter would have to be decided by the HSE. Perhaps a public private partnership may be in order, for example, in the case of the primary care facility, where local general practitioners may be interested in being involved in the project.

I do not have the answer to the Deputy's supplementary question on whether the ambulance service, on which I will communicate with him, can proceed in advance of the project. I share his view of the importance of the need for an ambulance base in east Galway and hope the base can be progressed.

I want to confirm that when the Bon Secours Order sold the site there was a view it all had to be held for health purposes. That is not the case and the HSE has confirmed that. I am aware that has caused some confusion in the area. It may well be that a portion of the site will be disposed of and the resources leveraged from that disposal would be used to fund the project involving the community hospital, the ambulance base and the shared services facility which I mentioned earlier.

The Minister stated that the primary care unit may be provided through a public private partnership. I understand she stated previously that the community hospital may be provided under a public private partnership arrangement also. If that was the case, could we expect that expressions of interest or the process concerned would take place fairly soon?

Yes. Clearly, whatever services are provided there will be for all patients. There will be no question of it being restricted to private patients. However, it may well be that local general practitioners, in conjunction with the HSE or others, may decide to provide a primary care facility there. There may be an interest in using the current tax breaks to provide the capital costs of the community hospital and the State would then obviously resource and operate it, or certainly buy services. We need to be innovative in the way we develop the facility. I hope it can happen quickly and that is the intention.

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