Priority Questions.

Hospitals Building Programme.

Liam Twomey


82 Dr. Twomey asked the Minister for Health and Children if she is satisfied that the selection process for the new national tertiary children hospital was rigorous, transparent and equitable and in line with best international practice; and if she will make a statement on the matter. [35754/06]

A review of tertiary paediatric services carried out by McKinsey & Company on behalf of the Health Service Executive, HSE, recommended the establishment of a single tertiary paediatric hospital in Dublin, co-located with a leading adult academic hospital. Subsequently, a joint HSE-Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital.

Based on this assessment, 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 task group's report and its recommendations were endorsed by the board of the HSE and by the Government, which mandated the HSE to move forward with the development of the new hospital and its associated urgent care centres and to explore any philanthropic proposition in respect of its development.

I am fully satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. The task group conducted a thorough assessment and consideration of criteria such as the breadth and depth of tertiary services necessary to complement the paediatric hospital, ease of access, governance and site suitability.

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 by the transition group 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 the new hospital. The group will consult with relevant stakeholders in the course of its work.

This is an extremely important issue. It is important that the selection process was transparent but the Minister's answer leaves me in some doubt as to whether it was rigorous and followed best international practice. I do not wish to make the charge that political interference occurred but this charge arises because people are unsure as to how this decision was reached. The Minister of State at the Department of Enterprise, Trade and Employment, Deputy Killeen, indicated in the Seanad that three hospitals were more or less immediately knocked out of this process because of the breadth and scope of their tertiary services. Given the Minister of State's assertion, the Minister should explain to the House the deficits in tertiary care that exist in St. Vincent's Hospital and the National Children's Hospital, Tallaght, which make them unsuitable sites for the new children's hospital.

If the Minister is insisting on closing down the National Children's Hospital, Tallaght, where does this leave all the other paediatric units across the country which are much smaller than the paediatric unit in Tallaght? Does the Minister also intend to rationalise the services in these units in the future when she examines the wider elements of paediatric care? These are extremely important questions. We need to find out how the Mater site was selected. Fine Gael has no difficulty with whatever hospital receives the new children's hospital but it has a considerable problem with how it is selected. The Minister has not made it sufficiently clear how the site was selected and her answers so far are not sufficiently transparent. She should also address the other questions. What is wrong with St. Vincent's Hospital and the National Children's Hospital, Tallaght, to render them unsuitable for tertiary paediatric services? What are the Minister's plans for paediatric units across the country which are smaller than the National Children's Hospital, Tallaght?

A total of six hospitals were considered as part of the process undergone by the group. These hospitals included the National Children's Hospital, Tallaght, St. James's Hospital, James Connolly Memorial Hospital in Blanchardstown, Beaumont Hospital, St. Vincent's Hospital and the Mater Hospital. The group felt that only three of these hospitals — Beaumont Hospital, St. James's Hospital and the Mater Hospital — had the breadth and depth of speciality needed to complement the paediatric hospital.

I am not a clinician and am, therefore, not in a position to say what the particular issues were, except to say there are not many tertiary facilities in the National Children's Hospital, Tallaght. The vast majority of children from that hospital's catchment area who have tertiary-related issues are treated at Our Lady's Hospital for Sick Children in Crumlin. As Deputy Twomey is aware, very sick children, regardless of whether their conditions relate to cancer or cardiac matters, are treated in Our Lady's Hospital for Sick Children, rather than the National Children's Hospital, Tallaght.

I understand the group narrowed it down to the Mater Hospital, St. James's Hospital and Beaumont Hospital. As a result of a number of other factors, including speed of delivery, it was felt that the Mater Hospital was the most central site and could be developed more quickly than the other two facilities, Beaumont Hospital being located on the north side of the city.

There will be urgent care centres. For example, the National Children's Hospital, Tallaght, has a bed occupancy rate of less than 40%. Thankfully, the vast majority of children who attend hospital do so for relatively minor events, day surgery or ambulatory reasons and do not require the kind of intensive care that will be available at this national tertiary hospital. There will, of course, be children's hospital facilities around the country. The new hospital will be a national hospital for those children who require very specialised treatment.

The McKinsey & Company report recommended co-location. In particular, there are considerable benefits when many hospital facilities are co-located. We can see these benefits even in large countries like the US. Given that Ireland has a population of only 4 million, the report argued very strongly that in certain specialties, it would be impossible to produce sufficient numbers of people to solely carry out paediatric work because the country simply does not contain enough children, given its small population base.

I was in the Children's Memorial Hospital in Chicago in the past two days. It is located about three miles out of the city but will move to a downtown city site to co-locate with an adult teaching hospital and a maternity hospital for much the same reasons that we are seeking to do that here. It has about 300 paediatrician consultants on its staff. It is operating on a scale much greater than anything we could have, yet it considers enormous benefits can be gained from co-location.

The question has not been answered. Will the Minister release the information that resulted in these hospitals being discounted so quickly? What is the breadth and depth of it? I understand the Minister is not a clinician but many people would like to know why the Mater Hospital was picked as opposed to any of the other hospitals. All they are looking for is the information on why the decision was reached. Concerns exist that it may not have been as clear-cut as the Minister has implied. The information should be released so that people know exactly why they were not selected. It should be made crystal clear why the HSE considered St. Vincent's Hospital and Tallaght Hospital unsuitable for a tertiary children's hospital.

If the Minister is still intent on closing the National Children's Hospital in Tallaght she should be aware it will have a significant impact on the many other paediatric units across the country. There are supposed to be joined-up policies in all aspects of the health service. What is the thinking of the HSE in this regard, as it will have a profound impact on aspects of the health service around the country? There is a need for the Minister to be honest with people about what she intends to do and why this decision was reached.

The Minister stated that the reason she wants to close the National Children's Hospital in Tallaght and Crumlin Hospital and amalgamate them on to one site was that the outcomes for children's cancer are the only ones in keeping with the EU average. That is an important fact. The Minister only got McKinsey & Company to look at paediatric services across the country. No attempt was made to examine tertiary services for adults across the country. Is there any request from McKinsey & Company to do exactly the same for adult services because that would impact on the future delivery of services? That is an aside and I do not wish to get into a discussion on the matter at present. The HSE should make known how it reached its decision and what its plans are for the future, not just for Tallaght Hospital but for all paediatric units around the country. The Minister should not hide behind the kind of answer we have been getting in recent months.

I am not hiding behind anything. We proceeded on the basis that we would build a new hospital in Crumlin with 400 beds and a new hospital in Temple Street with in excess of 200 beds, in addition to the facility in Tallaght. When the analysis was done the reason we came to this position in the first place was that many of the paediatricians in Dublin said to me that such an approach was crazy and that we should have brought services together years ago. This was not something I had ever reflected upon. That is how we came to the position of examining what we would do before it was too late and we had spent a great deal of money.

The same applies to adults but, unfortunately, there are more sick adults than sick children. Thankfully, there are relatively few sick children because children generally are healthy. With a population just in excess of 4 million, we are not justified in having more than one tertiary facility. In the case of adult treatments, we have to provide some tertiary facilities and they can only be provided on a single site basis. What we want to do on the adult sites is to develop regional facilities where people can be treated based on quality assurance, safety protocols etc. That is particularly important in the area of cancer care.

In the end, the decision came down to either the Mater Hospital site or St. James's Hospital. St. James's Hospital has the largest range of adult specialties. The Mater Hospital's advantage was that many of the paediatricians in Temple Street Hospital are also on the staff of the Mater Hospital. The site there could also be available more quickly because of the work that had been done on the redevelopment of both facilities. We want also to make arrangements for a maternity hospital because many of the children who will be treated there are neonates. It was for all those reasons that the decision was made. I assure Deputy Twomey that there is no question of closing Tallaght Hospital. The issue for that hospital is whether it will become an urgent care centre.

I asked the group to examine as a matter of priority where urgent care centres in Dublin should be situated and what should be their scope. Those matters must be agreed quickly. Anaesthetists and others will be required to perform day procedures. I cannot be certain, but, given the experience of the hospital in Tallaght, I would be surprised if the group did not designate it an urgent care centre.

Hospital Services.

Kathleen Lynch


83 Ms Lynch asked the Minister for Health and Children if her attention has been drawn to the fact that the number of children with diabetes being treated by the paediatric diabetes unit at Cork University Hospital has risen from 120 patients in 2002 to 207 in 2006; the extra resources which will be given to the unit to cope with this extra demand; her views on whether there is an urgent need to have a dedicated medical person appointed to the unit to give advice to parents on all aspects of their children’s health; and if she will make a statement on the matter. [35690/06]

My Department has been informed by the HSE about this matter and I have been advised that discussions are ongoing between the hospital, the parents' support group for children with diabetes and the network manager about the services provided for children with diabetes.

A post of clinical nurse specialist filled on an acting basis has been advertised for permanent appointment. A further clinical nurse specialist has also been appointed and will take up duty on 12 November. This increase in support will improve response time to phone calls for advice and insulin dose changes, improve access to education sessions and provide greater continuity of service for children by avoiding long periods without cover.

I am confident the HSE will continue to monitor the delivery of paediatric diabetes services at Cork University Hospital to ensure that the needs of service users are prioritised.

The Minister's answer epitomises what has happened on this issue since 2002. In 2002, 120 children with type 1 diabetes were treated at Cork University Hospital. This year, it is estimated that number will rise to between 207 and 215. As the Minister correctly stated, discussions between the parents' support group and the HSE are ongoing and have been taking place for 18 months. Local representatives are also involved in discussions. We hear different versions of the answer given by the Minister every time we attend a meeting.

The Minister's answer in written form, which I assume is correct because she has responsibility for this matter, states two full-time permanent clinical nurses will be in place from 12 November. Two weeks ago, the Deputies for the area were told two full-time nurses would be in place from 10 November but that one of them would be paid for by the private sector with a grant of €40,000 for one year and the other position would be filled by two part-time nurses.

It is easy to understand how the parents involved have become frustrated. No one knows what is the exact position or what it will be. The HSE states progress is being made and it has an estimate in for what the parents seek, including a full-time consultant — who will now be shared with other paediatric services — and three full-time specialist diabetic paediatric nurses. At present, 1.5 such nurses are in place, one of them for only one year. The parents also need a space dedicated to their needs instead of sharing with everyone else as they do now.

What the parents need to know is what the position will be. The requests made by the HSE are for a full-time consultant, a full-time dietician with expertise in this area and three specialist paediatric nurses with clinical expertise. I am sure the Minister has examined the Estimates for this year, particularly for this area. Is the answer given by the Minister today the same as that which the parents will receive next week?

I am informed a full-time clinical nurse specialist will start on 12 November. At present, a clinical nurse specialist is acting on a temporary basis and that post has been advertised for permanent appointment. That will mean a total of two nurse specialists.

With my support, the HSE recently advertised for 100 new consultants to be appointed to hospitals during the coming months. These appointments will be based on innovation. When I refer to innovation, I mean the hospitals which are performing well will get more consultants because it is clear we will get more from consultants who are applied to an innovative environment than if we appoint them in a traditional way. I do not know if Cork University Hospital will apply for consultants under that initiative but there is much interest from other hospitals.

On a more general point, adult and child diabetes should be managed in the community and treatment should not be hospital based, which is not best practice in other parts of the world. We are moving to ensure we manage illnesses such as diabetes on a community basis and the staff involved should work in a community setting. One of the major discussions we are having in the context of renegotiating the contract of employment with general practitioners is how what are essentially nurse-led clinics will manage type 1 and type 2 diabetes, which have very serious consequences for patients and the health care system.

Type 1 diabetes can take 20 years off one's life if it is not managed and type 2 diabetes can take ten years off one's life. I met a lady at a recent event who has had her diabetes managed for 67 years. She was perfectly healthy because it was well managed and she had not had many of the complications which, unfortunately, are suffered by other patients.

Diabetes is a major priority and challenge for the health service. I am conscious of the deficiencies that exist in Cork but I hope the appointment of the new nurse specialist will greatly alleviate some of the pressures parents are experiencing. In particular I hope parents can have their child assessed on a frequent basis rather than as an emergency case, which is what happens when there is not an appropriate service.

We all agree diabetes should be community managed. The difficulty in Cork is that diabetes is not managed at all, either in the community or the hospital. If we were to apply best practice in this area, we would have three nurse specialists, a committed consultant, a specialist dietician and a special area to which patients could come to have prolonged consultation on a frequent basis.

There were approximately 40 mothers with children from as young as 18 months up to 15 years of age outside Cork University Hospital this morning. In ideal circumstances, these people would probably tut-tut at anyone making a protest. However, the mothers have been driven to the point where they had to bring their children, who were being monitored, to the protest to highlight this issue. This is despite the fact the issue had already been highlighted in 2002 in a report on diabetes nationally in which Cork was earmarked as a blackspot with regard to the provision of treatment for type 1 diabetes, which affects children.

When a child is diagnosed in Cork, the parent is given a syringe and an orange and told to go home, to practise and that eventually they will get it right. The issue is more serious when children are involved, as the Minister knows, and there it is necessary to ensure a regular and constant balance with regard to diet, insulin injections and the energy children expend.

When things begin to go wrong for such children and their mothers telephone the nurse at Cork University Hospital, whether it is late in the evening or during the day, they will probably get an answering machine because the nurse works just two and a half days per week. They are lucky to get a call back the following week. There are parents in Cork who take their children out of the system there and bring them to Temple Street Hospital in Dublin, where there is a 24 hour call service and nurses bring their telephones with them to give the advice that is necessary.

Everyone agrees it should be a nurse-led service but hoping and wishing the system will be better is no longer good enough. The Minister knows the position and what needs to be put in place. The notion that she has instructed that 100 consultants be appointed is of no benefit to mothers in Cork given they are not certain one of the consultants will be available to deal with their children. Wishing and hoping for it is not good enough. What will the Minister do about it?

While the Estimates have not yet been published, it is no secret that this year the HSE will get at least an extra €1 billion to provide services around the country on a priority basis over the next year. We are fortunate that over the past nine or ten years we have been able to triple health funding because of the great success of the economy. Health Ministers from Europe and elsewhere tell me their challenge is to maintain services with increases of 2% or 3%, which in some cases does not even meet inflation.

As we increase funding, we must ensure we make appointments that make sense and on terms that make sense. That is why the 100 consultants the HSE has identified to appoint this year are not by speciality but by priority areas, particularly in hospitals where innovation is being embraced. I am not certain whether Cork University Hospital will qualify or has applied. I hope it has done so. Priority areas will receive consultant posts until we reach the stage where we can appoint the consultants we need for the health service over the next number of years.

I share Deputy Lynch's concern. Diabetes, if not managed early, has catastrophic effects on patients, their families and the health system and budgets. That is why this is a priority and I have had a number of meetings with HSE experts on how we can begin to have a community-wide initiative in 2007 to manage diabetes involving GPs and nurse-led clinics. If we can move into that space, it will be successful.

Infectious Diseases.

Caoimhghín Ó Caoláin


84 Caoimhghín Ó Caoláin asked the Minister for Health and Children the measures she is taking to ascertain the true extent of serious infections and fatalities from MRSA; the further measures she will take to tackle this crisis in hospitals here; and if she will make a statement on the matter. [35573/06]

The Health Protection Surveillance Centre, HPSC, collects data on MRSA as part of the European Antimicrobial Resistance Surveillance System, EARSS. This system collects data on the first episode of bloodstream infection per patient per quarter. The Irish data showed that there were 445 cases in 2002, 480 cases in 2003, 553 cases in 2004, 586 cases in 2005 and 285 reported cases in the first half of 2006.

This year Ireland participated in the Hospital Infection Society's prevalence survey of health care associated infections, HCAIs, in the United Kingdom and Ireland. The survey provides accurate and comparable data on the prevalence of health care associated infections including MRSA in acute hospitals in Ireland and can also be compared to similar data being obtained in England, Scotland, Wales and Northern Ireland. Preliminary results of this study are now available. The overall prevalence of health care associated infection in the UK and Ireland study, excluding Scotland, is 7.9%. The individual figures are England, 8.2%; Wales, 6.3%; Northern Ireland, 5.5%; and the Republic of Ireland, 4.9%, the lowest.

Active recruitment is ongoing within the HSE nationally to employ essential infection control staff, such as infection control nurses, hospital liaison pharmacists, surveillance scientists and clinical microbiologists. The HSE will shortly publish a three-year action plan which will set targets in this important area.

It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors. All medical practitioners have an ethical responsibility to complete death certificates as accurately as possible and this includes recording MRSA infection. Discussions are ongoing between the HSE and the coroner's office as to how best to ensure the accuracy of death certification can be improved.

The organisation MRSA and Families continues its work of collating the incidence of MRSA arising from hospitalisations in this State and will hold its second annual conference this weekend in Waterford. Is the Minister aware that the incidence of MRSA is increasing? Is she aware of the recent shocking case of a woman who presented at one of our hospitals for the removal of a kidney stone? She contracted MRSA through bed sores in her ankles and left hospital with both legs amputated. That is an astonishing fact. Does the Minister agree these are all preventable tragedies? What we require is proper hygiene and supervision and the implementation of the guidelines laid down as far back as 1995. Yet we see the alarming increase in infections and deaths being recorded. The Minister made a point about the coroner's office. Has she noted the requirement stipulated recently by the Dublin City Coroner for doctors to report to him all cases of death from MRSA prior to signing the death certificate? Does she accept this demonstrates the need for proper recording of these deaths? I believe this reflects the serious and growing concern among the public that the true extent of MRSA infection and its role as a primary or contributory secondary factor of deaths in our hospitals is not being recorded in all cases. While the Minister may show comparisons with neighbouring countries, as she did in her initial response, the truth is, as indicated by the concerns raised by the Dublin City Coroner, that the problem is much worse than the statistics suggest.

Will the Minister initiate action with her colleague, the Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell to insist that all coroners emulate the action of their Dublin city colleague? I am just looking at a number of particular points I believe are essential. For instance, will the Minister establish a national directorate for the inspection, prevention and control of MRSA? Will she expand the role of the Health Information and Quality Authority as regards MRSA? Does the Minister agree that these are specific actions that could aid the objective of reducing the incidence of MRSA to the maximum possible extent?

I accept the Minister is aware and appreciates the great frustration, hurt and pain of families who have lost loved ones to MRSA as well as those people who have had the harrowing experience of the loss of both legs as a result of being infected while in hospital merely for the removal of a kidney stone. I know she must share the same feelings. Will she now take on board the call of the MRSA and Families network for a public inquiry into the non-implementation of the 1995 guidelines? We need to see the guidelines for the control of MRSA implemented. Will she consider the example of a redress board, which the network has demanded, for the victims of MRSA in our hospitals?

The Deputy has a number of questions. The survey among different countries was a sample study of some 75,000 patients, 10% of whom were Irish. It was significant that our rates were much lower. I am not boasting about that, but simply pointing out that this is not often the message we hear. The Deputy asked whether I agreed that these matters were preventable. Unfortunately, they are not. There is no such thing as an environment where people will not contract hospital-related infection. The main reason we have higher figures for MRSA now is that there is more data available. In the past this was not measured. Nowadays there is much more measurement and that will reveal the type of data that was not available in the past.

The over-prescribing of antibiotics is a crucial factor worldwide, not just in Ireland. At the last general election in Britain, Mr. Tony Blair set a target of reducing MRSA and other hospital-acquired infections by a third over an eight-year period. Many would say that is a very low target, but it is nonetheless extremely difficult to achieve because of the difficulties involved in trying to eliminate hospital-acquired infection. The most common infection acquired in hospital is a urinary tract infection. That relates mainly to people who have a catheter-related infection, with the percentage being 56.2%. A large proportion of patients with pneumonia, some 18.5%, get ventilatory-related infections and so on.

We must have a hospital and health care environment which operates to the highest possible standards of cleanliness. The hygiene audit has proven successful. Second, we should have people in every health care setting who have responsibility for infection control. The hospitals that do best are those which have some senior person in charge of this. That is why we gave the HSE additional resources this year to recruit specialist nurses and microbiologists in this area. That is the only way of having the expert staff to ensure we have an appropriate environment within the hospital.

We should have more single rooms. On my two-day visit to the United States, the big issue there and in every other country is whether we should move entirely to single-bed rooms for infection control reasons. With these, the capacity of patients to acquire an infection is minimised, particularly for very sick patients in an environment where there is much sickness and people are extremely vulnerable.

We should not be complacent as we have much to do. The HSE is having discussions with the coroner, and I will pursue the matter with my colleague, as the Deputy suggested.

I thank the Minister for her reply. We all agree the kernel of the issue is hygiene and vigilance. The absence of same is the real contributory factor to the problem. Would the Minister not agree that hygiene issues arise for a number of reasons? Part of it can also be attributable to overcrowding and understaffing in our hospitals. Does the Minister believe there is a correlation and connection between both of these factors, which are very obvious and identifiable in many of our hospitals? They must also be tackled if we are truly to grapple with the issue of MRSA.

The Minister cited a number of countries for comparison. Is she aware of other countries with better results? I point her in the direction of the Netherlands as one example, as the Minister is probably aware of the success there. We should be comparing with best practice, not the sadder reality under Prime Minister Blair's Administration.

While accepting that the Minister has indicated she will look at the ideas mooted by the Dublin City Coroner, what we really need is accurate information, as well as real and concerted action. We require accurate information to establish the true picture. I am very much of the view that we are not seeing the full extent of either the primary or contributory factors of MRSA indepth in our hospital sites around this country.

With regard to concerted action, I made some points to the Minister in my opening contribution, which I will reiterate as the Minister did not respond. One was to establish a national directorate for the inspection, prevention and control of MRSA, and whether the Minister saw a role for the Hospital Information and Quality Authority in addressing MRSA. There were also two points raised by the MRSA and Families network with regard to a public inquiry and the establishment of a redress board.

The Minister has had to address such issues with other matters that have arisen with regard to hospital sites in this State. We are both very much aware of those. I do not believe for one moment that the issue of MRSA is going to quietly go away, or be suffered indefinitely by people without taking a serious stand. That is already apparent.

It is incumbent on the Minister, the Department and the Government to act now in a responsible fashion on this matter for all the right reasons, and not only because of the prospect of action by people who have suffered and lost loved ones from MRSA.

Hygiene has a factor to play in all of this, but the biggest contribution is made by the over-prescription of antibiotics. We must not forget that, as all the very strong evidence suggests, this is what has made our immune system so vulnerable to acquiring all kinds of infections, particularly in the developed world. Hygiene is still a factor and hospitals should be run to the highest possible standards. We have made major efforts over the past year with good and interesting results. The newest hospitals or those with most resources did not necessarily do best. In many cases old hospitals did well as a result of management. One of the first tasks of the Health Information and Quality Authority, HIQA, is to examine the matter of hospital acquired infection, particularly MRSA. I agree with the Deputy that HIQA is the appropriate body to do this.

The National Hospitals Office is headed by Mr. John O'Brien. He has a number of staff and is considering the recruitment of additional personnel for infection control. Staff are reporting to him on this matter and in time there may be a director at this level. One must consider who should be responsible in each health care setting, which is more important in the first instance.

Care of the Elderly.

Liam Twomey


85 Dr. Twomey asked the Minister for Health and Children the steps she has taken to ensure the publication of the Leas Cross report on deaths in Leas Cross by Professor O’Neill; and if she will make a statement on the matter. [35755/06]

It has not been possible to publish the Leas Cross report to date because of legal difficulties regarding its current format. The Minister sought legal advice from the Attorney General and has requested the HSE, in accordance with that legal advice, to engage in a further process to overcome the legal obstacles that heretofore prevented the publication of the report. The HSE has entered into such a process and has informed the Department that it hopes to publish the report on or about 10 November 2006.

It is vital that this report be published. Does the Minister of State agree it was his policy to place elderly people in any nursing home with no regard to the consequences or the level of care on offer? This is one of the core issues in the report. Does the Minister of State agree he is damned in this report, along with the Government and senior members of the HSE? His failure to publish this report gives the impression that it is a cover-up. It is important it is published for the sake of Ministers.

I have read the report and see no reason why it should not be published immediately. What are the legal matters that prevent its publication? There seems to be collusion between Ministers and senior members of the HSE to lie to the people. It is unbelievable that the Minister of State has implemented none of the recommendations of the report and that he has not commented on them. No legal matters prevent him from doing this.

How much did the former Minister for Health and Children, Deputy Martin, know about the situation in Leas Cross and other nursing homes over the past five years? Where are the senior staff of the HSE and former staff of the health boards and what do they have to say about this? They are not named in this report so no legal issues arise. The Minister of State need only worry about his own incompetence, which is scattered throughout the report. The report damns him for doing nothing over the past six years. The report states that Ministers of State were aware of what was occurring as far back as 2000. What briefing did the Minister for Education and Science, Deputy Hanafin, receive in May 2005 as referred to in the report?

What was Mr. Aidan Browne, national director of primary, community and continuing care, referring to when he stated he received no complaints from the clinical staff of St. Ita's visiting Leas Cross? It seems a huge amount of correspondence was sent between one of the doctors in St. Ita's and the HSE regarding the problems in Leas Cross. Was this incompetence or a cover-up? People deserve to know what Ministers and senior staff in the HSE knew. Why are these people remaining so quiet? There are no legal matters to be considered and if there are, they should be explained. There is no reason why the recommendations of the report should not be published. The Minister of State should answer rather than hiding behind lawyers and the Attorney General.

I am not sure what the appropriate reply is to the Deputy's question. He spoke before in this House about a cover-up when nothing could be further from the truth.

Has the Minister of State read the report?

The Deputy should allow me to answer because he has raised several questions. No one on this side of the House ever attempted to try to cover up this report. Following the television programme about Leas Cross the Health Service Executive asked Professor Desmond O'Neill to write a report on the deaths of residents in Leas Cross. That has been completed but there are difficulties and the HSE was legally advised not to publish it in its present form.

The Minister and former Tánaiste asked the HSE to work on the difficulties in the report to ensure that it would be published. On or about 10 November, next week, the report will be published, yet the Deputy continues to talk about a cover-up. We were always anxious that it would be published. There is little point in my commenting on the details or contents of the report, or the difficulties therein until it is published.

We were surprised at what we saw on the programme on Leas Cross. The decision to go into a nursing home is a serious commitment for any family or individual to make. It is important that we give the individual certain guarantees on the type of care he or she will receive while there. The programme made it obvious that the system operating then was not appropriate to provide what is required and what older people deserve when they go into a nursing home. We have worked on those areas and have promised legislation on that which will be published before the end of the year. We have also drafted new standards. We have made progress in ensuring that older people receive the care they deserve when they enter nursing homes. We never intended to cover up what happened in Leas Cross. We are happy to publish the report and learn lessons from the mistakes made in Leas Cross.

Is the Minister of State saying that senior HSE staff did not pass on concerns raised with them regarding Leas Cross, or any similar institutions, in the past six years, to any Minister? Were the Ministers blissfully unaware of what was happening in nursing homes around the country? While that may not verge on negligence, it verges on incompetence. It is almost criminal in regard to the senior HSE staff involved. It will be important for the Minister of State, when publishing the report on 10 November, to make clear what everybody, particularly the political Executive, knew.

Ever since the former Minister for Health and Children, Deputy Martin, washed his hands of all responsibility for the health services, this hand-washing seems to be endemic in Ministers. How can the Minister of State expect us to believe that he will look after elderly people when he has postponed all the relevant legislation until after the next general election? The Minister of State should make clear when he publishes the report how much he and each of the Ministers in the Department knew because its comments on the senior HSE staff and the Ministers is damning.

The Deputy said a few weeks ago that the report would never be published, now that I have given him a date for its publication he wants me to comment on it before then.

We have been waiting too long for the Minister of State.

Following the programme on RTE about Leas Cross I immediately wrote to the Garda Commissioner asking him to examine it to see if there was a case to be answered. The HSE asked Professor Des O'Neill to prepare a report, which has been done. This report has been completed and will be published next week.

Leas Cross nursing home is no longer in operation and has been closed down. I do not want to frighten people into thinking that what happened in Leas Cross happens in every other nursing home. From my experience, most nursing homes make an honest effort to provide a high standard of care to their patients. It is important, however, that a proper scheme is put in place to ensure this happens in every nursing home and not just the majority.

The HSE has adopted a policy of working with nursing homes. Where there are difficulties, it encourages them to change their practices to achieve a high level of care. It may not have worked in all nursing homes, but it has worked in many. Through a process of communication and regular callbacks, high levels of care have been achieved as a result of the HSE's intervention.

The legislation covering this area will be published this year. It is our intention, with the support of the Opposition parties, to pass it as quickly as possible. It is not intended to put it back beyond the general election. The Government has shown its commitment to older people and treated their issues as a priority through increases in the old age pension and the provision of an extra €150 million in the last budget. That money was targeted in areas where it had real benefit to people through home care packages, meals on wheels and home helps, improving the quality of the lives of older people.

Ambulance Service.

Jerry Cowley


86 Dr. Cowley asked the Minister for Health and Children if her Department will provide adequate funding for the transport needs of older and ill people requiring essential hospital investigations and treatment; her views on whether the funding required by her Department to the Health Service Executive west needs to be increased in order that the old and the ill can get to hospital for appointments; if her attention has been drawn to the fact that lack of funding by her to the HSE west is putting the emergency ambulance service in jeopardy by underfunding as the money supplied to run the HSE west ambulance service has not kept pace with the increased transport demands of ill and older people; when adequate funding will be provided to supply ambulance transport to persons who need it; and if she will make a statement on the matter. [35619/06]

The role and purpose of the ambulance service is to provide a clinically appropriate and timely pre-hospital care and transportation service. Pre-hospital emergency care and transportation services are provided as an integral part of the continuum of care for patients.

The Department of Health and Children has been advised by the HSE that there was a significant growth in demand for patient transport services in the west between 2004 and 2005. The ambulance service in that region has prioritised the provision of transport to oncology patients, dialysis patients, patients with acute lower limb injuries and transplant patients for one year after the operation.

The HSE has advised my Department that it examines all requests for patient transport services on a case-by-case basis, taking account of individual needs. The HSE's national ambulance office, in conjunction with the primary, community and continuing care directorate and the National Hospitals Office, is arranging for a comprehensive review to be undertaken of all non-emergency transport needs of patients. It will include an examination of the service delivered nationally and make recommendations for its future development. The group will also be tasked with developing proposals on how best to support patients who have to travel to access specialist services. One of the key outcomes for the group is to complete a needs analysis and strategic plan for a national patient transport scheme, to be finalised by the end of 2006. Subsequently, it will plan the migration to a separate role, which would be implemented on a phased basis from 2007.

I thank the Minister for Health and Children for her answer but the question I asked was would she provide enough money to the HSE west to bring ill people to hospital appointments. Patients requiring leg treatment will not get transport unless their leg is falling off from trauma but not if it is falling off from gangrene. I know of an elderly lady on a pension, whose family has a strong history of bowel cancer, who must have a check-up every year. She is expected to get her own transport home after being administered an anaesthetic. Does the Minister know that people on pensions must travel from Belmullet to Galway city, almost the same distance between Dublin and Galway? Can she imagine a pensioner in Dublin having to go to Galway for a hospital appointment at his or her own expense? Does this make sense? It is a scandal and outrage. How can the Minister stand over it?

Will the Minister provide enough money to the HSE to provide essential transport for those older people who need it? How can a pensioner pay €110 each way for a taxi to travel from Achill to Galway to have a pacemaker checked? It is my job as a Deputy to raise this matter in the House. I am outraged that the Minister has not responded to my specific question. The Minister has given so little moneys to the HSE west that it is now facing a €3.9 million deficit which is threatening the provision of emergency services. Does the Minister condone this situation? Why will she not provide additional moneys? What good is a review to a lady who must have her pacemaker checked but must borrow money to get a private taxi to do so? She, along with many more, deserves more. The categories of patients referred to by the Minister have been in place since March. What about those with cardiac failure, liver failure and other diseases?

Deputy Cowley is always outraged. Every time I reply to his questions, I get the same response. Last year, the HSE received an extra €1 billion, a 10% increase in resource allocation. I do not divvy up these moneys as autonomy and authority for them are vested in the HSE as a result of an Act passed by the House. It is the HSE's responsibility to use that money to provide for the transport needs of patients on a priority basis.

I want the HSE to examine alternatives to the traditional ambulance transport to hospital facilities, particularly where long distances are involved. We must be innovative in how we transport people to hospital. On some occasions, it may be possible to transport the medics and the diagnostics away from Galway city and closer to where the patient lives. If the case referred to by Deputy Cowley is common, it may be more cost-effective to bring the doctor and diagnostics closer to Belmullet. I accept the considerably long distance between Belmullet and Galway. The number of people receiving transportation in the west has gone up by 48% in two years and the cost by 51%. An extra ten crew members have been added. There has been an increase from three ambulances on a 24-hour basis to nine and 13 additional ambulances have been provided for the region.

I accept challenges and deficiencies arise in how patients travel for treatment. Earlier, in response to Deputy Lynch, I pointed out more must be done on a community level, particularly for patients with particular chronic illnesses. They are all required to come to the regional hospital for treatment, a model not used in other countries. It does not suit Ireland's circumstances. It is neither cost-effective nor suitable for patients' convenience. That is why one of the priorities this year will be to beef up community-based services that can provide greater supports to patients and minimise the need for them to enter the acute hospital system.

It is not fair for the Minister to throw it back on the HSE. She claims it is up to the HSE to prioritise resources. On 1 July 2005, the assistant chief ambulance officer for the region, Paddy Duffy, informed me that "transport is provided on a discretionary basis on having resources to do so".

That was July 2005. It is now almost 2007. Much more money since then has gone into the system.

More recently, the chief ambulance officer, Ray Bonor, informed me: "I would like to see all applications for transport for the elderly supported, but the financial resources to do so are not available." The Minister should read my lips. "Demand always exceeds our ability to supply certain services; this is a common problem throughout the health service". The HSE is willing and able to provide transport for these unfortunate pensioners if the Minister will only provide the funding.

The Minister is failing in her responsibility by not meeting the needs of these older people who have done so much for the State. In their autumn years, they simply require that they be able to visit the hospital to have their pacemakers checked. It is disgraceful that the Minister refuses to provide the HSE with the resources to provide the necessary transport. I would resign if I were in her shoes. Those categories that are covered, including dialysis and oncology, are already oversubscribed. As the population ages, there is an increased need for dialysis and a greater incidence of cancer.

The HSE is willing and able to provide transport for any impoverished elderly or ill person requiring hospital investigation or treatment. It is scandalous, in one of the richest countries in the world, that it is not able to perform this essential service because of a lack of money. The Minister should resign if she cannot even ensure patients can travel to their hospital appointments.

It is another opportunity for Deputy Cowley to protest.

Unlike Deputy Cowley, I am a full-time politician totally devoted to health reform. In addition to his parliamentary role, the Deputy is a practising GP with a large practice in the west. If he does not mind me saying so, he sometimes confuses those two roles. I am sure what he is saying will sound great on local radio tomorrow but the reality is that this country's increase in expenditure on health care in the last ten years, including in the western region, has been greater than that of any country in the developed world.

It is also the reality, however, that there are deficiencies and problems. One of the tasks I have assigned to the HSE is to look at innovative solutions to these difficulties. There may well be different ways of providing patients with their necessary treatments either closer to home, by means of doctors attending centres closer to where patients live on an outreach basis, or through the provision of modes of transport other than ambulances. In most countries ambulances are used only where they are necessary and there may be other modes of transport more suitable in the situations to which the Deputy refers. Other forms of transport are already in use in some areas.

Our priority is to ensure services are available as closely as possible to patients' homes so long as this can be done without compromising the high quality of provision for patient safety. If a person is obliged to make a round trip of 220 miles for a check-up, even on an annual basis, we should explore whether there is a better way of proceeding.

The time for Priority Questions has expired and the remaining questions will be taken in ordinary time. I remind Members that under Standing Orders, supplementary questions and responses to those questions are limited to one minute.