Other Questions.

Health Services.

Fergus O'Dowd

Question:

79 Deputy Fergus O’Dowd asked the Minister for Health and Children when, in relation to the CT scanner officially opened by her in April 2007 at Louth County Hospital, Dundalk the necessary radiology staff will be in place to operate this service; if there is necessary and sufficient support staff in place to assist radiology staff; the number of days per week this service will be available; and if she will make a statement on the matter. [24077/07]

The Health Service Executive has advised my Department that the CT service at Louth County Hospital, Dundalk commenced in June 2007 on a phased basis. The service is being provided in co-operation with staff from Our Lady of Lourdes Hospital, Drogheda. A CT specialist attends Louth County Hospital one day per week. Last year over 1,400 patients from Louth County Hospital received CT scans at Our Lady of Lourdes Hospital in Drogheda.

The HSE intends to introduce a full service at an early date. My Department is advised that, when fully operational, the service will be provided on a daily basis from Monday to Friday and will have the capacity to carry out up to 2,200 scans per annum. This will require the redeployment of a clinical specialist from Drogheda to Dundalk and the filling of the resulting vacancy. The necessary radiography staffing is in place. An after-hours service will continue to be provided in Drogheda.

Before the general election we had a major issue with Dundalk hospital. The Minister for Health and Children went to Dundalk — I was there with the others — and amid much fanfare and with the media present launched the CAT scan service. Everybody believed at the time that it was a significant development and that the service would be fully operational immediately. However, this was a political PR stunt which misled the people of County Louth and, more particularly, the people of Dundalk about this service. I find it unacceptable that the Minister states a full service will be available "at an early date". That is not good enough. The people were misled by the way the Minister opened the CAT scan service in such a public and open manner. Is she not ashamed of herself?

I remember that day. I remember the Deputy was there and I think we were photographed together.

I just about featured in it.

I think it was Albert Reynolds and his Fianna Fáil colleagues who got the CAT scanner.

A Deputy

Mairead McGuinness was there.

As Deputies know, I did not have any party political interest in Dundalk and do not do political stunts.

The Minister performed a stunt for the Government. She cannot avoid her responsibility.

Notwithstanding the embargo on recruitment, the HSE has granted a derogation to Drogheda to recruit the necessary staff to have the scanner in full-time service.

We want the scanner in Dundalk.

Yes, in Dundalk.

The Minister said Drogheda.

In Louth County Hospital which is in Dundalk. I have been there three times.

I hope the Minister will not go back and close it down.

Notwithstanding the embargo on recruitment, there has been a derogation granted in this case, as there has been in a few other cases around the country. I hope the service will be fully operational quickly

I will try to facilitate as many as I can if Members will be brief.

If the people of County Louth have been waiting since April, the people of Mallow and the north Cork community have been waiting two and a half years for a CT scanner to become operational. We need the staff to make it operational. Will the Minister appoint the necessary staff?

It is beyond the scope of the question, but if the Minister wishes to reply, I will facilitate her.

It relates to the policy on how CT scanners are rolled out.

To be fair to the Deputy, I do not have a brief on the up-to-date position in Mallow. I owe it to his father who used to mention this matter to me frequently to ensure we will have the necessary staff. I will revert to the Deputy, if that is in order.

As has been stated, this facility was opened in a blaze of publicity——

I do not remember getting any publicity.

A Deputy

Deputy Seamus Kirk got it.

It certainly was. With all due respect, this is another insult not only to the people of Dundalk and County Louth but also the north east. Clearly, it was a stunt in advance of the general election in which the Minister participated. Had she taken any time to establish if the HSE were going to ensure the human resources would be in place to operate this facility? Is she aware that it took until July before the service even opened for one day per week and that it then ground to a halt completely? Is she conscious that the Taoiseach committed on the floor of the Chamber that this facility would be up and running from March? From March until September and the announcement of the recent embargo on recruitment by the HSE the equipment remained virtually inoperable for all but one day per week. What is the HSE's excuse, and what vigilance did the Department exercise, in regard to the scandalous situation in which high tech equipment lay largely idle? What excuse does the HSE have for not recruiting staff to operate it? What excuse does the Minister offer? She need not trundle out the notion of an embargo on recruitment. There was no embargo in place over those months.

The hospital never had a scanner. It is positive that it now has one, notwithstanding all the criticism.

It is not much use if it is not functioning.

I do not justify the fact that it is not operational five days a week. I simply say that one day is better than none. There is no embargo on recruiting staff for this scanner and I hope the HSE proceeds to do it as quickly as possible. I could not and will not stand over a situation where public money is spent on the purchase of, in this case, a CT scanner and it is not fully operational. It is not fair, not only to the citizens and patients of Drogheda and Louth, because it obviously places an extra burden on Drogheda, but it is also unfair to the taxpayers who have provided the funding for this scanner.

It is in Dundalk. The Minister should not get confused.

I know it is in Dundalk.

There are two other Deputies offering. We have exceeded the time allowed but I will facilitate them.

Unlike Deputy Sherlock, the Minister does not owe me anything. I have a similar question in regard to the county hospital in Nenagh. There is a new CT scanner there which is not operational because there is no staff. It is crazy in the context of waste in the health service. What the Minister did for Nenagh hospital was to close 25 beds under the cutbacks and reduce it to a 75 bed unit. It has operated comfortably with 95 to 100 beds over a number of years but the Minister, in her wisdom, has cut it back to 75 beds.

That is outside the scope of the question. The Deputy should put a relevant question.

When will the Minister deal with the legacy of funding for Nenagh hospital?

That is a separate question but the Minister may answer if she wishes.

Those services were never granted an accompanying budget and that is the reason Nenagh hospital is over budget at the moment.

The radiology services in Navan, which according to the Minister's figures dealt with 177 patients every month for the past nine months, will have less work now that the orthopaedic ward is closed. Is it intended to move some of the staff to do work in other hospitals? The regional network manager accepted that 180 patients could miss out on having their operations in December. It is accepted that only six were booked in. However, the consultants have confirmed they only book their patients in three or four weeks in advance. That regional unit deals with many more than six patients so it is unfair to suggest that only six patients will be affected. In regard to the services, is it intended to move some of the staff out of Navan during this month when operations are cancelled to work in the other unit, given that it is a regional unit? In regard to the radiology services, pre-assessment works will probably not be carried out in respect of patients hoping to undergo procedures in January or February, so the delay in operations will be a lot longer than a month. That should be admitted.

I would wish no patient was inconvenienced and that operations never had to be cancelled.

Equally I must draw attention to the fact that the Navan hospital budget is increased by 21% this year.

It was cut by €1 million last year.

The budget for Nenagh was increased by 17% this year. If Limerick Regional Hospital and Waterford Regional Hospital and Holles Street Hospital where there is a huge increase in activity can live within their budget, we expect other hospitals to do so as well.

Additional services were put into Nenagh but there was no budget to operate them.

The budget for Navan hospital was cut last year by the Department for no reason.

I have the figures. I will give them to the Deputy.

I have figures as well.

Navan hospital got €36.5 million. That was an increase of 21%.

Its budget was cut by €1 million the year before. The Minister did not clarify the figures. The suggestion that only six patients are affected is not believable.

Does it make sense to have a scanner sitting idle?

One would have to get sick in January or February or just before an election.

I call question No. 80.

I do not seem to have it.

If it has anything to do with the HSE, it is no wonder it has been lost.

Cancer Screening Programme.

Brian O'Shea

Question:

80 Deputy Brian O’Shea asked the Minister for Health and Children when she expects that the national cervical cancer screening programme will be fully implemented; and if she will make a statement on the matter. [24017/07]

The National Cancer Screening Service is planning to roll out the national cervical screening programme on a national basis in January 2008. I have allocated additional revenue funding of €5 million to the service this year for this purpose and an additional 30 posts have been approved.

It is expected that approximately 240,000 women will be screened annually. Women aged 25 to 44 years will be screened every three years. Women aged 45 to 60 will be screened every five years.

The service is planning to have cervical screening managed as a national call-recall programme via effective governance structures that provide overall leadership and direction, in terms of quality assurance, accountability and value for money. All elements of the programme, call-recall, smear taking, laboratories, and treatment services will be quality assured, organised and managed to deliver a single integrated national service.

I asked the Minister when she expects the national cervical cancer screening programme to be fully rolled out. The reason I am sceptical and asked that question is that the breast screening programme was to have been fully rolled out approximately two years ago and that has not yet happened. Will the breast screening programme be fully rolled out by the end of this year as promised and is that timeframe in place? Will the Minister give a full timescale in regard to the cervical cancer screening programme? Could she also answer the question regarding laboratory facilities? Already waiting times for the results of cervical screening are approximately six months in some areas. Are there resources in the system to roll this out and to roll out quality control in terms of having the laboratories that are doing the tests accredited? Perhaps the Minister will expand on these aspects and tell the House whether BreastCheck will be fully rolled out this year.

BreastCheck has already been rolled out in the west. It was rolled out before the summer in Roscommon and it is being rolled out in the south within the next three weeks, either at the end of this month or the first week in November.

Cervical screening will not be done region by region; there will be a national roll-out. The national cancer screening programme, which is not part of the HSE at the moment, is going to tender and submissions are being invited and it is intended to roll the programme out in January. I understand it is going to tender in the next couple of days to invite interested parties to do the smears. In regard to laboratory facilities, I am assured we have sufficient laboratory services. I understand it is intended that results will be available within a matter of days, probably to the general practitioner.

This matter is close to my heart because in 1999 I was part of a team that negotiated the original pilot programme in the mid-west. We were told it would be rolled out within a short period. Why has this roll-out taken so long? Being a new Deputy I want to be nice. However, I must question the bona fides of a HSE that is currently outsourcing the laboratory requirement. If it has been doing that during the year because it cannot keep up with the amount of work it is getting before it rolls out nationally, how serious was it in regard to rolling it out nationally? The HSE's bona fides are highly questionable.

Can the Minister explain the delay of eight or nine years? Can she confirm that currently there is only one accredited laboratory in the country?

There are issues regarding accreditation of laboratories.

Is the Minister's answer a "yes"?

I am not certain whether we have one or two laboratories but it is a very small number. I will confirm that. There may be a second one. We have very few accredited laboratories. Now that we are moving rapidly into the whole issue of standards and quality assurance it is clearly important, if we are to have national roll-outs, that the test results are accurate in so far as they can be.

The national cancer screening programme is not part of the HSE at the moment. The resources that are currently used on what are called opportunistic smears will be diverted to the screening programme. Many clinicians have been looking for that for quite some time. I will not speculate on why that did not happen to date. Screening programmes are expensive. They take time. We must direct our services more into screening. Screening for colorectal cancers will be next. It is hoped that can be done as quickly as possible given that those are the three areas where we know screening works. Relatively few people have a problem but it can be fatal for the few that do if it is not picked up early.

I am glad to learn the Minister is committed to rolling out this programme from the beginning of next year although a delay has arisen. I have concerns regarding the quality of laboratories and the availability of laboratory time. At present many smears taken must be outsourced.

On a related question, what are the Minister's views on, and has she any plans to introduce, a vaccine programme against cervical cancer? Such a programme would be aimed at younger people and much discussion has taken place in this regard. Where stands the Minister? Obviously this would involve a financial commitment. I refer to the vaccine programme for cervical cancer.

I will bring in Deputy Ó Caoláin before the Minister responds.

Is the Minister aware we are approaching the third anniversary of the publication of the expert group's report in December? She must agree there has been far too little progress made in the subsequent period. The issue of the outsourcing of smear tests has been raised and large numbers of smear tests are being sent abroad for testing. Does the Minister agree such tests should be carried out in Ireland and that sending them to be checked overseas opens up a swathe of risks? Only this year, definite examples of the problems that can arise as a result have surfaced. What is the logic behind the closing of laboratories and hospitals in the face of real work that can be carried out effectively and proficiently within the laboratory system of the hospitals network? What steps is the Minister taking to address the deficiency in laboratory opportunities in this State?

In response to Deputy Clune, such a vaccine would have to be done in conjunction with other matters — it is not an either or scenario.

I await clinical advice in this regard and issues arise regarding how much should be paid to those who will administer the vaccine. In Ireland, as Deputy Reilly will be aware, we pay considerably more than is the case in other jurisdictions. While many issues arise in this regard, any innovation in the market must be used for the benefit of patients. This has always been a feature of the Irish health care system. On the smear——

Capacity is a major concern.

It is in the programme for Government.

As for smears, a total of 35,000 smears were outsourced for reasons of speed. It was taking far too long to obtain the results and there is no point in having smears without obtaining the results quickly because that defeats the purpose. The outsourcing was to an accredited laboratory. Clearly, the Health Service Executive is doing some work on the required number of hot and cold laboratories. However, quality is the key issue, as well as ensuring that all laboratories are accredited and operate to a high standard, which is essential.

Should they be here at home?

Yes, ideally we must have our own laboratory facilities in Ireland.

Suicide Incidence.

Dan Neville

Question:

81 Deputy Dan Neville asked the Minister for Health and Children her views on whether it is appropriate not to set up an independent clinical review of the death by suicide at Unit GF, Cork University Hospital, by a person (details supplied); and if she will reverse this decision and set up a clinical review of the death. [23962/07]

In March 2005, my predecessor asked the Mental Health Commission to prepare a report on the circumstances surrounding the death of this person who died in the acute psychiatric unit of Cork University Hospital in October 2004. The report of the inspector of mental health hospitals, who is independent, was received in my Department in November 2006 and does not recommend a further independent review of this case. The unit is monitored on an ongoing basis and is subject to annual inspection by the Inspector of Mental Hospitals.

The Health Service Executive, which is responsible for the management and delivery of this service, has accepted the report's findings and has advised that the majority of the recommendations have been implemented. Risk management has been addressed, the ward environment has been reviewed and the female nursing office was moved to facilitate better patient observation. The ward layout has been assessed and a group has been established to consider the redesign of the unit. This year an additional sum of €125,000 was allocated to the south Lee area for multidisciplinary team enhancement.

I ask the Minister of State to respond positively to the request of the family of the late Anne Carroll, who took her life on 17 October 2004 at Cork University Hospital, for a review of her death that is independent of State agencies. She was admitted on 6 September and was on weekend discharge when she attempted to stab herself. She was saved by her brother but while he sought help, she cut her wrists. Does the Minister of State agree that on her return by her family to the hospital it was unacceptable that no bed was available and that, consequently, she became extremely distressed? Her family expressed concern to the hospital staff regarding her safety. Does the Minister of State agree it was unacceptable for the hospital not to have a high observation or special care unit? Was the absence of specified intermediate levels of observation unacceptable? Does he agree it was unacceptable that the alarm system was out of order on the day in question? On its examination, no documentation regarding the death of Ms Carroll was found in the clinical file.

For these reasons, the family is anxious that an independent inquiry should be held. In a similar situation, the Minister of State's predecessor set up such an inquiry into the death of Anne O'Rahilly, who died in unit 5B in the Mid-Western Regional Hospital, Limerick. A highly extensive and far-reaching report arose from the independent inquiry. The Minister of State should consider doing something similar at the family's request.

I agree with Deputy Neville that this is a sensitive case. However, the Mental Health Commission is independent and there have been two reports on this tragic death. The second was carried out at the behest of the HSE by Professor Ted Dinan from Cork University Hospital. Moreover, all but two of the report's recommendations have been implemented by the HSE.

When I asked the Minister for an independent inquiry last August, I was not told of this. I was informed the matter had been referred to the chief executive officer of the Health Service Executive for his consideration, to ascertain whether he should hold an independent inquiry into his organisation, which is completely unacceptable. The Minister, not the Health Service Executive's chief executive officer, should make a decision on an independent examination of that organisation. Moreover, the family wish to have an inquiry that is independent of all State agencies, as took place in the aforementioned precedent.

The second report by the chief executive officer of the HSE, to which Deputy Neville refers, was the report carried out by Professor Dinan. However, the Mental Health Commission report was carried out independently.

I only received an answer to this question last week.

I congratulate the Minister of State at the Department of Health and Children, Deputy Devins, on his new appointment, particularly in respect of his work with people with disabilities. I refer to the broader issue of cystic fibrosis. I ask the Minister of State for an update on the new services that will be rolled out in the next few months for those with cystic fibrosis. I also commend the Minister for Health and Children, Deputy Mary Harney, on her particular interest in this issue. I ask for an update on those services that are to be rolled out.

The Minister of State, to respond to this broadening of the question.

I thank Deputy Finian McGrath for his question. In general, more money is being allocated to the cystic fibrosis field, for which I have a particular concern.

Will the Minister of State facilitate the family with a meeting?

I will be delighted to so do.

Health Services.

Billy Timmins

Question:

82 Deputy Billy Timmins asked the Minister for Health and Children the amount of the €1.5 million in funding allocated for cardiovascular issues, including heart failure and sudden cardiac death, in the Health Service Executive national service plan 2007 that has been spent to date, with a breakdown of these payments; and if she will make a statement on the matter. [23881/07]

As the Deputy's question acknowledges, these issues are a matter for the HSE and I have consulted it to provide a relevant reply to the Deputy. I can confirm that the sum of €1.5 million allocated to the HSE for these services in the current year was divided equally between the fields of sudden cardiac death and heart failure.

As for the funding of €750,000 for sudden cardiac death, it was agreed to prioritise the co-ordination and development of first response by employing one national and four regional co-ordinators within pre-hospital care and six pre-hospital resuscitation training officers. The sum of €520,000 was allocated to the National Hospitals Office for this purpose in the current year.

Plans for the remaining sudden cardiac death funding include media campaigns and joint funding of a further module of the medical emergency responders integration and training, MERIT, programme with the pre-hospital emergency care council. MERIT is a managed programme providing automated external defibrillators and relevant training to GP practices in most areas of the country. Areas still to be funded are the former North Eastern, Midlands and Northern Area Health Board regions.

A total of €750,000 was allocated for heart failure. It was agreed to prioritise support of the chronic disease management pilot project at St Luke's Hospital, Kilkenny, and the Mater Misericordiae Hospital, Dublin. Further spending was allocated to support heart failure community development projects in the Cavan-Monaghan and Louth-Meath areas. New developments in heart failure services at Beaumont Hospital, St. James's Hospital and Cork University Hospital are also being funded this year. Funding of €421,000 together with approval for the necessary whole-time equivalents were assigned for the implementation of these services in the current year. The availability of this funding is subject to HSE financial restraints. However, it is our policy to ensure these services are rolled out in all parts of the country.

In 2006, a commitment was given to support a three-year heart failure programme in conjunction with the Heartbeat Trust, which supports research and special services in the heart failure unit of St. Vincent's University Hospital. In 2007, the year-two costs of this programme were met from the targeted investment funding allocated for sudden cardiac death and heart failure, which were divided equally.

I thank the Minister of State for his reply. I acknowledge that the old regional ambulance service in the Eastern Regional Health Authority was supportive of community first responder schemes that were set up in Wicklow. There were around 30 groups and nearly 500 volunteers. After the establishment of the HSE and the Task Force on Sudden Cardiac Death, however, the scheme nearly collapsed, and would have done so if it were not for the volunteering spirit of certain individuals and the community. It is a fantastic scheme, but it has received no support over the last 18 months.

A nice press release that came through my fax on 3 October gave the impression that the world and its mother were being moved to implement the recommendations of the task force, but it simply has not happened. A total of 48 recommendations were supposed to have been implemented by the end of 2006, but I do not know whether any of them have been to date. The press release mentioned that members of the SCD implementation steering group had met a number of community first responders' groups. I know the group in Wicklow has made numerous attempts to meet these officials. I ask the Minister to ensure that they meet and assist these groups, because it will be impossible to re-establish them if they collapse. The press release also mentioned that there was a template available for first responders' groups, but I have not been able to obtain this. I ask the Minister to contact the steering group and ask that it take a more proactive approach in dealing with the groups that have already been set up.

I acknowledge the efforts of volunteers, on whom the success of this programme depends, from every part of the country. The provision of defibrillators is a bottom-up approach. Apart from the funding being provided by the HSE, there are many communities which are making major contributions towards the purchase of defibrillators. Agencies such as Údarás na Gaeltachta have also made a contribution. It is important to have the infrastructure, including defibrillators, in place but it is more important that we have first responders who can provide the service.

Deputy Timmins mentioned the report of the Task Force on Sudden Cardiac Death, which was published in March of last year. Of its 75 recommendations, as the Deputy pointed out, 48 were considered to require immediate implementation. Action has been taken on these 48 recommendations. Currently, the Department and the HSE are in the early stages of developing proposals on how community groups may best be supported and the setting up of first responder schemes, including training and the acquisition of defibrillators. As for the group mentioned by the Deputy in his own county, I will raise this issue with the HSE.

Could the Minister give a commitment that he will investigate the possibility of supporting these schemes? They do not need money, as this is provided by the communities. They just need training and administrative back-up whereby they can ring someone in the ambulance service if something goes wrong. There are many groups waiting to be trained, including several in Wicklow and Kildare and one, a Leas-Cheann Comhairle, in Askamore in your beloved Wexford. They have volunteers, but the training is not forthcoming. Will the Minister consider having this training provided?

There are 100 front-line patients attending the cardiac rehabilitation unit at Ennis General Hospital but because of the health recruitment freeze and funding cuts that service is under threat. I want a commitment from the Minister that the service will continue. It is invaluable to patients and should not be threatened because of these cuts. Can the Minister give a commitment that it will continue into the future?

Far be it from me to take over the Leas-Cheann Comhairle's responsibility, but the question does not deal with this matter. However, I will pursue——

The Minister may answer the part of the question that is appropriate.

I will certainly pursue the matter.

On a more general note, as the Minister of State with responsibility for health promotion, I am committed, together with my colleagues and particularly the Minister, Deputy Harney, to overseeing the development of a new cardiovascular health strategy which will build on the success of the Building Healthier Hearts strategy while taking into account the changed landscape of today's Ireland.

I am glad Deputy Timmins mentioned the ambulance service. Too many people ring the doctor or the hospital in an emergency, which is wrong and a waste of time. If there is one message I want to make clear, it is that people should dial for the ambulance service. I will pursue the issues raised by the Deputy.

I indicated that I wanted to ask a question.

I am afraid there was no time to call Deputy Ó Caoláin as I had to call the Deputy who tabled the question.

Acquired Brain Injury.

David Stanton

Question:

83 Deputy David Stanton asked the Minister for Health and Children if her Department has received a report (details supplied); if so, when this report was received; the action she has taken as a result; and if she will make a statement on the matter. [24070/07]

This report was commissioned by the former Midland Health Board and was completed during the period of transition to the new Health Service Executive structure. A multidisciplinary project team, including voluntary and statutory groups and clients and carers of people with an acquired brain injury, was established to examine the community-based health service needs of people with this condition.

Following receipt of the findings of the project team, a development officer was appointed to carry out a more detailed needs assessment and to formulate a development plan. The development officer submitted her report in April 2005. The HSE has since contracted the Peter Bradley Foundation to provide a service for people with acquired brain injury in the midland region and has set up a forum for information sharing with the chairperson of BRÍ, the Acquired Brain Injury Advocacy Association. The service includes access to a neurophysiologist, an occupational therapist and rehabilitative assistants. This is in addition to the usual services available to people with disabilities.

Discussions on the creation of a national strategy for the development of neurological rehabilitation services are taking place between my Department and the HSE. The report in question will contribute to this process.

I thank the Minister for his response. Could the Minister confirm the number of people who sustain head injuries annually throughout Ireland? Is it true that it is between 10,000 and 11,000? How many consultants in rehabilitation medicine are there in Ireland at present? Does he agree that by UK standards we should have 17 consultants, while based on the numbers in the Netherlands we should have 74? How many people are waiting to gain admission to the National Rehabilitation Hospital? Is it true that at the start of 2007 there were 120 people waiting for admission? Does the Minister accept that people were waiting between three and six months, and up to 18 months in some cases, for admission to the high-dependency unit? What is his opinion on this, given the importance of early admission to hospital? Can the Minister also tell us how many acute stroke units there are, and their locations?

When will we see action as a result of the report mentioned in the question? When will a national strategic policy on acquired brain injury be developed?

The Deputy asked a number of questions. I will do my best to answer as many of them as possible and come back to him on the others. It is estimated that approximately 10,000 people are admitted to hospital with acquired brain injury every year. Obviously, the causes can vary from road traffic accidents, physical assaults, brain tumours or infections of the brain matter, such as meningitis.

At the National Rehabilitation Hospital in Dún Laoghaire there are currently 120 beds. Plans are well afoot to build a new hospital on the same site which will have 240 beds. The Department is looking at the overall requirement for rehabilitation beds nationwide.

Would the Minister of State accept that there is a long waiting list for beds in the national rehabilitation unit and that families are trying to cope at home with seriously injured or disabled loved ones? Does he also accept that there is capacity in nursing homes, at least one of which has a brain injury unit, to take people from the national rehabilitation centre whose treatment phase is finished and who need a safe place in which to stay? These places are not being taken up because of the cutbacks and, as a consequence, the patients to which I refer, one of whom is in Swords in my constituency, are suffering undue and needless hardship?

I would agree with Deputy Reilly that there is a long waiting list and that is the reason we are proceeding to build a new hospital. Would the Deputy repeat the second part of his question?

I asked about the current availability in a private unit to which people may be referred from the national rehabilitation centre. I understand that a contract was nearly signed for the transfer of 22 patients which would have freed up those beds for people badly in need of care.

My understanding is that the home care packages will be re-introduced to the National Rehabilitation Hospital over the next week to free up beds. As the Deputy stated correctly, if the beds are occupied, people cannot be allocated to them. It is important that those who are ready to be discharged from the National Rehabilitation Hospital are discharged as quickly as possible.

Can we get clarity here? The Minister of State is speaking of home care packages, I am speaking about nursing home care.

I include packages for nursing homes as well.

To what is Deputy Reilly referring?

Although the normal practice is for a Deputy to ask the Minister a question, the Minister is asking Deputy Reilly a question.

Could Deputy Reilly give me the details?

Could Deputy Reilly identify the detail?

I can do that later, certainly.

I also wanted to ask about the home care packages because the Minister, Deputy Harney, in replying to one of my priority questions, indicated that there would be a restoration of home care packages. In the case of people currently in the National Rehabilitation Hospital who are ready to go home, will facilities such as home care packages be put in place to ensure that such people can move out of beds in order to allow other patients in?

Headway Ireland, which deals with patients with acquired brain injury, has identified a number of areas of support needed for those living with acquired brain injury who may be outside rehabilitation and who are back in the community. What measures will be put in place to address those needs? Has the Department ongoing contact with Headway Ireland to ensure that the needs of those people are addressed in their communities?

I met with Headway Ireland and Rehab over the past couple of weeks and shortly I will meet with the Peter Bradley Foundation. The service it provides is of a high standard and is badly needed.

My understanding with the HSE is that over the next couple of days those home care packages and nursing home packages will be made available to start allowing people to leave the National Rehabilitation Hospital if they are fit to do so, and to allow for the admission of patients who badly need the service.

This needs to be done urgently because there are people for whom every day makes a difference in terms of their access to the National Rehabilitation Hospital.

I do not intend to repeat everything that has been said. However, the wife of a person from County Meath who needs to be admitted to the National Rehabilitation Hospital was on "Liveline" on RTE radio yesterday, and today there was another case in County Cavan, in the constituency I share with the Minister of State's colleague, Deputy Brendan Smith, in which a person was seeking admission to the hospital. Serious cases are presenting every day of every week. How can the Minister of State explain the withholding of home care packages, not putting in place essential stepdown facilities necessary to free up badly-needed beds, and the fact that people in many hospitals around this country are waiting to be transferred?

Would the Minister of State agree the facilities in this area in Ireland compared with those in continental Europe are utterly inadequate? Would he agree, for instance, with the standards the Peter Bradley Foundation cites in its recent report, namely, that we should have 74 consultants in this area but we have only three? Would he agree that the issue is getting people with acquired brain injury or stroke quickly into rehabilitation so they can receive the proper treatment on time and so that most of them can go home to live a normal life? Does he agree that is not happening? There are thousands of people in Ireland whom we are failing on this issue. We are way behind the rest of Europe. Could the Minister of State give us some indication or commitment that action will be taken in this important area?

I would agree with Deputy Stanton that we are behind the rest of Europe. I agree we need more consultants. As soon as the consultant organisations have accepted the new contract, the recruitment of those consultants will start.

On Deputy Ó Caoláin's question, the budget for the National Rehabilitation Hospital is approximately €25 million. I understand that there was an overspend of approximately €850,000, which resulted in a blockage. We are now taking steps to unblock the blockage. I agree that we should not prevent patients who need to get into that facility from being admitted. From that point of view——

The Minister of State should not allow it to happen. This morning there was a Supplementary Estimate for the Department of Communications, Energy and Natural Resources. We are dealing with people's lives. If there is additional money required there should be no penalty for overspend. It is necessary.

Written Answers follow Adjournment Debate.