Dáil Éireann debate -
Wednesday, 20 Jun 2012

Vol. 769 No. 2

Topical Issue Debate

Emergency Aeromedical Service

Deputy Denis Naughten

I thank the Ceann Comhairle for allowing me the opportunity to raise this important issue on the floor of the House today. The air accident investigation unit is investigating what the Defence Forces called a heavy landing but was in fact a crash by the Air Corps of a Eurocopter helicopter operating the emergency aeromedical service, EAS, in County Tipperary yesterday. Significant damage was done to the helicopter but, thankfully, the Air Corps crew and Health Service Executive, HSE, paramedic staff escaped without injury. I hope the patient they were hoping to transfer is making a full recovery in hospital now. I understand the patient ended up being transferred by road to hospital.

The accident happened as a result of the helicopter becoming entangled in overhead electricity cables. The ambulance service feeds instructions to the Air Corps about potential landing sites for the airlifting of patients. What role did ground crew play in this? Significant damage has been done to the tail section of the helicopter. What is the extent of this damage? How long will it be before it is put back into service? What are the contingency plans for this service? There is one other Eurocopter helicopter available. Will it be made operational to get the EAS back in place? If so, when will it be made operational?

Why was the choice made for the Eurocopter rather than the Augusta Westland helicopter? The latter is fully equipped to provide 24-hour air ambulance missions while the Eurocopter can only operate in daylight. Across the world there have been accidents involving emergency aeromedical services because it is a risky business and requires skilled staff. Why were designated landing sites not used in this process before the service was put up and running? A list was compiled in some local authority areas of specific designated sites where an ambulance could actually meet the helicopter and have no issues with overhead lines. For some reason, this was not put into the final protocols for this service. Why was this the case?

Is the EAS regulated by the Irish Aviation Authority? If not, why not? Who is responsible for regulating the medical aspect of the service? Yesterday's accident was extremely unfortunate and gives rise to several questions that need to be answered. We want to see a fully fledged EAS operational across the island. We want to ensure those involved not just in traumas but who have had a stroke or heart attack can be airlifted in the minimum time to the nearest centre of excellence. The reason for the establishment of this service was the closure of the accident and emergency department in Roscommon County Hospital. People who suffer a heart attack, strike or a trauma in the hospital's catchment area cannot be brought to Galway University Hospital within the golden 90 minutes required. I look forward to the Minister's response.

Minister for Defence (Deputy Alan Shatter)

A 12 month pilot EAS in support of the HSE national ambulance service commenced operations on 4 June 2012. The service is operated by the Air Corps out of Custume Barracks, Athlone. The purpose of the pilot is to determine the extent, if any, of the need for dedicated aeromedical support to emergency ambulances in the region in light of existing road networks and transit times. The service is intended to support the requirements of HSE clinical care programmes such as acute coronary syndrome and stroke. In geographical terms, the primary focus of the service is on the west and north west. However, the service can on occasion respond to incidents elsewhere where aeromedical assistance is an appropriate response given the circumstances of the incident.

From 4 June to date, 11 aeromedical missions have been undertaken. An incident involving the EAS helicopter occurred yesterday afternoon, 19 June. The helicopter, an EC 135, departed Custume Barracks, Athlone, at 1.50 p.m.en route to an emergency call out in County Tipperary. At approximately 2.10 p.m. the helicopter was forced to perform a heavy landing near Borrisoleigh, County Tipperary. Thankfully, the two Air Corps crew and one HSE paramedic on board were uninjured. The patient who was subject to the call-out was transferred to hospital by road. The helicopter has been removed from the site of the incident and is now back in Baldonnel, but the extent of damage to it has yet to be determined.

The air accident investigation unit in the Department of Transport, Tourism and Sport was informed of the incident immediately and was in attendance at the site last evening. The unit will carry out an investigation into the incident. The Air Corps is examining the likelihood of resuming the EAS as soon as possible using an AW 139 aircraft out of Baldonnel. At this stage, it is not possible to say when the service will resume from Custume Barracks, Athlone. Following a preliminary investigation by the air accident investigation unit, this matter will receive further consideration.

It should be emphasised the EAS is a separate service from the air ambulance service provided by the Air Corps to the HSE for inter-hospital transfer of patients with serious injuries and for organ retrieval missions. This service is unaffected by this incident. The aircraft is crewed by an Air Corps pilot and crewman, supported by an Air Corps ground technician. The EC 135 helicopter is a light utility aircraft that is the appropriate platform for an air ambulance given its size and weight. It is used in other EU countries such as the United Kingdom and Germany for air ambulance services.

Deputy Denis Naughten

I thank the Minister for his response.

The AgustaWestland AW139 helicopter is being considered for use in this service currently based in Baldonnel. Will the Minister give an indication of the likely timeline for it to be based in Custume Barracks to provide an emergency aeromedical service? Why was the helicopter not used in the first instance to provide the service, as it has 24 hour capability?

What was the role of the ground crew in this incident? Was the forced landing site close to where the helicopter was travelling to meet the patient and what liaison took place with the ground crew? The original protocol involved the use of designated landing sites throughout the midlands and west, at which the helicopter would land and meet the local ambulance called to the scene. Why was that protocol not implemented when the air ambulance service was launched earlier this month? That would have prevented yesterday's incident from occurring. Who is involved in the regulation of the aeromedical service? Is the Irish Air Authority involved? Who is responsible for the medical aspects?

Deputy Alan Shatter

I will deal with some of the issues raised by the Deputy, although I cannot respond to certain questions because I will not prejudge the outcome of the investigation being conducted. Issues raised by the Deputy are directly relevant to that investigation and it is appropriate that we learn the answers from the investigation.

The helicopter involved in the unfortunate accident yesterday was deemed to be the appropriate aircraft as it was based in Custume Barracks and in the context of providing the service as I described it. It is of a type that is used appropriately for this service elsewhere. There is an issue with the size of helicopter used with reference to the aircraft that can be appropriately accommodated in Custume Barracks because of its proximity to what is generally an open urban area.

One of the issues with regard to the resumption of the service from Custume Barracks concerns the damage, if any, done to the medical equipment for this helicopter in order to provide the service deemed to be important to benefit the area. The preliminary investigation by the air accident investigation unit must take place first, as no medical equipment can be accessed or removed from the helicopter until after the investigation is complete. It will then be further assessed in terms of its suitability for future use. I do not know if the same equipment can be used in another helicopter, or if additional equipment may be required.

There are a number of questions asked by the Deputy for which I do not have an immediate answer. I hope we will have the answers in the not too distant future. I am very conscious that the service was put in place to benefit a great many people in the region and that it was widely welcomed. I hope that, as envisaged, it will be able to resume it without undue delay. The incident was most unfortunate, but I am pleased no serious injury resulted from it, which obviously would have been a matter of concern. It is not clear to me when the damaged helicopter will be back in service or what work will require to be undertaken on it. I hope to have the answers to these questions within a reasonable period. I want to be able to state without undue delay what the position is on providing an ongoing service.

Bank Lending

Deputy Ray Butler

I wish to raise the matter of high loan refusal rates and the detrimental effects they are having on small and medium enterprises, SMEs, and their vital recovery. From speaking to local business people in my constituency who are struggling to survive and pay back loans, this issue needs to be addressed in real terms. It is suggested banks are putting already pressurised businesses into further decline by withdrawing their overdraft facilities and restructuring them into term loans. This means that small businesses are now operating outside the original terms, which leads to their credit rating disappearing for anything up to six years and access to necessary funding drying up completely. Banks, on the other hand, are stating their current mechanisms for restructuring loans are helping SMEs to continue to operate, although I argue that this is clearly not the case.

Evidence appears in a recent survey carried out by the independent organisation working in support of the Irish small and medium enterprises, ISME, sector which confirms in its latest quarterly bank watch survey that the refusal rate of loans to SMEs has risen to 54% after slight improvements in the previous two quarters. It also indicates that 37% of respondents to the survey had requested additional or new bank facilities in the past three months, an increase of 6% on the figure for the same quarter in 2011. In addition, around 80% of businesses which had applied for funding outlined that banks were making it more troublesome for them to access the funding they needed to remain afloat.

In the light of the volume of SMEs in real financial trouble, the entire credit rating system needs to be reviewed if they are to be given proper opportunities and have prospects for recovery. It has been widely reported that there is a high percentage of SMEs with restructured loans on bank books and no access to further loan or overdraft facilities from banks. It is certainly time to reduce the period of credit blacklisting from six years to two as a means to improve the position for all small and medium enterprises. This would allow them time to repay their existing loans, while providing access to cash injections, if necessary, within an earlier timeframe.

We must carefully assess and address this matter by taking definitive action before it becomes too late for many SMEs which are doing their very best to keep the wolves from the door and those of their employees also. If we cannot offer them real support in these unprecedented economically turbulent times, how can we really expect the sector to survive, much less thrive?

Minister of State at the Department of Finance (Deputy Brian Hayes)

I thank the Deputy for raising this most important issue of credit availability for small and medium enterprises. One of the key priorities of the programme for Government is to ensure an adequate pool of credit is available to fund SMEs in the real economy during the restructuring and downsizing programme of the banks. The Government has introduced a number of policy tools to achieve this objective. For example, the banking system restructuring plan creates capacity for the two pillar banks - Bank of Ireland and AIB - to provide for lending in excess of €30 billion from 2011 to 2013. SME and new mortgage lending for these banks is expected to be in the range of €16 billion to €20 billion during this period. This lending capacity is incorporated into the banks' deleveraging plans which allow for the repayment of Central Bank funding through asset run-off and disposals during the period.

The Government has imposed lending targets on the two domestic pillar banks for the three calendar years from 2011 to 2013. Both banks were required to sanction lending of at least €3 billion in 2011, €3.5 billion this year and €4 billion in 2013 for new or increased credit facilities for SMEs. They achieved their lending targets for 2011.

In addition to the lending targets imposed on the banks, the pillar banks are required to submit their lending plans to the Department of Finance and the Credit Review Office at the beginning of each year, outlining how they intend to achieve their lending targets. They also meet the Department and the Credit Review Office on a quarterly basis to discuss progress. The Credit Review Office reviews decisions by the pillar banks to refuse, reduce or withdraw credit facilities from €1,000 up to €500,000. The office is overturning 60% of the decisions referred to it, supplying €6.9 million of credit and supporting 683 jobs in the SME sector. I appeal to SMEs that have been refused credit by banks to avail of the services of the CRO. That is what it is there for and it clearly has a track record of making decisions in favour of SMEs where a negative decision has been made by the banks.

In November 2011, the Government committed to completing an annual action plan for jobs that would involve the whole of Government focusing on what part it and its agencies could play in protecting or creating jobs. A key component of the plan is to ensure that viable SMEs can access credit and the plan introduces a number of important measures to achieve this objective.

The temporary partial credit guarantee scheme aims to provide credit to job-creating SMEs that currently struggle to get finance from the banks. It is intended to address market failure affecting commercially viable businesses in two specific situations, namely, where businesses have insufficient collateral and where businesses operate in sectors with which the banks are not familiar. In addition, a micro-finance fund to provide loans to small businesses is also being developed within the Department of Jobs, Enterprise and Innovation.

The first meeting of the reinstated SME credit consultation committee took place on Tuesday, 12 June. The role of this committee is to provide a forum where stakeholders can communicate and interact regarding difficulties in respect of credit.

I should also note yesterday's launch by the Minister for Finance of Silicon Valley Bank's commitment, in collaboration with the National Pensions Reserve Fund, of a minimum of US$100 million in new lending to fast-growing Irish companies in the high tech technology and innovation sector.

In November 2011 Mazars published a report commissioned by the Department of Finance outlining the situation in credit demand by SMEs in the period April to September 2011. This was an extensive survey of firms across the SME sector conducted by a professional market survey company. Of the 1,500 SMEs surveyed, only 36% requested bank credit in the period and, of these credit applications, some 70% were approved or partially approved when pending applications were excluded. As I mentioned earlier, the Credit Review Office offers an important mechanism separate from the banks' internal appeals procedures for SMEs to have the decision of the bank reviewed. The Government would encourage more active use of the office by those companies that feel aggrieved at the decision of the banks on their credit applications.

It is vital that the banks continue to make credit available to support economic recovery. However, it is not in the interest of the banks, businesses or the economy for finance to be provided unless the business is viable and has the capacity to meet the interest payments and repay the sum borrowed.

Deputy Ray Butler

I thank the Minister for State for his reply. I welcome the fact the Credit Review Office has overturned 60% of decisions. Many SMEs in my constituency that have been dealing with the banks and that have restructured their loans find it difficult to deal with the banks after restructuring. They feel they have been blacklisted and there is no point in them going to the Credit Review Office. That is a problem and the entire credit rating system should be examined. If we are to move forward, we do not need to place debt upon debt. Many of these businesses are doing okay but they need some cash flow. When an overdraft is converted into a long-term loan to a business, the business is being starved of cash flow. Something should be done to ensure these people have some sort of overdraft. I welcome the overturning of 60% of decisions but we must examine the credit rating system because we are in different times and it is now outdated.

Deputy Brian Hayes

The Deputy makes a valid point. It is one question to look at how much money is being lent into the real economy and how much is being drawn down but it is entirely separate to look at the credit rating system that surrounds those businesses that have experienced difficult times. If there is an effective blacklisting or negative mark against those businesses that have gone through restructuring, it is a very important issue we must examine.

The Minister of State, Deputy Perry, and the Secretary General of the Department of Finance, has completed seven regional meetings around the country. Those meetings were with stakeholders, the very businesses to which he referred in his speech. A report will be published shortly and the issue to which he referred in respect of credit ratings was raised at those meetings. If additional action can be taken by Government, we will do that.

I also understand that the Mazars report for the next six months will be also issued shortly. It did the initial work in this area and produced the more relevant data because of the numbers responding to the survey. On the specific issues to which the Deputy referred - the credit rating system - we will have two reports, one from Mazars and one from the Department of Finance, that will consider this question, along with other issues.

I appeal again that where businesses have been refused credit and an opportunity to draw down funds from a bank, the issue should be taken up with the Credit Review Office, which has overturned 60% of decisions that were taken. That shows the Credit Review Office is on the side of the borrower and the person who is attempting to restructure his business and secure investment so the economy will get back on its feet. That message should be highlighted by this House and I thank the Deputy for raising it.

Special Educational Needs

Deputy Michael McCarthy

I thank the Ceann Comhairle for allowing me to raise this issue that came to light last week. It is a perfect example of a topical issue.

The Minister of State will be aware due to his own situation in Galway and his position in the Department of the emotive nature of SNA provision. Every case is exceptional but because of the unique circumstances surrounding the Maria Immaculata community college in Dunmanway, it is particularly exceptional because there is a designated special unit in the school and, as a result, there are special classes. I am sure the Minister of State will say in his reply that there are SNAs in the mainstream as well but we must bear in mind in this case that there will be 17 pupils in a special class in this school from September.

The Minister of State will know that the National Council for Special Education announced last week the resource teaching and SNA posts for the 2012-13 school year. There is considerable merit that there has been no change in the overall level of resources for allocation to schools but I wish to bring to his attention the particular case of MICC in Dunmanway. Last week the college was informed it would lose four SNAs in September, with numbers falling from 15 to 11. This is a disturbing and distressing move for the parents of children in the special classes. It is an exceptional case in my view. The number of special needs children will increase by two in September but the overall SNA allocation will decrease by four. That is particularly difficult to comprehend when we consider the overall level of SNAs in the system will remain the same for the 2012-13 academic year as for the 2011-12 academic year.

MICC is home to a designated special needs unit, which is growing by two, making it one of the biggest groups of its kind in the Munster region. Disabilities in the unit are complex and wide-ranging. Some pupils have incontinence issues and sensory difficulties and need assistance with basic living skills, such as eating or going to the bathroom. The prospect of having to share various SNAs throughout the day is untenable for certain pupils because their needs are so multifaceted. I have been in regular contact with the parents and teaching staff of MICC since news of the SNA reduction first reached them last week. What has clearly been communicated to me is that stability and consistency in the support they receive are key for all of the pupils. Nurturing and developing stable and consistent relationships between pupils and their SNAs can take years, as it takes time for pupils to settle into a routine, adapt to a system and get used to an SNA, but this is set to be undermined, with many pupils moving from having their own SNA to merely having access to one.

There is also a tangible fear among parents that special educational needs organisers, SENOs, are overriding the views of psychologists and disregarding psychological assessment reports that recommend a certain level of SNA provision for a child. They are particularly worried about the ruling that psychologists should not make specific recommendations. I sincerely hope that is not the case and I have every faith that SENOs will take into serious consideration the assessments provided for them and the interaction between psychologists and SNAs. It is worth bearing this issue in mind in the debate.

I have spoken to an official in the National Council for Special Education, NCSE, about the case at MICC and in the next few weeks I intend to have a face to face meeting with the local SENO, with whom I hope to interact on the rationale and logic behind the decision. What I find most difficult about the issue is the process involved in arriving at a conclusion such as this. I acknowledge the fact that the overall SNA allocation will be the same in 2012-13 as this year. That is important when one considers that the Government is borrowing €1.25 billion a month to fund essential public services before it ever goes near the banking debt. Many cases will rightly be made to Ministers and the Government to retain services in various areas, but this is one area in which every effort should be made to retain the level of service provided. I ask the Minister of State to be cognisant of this.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I am taking this issue on behalf of my colleague, the Minister for Education and Skills. I thank the Deputy for raising it, as it gives me an opportunity to clarify to the House the position on the allocation of SNAs for the coming year.

The Government, as the Deputy confirmed, has maintained funding for resources for children with special educational needs at a time when there is a continued requirement to make expenditure savings across a number of other areas. We are providing 10,575 SNA posts for allocation to schools for the 2012-13 school year. As the Deputy acknowledged, this is the same number of posts available for allocation for the current year. There has been no reduction in the overall number of SNA posts available in the coming school year. It is considered that, with prudent management of these resources, there will be sufficient posts to provide access to SNA support for all children who require such care support to attend school, in accordance with my Department's criteria.

The NCSE is responsible, through its network of local SENOs, for allocating SNAs to schools to support children with special educational needs. The council operates within my Department's criteria in allocating such support which now includes a requirement for them to have regard to the overall cap on numbers. Schools had been advised to make applications to the NCSE for SNA support for the 2012-13 school year by 16 March 2012 and they are being notified of their allocations based on the number of valid applications received and the extent of the care needs of qualifying children. In determining the level of SNA support allocated to a school the NCSE takes into account the individual care needs of all qualifying children, supports freed up owing to school leavers and the identified care needs of newly enrolled children with special educational needs.

It is important to note that a school's allocation of SNA support may alter from year to year as pupils enrol or leave or where a child's care needs have diminished over time. As there have been no reductions in the overall number of SNAs available for allocation in the coming school year, no school will lose SNAs because of cuts. Changes to the allocation of SNAs to a school, therefore, will arise because either the number of qualifying children has changed owing to pupils enrolling or leaving a school or because the assessed needs of the qualifying children have changed, for example, where pupils may have developed increased independence. In a small number of cases schools may have had surplus SNAs who were not removed when children left school or needs changed. In such cases the NCSE will adjust the allocation to the schools to reflect the needs of the children enrolled.

The NCSE has confirmed that the SNA allocation for the school in question for the 2012-13 academic year reflects the level of care needs identified in the qualifying applications and represents a sufficient level of support to cater for the care needs of all qualifying children for the coming school year. I understand the NCSE has been in contact with the Deputy in recent days to clarify the position in this regard.

Deputy Michael McCarthy

I have been in contact with the council. I am deeply uncomfortable with the fact that while the system has retained the overall number of SNAs, the number allocated to MICC will reduce from 15 to 11. We can use whatever statistics and information are available, but it is inescapable that the number will reduce from 15 to 11, despite the Minister of State saying, "As there have been no reductions in the overall number of SNAs available for allocation in the coming school year, no school will lose SNAs because of cuts." I am having great difficulty understanding the absence of logic in arriving at the decision relating to MICC.

The Minister of State at the Department of Health and Children, Deputy Kathleen Lynch, has ring-fenced, albeit through the health budget, €40 million for adults with intellectual disabilities and makes the point consistently that resources should follow the individual. Nobody has a difficulty with this. It is positive that the school system has retained the overall number of SNAs when it stands to reason that demand will increase, but it is difficult for parents of pupils at MICC to head into the summer knowing that their SNA allocation will reduce from 15 to 11, while the overall number has been retained. This is an exceptional case because there is a special unit in the school.

I welcome the NCSE's confirmation that it is developing an appeals process which is expected to be finalised in late August. I appeal to the Minister of State and the Government to consider a robust appeals system that will take into account the exceptional case that undoubtedly can be made for this school. This is a special, not a mainstream, class with special needs children. God knows, any of us would go through fire and water for them as parents.

Deputy Ciarán Cannon

I apologise if my reply was not clear, but I reiterate that no SNAs will be lost owing to budgetary cuts. The same SNA provision will be made next year as in previous years. Changes to the SNA allocation in a school relate to the evolving care needs of its pupils. For example, children may have diminishing care needs over time or a number of children will leave school at the end of each academic year and the school population may change over time. I am aware of a number of parents who are happy that their child no longer needs an SNA in a school setting. Assessment of service is ongoing to ensure children who genuinely need SNA support are getting it and those who have reached a point where they do not need such support no longer receive it in order that resources can be allocated where they are badly needed. It is not in the interests of a child for the NCSE to leave an SNA in place where he or she has achieved greater independence because this can impact negatively on his or her development.

We trust, as we should, the NCSE to make these decisions on the care needs of children. We will be in a difficult place if we seek to somehow usurp or undermine that expertise. I have no problem engaging further with the Deputy in an effort to address his valid concerns and perhaps provide a more detailed response for him on the decision taken regarding the school in question. It is important to stress, however, that SNAs are not removed because of budgetary reductions; they are removed because the care needs of children within schools are evolving.

Hospital Facilities

Deputy Billy Kelleher

I thank the Ceann Comhairle for the opportunity to raise this issue as a Topical Issue matter. It was brought to my attention by Councillor Paul McAuliffe, who represents the Finglas-Ballymun ward in north Dublin, that an X-ray machine purchased for some €500,000 in 2006 as part of the fit-out of the health centre at the Ballymun civic offices has never been used. I had to read the entire Health Service Executive report on the matter before I could be convinced he was correct in his information. A spokesperson for the HSE, indicating that it was not financially viable to use the expensive scanner at present, further stated:

Following wide consultation with relevant clinicians regarding the X-ray machine, which was installed in the Ballymun health centre as part of the initial fit-out, it has been decided that in the current economic climate and with reduced resources, it would not be prudent to invest further in the X-ray facility... This decision was taken following consideration of the highly responsive X-ray service currently available, the fact that plain X-ray is only occasionally used in routine GP investigations and due to the potential waste involved in investing in a service that would result in the under utilisation of staff and the equipment.

The spokesperson went on to indicate that alternative venues had been explored but the costs associated with relocating the X-ray machine were, in the current climate, prohibitive.

There must be a further evaluation of the HSE's position in regard to the relocation of the machine. Surely this costly equipment could be put to good use elsewhere if it is not needed in the Ballymun area because of the X-ray services that are already available there. Has an evaluation been done of the depreciation to which the machine has been subjected and do we know how much it is now worth? Has the HSE undertaken an extensive review of potential alternative locations or considered the possibility of selling the machine? The Minister of State, Deputy Róisín Shortall, can rightly say this situation did not arise on her watch, but it is now her responsibility to find a solution to what is an appalling waste of public money. Councillor McAuliffe has written to the Chairman of the Committee of Public Accounts seeking an investigation of the matter. In these straitened times, it is simply unacceptable that a machine worth up to €500,000 has been lying idle for six years. It is not good enough merely to have a statement from the HSE that the situation has been evaluated and it would be too expensive to relocate the equipment. The machine could be used elsewhere, or sold. What is certain, however, is that it should not be left to lie idle and depreciate in value in the years ahead.

Minister of State at the Department of Health (Deputy Róisín Shortall)

I welcome the opportunity to respond to the Deputy on an issue with which I am very familiar. The Health Service Executive established the Ballymun primary health care facility at the civic offices in April 2006. It is fine facility offering a wide range of services including an X-ray suite. The latter was fully commissioned in 2008 but, as I understand it, it was not possible to staff it due to the moratorium on recruitment.

The fact that this facility was lying idle was brought to my attention last year, whereupon I visited the site and raised the matter with the HSE on several occasions. As a result of those inquiries, the HSE established an assessment team in 2011 comprising the area manager for north Dublin city and the national clinical leads for primary care and emergency medicine to explore evidence-based options for the use of the X-ray machine that was installed as part of the centre fit-out. Following wide consultation with relevant clinicians, it was decided that in the current economic climate and in view of reduced resources, it would not be prudent to invest further in the X-ray facility. As the Deputy observed, this decision was taken following consideration of the highly responsive X-ray service currently available, the fact that plain X-ray is only occasionally used in routine GP investigations and taking account of the potential waste involved in investing in a service that would result in the under utilisation of staff and equipment.

The assessment team found that the existing X-ray services for north Dublin are very good and that there is no waiting time for trauma cases or chest X-ray referrals. The service at the Mater hospital was found to operate very successfully as a walk-in facility and GP satisfaction with the service is very high. The availability of the community rapid access clinic at Smithfield has, the team concluded, provided another option for GPs. It was further observed that Beaumont Hospital operates a similar service with equally high levels of local GP satisfaction. While it was decided to explore the option of relocating the X-ray machine, the costs associated with moving and installing it in the current climate were found to be prohibitive. The HSE will consider other options regarding the future of the machine, but no consideration has been given as of yet to selling it.

I am loath to lose an important item of medical equipment from the primary care service or the public health system generally and I am keen to ensure it is brought into use as soon as possible. Therefore, I have asked the special delivery unit to ascertain whether it could be used as part of the unit's work in taking pressure off local hospitals. I await a response in this regard.

Deputy Billy Kelleher

I thank the Minister of State for her comprehensive reply. There is a positive in this in the acknowledgement that there are reasonable X-ray facilities available between the Mater hospital, the rapid access clinic at Smithfield and Beaumont Hospital. I am not asking the Minister of State to give firm commitments today but she might consider whether this expensive equipment could be incorporated into the roll-out of primary care centres. In an area where there is a deficiency of X-ray facilities to GPs, the machine could, perhaps by way of a lease arrangement, be pressed into service. It might even be given as a gift from the State to the State as part of its regional primary care programme. Every option must be considered to ensure this machine is plugged in and used for the benefit of the citizens who do not have access to X-ray services on a walk-in basis. The last thing we need is for this issue to be brought before the Committee of Public Accounts and tied up for ages in discussions about what went wrong while the machine remains idle in Ballymun.

Deputy Róisín Shortall

It is a shame that the necessary resources for staffing were not provided when the facility was established in 2006. It is yet another example of poor planning within the health service, where capital and revenue are often not co-ordinated. It is important to point out that there is changed thinking in regard to diagnostics. There are concerns, for example, about having an X-ray machine in a primary care facility on the basis that it is unlikely there would be sufficient critical mass to justify the provision of attendant staff. The thinking now tends to be that where one has X-ray facilities, it is important also to have the follow-on services on the same site.

I take the Deputy's point, however, and agree that the current situation is far from ideal. I would very much like to see the machine brought into use, but I understand the cost of moving it would be substantial, being in the region of €85,000. We are considering all possibilities with a view to seeing if it can be used. It is a shame to see facilities like this lying idle. I thank the Deputy once again for raising the matter.