I call Question No. 35. I understand other questions are grouped with it.
Other Questions
Hospitals Building Programme
Mary Lou McDonald
Question:35 Deputy Mary Lou McDonald asked the Minister for Health and Children the position regarding plans for a national children’s hospital; and if he will make a statement on the matter. [7547/11]
Robert Dowds
Question:386 Deputy Robert Dowds asked the Minister for Health and Children the position regarding a decision as to where and when a new national children’s hospital will be built. [7479/11]
Eamonn Maloney
Question:391 Deputy Eamonn Maloney asked the Minister for Health and Children when the proposed review of the location of the new national children’s hospital is to commence and the person who will be the chairperson of this review. [7511/11]
I propose to take Questions Nos. 35, 386 and 391 together.
As I stated in my earlier reply to the House, the Government has committed, under the programme——
What is the grouping?
Questions Nos. 35, 386 and 391 are being taken together. Is that agreed? Agreed.
Does it include Question No. 38?
I do not have the question numbers before me, but they are questions from Deputies McDonald, Dowds and Maloney.
Those are the three Deputies.
As I stated in my earlier reply to the House, the Government has committed under the programme for Government to the construction of the new children's hospital.
Since my appointment as Minister, I have been engaged in discussions with my officials and with the national paediatric hospital board to brief myself on the work done on this project to date. I wish to be clear about how we can best provide the hospital in the most cost-effective manner while ensuring a high quality service for children and young people.
I intend to carry out a review of the national children's hospital project and will announce the details shortly. I am currently being briefed in some detail on all aspects of the project. Following consideration of the evidence presented to me, I will decide on the scope and terms of reference of the review and the appropriate person or persons to carry it out. I anticipate that the review, once commenced, should take approximately four weeks to complete.
It is essential that all the facts are carefully considered before a final decision is taken on the best approach. In particular I wish to be satisfied that the hospital will provide the best possible clinical outcomes for children and young people. The Deputy may rest assured that I wish to avoid any unnecessary delay to the development of this important project.
Before I call Deputy Ó Caoláin, I advise that as two of the questions are written ones no extra time is available for the grouping.
When does the Minister expect to be in a position to advise us on how he proposes to proceed with the review on the proposed building of the new national children's hospital at the Mater Hospital site? He indicated that he hopes to have those details shortly. When does he expect to have them? Does the Minister have anything further to share with us today on how he expects the review to proceed, particularly given the very short time within which he expects it to conclude its work, a four week period?
Could he indicate whether he is intent on avoiding the engagement of outside, expensive consultancy firms to do the work? Could he indicate the make-up of the review team and assure the House that there will not be additional costs arising from the review to either the Department or the overall public budget?
Does the Minister accept that in the current situation the key concern for many people is the continuation of services at Temple Street, Crumlin and Tallaght hospitals and that there is a reasonable expectation — one that I support — that in the advent of the Mater Hospital site being used for the new national children's hospital that we would continue to have inpatient facilities provided for children at Tallaght Hospital and that the Crumlin Hospital site would continue to service health care needs in that community?
The Deputy mentioned Temple Street, where I have been. I visited just before the election and met the doctors. There is no doubt that the hospital leaves much to be desired in terms of its structure. The work going on there is excellent but the conditions are Victorian. The need for a replacement is acute.
Deputy Ó Caoláin inquired whether external experts would be involved in the review. Absolutely. I want them to be people of the highest repute internationally. It has not been determined yet whether there will be three or four people. I wish to have the input of a paediatric specialist, a cost accountant and managerial economic expertise. It is very important that the hospital is built at an affordable price, that we do not start a hospital we cannot finish, and that we do not hold out false hope by starting on the process and finding in three or four years that we cannot finish it.
I remind Members that the International Monetary Fund is in town and it will be watching the process very carefully. I wish to ensure we get value for money but I reassure Members, that as a doctor, I am acutely aware of the benefits of collocation. Some things go beyond price. It will not be purely a case of whether the hospital could be built more cheaply somewhere else. The benefit of collocation to the patients, the young lives we seek to alter through the provision of the best treatment, must be borne in mind. They are the ones to whom we must give prime consideration.
I call Deputy Crowe.
I have a brief——
I have time for only one question.
As you are aware, a Leas-Cheann Comhairle, with oral questions taken in ordinary time every Deputy is entitled to offer, unlike with priority questions.
The Deputy should ask a brief question and then I will take a question from Deputy Crowe.
The Minister should note that I did not refer to Temple Street in an ongoing way, I referred to both Crumlin and Tallaght hospitals and the roles they would play post the advent — if it is to be — of the utilisation of the Mater hospital site. Will the Minister indicate his current expectation of service delivery at Tallaght and Crumlin hospitals and, in regard to the former, address my argument that it should continue to provide inpatient care for children?
I do not take issue with the Minister bringing in external expertise. My question focused quite particularly on the engagement of expensive consultants. If the Minister could share the detail with us, I would like to know the make-up of the review team. I welcome the Minister's reference to individuals with expertise. We do not take issue with that but we take issue with the inordinate moneys that have been wasted on external consultancy contracts in the past. That is something I want to avoid.
I welcome the Minister's stated four week timeframe on the review of the Mater hospital site. When will the review start? Therefore, we will know when the four weeks will end.
The Minister should be brief as we are out of time.
I reassure the Deputy that I am equally concerned about the cost of external consultants. That is why I do not envisage the review going to a firm but to named individuals who would provide us with an independent opinion, having had all the facts put in front of them. That is why I am delaying the process until we have all the facts put in front of us through the Department and the Health Service Executive.
Discrepancies were noted between the moneys identified by the previous chairman and the moneys identified by the Health Service Executive. If we are out by €10 million we should consider whether we want to be out by €100 million later. I am very concerned about that. We will shorten the review process and make the projected four week timeframe achievable if we have all the information to hand for the people concerned. The other criterion on which I will insist is that the consultants come to the country and visit the sites. It is not my intention to open the argument again. That is not what this is about. It is about assessing the hospital in the specified location at the projected cost as being the way forward to deliver the best for our children.
Ceist 36 is taken with other questions.
Gabh mo leithscéal, a Leas-Cheann Comhairle, another Deputy had——
I am sorry, but the time has expired. It is up to Members to ask shorter questions if they wish more progress to be made. We must now proceed with other questions.
I understand that any Deputy can offer on questions taken in ordinary time. On a point of order, with respect, is it not the case that if another Deputy wishes to ask a question——
We are moving on to Question No. 36.
We are not on priority questions any more. We are entitled to a one minute question.
We have gone way over time. I wish to allow other Members to contribute.
I do not know to which rules you refer, a Leas-Cheann Comhairle.
You indicated, a Leas-Cheann Comhairle, that you would take a question from me.
I now call the next question, No. 36.
Are we not taking Question No. 54 with that?
Yes. The Minister will read out the reply now. Question No. 36 is taken with Questions Nos. 47, 54, 66, 71, 76 and 376.
It is like being in a Bingo hall.
According to my notes, Deputy Naughten is head of the class.
Health Service Reform
Denis Naughten
Question:36 Deputy Denis Naughten asked the Minister for Health and Children the position regarding his review of the Health Service Executive reconfiguration process for acute hospitals; and if he will make a statement on the matter. [7392/11]
Caoimhghín Ó Caoláin
Question:47 Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children if he will bring forward new plans for hospital configuration in the north-east region and in other regions. [7531/11]
Seamus Healy
Question:54 Deputy Seamus Healy asked the Minister for Health and Children further to his announcement of a review of the general hospital reconfiguration process, the nature of the proposed review; its terms of reference; the persons who will carry out the review; the involvement of all stakeholders including staff, patients, service users and the public; the timescale involved; and if he will make a statement on the matter. [7495/11]
Peadar Tóibín
Question:66 Deputy Peadar Tóibín asked the Minister for Health and Children his plans to restore any or all of the services cut from Our Lady’s Hospital, Navan, County Meath; and if he will make a statement on the matter. [7535/11]
Gerry Adams
Question:71 Deputy Gerry Adams asked the Minister for Health and Children his plans to restore any or all of the services cut from Louth County Hospital, Dundalk; and if he will make a statement on the matter. [7533/11]
Michael Colreavy
Question:76 Deputy Michael Colreavy asked the Minister for Health and Children if he will restore any or all of the services cut from Sligo General Hospital; and if he will make a statement on the matter. [7553/11]
Jerry Buttimer
Question:376 Deputy Jerry Buttimer asked the Minister for Health and Children the timeframe surrounding the reconfiguration process that is intended to take place in Health Service Executive south. [7430/11]
I propose to take Questions Nos. 36, 47, 54, 66, 71, 76 and 376 together.
I am committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular, I wish to ensure that as many services as possible can be provided safely in smaller, local hospitals. To fully consider the issues involved, I am being briefed by my Department and the Health Service Executive, HSE, on the organisation of acute services in each region and on the important clinical programmes being developed by the HSE. These inter-related programmes aim to improve service quality, effectiveness and patient access and to ensure that patient care is provided in the service setting most appropriate to individuals' needs. The aim is to ensure that patients receive treatment in the most timely, cost-effective fashion that is safe and as close to home as possible.
I am very impressed with the work done by Dr. Barry White and his colleagues in developing these programmes. I have already had several discussions with him about how best to ensure that they are implemented. I have also made it clear that patient safety must be the overriding priority. I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.
I also want to be briefed by the HSE before any further services are withdrawn from individual hospitals. The Secretary General of my Department has written to the CEO of the HSE asking him to make the necessary arrangements.
I congratulate the Minister on his appointment and wish him well in his new role. He has an understanding of the issues affecting small local hospitals.
Patient safety must be the main priority. Does the Minister not agree that transporting patients for hours from small local hospitals that could treat them to regional super-centres, as have been proposed to date, is not necessarily the best approach in that it puts lives at risk? Will the Minister clarify the direction that has been given to the HSE on the roll-out of the reconfiguration process and the implications it will have for small hospitals from 1 July, bearing in mind the appointment of non-consultant hospital doctors in the new rotation and, specifically, the non-training posts? This issue should be addressed immediately with reference to the regional structure rather than leaving hospitals in a dire predicament from 1 July.
I certainly agree with my colleague Deputy Naughten in regard to transportation or forcing people to travel without providing transport. It is not wise or cost effective to transport patients to have treatments that could and should be available in the local hospitals. This is certainly an area we are examining very closely. As I said to Deputy Ó Caoláin in respect of Monaghan hospital, many more facilities and treatments could be provided at the hospitals in question; they are being under-utilised. They not only could, but will, be a key part of our drive to address the waiting times many citizens must endure before obtaining the treatment they have been recommended.
I congratulate the Minister on his appointment and wish him well.
Will the Minister confirm that the hospital reconfiguration programme is parked and that an instruction to this effect has been accepted by the HSE officials? I was disappointed that the Minister did not set out in his reply the detail of the process. When does he envisage that the review process will commence? How will it be carried out and by whom? Will all stakeholders be involved?
I thank Deputy Healy. The review will be carried out by officials in my Department. I certainly want to be made aware of any withdrawal of service because I want the impact of any such withdrawal to be assessed fully. I do not want a recurrence of circumstances in which services are withdrawn on the promise that they will be replaced by new ones at a regional centre, only to have that promise not met. I have requested that there be no further withdrawal.
To say reconfiguration has ceased is untrue because it has not. Some parts of the reconfiguration process do not entail the withdrawal of services. I have no issue with these proceeding although we are reviewing the very nature of what we are trying to achieve. The health service is taking a new direction and we have made that very clear. I am very pleased with the appetite for change, both in the Department of Health and the Health Services Executive.
I want to refer to the Minister's earlier reply. In the hope of having an accurate record, will he revisit his statement that he is an advocate of co-location? I know he was only referring to the National Children's Hospital in regard to the Mater site, for example; I do not believe he has made a volte-face in regard to co-location. He should clarify this for the record in case some scribe picks up on it such that it will be the story we read tomorrow.
On Question No. 47, specifically with regard to HSE Dublin North East, with which the Minister is very familiar, can he indicate whether there are new plans for hospital reconfiguration in the north east against the backdrop of his knowledge of and exposure to the inadequacies and failures of the approach employed by a series of three Fianna Fáil-led Administrations since 1997? His substantive reply did not indicate this.
To confirm for the House and any scribe who might be interested, when I referred to my support for co-location I was referring to the location of a children's hospital next to an adult hospital, not to what might have been construed as a co-location policy of placing private hospitals on the grounds of public hospitals.
I am protecting the Minister's back already.
I really do appreciate that.
With regard to new plans for reconfiguration, we will reconsider the overall picture in terms of re-structuring the health service to deliver for patients in a timely fashion as near to their homes as possible, and also in a far more sensible fashion for us. The idea that somebody would go to a tertiary hospital such as Beaumont or the Mater for treatment for varicose veins, gall bladder surgery or hernia repair is akin to taking a ten-year-old Volkswagen to the Ferrari testing centre for a service. The latter would surely do a wonderful job but it would not comprise an appropriate use of resources. If people avail of the services of the county hospitals for the procedures in question, not alone will they be very pleased with the outcome, they will find their overall experience far more pleasant in that they will be away from the hustle and bustle and chaotic atmospheres of the larger hospitals. We will seek to address the latter issue because, in fairness to the larger hospitals, they are trying to do the impossible, very often with limited resources. I have no problem putting that on the record and seeking further rationalisation of our resources in respect of the sorts of conditions we treat. I refer to the number of people who end up in hospitals for treatment that could possibly take place in a primary care environment.
In the context of reconfiguration, the Minister has requested a review of the transfer of orthopaedic services from St. Mary's Orthopaedic Hospital to the South Infirmary Victoria University Hospital in Cork. Why has work not ceased on the construction of theatres in the latter hospital and on the transfer of services thereto while the review is being carried out? If the review recommends that the services remain where they are, what will be the position on the two theatres built in the South Infirmary Victoria University Hospital? Was the commitment just a commitment by a deputy leader so as to appear slightly enthusiastic during the election campaign?
On the same matter, will the Minister confirm whether the orthopaedic services review has started? If it has, how long will it take? When can a decision be made on whether the services will be transferred?
The review is ongoing. My understanding is that the transfer of services is not continuing and has ceased. The building may well be in the process of being built but it may be put to many different uses. The fact that building is continuing and a contract has been entered into does not indicate the end use will be as first proposed. I am not saying the proposed use may not be the end use but this does not mean it will be either. I am not in a position to give a timeline for the review. It will only be a matter of months; it will not take a year. The Deputy need not worry in that regard.
That is like saying we will build a house and not use it as a house.
With regard to reconfiguration and acute hospitals, there is in Tallaght an adult and children's accident and emergency unit. The unit in Tallaght is probably the busiest in the country and I believe it had 77,000 admissions last year. One of the problems with adult accident and emergency departments is a lack of beds and this is causing many of the bottlenecks in the hospital system. With regard to the service for children, current policy means that on the south side of Dublin we will be left with no beds for sick children. Will this be part of the review process? It is daft that sick children will not have overnight beds on the south side of Dublin.
To answer the latter question first, the review relates to the provision of the new hospital at the Mater Hospital. I do not think it will include the present situation at Tallaght Hospital. With regard to adult services, I am loth to give an answer to the question without having studied the situation. There may be a bed capacity issue, however there are also managerial issues at Tallaght Hospital which must be addressed and this is what is being examined at present. As in several of our major hospitals, issues arise on how discharges happen, how patients are assessed, how long patients are in hospital before their procedures are carried out and how long they remain in hospital after the procedure has been carried out. There is a host of issues around this. I will leave the door open on this as I do not have the answer for the Deputy on whether the problem in Tallaght Hospital has to do with bed capacity or use of the beds, or issues to do with management, as I know issues arise with regard to this.
I congratulate the Minister on his appointment. With regard to configuration, in advance of the general election the people of Roscommon and south Leitrim were made promises on the future of Roscommon and Portiuncula hospitals. It was stated that services existing at the time of the election would be maintained and enhanced. Given that a few promises made to people in my constituency have been broken in recent days I wonder whether the Minister will stick by this one.
With regard to services at Portiuncula and Roscommon hospitals and based on the Minister's previous response, will he clarify that existing services will be maintained and that we will examine providing additional services at both hospitals? In this context, I wish to bring to the Minister's attention an issue that needs to be addressed, namely, the situation regarding non-consultant hospital doctors at Roscommon County Hospital. The hospital has a projected spend on agency staff of approximately €4 million by the end of year, which is more than one quarter of the hospital's budget. Will the Minister assure us he will investigate this issue?
The issue of non-consultant hospital doctor numbers in our hospitals is one that creates a major difficulty for us and is being addressed in a fairly aggressive fashion at present through recruitment from abroad to make up the shortfall. There is every reason to believe this will be successful. Part of the problem with regard to non-consultant hospital doctors is with regard to their training. Sometimes they prefer to see on their curriculum vitae the names of large regional hospitals rather than smaller hospitals. One of the methods of dealing with this is an initiative undertaken by Dr. John Higgins in Cork. Rather than joining a CUH surgery team, one joins a Cork, Kerry and south surgery team which allows people to be placed throughout the system and rotate through smaller hospitals as well as gain experience at bigger hospitals. Participants are always under the one training team of surgeons who also rotate through the hospitals. If this model were to be repeated in Roscommon it would go a long way to solving the problems we have.
Written Answers follow Adjournment Debate.