Vol. 637 No. 3
68 Deputy Alan Shatter asked the Minister for Health and Children her plans with regard to Tallaght Children’s Hospital; and if all medical and surgical services presently provided by the hospital will continue to be so provided. [17483/07]
I recently signed an order establishing the National Paediatric Hospital Development Board on a statutory basis. The development board held its inaugural meeting last Monday.
The principal functions of the board will be to plan, design, build, furnish and equip the new National Paediatric Hospital in accordance with a brief to be approved by the Health Service Executive. The brief will set out the preferred model of care, the core services to be delivered at the new hospital, and the additional range of services to be provided in an urgent and ambulatory care setting, taking account of international best practice.
The HSE is being advised in this context by Rawlinson Kelly & Whittlestone Ltd., RKW, an established UK-based health care planning company. In finalising its work RKW, together with a panel of international advisers, has arranged a series of meetings later this week with key stakeholders, including the three paediatric hospitals.
I am aware that the position on the provision of paediatric services at Tallaght has been a matter of concern for the hospital and the local community. I was therefore pleased to confirm recently, that a major ambulatory care centre at Tallaght will be advanced as part of the initial phase of the new paediatric hospital's development. The ambulatory care centre at Tallaght will offer a comprehensive and wide range of services to children, including an urgent care service, a major expansion in outpatient services and a significantly increased day surgery service.
This followed an analysis of the current location of major paediatric populations in the catchment area for the new hospital and the need to minimise the travel time for children requiring access to such services. Most attendees at the existing children's accident and emergency unit at Tallaght do not require admission and will continue to access their care at the ambulatory care centre.
I congratulate Deputy Brendan Howlin on his new position.
Will the Minister tell the House what paediatric services currently provided in Tallaght Hospital will be removed from the hospital? Is she aware that the widespread concern across the community about her plans to close down Tallaght as a paediatric hospital derives from serious concerns about the inaccessibility of the Mater site, and this Government's breach of faith with the original board of Harcourt Street Children's Hospital, to whom it said that a paediatric hospital would be maintained indefinitely in Tallaght? Will she indicate the time frame for transferring paediatric services from Tallaght to the projected new hospital on the Mater site?
The board's remit is to put the new hospital in place to have it operational in 2012. I was happy to hear from the chairman and the board members, whom I met on Monday, that they believe that ambitious deadline can be met. Among the functions of the board is to work on the transfer from the three existing hospitals. No tertiary facilities exist at Tallaght. Those that were there moved to Crumlin Hospital some time ago. I understand that between 80% and 85% of the patients treated in Tallaght will continue to be treated there. The facility will operate from 8 a.m. to midnight. There will also be an ambulance service to transfer patients who need to be transferred to the tertiary facility at the Mater. The volume of activity in Tallaght will increase substantially depending on whether there are one or two additional centres on the south side and maybe the west of Dublin but that has not been determined yet. I am happy to furnish the Deputy with a copy of the list of the activities envisaged in the ambulatory care centre in Tallaght Hospital.
I welcome the Minister's colleagues, Deputies Brendan Smith and Jimmy Devins, and commend and congratulate them on their respective appointments and wish them the very best in their areas of responsibility. I am sorry to say I cannot give the same welcome to the Minister with the health portfolio because her approach to health care and the needs of our people do not meet at all.
Does the Minister accept that the board of Tallaght Hospital maintains that the loss of its paediatric services would be in breach of the charter which established the hospital and which was passed by the Houses of the Oireachtas? Does she also accept that it would clearly be in breach of a personal promise, made by the Taoiseach in 2006, to the leaders of the various Protestant denominations who are represented on the board? Does the Minister further agree that, given the growth in population in south Dublin and Leinster, served by Tallaght Hospital, the loss of paediatric services would present an unacceptable danger whereby the safety, wellbeing and perhaps even the lives of young children would be put at risk?
Finally, does the Minister agree it was a disgrace for the HSE effectively to threaten the board of Tallaght Hospital that if it did not accept a co-location private hospital on its site it would not receive funding for the additional public hospital beds it required?
I am well aware of the Deputy's views on myself as they were well publicised in the aftermath of the election. I am, however, delighted to see him back in good health and I say so genuinely.
As I understand, the board of the National Children's Hospital, Tallaght and certainly the paediatricians in the hospital generally support the move to a single tertiary hospital for sick children. I have not met all the paediatricians but have met many from all over the country and I have yet to meet one who does not support what we are doing, which represents best practice internationally to get the best possible state-of-the-art hospital for very sick children. Most clinicians in the area, whether nurses or doctors, would strongly favour that.
I am not an expert on the charter but do not believe any charter would put patients' safety second to anything else. For those with serious organ failure and serious illnesses there can only be one tertiary level centre with the expertise required in a country such as ours, with a population of 4.3 million, or even on the island of Ireland. That centre must be co-located with the national hospital because even with sick children we will not have sufficient numbers in the different specialties for sub-specialists to be able to deal only with children. I do not accept that the decision that has been made in any way undermines Tallaght Hospital.
Finally, the HSE did not bully, harass or threaten Tallaght Hospital. It told Tallaght Hospital to make up its mind and asked if it wanted to proceed with co-location or not. That was not unreasonable and I am pleased to say the board unanimously agreed to go ahead.
With a gun to their heads.
I am surprised the Minister has made this decision without reading the Tallaght Hospital charter. I suggest she does so because what is now proposed is contrary to the charter and amounts to a serious breach of faith on the part of the State towards those involved in Tallaght, and particularly those involved in the move of the National Children's Hospital from Harcourt Street to Tallaght.
Will the Minister acknowledge that, while paediatricians rightly favour the provision of one tertiary centre of excellence, they have major reservations about the Mater Hospital site? It is untrue to suggest they support it. Does the Minister acknowledge the proposed ambulatory centre will have no accident and emergency facility, no inpatient beds and will not be open after midnight? Does the Minister accept that, given the current needs of the population catchment currently served by the paediatric section in Tallaght Hospital, there will be a grossly inadequate service? Can she also confirm to the House the point she appeared to make in her response that, while 80% of the procedures currently provided by the National Children's Hospital, Tallaght will continue, 20% will not continue? Am I wrong or is she unable to identify that 20% to the House? Can she clarify the 20% of services currently provided which will be discontinued in Tallaght Hospital?
We are well over time on this question but a number of Deputies wish to come in so I will ask the Minister to be as brief as she can and I will allow two more brief supplementaries.
I fully accept that not everybody is in favour of the Mater Hospital site. If the impression was created that everybody was happy then it was wrong. Of course they are not, but I do not believe that there is any site in the country to be co-located with an adult hospital that would have met all the requirements.
I said that 84% of the children that attend the accident and emergency department in Tallaght Hospital do not get admitted. The children's hospital in Tallaght has a 40% bed occupancy, so 84% of children who present there are dealt with and go home. We believe this will continue to be the case in an 8 a.m to midnight facility. There will be ambulance facilities in the hospital and very few children get transported to hospital between midnight and 8 a.m. Having a single facility in the city that will take children between those times is not unreasonable. Given the level of care that will be provided there, it will be much more reassuring for the parents of sick children, many of whom I have met. The message they have given me, whether they are parents of children in Tallaght, Crumlin or Temple Street, is to get on with it and give them the hospital they deserve.
The Deputy is right to say there will not be inpatient beds, as it will consist of day procedures and activity in the accident and emergency departments. I am not in a position to say what is appropriate in 2012 on a day basis and what requires inpatient facilities. That will be a matter for clinical decisions and not for me.
I thank the Minister for clarifying her statement because she accepts that there is deep anxiety among many paediatricians who have given their working lives to the care of children and have expressed very strong concerns about her policy on this hospital. Does she accept we do not live in an ideal city? Transport congestion is a serious block to children accessing care. Rather than seeing it as a question of one site, a hospital could be provided on two sites north and south of the Liffey. She has completely dismissed that option.
When does the Minister envisage the publication of the RKW report? If the report comes to the conclusion that the existing site is not sufficient for the kind of development of a world class tertiary hospital in Ireland, will she reconsider it?
Where did the Minister get the information that there is a 40% bed occupancy for the National Children's Hospital in Tallaght? I can tell her that it is wrong.
I got it from my Department and from the HSE.
Maybe she should ask them again.
If the Deputy gives me the correct figures, I will be happy. I have quoted that for the last year and it is yet to be contradicted. It may have increased in the last few weeks, but I am referring to the period 2003-06.
She should speak to some of the paediatricians.
I have spoken to many of them and I think the Deputy is aware of that. We are following the advice of what happens in the best children's hospitals in the world. Most of those hospitals are downtown in the centre of the city, co-located with research facilities, adult teaching hospitals and so on. When the consultants were appointed to look at 17 different children's hospitals, they came to a strong recommendation that this was the way forward for our population base. I do not think a good model of care is provided if experts have to travel from one site to another. It is better that all the expertise is together.
The development board must develop a hospital. It must appoint a CEO and take the design that will be given to it by the HSE. None of that will happen until we get the RKW report. After the consultation this week with the stakeholders, my understanding is that RKW intends finalising the report in a matter of weeks.
So the Minister has been tipped off.
I have not been tipped off. It is in the ambulatory care centre. Does the Deputy not want it in Tallaght?
69 Deputy Charles Flanagan asked the Minister for Health and Children the reason the Health Service Executive did not introduce the six hour target waiting time for relevant hospitals on 1 February 2007 as recommended by the accident and emergency task force; when this target will be implemented; and if she will make a statement on the matter. [17723/07]
162 Deputy Tom Hayes asked the Minister for Health and Children her views on whether it is accurate to record patient waiting times at accident and emergency from the time a decision has been made to admit the patient, as opposed to the time the patient arrives at accident and emergency; and if she will make a statement on the matter. [17724/07]
169 Deputy Michael Creed asked the Minister for Health and Children the reason the Health Service Executive did not introduce the 12 hour waiting time target for accident and emergency on 1 January 2007 as recommended by the accident and emergency task force; when this target will be implemented; and if she will make a statement on the matter. [17722/07]
The final outturn on Vote expenditure for the Health Service Executive showed a capital saving of €114 million, of which €42 million was used to offset a revenue overspend and a further €47 million was used to offset a shortfall in projected appropriations-in-aid. This left a balance of €25 million to be surrendered to the Exchequer.
The Health Service Executive's appropriation account for 2006——
With respect, the Minister is reading another reply.
I am afraid the Minister has proceeded to Question No. 70. I called Question No. 69.
I beg your pardon, a Leas-Cheann Comhairle.
The Minister was anticipating Deputy Sheehan.
Deputy Sheehan has just arrived. I understand two other questions are being taken with QuestionNo. 69.
It relates to the accident and emergency task force.
I am sorry. I think we dealt with that in Priority Questions.
Is it Question No. 70?
It is Question No. 69. I welcome Deputy Sheehan to the House.
A new boy.
I beg the House's pardon, but one of the difficulties in having priority questions is that one ends up reading out the same answer.
The Minister has all these Ministers of State now.
The answers certainly do not change. It is not like, with a student of mathematics, where the questions might change but the answers do not.
We are eating into the time.
I apologise. I propose to take Questions Nos. 69, 162 and 169 together.
Improving the delivery of accident and emergency services is the Government's top priority in health. Our objectives are to reduce the numbers waiting for admission, the time spent waiting for admission and the turn-around time for those who can be treated in accident and emergency departments and who do not require admission.
In March 2006, the HSE established a dedicated task force to facilitate the implementation of the HSE's framework for addressing the problems arising in the delivery of emergency department services. The report of the task force was published on 1 June.
The task force report noted that the majority of the hospitals which were identified as experiencing difficulties in the delivery of emergency department services have for some time been meeting the initial performance targets set by the HSE. There are a small number of hospitals that have experienced particular difficulties in seeking to achieve the targets.
The task force report recommends that revised targets should be set to ensure that no patient waits longer than 12 hours for admission to an acute bed, once the decision to admit has been made. The ultimate objective is a total wait time target of six hours from the time a patient presents at the emergency department to the time he or she is either admitted to an acute bed or is treated and discharged home. The task force acknowledged that further work is required on the establishment of total wait time targets. Key issues to be addressed by the HSE in this context are the standardisation of processes and models of care within emergency departments and the standardisation of waiting time measurement.
The HSE has announced that it intends to introduce revised performance targets in October next. The basis for the timing of the introduction of the revised targets is to take account of key infrastructural developments, including the commissioning of 700 additional public long-stay beds. In addition, a number of emergency department developments, including admission lounges and acute medical units, are to become operational in 2007 and at the start of 2008. These developments are designed to deliver improvements in terms of the clinical decision-making within emergency departments and to address dignity and privacy issues for patients awaiting admission to an acute bed.
The Minister will recall setting up this task force in March 2006, when she heralded its inauguration in the context of there being a national emergency in the accident and emergency sector. Where stands that statement now? Does the Minister still accept that is a national emergency or is she prepared to row back on that in the context of publication of the report?
In the context of an earlier question to which she delivered a reply to Deputy Brian Hayes, when the Minister stated that this report forms part and parcel of a jigsaw, I put it to her that the most important aspect of anybody engaging in putting together a jigsaw is the matter of setting targets, that one will never finish a jigsaw unless one sets a completion hour in which to put it together. Does she accept that is the fundamental flaw in this report? As well as the report casting a poor reflection on the accident and emergency facilities and performance in seven of the country's major hospitals, it does not identify the targets. It is merely a catalogue of failure and a cosmetic exercise. When one considers the substance of this report, one sees failure after failure.
Having been out of the House for the past few years I have noticed a total remove by the Minister from the health services, illustrated in her semi-detached reply. The Minister receives the report in a semi-detached manner. I regret that the Minister does not appear to have any role in this. If she has a view on setting targets perhaps she could inform the House of the nature of her involvement.
I welcome the Deputy back to the House. In March 2006, when the number of patients on trolleys awaiting treatment for a number of hours hit 500, I stated that it must be treated by the HSE as if it were a national emergency. In other words, we had to apply a focus as if we had a national emergency. That was the appropriate way to treat the difficulties that had arisen. Everyone, including the Irish Nurses Organisation, the IMO and others, has acknowledged that we have seen major improvements, particularly in five hospitals. Different practices have resulted in great improvements for the benefit of patients. Challenges exist in other places, some of which relate to the physical capacity of facilities in places such as Drogheda. Money is being provided this year to provide new facilities there.
The initial target was 12 hours, which I accept is a long time. The next target will be six hours. Setting a target is not a sensible idea if one does not have the wherewithal to measure it. The HSE is setting up procedures so that a target of six hours can be set in October. I hope this can be reduced further.
More than 90% of people who present do not require admission and go home. Those people may still have long waiting periods before being treated and leaving. The target applies not just to those who must be admitted to an acute bed. We also need a target for the period between arrival time and the time one is dealt with, by being admitted or sent home. I look forward to that target being set in October.
What is being done to expedite the implementation of the task force recommendations? Recently, I asked if the Minister had received the report of the Irish Association for Emergency Medicine, Health and Safety Standards for Irish Emergency Departments. I was surprised at the Minister's reply yesterday, stating she had not yet received a copy. I have made a copy and would be happy to pass it on to the Minister. The report states: "The persistent overcrowding in Irish EDs fundamentally contravenes this duty of care and as a result both patients and staff are exposed to significant risk on a daily basis." Does the Minister recognise the urgency for action to relieve overcrowding in our accident and emergency units? What further action and funding will she provide?
The implementation of many recommendations of the task force is already under way. Many concern capacity in various hospitals. These began during the gestation period of the task force report. Overcrowding is something of a jigsaw. We need more consultants on duty in hospitals, more access to diagnostics and more measures taking place at community level. All of these make an impact on accident and emergency units. Until relatively recently, there was one hospital on call in one part of the city and one hospital in the other. Now, we have accident and emergency units everywhere.
In those years they were for genuine accidents and emergencies. Today our accident and emergency departments are dealing with people who have chronic illness because it is not being appropriately managed in the community or with people who need diagnostic care because they are waiting so long. That is why, in time, the other measures that have been put in place by the HSE will have a significant impact. When I had a long meeting last week with Professor Drumm — whom I had not met since prior to the general election being called — he informed me of a number of initiatives that had been put in place by the HSE in the intervening weeks to help hospitals to achieve the kind of targets we are talking about.
Gabhaim comhghairdeas don Leas-Cheann Comhairle faoin a phost nua.
Go raibh maith agat.
The target to which the Minister alluded was a six-hour target which the HSE has set itself that starts from the time the decision has been made to admit the patient. However, even here there is disingenuity because the decision to admit the patient may well have been made by the doctor in accident and emergency but the clock does not start running until the admitting doctor from the various specialties within the hospital can make that decision. This can often take many hours, as I know only too well.
The Minister alluded to the 5% capital fund and spend in this country being second only to Norway in the OECD, yet we have the second lowest expenditure on health and education in the OECD. As I stated in last night's debate, our GNP last year contained a 7.2% spend on health. It has been acknowledged that we have fallen behind in health spending due to the many cutbacks in the 1980s and 1990s and that we are playing catch-up. Will the Minister outline how we can possibly catch up when we are still spending less per capita than the European average, which is 8.6% and Germany and France which are at 10%?
I am pleased to hear the Minister is looking outside accident and emergency services because this area is merely the symptom of the problem. A bottleneck has been caused by a lack of beds and inappropriate use of beds on the one hand and a lack of diagnostics, to which the Minister has alluded, but also the lack of a proper preventative medical scheme. Fine Gael had promoted the latter, in addition to a chronic illness scheme prior to the general election to keep people out of hospital and identify illness early. It is well known that for every euro one spends on prevention, one saves €20 on treatment.
I recall the Minister referred to the accident and emergency crisis as a national emergency but I do not recall when she declared that was no longer the case. Perhaps she will inform the House of when she made that announcement.
Where are the acute medical admission units that were promised? One such unit was promised for Beaumont Hospital on the north side of Dublin. This would have alleviated the situation in accident and emergency departments. GPs are highly experienced doctors who, when they have seen patients and examined them, know whether they need admission. It is regrettable to have to route patients through accident and emergency departments and for them to have to put up with all the unpleasantness that goes with that kind of experience in the current poorly-funded health system.
Normally one minute is allowed for supplementary questions but latitude can be given. Deputy Reilly is very welcome to the House.
I object to Deputy Reilly's statement that our health system is totally underfunded. I cannot remember the exact words he used. I do not know whether he referred to GDP or GNP. He may be referring to 2005 figures. If one takes the spending in 2007 and compares it on a per capita basis with purchasing power, parity and so on with many other countries, including France, the United Kingdom and Northern Ireland, we compare most favourably. The issue we have all recognised in Ireland over the past decade as we multiplied public spending on the health system fourfold, is that spending alone would not resolve the challenges without changing how we do business.
When the figure of 500 patients on trolleys was reached on a particular day for the first time in March 2006, I said the HSE had to apply itself to the task of resolving the challenges in accident and emergency services as if it were a national emergency, which it did. We have seen improvements of 40% to 60% over the past 12 months. That has been acknowledged by an organisation of which Deputy Reilly is a member, as well as the INO and others.
Admission lounges and facilities are being put in place. I do not have the date of when this will happen in Beaumont Hospital but during the remainder of this year and next year, huge——
They are not acute medical assessment units.
That is what I meant. There are two types of unit. I understand Tallaght Hospital has just got an admission lounge and other hospitals are getting acute assessment medical units.
I fully agree with Deputy Reilly that we need to have the kind of measures in place which I know he would like from a general practitioner perspective, in particular for the management of chronic illness in the community. Many patients, especially older people who thankfully are living longer, have chronic illnesses such as diabetes and if such illnesses can be managed, we will relieve pressure on the acute hospital system.
While Members are anxious to reach Deputy Sheehan's question, two Deputies have indicated and I will take brief supplementary questions from both. I will call Deputy Shatter first, followed by Deputy Charles Flanagan.
I will be brief. The Minister stated there are many pieces to the jigsaw when dealing with the accident and emergency services problem. Does the Minister agree and acknowledge that the major problem is the availability of acute hospital beds and, as she noted in reply to an earlier question, that beds are being used inappropriately? Moreover, does she acknowledge that beds are being used inappropriately because of the Government's total failure to provide necessary step-down facilities? I refer to those people who have been through the worst of their illness, are not sufficiently well to return home and who need continuing care but who do not require acute hospital care. Does she accept that the Government has contributed to the national emergency that was created last year and that the problems in accident and emergency will not be resolved until it takes up its obligations to provide the requisite step-down facilities? Does she accept that these are the facilities that should be provided within those hospitals now designated for co-location and the construction of private hospitals?
A total of 222 people were on trolleys as recently as last Wednesday evening. As this figure does not include the number occupying beds that have given rise to the cancellation of day care procedures, the real figure is much higher. On the matter of targets, I am a little confused in respect of the six-hour and 12-hour targets to be set in October on foot of this report. It seems the Minister is missing the targets and is opting out of the placing of targets. Unless she sets clearly defined targets that will be met, this issue will not be dealt with in a satisfactory manner.
The Government is providing step-down facilities. It has provided a couple of hundred such beds in recent years. I fully accept——
Not enough.
——it must provide more and more are being provided. A number of things must be done. Obviously, rehabilitation capacity is also important as many people in the acute system await rehabilitation. This is the reason the building of the new hospital and additional rehabilitation capacity is important. I understand that one of the co-location proposals, from Blanchardstown, may include step-down facilities.
As for trolleys, some people spend all their time, perhaps 24 hours, being observed on a trolley. Recently, a close friend of mine who would be known to many Members had such an experience in a Dublin hospital. He told me it was a very pleasant experience. There will always be people on trolleys and many people are treated on them. The issue is the length of time someone must wait to be dealt with in an accident and emergency department. Some of the private clinics that have opened in the Dublin area, which have been subject to much criticism, operate a target of one or two hours from the time one enters to the time one leaves. I accept they deal with minor injuries.
The Minister should not suggest that the general experience of being on a trolley is pleasant.
It is for many people.
I would use a different word to "pleasant".
Many of the issues——
Many people regard the experience as being much less than pleasant.
That is an extraordinary statement.
The Minister, without interruption.
They regard it as being quite unpleasant.
If the Minister can conclude, we can move to the next question. An tAire, without interruption.
May I inform Deputy Charles Flanagan——
Through the Chair.
I apologise. Through the Chair, some of the issues that arise concern privacy, as well as whether someone is on a trolley. Many issues exist, which is the reason that capacity improvements and creating a better environment, including the provision of toilet and other facilities, constitute part of what we seek to do.
As for the setting of targets, we never had them until some time ago when we set the 12-hour target. The six-hour target will be from the time one arrives and not simply from the time one is seen. I accept Deputy Reilly's point that it is not simply when the accident and emergency consultant decides that one may require admission but when someone else in the house comes down and so decides. In the first instance, we seek a target of six hours from the time one presents until one can either go home or be admitted to an acute bed.
The Minister has missed the target.
Have we got a target?
That target has not been set. Incidentally, such a target is being met in many hospitals nationwide, including those located in Deputy Charles Flanagan's home region of the midlands.
Not according to the task force report.
70 Deputy P. J. Sheehan asked the Minister for Health and Children if the €71 million the Health Service Executive failed to spend on capital projects in 2006 can be carried over to fund capital development in 2007; and if she will make a statement on the matter. [17731/07]
78 Deputy Ulick Burke asked the Minister for Health and Children if capital projects are multi-annual in nature; the reason allocated capital funding is not automatically transferred from one year to the next; and if she will make a statement on the matter. [17738/07]
I welcome Deputy Sheehan back to the House.
I also welcome the Deputy. I propose to take Questions Nos. 70 and 78 together.
The final outturn on Vote expenditure for the HSE showed a capital saving of €114 million, of which €42 million was used to offset a revenue overspend and a further €47 million was used to offset a shortfall in projected appropriations-in-aid. This left a balance of €25 million to be surrendered to the Exchequer. The HSE's appropriation account for 2006 will show an overall surrender of €365 million comprising the €25 million capital saving and €340 million in respect of the long-stay payments.
Unspent capital funding cannot automatically be transferred from one year to the next. However, under section 91 of the Finance Act 2004, Departments and the HSE may apply to carry over up to 10% of any net underspend on the capital Vote to the following year. If approved by the Minister for Finance, provision for such carry-over is made in the Appropriation Act for that year. However, the HSE was not in a position to provide a firm projection of its net capital expenditure saving for 2006 within the prescribed time limit. As a result, the Appropriation Act 2006 does not include any provision for the HSE to carry over its €25 capital saving.
The HSE has taken steps to strengthen its capital management capacity, including the establishment of a single estates function and the appointment of a new director of estates. The level of capital funding provided to the HSE for 2007 will support a continuing high level of investment in our public health services and will enable the completion and commissioning of many new acute and community health care facilities.
I thank the Minister. Will she also answer Question No. 139?
We will take Questions Nos. 70 and 78 submitted by the Deputy and Deputy Ulick Burke first. Deputy Sheehan should ask his supplementary question.
I congratulate the Leas-Cheann Comhairle on his seat of office. I look forward to happy days working with him.
Go raibh maith agat.
I also welcome the Minister back to her old seat as the Minister for Health and Children.
It is amazing that €25 million of the €71 million is to be returned to the Exchequer. Why was Bantry General Hospital's orthopaedic service withdrawn four years ago? While orthopaedic facilities had been available for years, they were withdrawn for some unknown reason. A minor fracture cannot be treated in that major county hospital. Fracture patients from the south-west Cork and south Kerry regions must travel more than 100 miles to Cork University Hospital for treatment. That should have been taken into consideration and that facility should have been provided.
I am sure a question is coming.
Kidney dialysis patients must also travel from south-west Cork and south Kerry for treatment. It is a pity that Deputy Healy-Rae is not present to support me. Perhaps he is too engaged elsewhere getting his package ready. Why can kidney dialysis treatment not be provided in Bantry General Hospital? There would be no need to return €71 million to the Exchequer.
Where is the €97.7 million, also allocated to the HSE due to be spent? My question reads: "the reasons it was not spent; the action she will take to ensure that urgently needed resources are delivered; and if she will make a statement on the matter."
We will get to that question later.
My going back to south-west Cork without an answer to why we do not have the facilities would be no good.
There will be no opportunity for the Minister to reply unless I call on her now.
I am not familiar with the reason the orthopaedic facility was withdrawn from Bantry General Hospital, but I assume it related to staffing levels and safety issues. I visited the hospital some time ago. It is efficient and I was particularly taken with how various staff members seemed to work well together at the local level. Government policy is to have services provided as close as possible to where people live, particularly in a region as peripheral as Cork South-West, which Deputy Sheehan represents, but it must be done on the basis of safety.
I can be half the way to Dáil Éireann and still be in County Cork.
I know. That has not changed since the last time the Deputy was a Member of the House.
Written Answers follow Adjournment Debate.
