I proposed to take Questions Nos. 215 and 246 together.
Each hospital funded by the HSE is required to deliver services within the financial allocation provided. In common with all hospitals, Our Lady's Children's Hospital, Crumlin is faced with the challenge of delivering a high quality service to its patients, while remaining within budget.
The priority of the HSE and hospital management at Our Lady's Children's Hospital is to ensure that services at the hospital are maintained at an optimum level and to protect patient care. The HSE is involved in ongoing discussions with hospital management regarding its 2009 financial allocation and Service Plan.
It has proven necessary for Our Lady's Children's Hospital, Crumlin to take measures to stay within budget. The HSE has advised that, based on the financial performance for the first five months of 2009, the hospital should achieve a break even position at year end. This assessment takes account of cost saving measures totalling €6.5m which have been agreed with the hospital, and which are to be implemented over the remainder of the year. Much of the focus of the discussions between hospital management and the HSE has been on ensuring that all areas of non-pay expenditure are critically examined and that costs are reduced where possible.
Part of these measures to stay within budget included the temporary closure of a theatre and a ward from this month. The hospital has now indicated that further ward and theatre closures which had been proposed for in July and August will no longer be necessary. This is to be welcomed.
Following on from a meeting last week between the HSE and the three Dublin paediatric hospitals, it was agreed that Crumlin Hospital would revert to the HSE with its proposals to specifically address the needs of scoliosis patients between now and year end. The HSE will consider these proposals within days and form a plan of action with the hospital.
The allocation to Crumlin for 2009 is €139.6m, an increase of some 39% over the last five years. In line with the budgetary constraints facing the entire public sector and the wider economy, this does include a reduction of 3% this year over 2008. A particular challenge for the Hospital is that it has been operating at some 91 posts above its employment ceiling — it employed 1,641 people (whole-time equivalents) at the end of April compared with its ceiling of 1,550. This is contributing to the current financial difficulties.
The way to provide the best possible tertiary care most cost effectively involves the creation of one single national paediatric hospital, alongside a major teaching hospital, bringing together all the medical and nursing expertise for complex conditions. The concept of bringing together all three present services is widely accepted.
The Children's Health First Report commissioned by the Health Service Executive indicated that the population and projected demands in this country can support only one world class tertiary paediatric hospital. It recommended that the hospital should be in Dublin and should, ideally, be located with a leading adult academic hospital in order to optimize the outcomes for children. Following detailed consideration, it was decided that the most appropriate location for the new National Paediatric Hospital is at the Mater Hospital.
The development, one of the most significant to be undertaken in the health service, is being overseen by the National Paediatric Hospital Development Board which was established in May, 2007.
The current timetable for completion of the new hospital is:
Q2, 2009 — Completion of the Project Brief (including the detailed design brief);
Q3, 2009 — Sign-off detailed design brief;
Q3, 2010 — Preliminary foundation works with site development to begin (subject to Planning Permission);
Q4, 2013 — Construction completed;
Q4, 2014 — Fit-out and commissioning.
It is therefore entirely appropriate that we should now move towards that model of care in terms of closer integration and co-operation in the medical areas and in the most cost effective use of resources.
In 2009 the Government will provide over €250m for the running of three paediatric hospitals in Dublin. We can achieve significant cost savings if services and practices are more closely integrated across the three hospital sites, even before the new National Paediatric Hospital has been completed.
With this in mind, the HSE is pursuing ways in which services across the three hospitals can best be co-ordinated, to avoid unnecessary duplication and to achieve savings that can be put back into patient care. For example: the three children's hospitals in Dublin have agreed and developed a model for the development of a joint department of paediatric surgery. The clinical network across the three hospitals will make the best use of the resources that are available and will ensure a ‘single system of care'. A recruitment process is underway to recruit three replacement surgeons that will then give the joint department a complement of 7 surgeons (currently 5 in place, with 1 due to retire shortly). It is anticipated that these posts will be filled by year end.
The HSE commissioned a review in 2008 of paediatric critical care facilities and services with a view to addressing any identified deficits in advance of the opening of the new National Paediatric Hospital.
The resulting Report recommended that Paediatric Critical Care Services should operate as a single/joint clinical department across Temple Street and Crumlin sites (Tallaght does not have an ICU) with a lead clinician, initially as part of a combined Department of Anaesthesia and Critical Care. An Irish Paediatric Critical Care Network has been established as the advisory body to lead the development of a co-ordinated system for the delivery of paediatric critical care services and to develop advice, standards and recommendations regarding the optimum delivery of paediatric critical care services in the country.
An independent chair has been appointed (Dr. Des Bohan, Medical Director, Critical Care Services for Children, Toronto), who is an international respected expert, to facilitate and guide the development of the joint department of paediatric critical care. Other areas currently being examined in relation to increased co-operation are in the areas of renal services, genetics, endocrinology and dermatology services amongst others.