Vol. 686 No. 3
28 Deputy Aengus Ó Snodaigh asked the Minister for Health and Children the measures she will undertake to address the general shortage and uneven distribution of general practitioners, particularly in the Dublin region; and if she will make a statement on the matter. [26287/09]
79 Deputy Róisín Shortall asked the Minister for Health and Children her views on the report of the Expert Working Group on Future Skills Needs carried out for her and the Health Service Executive which found that there will be a need for more than 100 additional general practitioners annually to meet the needs of the population and to address changing work practices and gender distribution; if the number of general practitioner training places will be increased to address this need; and if she will make a statement on the matter. [26336/09]
I propose to take Questions Nos. 28 and 79 together.
I welcome the recently published report by the Expert Group on Future Skills Needs which includes workforce planning analysis for selected health care occupations, including general practitioners. Among its findings, the report indicates that the current gender distribution in general practice will be reversed in the future with a ratio of 65 females to 35 males. It also predicts that by 2020, almost 30% of female and 5% of male general practitioners can be expected to work part-time. There are 12 general practitioner specialist training programmes currently in operation in the State. They are all of four years duration — two years spent in hospital posts under the supervision of hospital consultants and two years in an approved general practice under the supervision of a general practice trainer. The total number of places available is 120. The report predicts that this figure will not be sufficient to meet the demands of a growing and ageing population into the future.
The Health Service Executive and the Irish College of General Practitioners are currently in discussion with a view to increasing the number of general practitioner trainees by streamlining existing programmes in a cost-effective manner. In addition, the college has identified a number of doctors who have not had formal training in general practice but who are interested in pursuing a career as a general practitioner. The provision of a programme of training for these doctors is also being examined.
The Health Service Executive is also taking steps to increase the number of general practitioners who can take on patients with medical cards. A rule which allowed doctors who currently have patients who hold general practitioner visit cards to also take on medical card patients after five years has been amended to allow such doctors to take them on with immediate effect. Nationally, there are in excess of 50 doctors in this category, 20 of whom are in practice in the Dublin area.
Recruitment of general practitioners to provide services under the GMS scheme has been made simpler with a list of posts being advertised centrally on the HSE website. Proactive management of upcoming retirements by local health offices is in place to flag potential general practitioner vacancies at an early stage. Articles have also been placed in UK medical magazines highlighting general practitioner opportunities in Ireland.
It has been my intention for some time that any restrictive rules preventing fully qualified general practitioners taking on patients under the GMS scheme should be ended. In that context, a consultation group involving my Department, the HSE and the Irish Medical Organisation has been reviewing the provisions relating to entry to the GMS scheme. I understand that considerable progress has been made and that detailed recommendations from this group will be presented to me shortly, with the objective of increasing the pool of general practitioners who can take on medical card patients.
My Department will discuss the contents of the expert group report with the HSE and other appropriate agencies in the coming months to ensure we continue to have an adequate supply of general practitioners available.
I thank the Minister for her reply. Does she accept that the ratio in this State of 0.6 GPs to every 1,000 of the population is a major problem? This ratio compares to an EU average of one GP to every 1,000 of the population. This ratio falls even further in more disadvantaged areas such as north Dublin where its stands at one GP to every 2,500 of the population. This issue was also recently raised at Carrickmacross Town Council where a Government party councillor highlighted the fact that some locals had been forced to travel as far away as Dundalk to attend a GP. A 2007 study found that one in every four of paying patients in the 26 counties who had a health problem did not attend a GP because of the issue of affordability. That is another alarming fact that must be taken on board.
Does the Deputy have a question?
I am concluding with this point. The shortage of GPs restricts the time a GP has to engage with a patient and the opportunity he or she has for health promotion. While acknowledging some steps have been taken as the Minister's reply indicated, what further steps are proposed? Will the Minister agree it is alarming the HSE has had to recruit GPs outside of Ireland to meet the current shortfall?
Deputy Ó Caoláin is correct that Ireland has a lower GP-population ratio of 58 GPs to 100,000 people when it is 67 to 100,000 in Northern Ireland and the UK, a difference of nine. Notwithstanding that, we also have restrictive work practices with up to 400 doctors not being allowed access to the GMS lists because of an industrial relations agreement. While we want to provide practice supports to practices with relatively large numbers of patients — otherwise it would not be cost effective — I do not believe it is sustainable or fair to those general practitioners. The 50 doctors on the doctor-only medical card scheme will be allowed to have access to the full GMS list. That will increase the number of GPs in the Dublin area, where there are particular shortages, by 20.
Since 2004, the number of training places has been significantly increased from 84 to 120. A number of doctors who work in general practice have not done the GP-training programme. I have encountered several of these cases where they were working with a general practitioner for years but when he or she retired they were not qualified to take over the practice. It is a sore point and I understand the colleges are examining the possibility of a training programme for doctors affected to increase supply.
The main challenge with changes in gender distribution, family and lifestyle commitments and so on is to ensure the numbers in general practice increase. It is essential for the move from hospital to community care to place more emphasis on general practice.
All Members will agree having an adequate number of GPs is crucial in treating more people in a primary care and community system rather than an acute hospital one. The Minister stated in her reply the current graduate supply is 120 GPs per year and hoped to increase that figure by "streamlining existing programmes in a cost effective manner". Will the Minister decode this HSE-speak? Does it mean training more GPs for the same amount of money?
The number of trainees has increased from 84 to 120 since 2005, a significant increase. Discussions are under way between the Health Service Executive, the Irish College of General Practitioners, the Irish Medical Organisation and the Department on many of these issues and they will report to me presently. While I do not like using the word "innovative" in an inappropriate way, we need to be innovative, particularly with those doctors already working in general practice who have not done the original GP-training programme. We need to provide an opportunity for them to qualify for a GMS list. It is unfair they are already dealing with all other patients, including GMS patients, but they cannot take over the GMS list.
I welcome the Minister's acknowledgement of doctors working in general practice who have not completed training but are quite experienced. It would be laughable for them to have to undergo full training. We must, however, be careful about maintaining the quality of general practice. I also welcome that those doctor-only visit card doctors will be now able to take on all GMS patients. When was the rule amended?
The Minister must acknowledge there is an increased need for training. While the number of trainee GPs has increased to 120 since 2005, with changing demographics and working practices the whole-time equivalents of those currently qualifying will actually turn out lower. While the Irish College of General Practitioners sought 150 graduates a year, up to 200 are needed. What plans has the Minister got to address this matter? The HSE has also been suppressing this by allowing doctors to amalgamate lists when the doctors' organisations opposed it. I certainly oppose it, wanting more, not fewer, doctors in the community.
The restriction on access to the GMS scheme was an agreement with the Irish Medical Organisation, representing general practitioners a long time ago. I have had many young doctors ask me why they cannot have access to the GMS scheme. I put a group together to examine this and it will report to me shortly. I see no justification for restricting access to GMS to any doctor.
I acknowledge that for supports such as practice nurses to succeed, critical mass is needed. France has 164 general practitioners for every 100,000 people. Last year I met a group of French general practitioners. Before Deputy Reilly gets a fright, I am not advocating their pay rates. However, I learned they earn €60,000 a year; they were amazed at how much our doctors earn. They get no practice supports whatever, do an incredible amount of work and greatly alleviate pressures on the acute hospital system. I am all for increasing the number of general practitioners. As we are doubling the number of medical students, I would hope we will be able to retain as many of them as graduates in medicine, particularly in general practice.
How many of the trainees are being retained in Ireland and how many leave the country? I am concerned with the aging population of doctors in the north east and the need for their replacements. With the new services proposed by the Minister, their replacement will be necessary.
I am glad the Minister used the French example. The figures she cited for the North of Ireland and Britain do not reflect the EU average, which stands at one GP per 1,000 people. I would like to ask the Minister about access to medical education. Places are critical in terms of the number of general practitioners we turn out. We also need to examine the issues of affordability. Access to medical training continues to be affected by elitism. I do not mean any disrespect when I use that word. Very few families can afford to pay for the many years of training a young person needs to become a doctor. The course that is followed during the period of training is quite intense. We need to bear in mind that fine young people from many families across this country who could become excellent general practitioners are not able to access what they see as their natural calling as a consequence of the exorbitant and prohibitive costs involved. I would like that aspect of the matter to be addressed so that we can achieve equality of access.
I spoke earlier about the number of locums working in general practice. I understand that the Irish College of General Practitioners, in conjunction with the HSE, recently published an advertisement seeking expressions of interest from practitioners who would like to qualify to be on the specialist register. The Irish Medical Council requires doctors to be on the specialist register in order to work as general practitioners. I understand that 219 people have responded to the advertisement, which is very satisfactory. If the number of general practitioner training places, which is approximately 120 at present, can be increased by a further 219, that would be very welcome indeed. I accept that the people in question are currently working in general practice. However, they are not in a position to hold general practice registration with the Irish Medical Council.
29 Deputy Paul Connaughton asked the Minister for Health and Children if the National Treatment Purchase Fund will fund scoliosis surgeries for children experiencing acute pain and needless suffering; and if she will make a statement on the matter. [26374/09]
53 Deputy Aengus Ó Snodaigh asked the Minister for Health and Children the measures she will undertake to address the situation at Crumlin Children’s Hospital, Dublin; and if she will make a statement on the matter. [26286/09]
71 Deputy Michael D. Higgins asked the Minister for Health and Children if it is proposed to provide a new funding stream for the extra work on specific conditions such as sickle cell disease which has been undertaken by Crumlin Children’s Hospital, Dublin; if the funding provided for the hospital will take account of the fact that the children who previously had their operations carried out abroad at extra expense to the State, are being treated in Crumlin; and if she will make a statement on the matter. [26318/09]
I propose to take Questions Nos. 29, 53 and 71 together.
The National Treatment Purchase Fund was established to tackle the issue of excessive waiting times for hospital treatment for public patients. The fund has been successful in fulfilling this remit. It has arranged treatment for more than 145,000 patients to date. Public patients now wait an average of 2.6 months for operations, compared to between two and five years before the establishment of the NTPF. For reasons of patient safety, highly specialised and complex paediatric cases like scoliosis cannot be provided within the private sector. The NTPF has arranged for a limited number of patients with scoliosis to undergo surgery in a public hospital. No additional remuneration accrued to the treating consultant in respect of these exceptional cases, which involved patients whose medical condition was deemed clinically suitable for treatment in another hospital. The NTPF will continue to work with the HSE and the public hospital system to identify and agree cases suitable for treatment through the fund. In doing this, regard will be had to the patients' medical conditions, to suitability and safety issues and to the length of time the patients have spent waiting for treatment.
Each hospital funded by the HSE is required to deliver services within the financial allocation provided to it. Like all hospitals, Our Lady's Children's Hospital in Crumlin must deliver a high quality service to its patients while remaining within budget. The priorities of the HSE and the hospital management at Our Lady's Children's Hospital are to ensure that services at the hospital are maintained at an optimum level and to protect patient care. Following a meeting between the HSE and the three Dublin paediatric hospitals last week, it was agreed that Our Lady's Children's Hospital would revert to the HSE with its proposals to specifically address the needs of scoliosis patients between now and the end of the year. The HSE will consider these proposals within days and form a plan of action with the hospital.
The incidence of sickle cell disease has increased significantly over the past ten years. Earlier this year, a consultant was appointed to a full-time consultant haemophilia post at Our Lady's Children's Hospital, covering inpatient and outpatient haemophilia services for children. Prior to this appointment, another consultant covered inpatient haemophilia services, in addition to covering sickle cell and other red blood cell disorders and other benign disorders. The new appointment has allowed one of the consultants concerned to focus virtually full-time on treating patients with sickle cell and other red blood cell disorders in Crumlin. Patients who had procedures funded by the NTPF at home or abroad, and require ongoing treatment, are treated within the overall annual funding allocated to the hospital.
The most effective way of providing the best possible tertiary care involves the creation of a single national paediatric hospital, alongside a major teaching hospital. The concept of bringing together all three present services is widely accepted. A report commissioned by the HSE, Children's Health First, indicated that the population and the projected demand in this country can support one world-class tertiary paediatric hospital. It recommended that the hospital should be in Dublin and, ideally, should be located with a leading adult academic hospital to optimise outcomes for children. Following detailed consideration, it was decided that the most appropriate location for the new paediatric hospital was adjoining the Mater Hospital. The development of the new hospital is being overseen by the national paediatric hospital development board, which was established in May 2007.
We must move towards a model of care that involves closer integration and co-operation. More than €250 million has been provided for the running of three paediatric hospitals in Dublin in 2009. Significant cost savings can be achieved if services and practices are more closely integrated across the three hospital sites, even before the new 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 achieve savings that can be put back into patient care. The areas of possible increased co-operation that are being examined include paediatric surgery, paediatric critical care services, renal services, genetics and dermatology services.
The Minister has said that great savings can be made by amalgamating the three hospitals, or by providing for greater co-operation between them. It is important to point out that in September 2007, representatives of Our Lady's Children's Hospital in Crumlin asked for a meeting with HSE officials on this matter. The prospect of a meeting being arranged as part of this debate did not re-emerge until recently. On a previous occasion, the Minister argued that €4 million could be saved on blood products. However, Our Lady's Children's Hospital spends an average of just €6 million on blood products each year. It returns all unused blood product to St. James's Hospital, where it is used. Our Lady's Children's Hospital is not reimbursed for that blood. That shows that the Minister's argument is fallacious. The comparisons she previously made with a hospital in Birmingham are equally null and void. How many children are waiting for scoliosis surgery? As the Minister knows, the longer they are left without surgery, the more operations they will need and the more disabilities they will suffer. How many children have had scoliosis treatment under the National Treatment Purchase Fund? How many of them will get such treatment? How many children have had scoliosis surgery under the fund this year? How many more operations are planned before the end of the year? How many children are on the waiting list at Crumlin?
We should all get on with doing what we are supposed to do, rather than trying to fight battles day and night. The saving of €4 million that I mentioned previously did not relate solely to blood products. I agreed with what the Minister of State, Deputy Moloney, had said on "Prime Time", which was that €4 million could be saved if the hospital worked with St. James's Hospital on blood products and with the other two hospitals on the procurement of medical devices and drugs, etc. That is where the figure of €4 million came from. I stand over that. Professor Drumm will address these issues when he attends a committee meeting next week. I stand over all the facts I have mentioned. Somebody said today that there is one physiotherapist in Our Lady's Children's Hospital, Crumlin, even though 17.5 physiotherapy posts are filled there. I do not suggest that more posts are not needed. I am simply saying it was not accurate to say that just one post is filled at present.
I did not hear that contribution. Just one physiotherapy post in rheumatology is filled at present — that is for certain.
Yes. A total of 17.5 physiotherapy posts are filled at the moment. It is a question of the manner in which physiotherapists are allocated. I understand that the person in question will be replaced when she goes on maternity leave. I do not have the figures on scoliosis in my head. I think I had them for an earlier question. I understand that 11 operations were postponed, of which nine were rearranged. It was something in that order. If I cannot find the figures, I will give them to the Deputy after this debate. As I said in my initial reply, the HSE is working with the hospital on the issue of scoliosis, which is a serious condition. As I see it, the money we are allocating to the three hospitals in 2009, for the treatment of children with these serious conditions, should be sufficient to deal with those who most need attention. I acknowledge and welcome the fact that, notwithstanding the current budgetary constraints, the level of activity at Our Lady's Children's Hospital, Crumlin, this year is already ahead of that for last year. If the three hospitals work with the HSE, they will be able to deal with the issues that are concerning them all.
In response to an earlier priority question, the Minister referred to an article in a County Louth newspaper, The Argus. She suggested that a representative of Sinn Féin had expressed a particular view on public-only general practice. I have to say she misrepresented the situation.
I would prefer if the Deputy addressed the question we are dealing with.
In line with Sinn Féin policy, my colleague in County Louth has very clearly indicated that a two-tier approach does not work, and that is wholly in line with the position I have articulated here, time and again. I thank the Leas-Cheann Comhairle for allowing me to clarify that point.
Regarding the grouping of questions before the House, the Minister has never given us a breakdown of the alleged €20 million to be generated from the proposed co-operation or amalgamation of the three existing child-related hospitals in the greater Dublin area. Can the Minister give such a breakdown and the facts and figures on the €20 million she alleges is the crock of gold at the end of the rainbow, which, in real terms, represents the end of Crumlin children's hospital as we have known it? It is very important that the debate is informed of the full facts.
While the further cuts at Crumlin were deferred for the summer period, there is, nonetheless, the restraint created as a result of a €9.5 million budget cut already at that hospital. As the national children's hospital, which is supposed to be a centre of excellence, how can the provision of services be allowed to be so restricted, where young people in need of major operative procedures are having access to them denied or deferred, resulting in great pain and potentially life-debilitating consequences?
There are a large number of questions there. That is the article I am referring to, from The Argus newspaper, with the headline, “Private care is curtailed”, and——
I have it here. It states: "Public only consultant can't admit VHI patients."
——the Sinn Féin public representative was critical of that. I very much welcome the contribution from The Argus newspaper to this debate because it displays the hypocrisy that exists. We curtail private care and we are all entitled to access to public hospitals, and that is being criticised.
There is no hypocrisy. The hypocrisy is on the Minister's side——
The Deputy cannot have it every way.
——and proves, once again, that co-existence of private and public service provision in the one system does not work.
The Minister, without interruption. The Minister, please, without provocation.
The Deputy surely does not want us——
It does not work and the Minister has presided over two tiers in the health services all along, without consequence.
The Minister, without interruption, please, Deputy Ó Caoláin.
The Minister should stick to the facts.
I should not have allowed the Deputy to raise the matter at all. It was in order in the question, but it is not in order now. I call on the Minister to respond to the questions that are in order.
Deputy Ó Caoláin can tell his colleague that the public hospital is for all patients.
The Minister can tell him herself——
I am pretty sure the Deputy will tell him.
I want to clarify what I said regarding the point I was making to Deputy Reilly. The numbers of scoliosis patients' appointments cancelled was 13, not 11, as I said, and I am sorry. Five of those had their appointments immediately rescheduled. I believe Professor Drumm will deal specifically with that issue when he addresses the Oireachtas committee on Tuesday.
How many are waiting overall?
Regarding the €20 million, I am satisfied this is true and in fact a minimum figure when four catering departments are combined as well as four HR departments, four payroll systems, four central sterile units, waste management and all of these things. One does not need to have four CEOs, although two directors of nursing are required, one for children and one for adults. There are very significant savings to be made, I have no doubt, and part of this relates to the €4 million figure I mentioned regarding single procurement, just to make matters clear. I do not want to be accused of double counting.
Will the Minister circulate the details?
I will leave it to the CEO of the HSE to deal with that when he addresses the committee next week. He is a distinguished paediatrician of world renown who worked in Crumlin hospital and knows it well. He will be addressing all the issues.
He is an excellent paediatrician, but what about his management skills?
He is an excellent CEO as well, a man of substantial vision, who had the guts to take on the job and not merely be a hurler on the ditch.
Guts are not needed to be a CEO, but specific managerial skills.
Allow the Minister, please.
One needs to have lots of guts to be a CEO, and vision too. I believe the sum of money allocated within the resource constraints we are living within should be adequate to provide the tertiary services for the sick children from the country and the other services for the children in the Dublin area who require that their secondary care be provided in the three hospitals that exist in the city at present.
The Minister, in reply to Deputy Reilly, said that there were five scoliosis surgery patients appointments rescheduled. In the earlier part of her reply she said, basically, that the private hospital system could not do this operation and, therefore, they were all rescheduled in public hospitals. I believe that is what the Minister said, in any event. That puts a hospital such as Crumlin at an unfair funding disadvantage to other types of acute hospitals which can farm out much of their waiting lists to the NTPF. Obviously, Crumlin cannot in these types of situations. Does that not make an argument to the effect that Crumlin should be treated differently in terms of funding, since it does not have the outlet that other hospitals have?
On the question that was grouped with this one, from my colleague, Deputy Michael D. Higgins, specifically about sickle cell disease, again, that is something that Crumlin has taken on as an extra, without any funding stream. Should it have refused to deal with sickle cell cases on the grounds that it did not have the money? What is a hospital such as Crumlin supposed to do in those circumstances?
It is not correct that there have been no additional resources. In my response I said that Dr. Beatrice Nolan was appointed as a consultant haematologist to Crumlin in March. She came from the national tertiary centre at St. James's and relieved the doctor who was working with haemophiliacs and sickle cell patients to allow that other consultant to deal exclusively with sickle cell cases, because it is a big issue. We know the cause of sickle cell in a large percentage of births relates to people coming here from African countries. A large percentage, some 20%, of births in national maternity hospitals relate to people from that continent and there is no doubt it will be a growing problem. However, the resources of the hospital have increased significantly. We would love to have more money for everybody. The reality is we are living in an environment where resources are very constrained and, therefore, we have to do our best with what is available, in the way we organise services and how we prioritise things within the hospitals.
Regarding the private system, Cappagh is not a State hospital but a voluntary not-for-profit facility and is in a position to do scoliosis cases. However, there is no question of the treating consultant being paid a fee to perform the surgery there. The NTPF has procured surgery there, I understand, for a number of patients, and two are scheduled to happen at Cappagh within the next couple of weeks. Clearly, we have to use whatever resources we have, whether from the NTPF or the direct allocation to the hospitals, to treat the patients who require medical attention most.
I would like to point out to the Minister that 75% of the increased funding went on wage increases approved by her Government, through benchmarking and social partnership. I asked the Minister how many patients would be and have been operated on through the NTPF and I have not been told. The waiting list for scoliosis surgery is much longer than the Minister has indicated. She is just talking about the cancelled cases. It is not good enough for the Minister to say she has a gut feeling about catering and four of this and four of that, etc. We were told that with the HSE when ten health boards were amalgamated and the shared services unit. All we got was a mess. Has a cost-benefit analysis been done to justify the Minister's figure of €20 million?
Contrary to the Deputy's impression, there has been an significant reduction in the number of people working in management and administration since the HSE was established, and I can give him the data on that.
Crumlin hospital has had an increase of 18% in medical and dental staff and 29% in nursing staff. Extra people provide extra services, so when the Deputy says it goes on pay, that is true of 80% of the health budget. It goes on recruiting extra people or to pay increases to existing staff. There has been a substantial increase. The day before the decision was made that the location for the new children's hospital should be the Mater, it was clear that the three choices were the Mater, Beaumont or St. James's. There was no choice as regards a site on the Naas Road.
I recall talking to the current chairman of the medical board at Crumlin, and he was very excited. In fact, he was very complimentary to me, and then it all fell apart once the site was chosen. It is bigger than a site. It is about a service. I had a very good meeting recently with the chairman of the medical board and one of his colleagues at Crumlin with Professor Drumm and I very much welcome the fact that serious engagement is taking place. I salute that and welcome it. Long after all of us have gone — clinicians, Ministers or politicians — there will hopefully be a state-of-the-art facility for sick children.
The question was on a cost-benefit analysis.
Yes, absolutely.
Can the Minister make it available to us?
I am hearing all about care models and the cost-benefit analysis. Does anybody think the facilities at Temple Street and Crumlin are adequate to the needs of our children and that we should build two new hospitals?
The Minister has been asked twice to share the information.
I am inviting the Deputies to deal with these issues at the committee next week.
30 Deputy Joe Carey asked the Minister for Health and Children her plans to relocate the Central Mental Hospital to an existing psychiatric institution (details supplied); and if she will make a statement on the matter. [26370/09]
In May 2006 the Government confirmed the decision to develop a new Central Mental Hospital, CMH, at Thornton Hall, County Dublin. Since then, a draft project brief has been prepared and a cost-benefit analysis completed. None of the work undertaken to date has been site specific but a number of difficulties have emerged with the Thornton Hall site. The HSE has identified a need for an intellectual disability forensic mental health unit and a child and adolescent forensic mental health unit. Neither of these units would be viable as a stand-alone facility and they should be co-located with the CMH, but the 20-acre site at Thornton Hall is not large enough to allow for these additional developments.
The construction of these additional units at a location separate to the CMH would incur increased capital and revenue costs. The planning and design process for the CMH redevelopment project will soon need to become site specific and all of the issues involved are being considered. The Deputy can be assured that if the Government decides to change the location of the new hospital, the HSE will, in due course, undertake a consultation exercise with stakeholders.
Clearly the Thornton Hall site is no longer a runner. Is that correct? Is it the case that the CMH is no longer going out there and the PPP is no longer a prospect? I am trying to interpret what the Minister of State has told me.
The response goes on to make the point that it was never site specific, but a time is arriving when it needs to be site specific. I had a meeting with Dr. Harry Kennedy and his people in the hospital some months ago and I made it clear that the Government's priority is to fast-track the building of a central mental hospital. Nothing has changed since then. The Government must decide on a site specific location and the Government is doing that.
Forgive me, a Leas-Cheann Comhairle, but I thought we had a long debate in this House about how we did not consider that Thornton Hall was an appropriate site although the Government was intent on making it the site. Clearly it has now moved position and I welcome that. I equally welcome the fact that we need to fast-track a new central mental hospital. However our interpretation of the word "fast" when it comes to central mental hospitals or co-locations seems to be at variance with one another.
It was recently reported in the newspapers that the Central Mental Hospital is no longer in a position to take new admissions because it is so full. Would the Government consider proceeding with the original plan the Central Mental Hospital had for using the existing grounds in the area to build a new facility which would overcome many of the difficulties and issues which had been originally raised by Schizophrenia Ireland, Friends of the CMH and Amnesty International, to mention but a few from a long list?
I would like to be definite on this. When I held the meeting in Dundrum at the invitation of Dr. Kennedy some months ago I made it clear that Dundrum would not be a runner. I also made it clear that upon taking up my role in the Department of Health and Children, the Minister, Deputy Mary Harney, never made an order to me that it had to be Thornton Hall, although I was asked to proceed as quickly as possible with a new central mental hospital. We are coming to a time when we must be site-specific but the real issue has been to ensure we build a new central mental hospital. The only change is the fact that we are coming to a site-specific decision.
I welcome this, the cleverest U-turn I have heard announced in a long time.
It was so subtle the Minister of State did not even realise it himself.
I do not understand why we were all brought out to look at this site. What sort of planning is this? How did these two units that will no longer fit suddenly appear on the horizon? Did the Minister of State not know he needed them before this site was suggested? It is extraordinary that we are casually being told this site is not big enough after all the trauma the various groups and families have gone through in the he last couple of years.
It is important to welcome what the Minister of State has said but to add that it does not arise from a recognition on the part of the Department, Minister, her colleagues or the HSE that the proposition to site at Thornton Hall was wrong in the first instance. It is a quirk of fate. Welcome though it is, it is important to recognise that is the case. Question No. 30 asks the Minister her "plans to relocate the Central Mental Hospital to an existing psychiatric institution (details supplied)". At no time in the Minister of State's comments or Deputy Reilly's remarks were these details supplied. Can the Minister of State share with the House the site-specific existing psychiatric institution to which the question refers?
There are many questions but I will try to answer them. First, this is not a U-turn. Dr. Kennedy will confirm that I made a visit on my first day in office. I made it clear to him that my instructions were to proceed as quickly as possible to build a new central mental hospital. I told him the only commitment I could give him was that it would not be Dundrum, for many reasons, including the fact that the sale of the property could provide value towards providing further mental health services. It is not by way of coming to a decision quickly, dishonestly, by a U-turn, or whatever the Opposition Members want to say. It was always a matter of the Minister making it clear that we needed a new central mental hospital. Thornton Hall was picked because it would expedite that process.
When leaving after a two-hour meeting I told Dr. Kennedy that he would not wake up some day and read in the newspapers that the central mental hospital was moving to Thornton Hall. It was the only game in town at that time and I was working with the Minister to locate a site. I am working on that. I am not in a position to say where it will be located except to say that I had the opportunity to present the case to Government last Tuesday. It is not a matter of waving flags and saying we did something because we responded to pressure. It is a matter of doing the right thing to provide a central mental hospital as quickly as possible.
It is a matter of the recession.
Written Answers follow Adjournment Debate.
