Dáil Éireann debate -
Thursday, 19 Oct 2006

Vol. 625 No. 6

Adjournment Debate.

Health Services.

Mr. Rabbitte

I thank the Leas-Cheann Comhairle for calling me on this important subject.

There was a public protest in my constituency in Tallaght last Saturday, organised by the mayor of the county and the Labour Party, at which 4,000 people were present. It is only an indicator of the scale of public concern in the greater Tallaght region about the implications of the Government decision on a new national children's hospital, and the apparent implication of it for the retention and development of paediatric services at Tallaght Hospital. There are also implications arising from this decision on the downgrading of Tallaght Hospital itself.

Somebody was quoted as saying — I believe it was Mayor Eamonn Moloney — that 30,000 children were treated at Tallaght Hospital last year and that was 30,000 good reasons for ensuring the National Children's Hospital continues at Tallaght. There is no exaggerating the concern among parents and members of the public in the most densely populated area of the prospect of paediatric services being scaled down at Tallaght.

The situation would appear to be that following the development of a new national children's hospital, we may get what is termed as an urgent care centre at Tallaght. We do not know this because we cannot get clear answers from the Government. Although we do not know this, we would expect that if urgent care centres mean anything, one is likely to go to Tallaght.

From the perspective of the people of Tallaght, some of whom spent 20 years campaigning for the hospital at Tallaght, an urgent care centre is no more than a glorified clinic. It certainly does not meet the needs of people in the area, where there are so many people at the family formation stage and where all the modern day arguments about traffic, congestion, accessibility, communications, etc, apply.

The Government tends to indicate that the McKinsey consultants made this decision. The Government made this decision. The McKinsey consultants were brought in to advise on the ideal provision of paediatric services for a population of about 5 million. They were expressly prevented in the terms of reference from having regard to the current configuration of services and from deciding on a site. That was a Government decision.

I see much merit in the recommendation put forward by Archbishop Eames. It suggests that the best arrangement for Ireland is a single governance structure with two campuses, one northside and one southside at Tallaght. That does not mean the complex tertiary requirements would all have to be done in both locations. However, that would allow for the retention and development of paediatric services on a southside campus, in this case Tallaght, which would be accessible not just to the immensely populous region of the hinterland, but to people who travel from Cork, Mayo and Galway, etc. It is as much a struggle to get from Portlaoise to Newlands Cross as it is to get from Newlands Cross to the Mater Hospital.

The difficulty is that we cannot get any clarity from Government. The rather extraordinary procedures that were pursued in the making of this decision, and on which I have spoken on other occasions, have added to the concern and worry in my constituency. In submitting its tender, in the short timeframe allowed, the board of Tallaght Hospital drew attention to the nine McKinsey criteria, which included space, services, co-location, access, efficiency, people, teaching and research, financial stability and full project plan. They concluded that no other location met those nine requirements as well as Tallaght Hospital, and that conclusion has never been challenged. It has co-location with a major teaching hospital, ample space on the campus and offers the required services with a proven track record of expertise. It is accessible from all parts of the country, is efficient and has the necessary staff.

We do not know what the future holds for Tallaght Hospital. It is the conviction of the leadership of the hospital that if, as seems to be the import of the Government decision, all paediatric and tertiary services are transferred out of Tallaght and Crumlin to the Mater Hospital, it will not just be a blow to parents looking for services for their sick children but will impact on the stature of Tallaght Hospital itself, downgrading it when we should be planning for its continued development with the provision of maternity services and the retention and development of the paediatric services that are currently offered. I hope the Minister of State will be able to throw some light on the Government decision during this debate.

Ms O. Mitchell

I wish to raise precisely the same issue as my colleague, Deputy Rabbitte. Senator Brian Hayes raised the matter in the Seanad, with particular reference to the method used to select the tertiary hospital. That certainly needs explaining because, in terms of accessibility alone, it is difficult to think of anywhere less accessible than the Mater Hospital.

My concern is over the decision that the tertiary hospital, wherever it is located, is to be the only hospital providing paediatric services to children in Dublin. It makes absolutely no sense to run down or eliminate existing services which work very well and with which the public is absolutely satisfied. Many of us have known the writing has been on the wall for Crumlin Hospital for a long time, because it is a single specialty hospital, but it makes no sense to also run down and eliminate the services in the National Children's Hospital in Tallaght, leaving most of the children in the Dublin region with access to only one hospital where they will have to go even for ordinary paediatric services for the most common illnesses, rather than complex, tertiary services. Most childhood admissions to hospitals are for ordinary illnesses, often overnight. The idea of blocking expensive beds in a tertiary hospital for that kind of use is absolute nonsense and cannot be justified on expense grounds alone. Those beds will be so limited that Dublin children will not have access to hospital beds in the way the rest of the country might.

Parents understand that everybody cannot have a local hospital but do not understand how the rest of the country can have the services of a secondary hospital for the more common illnesses in addition to a tertiary hospital, while Dublin parents will only have access to the limited beds available in the national tertiary hospital.

I fully support the concept of having specialist services in one national tertiary hospital. To remove from a large swathe of the population vital, accessible children's services, and to abandon all the expertise and experience that has been painstakingly built up in the National Children's Hospital, Tallaght, over the years is economic, demographic and medical folly.

I do not know which bright spark decided that, uniquely for children in Dublin, the national tertiary hospital should also be their local hospital. Why is this arrangement being made for children but not for adults? Tertiary hospitals are required for all specialties but no one suggests we close all the adult hospitals in Dublin to provide the critical mass necessary to provide a tertiary service to the rest of the country. If anybody suggested the closure of five of the six major Dublin hospitals they would be laughed off the stage so why are we suggesting it for children? Just under 40% of the population live in the greater Dublin area. What on earth made anybody think one tertiary hospital would meet all the paediatric needs of the Dublin area?

I ask the Minister of State to heed what we say. I am not an alarmist but this is absolute nonsense. It is dangerous nonsense and has to be stopped.

Minister of State at the Department of Communications, Marine and Natural Resources (Mr. Browne)

I thank both Deputy Mitchell and Deputy Rabbitte. I see that Deputy O'Connor is also present and has an interest in the issue. I apologise for the absence of the Minister for Health and Children, Deputy Harney.

In late 2005, the Health Service Executive, HSE, at the Minister's request, undertook a review of tertiary paediatric services. McKinsey and Company were engaged by the HSE and its report, which was presented to the HSE in February, included a number of key recommendations, namely, the population and projected demands in this country can support only one world-class tertiary paediatric hospital; the hospital should be in Dublin, and should ideally be co-located with a leading adult academic hospital, that is, it should be within a practical walking distance of such a hospital; and the hospital should also provide all the secondary, that is, less complex, hospital needs of children in the greater Dublin area and these secondary services should be supported by strategically located urgent care centres. The HSE welcomed the report as providing a clear outline of how to provide the best hospital care for children throughout the country, in line with best practice.

It is worthwhile at this point to explain why the principle of co-location of the paediatric hospital with the adult hospital is so important. The McKinsey report emphasised that best outcomes for children are critically dependent on having breadth and depth in sub-specialist services, that is, a critical mass. To achieve such a critical mass, it is considered that tertiary centres should serve a population which is large enough to support a full complement of paediatric sub-specialists, co-located with an adult teaching hospital. The collaboration of adult and paediatric specialists creates a larger critical mass of specialists in a particular area, which in turn creates the platform for improved outcomes.

Arising from the McKinsey report, a joint HSE and Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital. Each of the six major adult academic hospitals in Dublin, including Tallaght Hospital, made a detailed submission to the task group. The task group concluded that each of the sites adequately demonstrated the feasibility of accommodating the proposed new paediatric hospital and a new maternity hospital.

However, the task group considered that three of the hospitals, the Connolly Hospital, St. Vincent's University Hospital and Tallaght Hospital, did not offer the necessary breadth and depth of tertiary services to complement the paediatric hospital and on this ground those three sites were ruled out as co-location options. Following assessment of the remaining sites, the group concluded that Beaumont Hospital was significantly less suitable, in terms of ease of access, than either the Mater Hospital or St. James's Hospital, particularly for the children of the greater Dublin area who will use the hospital for all of their hospital care. The task group found that both the Mater Hospital and St. James's Hospital demonstrated their ability to meet all of the assessment criteria set by the group and, on the basis of these criteria, it was not possible for the group to recommend one location on a basis that rendered it clearly distinguishable from the other. The group decided the selected location would have to develop clear cross-site, team-working arrangements with the corresponding adult specialist teams based at the other adult hospitals.

In the context of the current configuration of adult specialties, the group considered the Mater Hospital to be in a better geographical position than St. James's Hospital to facilitate a clinical network of critical adult and paediatric specialties. Accordingly, the task group recommended that the new national tertiary paediatric hospital should be built on a site to be made available by the Mater Hospital. The board of the HSE and the Government endorsed the task group's report and its recommendations. The Government mandated the HSE to move forward with the development of the new hospital and its associated urgent care centres, and to explore any philanthropic proposals connected with its development. The governance arrangements that will arise in the context of the amalgamation of the three children's hospitals will also be pursued, in particular the measures needed to ensure the new hospital is multi-denominational and pluralist in character.

The Minister is fully satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. The task group consulted widely in arriving at its recommendations, and gave detailed consideration to the key issues of access, governance, clinical values and site suitability. Each of the three existing paediatric hospitals expressed strong support for the development of a single paediatric hospital, and emphasised the need for decisions on the new hospital to be taken urgently. Paediatric consultant representatives expressed their willingness to move to the new hospital regardless of its location.

A joint HSE-Department of Health and Children transition group has since been established to advance the development of the new hospital. Among the key items to be addressed are the definition of a high level framework brief for the new hospital and the determination of the range of services and location of the associated urgent care centres required to support it. The group will have consultations with relevant stakeholders, which will include representatives of the National Children's Hospital at Tallaght. To date, no decision has been taken on the range of services to be provided at the National Children's Hospital at Tallaght in the context of the development of the national paediatric hospital and the associated urgent care centres.

The Taoiseach, the Minister and the chief executive officer of the Health Service Executive met with representatives of the Adelaide Hospital Society, including Archbishop Eames, in June to discuss issues relating to Tallaght Hospital. The hospital representatives expressed concern at the implications for the National Children's Hospital at Tallaght of the Government decision to endorse the development of a single national tertiary paediatric hospital at the Mater Hospital. They also discussed several other matters relating to the provision of hospital services at Tallaght. Development proposals submitted by the delegation, which have significant resource implications, have been forwarded to the Health Service Executive for consideration.

In a letter to Archbishop Eames following the meeting, the Taoiseach gave an assurance that the Government wishes the hospital to thrive on a sustainable basis as a focal point for the involvement of the minority tradition in the healthcare system and as a key health provider to an expanding local population. These objectives will be pursued in tandem with other compelling objectives, including the achievement of an effective and efficient hospital care system, which will deliver the highest possible standards of care within a framework designed to respond to the needs of patients at national, regional and local level. Arising from the meeting, it has also been decided that a review will be conducted of decisions taken with regard to the funding and development of the hospital. The arrangements for this review are being finalised.

Job Losses.

Mr. Broughan

Yesterday's confirmation that approximately 450 jobs are to be lost at Cadbury over three years is a shocking hammer blow for Coolock and Dublin's north side. Of the 1,500 member workforce at Cadbury, workers in Rathmore, County Kerry, and in Tallaght in west Dublin, will be affected but as 1,100 workers are based in the Coolock plant the most serious impact will be felt there.

My first thoughts are with those workers and their families who face the prospect of being made redundant over the coming months and years. This will be particularly difficult for many of the senior men and women who have worked at the factory for decades. These job losses will deeply affect Coolock district and its environs where in some areas there is up to 20% and 25% unemployment, despite the Celtic tiger. Cadbury has a decades-long connection with Coolock since its arrival in Ireland in 1932 and the factory on Oscar Traynor Road is a famous local landmark, providing work for generations of people.

People were always interested in working for Cadbury with intense competition for jobs as the company provided good wages and working conditions. Cadbury executives also supported employment initiatives undertaken by the Coolock Development Council, of which I was the first chairman in the mid-1980s, the Northside Partnership and the Northside Centre for the Unemployed. Their assistance was very important in the early days of those organisations and from that point of view too yesterday was a sad day.

Cadbury management has said it intends to undertake a change programme which will involve the investment of €100 million over the next three years and that it has invested €80 million since 1999 to restore competitiveness. I hope it follows through with this and new technology and that the remaining 700 or 800 jobs will be secure. This hammer blow to our region comes on top of a steady haemorrhaging of jobs from the local industrial estates, particularly Clonshaugh Industrial and Business Park which has lost dozens of IT companies to eastern Europe and Asia over the past seven years. These include flagship companies such as Gateway 2000 and Data Products, and Saronix and Terradata. Most of these businesses have not been replaced and their factories are lying empty. Over a year ago, when Tayto closed its famous north side factory with a loss of 98 jobs, I raised the issue of the failure of the IDA to attract jobs to the north side and urged Sean Dorgan urgently to change the IDA policy of directing jobs away from Dublin's north side. There is a need for less skilled jobs to be aimed at areas of high unemployment. So far that message does not seem to have got through to either Mr. Dorgan or the Fianna Fáil Party and the Fianna Fáil-Progressive Democrats Government.

The disgraceful rise in energy costs of well over 100% in gas prices for example and 60% to 70% in electricity during the lifetime of this Government has put a significant strain on business. The organisation for small and medium enterprises, ISME, describes the rising cost of energy as the "number one enemy" for business in this country. The Irish Exporters Association referred to "the unacceptably high increases in the cost of energy supply" which the Government needs to address urgently. IBEC has stated that perhaps 120 companies with over 52,000 workers are directly in danger of major pressures and downsizing, or even closure and liquidation, due to escalating energy costs.

Yesterday was a sad and regrettable day for Coolock and for the whole northside region. It is time for the Taoiseach and the Minister for Enterprise, Trade and Employment, Deputy Martin, to come forward with a strategy for our region to address competitiveness and energy costs and to implement it quickly. The organisations to which I referred earlier, in particular Northside Partnership, its chief executive officer, Ms Marion Vickers and chairperson, Mr. Willie Hamilton and their staff, the Northside Centre for the Unemployed and Coolock Development Council will be willing to liaise closely with Cadbury's management in respect of any retraining and reinstatement of workers affected by this restructuring programme. I urge the Government and Government Deputies to give the strongest possible financial and other assistance to the local organisations to enable them to do so.

Mr. M. Brady

Since the 1930s Cadbury has been a pivotal employer in the Coolock area and north-east Dublin. It has served the area well both in good and bad times. It was seen to be a privilege to work there. Cadbury is an institution in that part of Dublin, as well as one of the best known brand names in the country. In many cases, three generations of families have worked at the factory which employs 1,400 people.

From time to time, companies must modernise, streamline and restructure their operations. Like Deputy Broughan, when I first heard the news of the job losses, I was aghast at the swiftness of the decision. In a letter I received from the chairman of Cadbury yesterday, I was informed the 450 job losses will be on a phased basis over three years, hopefully on a voluntary basis. I contacted the office of the Minister for Enterprise, Trade and Employment and was assured the full details of the Cadbury package will be made known. As a former trade union official with the Communication Workers Union, I was involved in working out voluntary redundancies and early retirement schemes, and it is not as bad as some may believe.

The Minister assured me he will meet the unions, the workers and management of Cadbury. With an announcement like yesterday's, an unsettled atmosphere can be created among the staff who remain. People often ask who will be next to be laid off. I want to know what is planned for the next 15 years in Cadbury. I understand the company must streamline to be competitive to ensure it can give good employment in Coolock.

I recall when more than 60 people were laid off from a plastics factory in Coolock. FÁS retrained many of these workers and redeployed them in employment in their own area. I hope the same can be done for those affected in Cadbury. Cadbury must consult the Department of Enterprise, Trade and Employment and the employment agencies to ensure the workers are well informed of their options before the job losses come into effect. The Minister has informed me consultations will take place to reassure those not affected of their continued employment at the plant. As a former trade union official, I joined Fianna Fáil because I believe it is the party that protects the workers and will continue to do so.

Mr. Browne

When the Minister for Enterprise, Trade and Employment, Deputy Martin, returns from abroad, he will meet Deputies Broughan and Martin Brady to discuss this issue. Both the Minister and Enterprise Ireland were aware for some time that the company was carrying out a strategic review of its operation in Coolock. It was only completed recently. During the course of the review, the company chairman, CEO of Enterprise Ireland and senior management from both organisations have been in discussions.

The Coolock facility is one of 11 similar facilities Cadbury has in Europe, the Middle East and Africa. Concern was expressed at the high level of operating costs at the Coolock plant and it was decided its current business model was unsustainable. Cadbury was faced with either the full closure of the operation in Coolock or to streamline and increase efficiencies. The latter option will require a reduction of 400 to 450 jobs on a voluntary basis over the next three years. Management and the unions will discuss the best way to achieve this. I am heartened by the commitment given by the company to the long-term future of the Coolock plant.

The Government is conscious of the effects the job losses will have on the workers involved, their families and their community. It is distressing news for those who will lose their jobs. The relevant State agencies will provide every support they can. The priority will be to find alternative employment for those involved at the earliest opportunity. The role of FÁS will be of particular importance in providing support and assistance to the workers concerned. The Minister for Enterprise, Trade and Employment, who is abroad on official business, has been following the case. Enterprise Ireland has been working closely with the company for some time.

There is a significant churn in employment. Traditional low-cost industries are under pressure and are closing, while other industries, especially the service industry, are providing much employment. In the past six years, more than 440,000 jobs were created in services and 150,000 jobs in high-end manufacturing, a significant turnaround in the nature of employment. Long-term, sustainable economic growth and expansion in employment depends on a competitive and adaptable economy. The effects of globalisation are felt in even the smallest markets and global competition will intensify and extend its reach. The Government has recognised the inevitable changes taking place across world markets for both trade and investment. Enterprise policies that equip companies with the ability to better compete in world markets, capture the opportunities from globalisation and build competitive advantage in innovation and knowledge have been central to policy development.

The impact of globalisation on Ireland has to be put in perspective. In the past eight years more than 523,000 people have been added to our workforce, an unprecedented growth of 35%, with more than 2 million people in employment. Job relocations, which inevitably arise in the globalised marketplace, are far exceeded by new job creation, usually accompanied by better paid high skilled employment. Furthermore, unemployment continues to fall.

The best response to globalisation is to ensure Ireland remains attractive for investment and enterprise growth. As the economy has matured, foreign direct investment incentives have been tailored to match our strengths. Low wage costs are no longer an enticement but have been replaced by other attractions. These include a benign tax and regulatory environment, a better educated workforce, an improving infrastructure and a commitment to world-class standards of research, development and innovation. Maintaining and improving upon these standards is vital to sustaining Ireland's competitiveness.

The IMD world competitiveness scoreboard ranked Ireland as the world's 11th most competitive economy in 2006, up one place on last year's position. The agencies under the Department of Enterprise, Trade and Employment are working to maintain Ireland's attractiveness to foreign investment while assisting indigenous industry. In 2005, the IDA supported more than 50 research and development projects related to business investment to the value of more than €275 million, a record both in number and value for the agency. Enterprise Ireland has introduced a productivity improvement fund for indigenous enterprises to improve levels of productivity through technology acquisition or labour force training. In 2005, Enterprise Ireland helped 515 client companies invest more than €100,000 each in meaningful research and development, with 33 companies investing more than €2 million. With this and other assistance, Enterprise Ireland is making significant progress in helping Irish enterprises to improve their export performance, with growth of 7% in 2005 and 15% in exports to Asia.

Dublin has been a success story in terms of foreign direct investment, FDI, with a critical mass of population, skills pool, educational infrastructure, international access connections, existing business activity across all sectors and extensive property solutions for future activity. New company arrivals in 2005 included Google, eBay, Kellogg and QLogic and, in 2006, SanDisk, Actel and Sage.

The Government strategy for Dublin is to progress the development of a knowledge economy so that the region can compete both nationally and internationally for foreign direct investment; work with the existing client base in Dublin to encourage it to expand and diversify into higher value added goods and services; act as a broker with the higher education authorities, key client companies and Science Foundation Ireland to encourage further research and development; provide modern property solutions with supporting infrastructure; and work with local authorities and other relevant agencies to influence the delivery of the necessary infrastructure in the county.

In 2005, there were 474 IDA companies in Dublin employing 48,178 people. The capital has traditionally been a centre for manufacturing industry for FDI. In recent years, however, there has been a shift away from manufacturing, due to cost competitiveness, to more knowledge-based higher value-added projects in fund management, e-commerce, software and high-end back office services. I assure the Deputies that the industrial development agencies will continue to promote north Dublin in order to create sustainable investment and job opportunities in the future.

I again apologise for the absence of the Minister. His officials have assured me he will meet both Deputies to discuss the matter further as soon as he returns.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 24 October 2006.