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Dáil Éireann debate -
Tuesday, 10 Mar 2015

Vol. 871 No. 1

Topical Issue Debate

Litter Pollution

I thank the Minister for coming to the House.

I was hoping to produce a chewing gum levy Bill but it appears that under Standing Orders I am not allowed do so. In fact, it can only be done by a member of Government. I thought it was something that could be done by a member of the Opposition. As a result, I must raise this by way of Topical Issue, and I am glad to do so.

It is also disappointing that it proves difficult when one tries to get information on the sums spent on dealing with litter. I tabled a parliamentary question to the Minister last December to try to ascertain the individual sums spent on removing litter generally and chewing gum from the roads and footpaths in various counties and local authority areas, but that information is not available in the Department as it does not collect detailed information. I did get an answer, however, from the Minister for 2003, when local authorities spent in excess of €82 million on street-cleaning activities. This shows there is quite an amount spent on removing litter and chewing gum.

I am aware also that last year €841,000 was given to local authorities in anti-litter awareness grants. In fact, the figure for Galway City Council was €33,000 and for Galway County Council, it was €25,500. Obviously, there is a big issue in dealing with the various types of litter on the streets and footpaths. The most common types of litter are chewing gum, cigarette butts, fast-food wrappers, plastic bottles, plastic bags and cans. The litter I am addressing in my few short minutes is chewing gum. I saw figures for the Dublin city area where there is a real problem with chewing gum being thrown on the streets and footpaths. In 2013, in the O'Connell Street to Grafton Street area monitored by the Department, €83,000 was spent on removing chewing gum litter in 2013.

I was hoping a levy would be imposed on manufacturers that would raise funds to remove the litter from public roads and footpaths. Failing that, I understand that there was to be a meeting of all the major stakeholders - the manufacturers and the local authorities - to come to an arrangement where the manufacturers would contribute towards removing chewing gum. There was agreement in the past that there would be advertising campaigns but we must do much more than that. We must get funding from the manufacturers. The other issue that arose in discussions was the question of a biodegradable product that would ensure we would not have the difficulty in removing such a product.

I hope the Minister can give me some indication of the state of play. Needless to say, the Minister, Deputy Kelly, is the fourth Minister with whom I have raised this issue. I have not had much success with other Ministers and I hope he might able to give me an update on what is happening at present.

As the fourth Minister, I might give Deputy Kitt a slightly different answer.

On foot of the success of the plastic bag levy, my Department commissioned a study on the possible extension of environmental levies to other materials that are problematic from a litter perspective. With regard to chewing gum, the study recommended that either a levy on sales be put in place or that a negotiated agreement be entered into with the sector.

However, unlike the use of plastic bags, the Government has no desire to curtail the use of chewing gum. What the Government wants to do is change the attitude and behaviour of those people who see it as acceptable to discard their gum on our streets. Some of the chewing gum litter we see on our streets is absolutely disgusting. I do not currently believe that a levy on chewing gum is the appropriate means by which to achieve our aim. I would stress the word "currently" because this may change. A levy would penalise both the industry and the consumer and would not provide an incentive to people to alter their behaviour with regard to disposing of gum. It was therefore decided that a negotiated agreement with the industry was the most appropriate direction to take on this issue. Such an agreement provides a mechanism for achieving a lasting change in behaviour with regard to the disposal of gum rather than a short-term clean up solution that does not address the underlying problem of the irresponsible disposal of gum.

A negotiated agreement has been in place with the chewing gum industry since 2007. The agreement facilitates a partnership approach through a range of agreed programmes that are practical, robust and targeted to address the root cause of the problem. As part of this agreement, the chewing gum industry mounted a national media campaign involving outdoor advertising throughout the country, national radio and TV advertising, in-store and around store advertising, as well as a schools' educational campaign promoting greater awareness of the damaging effects of chewing gum litter on our environment and of the penalties associated with the irresponsible disposal of gum.

Evidence indicates that the negotiated agreement approach is working. Since 2008, my Department's national litter pollution monitoring system report demonstrates that the percentage of national litter represented by chewing gum has decreased from 30.79% in 2008 to 15.32% in 2013, a reduction of 50%. The most recent programme, which ran from 2012 to 2014, has just concluded. It was funded entirely by the industry and was valued at an estimated €9.6 million. I have received a further proposal from the industry to renew the negotiated agreement for the term 2015 to 2017, and this matter is under consideration. I assure Deputy Kitt that while a renewed agreement is under consideration, it is not something that will simply go through on the nod. It is something that I will consider deeply. If we feel that we need a change of tack or need to consider levies or any other measures, we will do so.

I thank the Minister for his reply. The figure of 15%, while an improvement, is still high. This is an important issue because of the cost involved in removing this particular product from our streets. The problem boils down to the irresponsible disposal of chewing gum. Like the Minister, I am not trying to stop anyone from using chewing gum; it is the disposal of gum that is the issue. We have reached a compromise with the industry whereby it is funding an advertising campaign. However, if this situation continues, I do not envisage seeing any further improvements.

The Wrigley company has its headquarters in Chicago and, to the best of my knowledge, there is no problem with chewing gum or other litter on the streets of that city. We must try to get some more help from the industry. It was proposed in the past to put a levy on the chewing gum itself but that would have hit the consumer unfairly. It is very regrettable that the industry is not prepared, as I understand it, to contribute towards the cost of removing the gum from our streets. Will the Minister indicate if any discussions have taken place on the development of a biodegradable product?

On the Deputy's last point, discussions on that issue are under way and I will inform the Deputy of the outcome when I know it. The solution that has been put in place, namely, the negotiated agreement, has had a dramatic impact and the statistics prove it. That said, I agree with the Deputy that the figure that pertains is still of concern. I will consider whether a further agreement is feasible. I will examine the contributions that could be made, including whether we can increase the level of funding involved. I will make a decision then whether we should proceed with another negotiated agreement or go down another avenue entirely, possibly involving the imposition of a levy or some other measure. That will be up for discussion in the very immediate future.

Ambulance Service Provision

I thank the Ceann Comhairle for giving me the opportunity to raise this issue and I also thank the Minister of State at the Department of Health, Deputy Kathleen Lynch, for her attention.

The Dublin Fire Brigade ambulance service is one of the oldest in the world. In 1899, the service dealt with approximately 520 calls but today it deals with approximately 80,000 incidents annually. The Dublin Fire Brigade ambulance service has an added advantage when attending emergency incidents. Where necessary, a fire tender or other specialist vehicle may also be deployed to an incident. Each fire tender has fully trained paramedics who are often the first on `the scene in the case of ECHO or DELTA calls and act as first responders. In many instances, the fire crews initiate first interventions which aid in reducing time to defibrillation and resuscitation as well as reducing on-scene time and ensuring good patient handling and removal. Fire crews are particularly good at patient handling. They take a full-team approach at road traffic collisions and are vital in the stabilisation, immobilisation and management of spinal injury patients and their removal to hospital.

Dublin Fire Brigade has a duty under section 25 of the Fire Services Act to take charge of major or complex incidents. Its ambulance crews can be deployed in high-risk situations involving chemical, fire or other serious incidents where it may not be possible to deploy other services such as the HSE ambulance service. In the event of an emergency incident at Dublin Airport or at Dublin Port, for example, the local authority is responsible under the emergency framework for providing fire and rescue services. The best resource available to provide this incident cover is the Dublin Fire Brigade integrated fire and ambulance service. Its integrated control room has a pivotal role to play in providing the cover needed for such events. An added bonus of the combined fire and emergency medical service is the extra equipment available to crews to ensure scene safety and to extract entrapped patients.

If Dublin Fire Brigade becomes just a fire and non-medical emergency service, vital life-saving services will be lost. If it loses its ability to dispatch integrated emergency medical services, lives will be put at risk. Fire services in the United Kingdom are moving towards an integrated service, combining or co-locating fire and emergency medical services.

Dublin Fire Brigade is contracted to supply 11 ambulances to the Dublin area and handles approximately 80,000 incidents per annum. The National Ambulance Service is supposed to be the first responder in the Tallaght and Swords areas but it usually does not have an ambulance available for these areas. The National Ambulance Service regularly does not have an ambulance on duty in certain areas because if crew members are unavailable for any reason, they are not replaced, as was highlighted on "Prime Time" recently.

I thank the Deputy for raising this issue and giving me the opportunity to update the House on the proposed changes to Dublin ambulance services. Historically, the Dublin emergency ambulance service has been provided by Dublin Fire Brigade, DFB. The National Ambulance Service, NAS, supports the DFB as required. However, HIQA published a report last December which identified serious patient safety concerns with regard to the lack of co-ordination between the NAS and the DFB. The urgent need to address these issues was stressed, particularly for 999 call-taking and ambulance dispatch, as well as overall clinical governance.

Following discussions, the HSE and Dublin City Council have agreed in principle to address the identified weaknesses through the provision of a single point of contact for all emergency calls in Dublin. Under the agreement reached, all 999 and 112 ambulance calls for the Dublin region will be routed through the national emergency operations centre in Tallaght, and all ambulances, regardless of whether they are DFB or NAS, will be dispatched from Tallaght. In addition, clinical governance of Dublin ambulance services will become the responsibility of the NAS medical director.

The new arrangements will mean that people in Dublin will get a better ambulance service that will be safer. Currently, where the DFB does not have an ambulance available, it may or may not pass the call to the NAS. Passing calls between call centres is not without risks. Calls can be delayed or, worse, missed. The people of Dublin can also look forward to a more responsive service, as all ambulances will be dispatched from Tallaght. The dispatcher will be able to see every available ambulance in the region. The nearest available ambulance, regardless of whether it is NAS or DFB, will be sent to the incident. The clinical governance changes will mean that patients will receive exactly the same level of care no matter which ambulance arrives.

I am aware that concerns have been expressed in the media about a takeover by the NAS of Dublin ambulance services. I can assure the House that claims of a takeover are wide of the mark. The proposed changes will not impact on the delivery of services. The DFB will continue to provide ambulance services in Dublin. Only the structures around clinical governance of the service and call management will change.

The DFB has provided very well for the emergency needs of Dublin since 1898, as the Deputy outlined. However, no health service can afford to stand still. A single contact and dispatch point for emergency ambulance calls is needed to address the safety issues raised by HIQA. I am delighted, therefore, to note that agreement in principle has now been reached with the unions on the integration of emergency ambulance call taking and dispatch. It has also been agreed that the DFB will continue to be fully involved in emergency ambulance service delivery and there will be no diminution in such services. I understand that a joint forum within Dublin City Council, which will include management and union representatives, is to be established to address issues regarding the control centre reconfiguration. That is a very welcome development and will ensure that the people of Dublin get the ambulance service they deserve.

I thank the Minister of State for her reply and take special note of the fact that the new arrangements mean that the people of Dublin will get a better ambulance service. She made reference to delays, which are clearly a resource issue. It is my understanding that the DFB was allocated one additional ambulance during a period of approximately 20 years. I may stand corrected, but that is my understanding. The population has increased and the numbers of calls has increased exponentially without a corresponding increase in required resources. The broader problem is that while these arguments rage, lives can often be put at risk. It is my understanding that both the DFB and the NAS are committed to their respective roles.

I welcome the recent announcement by the Dublin city manager that a forum will be created to discuss these issues. Many welcomed the statement by the Minister for Health recently in which he committed to discussion on this matter. It is important to take into account the views of stakeholders, the workforce, service users and, of course, the citizens of Dublin. These views need to be gauged before any step is taken.

The truth needs to be made clear. We should not throw the baby out with the bathwater. After all, 80% of DFB ambulance responses are within the HIQA standard of seven minutes and 59 seconds. We should not overlook that. It is likely that it is one of the best performers in the country. The response time, supplemented by the ability to dispatch a fire attender fully staffed by paramedics, is not something we can lightly afford to lose.

I should have declared an interest when I first stood up. One of my sons-in-law works in the fire service in another part of the country. I know from listening to him and from news reports that there is often a need for both services to attend, depending on the circumstances. In a major accident, it might be necessary to use equipment that paramedics in an ambulance service would not necessarily have.

In respect of ambulance time response, be it the DFB or the NAS, I often wonder whether we are setting the bar too high, because there can be circumstances in which ambulances cannot possibly meet the timeframe set for them. I know that to someone waiting for an ambulance, including someone in a support role, the time taken for the ambulance to arrive can often seem to be an awful lot longer than it is. We would all like ambulances and the services we require to be there instantly, but that is not always possible.

There is a positive outcome to the ongoing discussions within the forum in Dublin City Council. I believe the need for both services cannot be underestimated, but it is important that these services comply in respect of the safety concerns highlighted by HIQA. I am not sure whether anyone who has ever waited for an ambulance or any of the emergency services worries about which one of them gets there first, provided someone does get there and those who get there have the competence and training to deliver what the patient needs. I thank the Deputy for raising the issue.

Hospital Services

I thank the Minister of State for taking this debate. I am very disappointed to find myself here once again. This is an issue I have raised on numerous occasions in the Dáil Chamber and at the Oireachtas Joint Committee on Health and Children. It shows how important the issue is for the people of Waterford. Two years ago, I received a letter from the former Minister, Deputy Reilly, offering certain assurances to the people of Waterford and the south east regarding the health services in Waterford. This letter came after a winter of discontent in Waterford in which we saw thousands of people take to the streets, having come from all around the south east, to show that they were concerned about a possible downgrading of Waterford Regional Hospital, as it was known then. Their fear was centred, as it is centred now, around the Higgins report, which examined the reorganisation of hospital groupings. After a lot of fear, we were promised that this would make things better. I attended a lot of meetings, and at each of these Professor Higgins promised us time and again that what we had would be protected and services would be enhanced. We were told this would be a good thing for people in Waterford and the south east. The letter from the former Minister, Deputy Reilly, said that the establishment of hospital groups would enhance cardiology cover in Waterford. It went on to say: "[T]he increased flexibility of staff across the group will enable us to achieve our goal of providing cardiology cover at Waterford Regional Hospital 24 hours a day, seven days a week."

Two years on, we are no closer to that. Deputy John Halligan, who also represents Waterford, raised the very serious case two weeks ago of a man from Waterford who sadly and tragically died because the service was not available. A second cath laboratory to provide 24-7 cardiology services is needed. We were told at the time that we would get it. I now understand that a business plan is being put together and that this would cost €1.5 million, which is only a small amount in the context of the delivery of health services. This small amount of money would copperfasten services at University Hospital Waterford, UHW. We need an around the clock service. This requires provision of a second cath laboratory and the staff required to keep two laboratories open.

There are also shortcomings at the hospital in terms of dermatology services. It is worth noting that the south east has one of the highest rates of skin cancer in the country. Currently, there is no consultant dermatologist at University Hospital Waterford. One consultant is due to return from leave at the end of the month and interviews are taking place to fill other posts. This means that the people of Waterford now have to travel from the city to the South Infirmary-Victoria University Hospital in Cork to see a consultant. I will give an example in this regard. I was contacted by a distressed family whose mother is 79 years of age and is in a great deal of pain because of a very serious skin condition. She constantly breaks out in blisters which burst which, as one can imagine, is very painful. This lady, who is almost 80 years of age, is forced to travel to Cork to see a consultant for a five or ten minute consultation. This involves a four hour round trip journey for a fragile woman. It also places extra pressure on her family, who, because there is no transport available, have to take days off work to bring her to Cork, and all for a service that should be available in Waterford. Dermatology services at University Hospital Waterford have been reduced to one afternoon clinic on a Wednesday. This is not the vibrant future that was promised to the people of Waterford. The case I highlighted is only one of the less serious cases.

I invite the Minister of State, Deputy Lynch, to read last week's Waterford News & Star which outlines a truly awful case of a man who almost died because of a lack of dermatology services in University Hospital Waterford. A father of two whose skin was red and bubbling arrived in accident and emergency, where he spent 18 hours on a trolley and was misdiagnosed twice. As the doctors had never before seen the condition, a conscientious nurse faxed photographs of the man's skin to the Cork hospital. The consultants there took one look at them and advised that the man be sent to Cork immediately. The irony is that although there was a consultant dermatologist conducting his Wednesday clinic in UHW, the man did not get to see him. There were no ambulances available to take this extremely sick man to Cork as, he was told, access to the ambulance service required two days notice. This man, whose life was in danger, was then put in a taxi and sent to the Cork hospital. When he got there, he was told by the hospital staff that had he spent any more in Waterford hospital he would no longer be with us.

I will first address the Deputy's last concern regarding dermatology services. There are three approved permanent consultant dermatologist posts at UHW. As rightly pointed out by the Deputy, one consultant is currently on maternity leave but is due to return to work on 25 March. Interviews to fill the other two posts were held on 25 February and two successful candidates are currently being processed by the national recruitment service. University Hospital Waterford is optimistic that contracts for these posts can be agreed in the coming months. I will do as much as I can to ensure this is done as speedily as possible. I do not propose to repeat what the Deputy said in regard to the special arrangement with the South Infirmary-Victoria University Hospital, Cork, for urgent dermatological referrals. The two new posts at UHW, when filled, will have a significant impact on services. I will do my best to ensure the process, including vetting and so on, is completed as quickly as possible.

I thank the Deputy for raising the issue which I assumed to be in relation to cardiology services in Waterford. The report on the establishment of hospital groups as a transition to independent hospital trusts noted that the cardiology service at University Hospital Waterford, UHW, should be extended. The hospital's regional cardiology interventional suite opened in 2008. In 2012, the suite was identified as the designated primary PCI centre for the region, under the national clinical programme for acute coronary syndrome. Its services cover Waterford, Kilkenny, south Tipperary and Wexford. The centre currently has one catheterisation laboratory, which operates five days a week and incorporates a dedicated six-bed cardiac day ward. Staffing includes three consultant interventional cardiologists based at Waterford and two visiting consultant cardiologists from Wexford and south Tipperary, who work there one day a week. I understand that a business case, prepared by UHW, for the development of a second catheterisation laboratory and a 24-hour PCI service, is under consideration within the south-south west hospital group. The development of a second catheterisation laboratory is, I believe, considered a priority within the group.

In regard to the suggested extension of the PCI service to a 24-hour service, for any complex acute hospital service, a key criterion for deciding whether a 24-hour service should be provided is whether there is a sufficient volume of appropriate activity to ensure safe provision of the service to patients. Without sufficient throughput of patients, staff engaged in the service will not be able to maintain their skill levels. This could put patients at risk. lt is my understanding that under the acute coronary syndrome programme to be viable, a 24-7 PCI service must serve a population of 500,000 to 1,000,000 people, which requires at least six interventional cardiologists to staff the necessary roster. It is worth noting that the acute coronary syndrome programme is of the view that the current population base covered by UHW does not provide for a viable 24-7 service. I am aware that the consultants currently providing the existing service have indicated their willingness to work extra hours to facilitate the extension of the current nine-to-five service, and I welcome their commitment. However, this would also require the provision of additional specialist support services provided by radiographers, nurses and cardiac technicians, with considerable additional revenue costs. I take on board what the Deputy had to say in relation to the extra cost. A review of PCI services in Dublin is due to be completed shortly. On completion of that process, PCI capacity and requirements in areas outside Dublin, including Waterford, will be examined. Any decision on further provision of PCI services in any region will be based on the best interest of patients, evidence on the volume of clinical need, the quality and safety of the service that can be provided, the ability to staff it safely and the resources available.

I know that my response in relation to additional cost is cold comfort to the Deputy. I will find out exactly what is the additional cost. It is hoped that following the review of the PCI services we will be able to progress the case highlighted on numerous occasions by the Deputy. It is not that we are ignoring it. Patient safety is paramount. When the Deputy highlights cases of people having died for lack of a service that must also be taken into consideration.

I thank the Minister of State for her response. I take no pleasure in raising this issue time and again. I represent the people of Waterford, who feel like they are getting a shoddy deal. We were told at the time of the Higgins' report that one of the main requirements to secure services into the future was an increased population base. In regard to the case I highlighted of the elderly woman having to attend the South Infirmary-Victoria Hospital in Cork for a dermatology service, I was told on numerous occasions by the former Minister for Health, Deputy Reilly, and current Minister, Deputy Varadkar, that the consultants would travel to Waterford, because that makes more sense than frail sick people having to make a four-hour journey in great discomfort to avail of a service they are entitled to receive on their own doorstep. We were told that with the birth of these new hospital groups we would be able to attract the calibre of consultant that requires a big population base to ensure his or her skillset is maintained.

We were assured that through the provision of services in Cork, Waterford and in the other hospitals that they would have the necessary throughput of patients to maintain their skill set to a high standard in order that they could give the best service to the people of the south east. We were promised professorships and academic posts. Could the Minister of State please indicate the current position in that regard? I would welcome an update on the partnership between University Hospital Waterford and University College Cork, UCC. To be honest, the current situation is just not good enough. The hospital is called "University Hospital Waterford", which sounds good but it means nothing. We do not have what we were promised. I understand we are in a time of limited resources but as the economy starts to improve, the Labour Party must focus on the provision of public services. I will fight tooth and nail to ensure the people of Waterford and the south east get what they deserve. As a party in government we must make real decisions about where we want to provide investment. I, for one, will support investment in public services. Currently, nurses, doctors and care assistants are working to the pin of their collar to ensure service provision in University Hospital Waterford, but they need the Minister's support and that of his Cabinet colleagues to ensure we get the services that are so badly required in Waterford and the south east.

The two new consultants will have an impact in terms of dealing with the needs of the elderly lady and the man with the rare complaint. Inasmuch as I can, I will do my very best to ensure the national recruitment service expedites those two appointments.

I will keep an eye on the business plan that is being prepared in regard to the catheterisation laboratories. Deputy Conway is correct in that when the hospital groups were being considered the reason Wexford, Kilkenny and all of the other areas were brought together was to provide the required population base, because it is important that consultants in particular specialties have the required throughput on an ongoing and continuous basis, as that is what makes them expert in their field. The people delivering the service in Waterford at the moment are doing an incredible job. The unfortunate difficulty is that they are not there for long enough and they are not there at weekends. As Deputy Conway correctly pointed out, as the economy improves we will have to examine the issues that directly affect people.

Hospital Waiting Lists

I tabled parliamentary questions on waiting times for scoliosis surgery at University Hospital Galway to which I received a reply on 2 February outlining that one patient was waiting three to six months - I know who that person is - that three people are waiting between six months and nine months - I know one of those three people - and five people are waiting for 12 months. That is a total of nine people. The general manager outlined in the reply that the waiting lists for spinal surgery is one the priorities of the Saolta University Health Care Group. He further outlined that a number of arrangements are being put in place to facilitate the level of complexity involved in relation to spinal surgery for patients with scoliosis and that the group is currently reviewing a number of resources in the context of bed availability, access to diagnostics, purchase of specialist spinal equipment and access to theatre. He stated that when the key elements required are in place, potential surgery dates for the cohort of patients can be identified and scheduled accordingly.

The patients who contacted me have not received any date whatsoever and they are still waiting. I will not name them although they said it would not be a problem if I wanted to name them. They live in Mayo and Roscommon. A surgeon dealing with one of the cases raised a serious situation in September. He said that the patient in question was one of approximately 40 under his direct care who require major, complex spinal surgery at the Galway University Hospitals. He said she had been placed on a waiting list for the surgery to take place and that the rods were taken out of her back in September due to infection and she is now waiting to have the rods replaced. Surgery is required when the curvature level reaches 50% and the curvature of the patient in question is 70%. The surgeon indicated that in the current context of the allocation to him, he does not envisage the operation taking place for the foreseeable future. He said it was the case up to approximately two to three years ago that he could perform that type of surgery at Merlin Park University Hospital and had been doing that regularly since 1996. However, as a result of the withdrawal of support services for this type of surgery, the only place capable of providing it on the western seaboard was in University Hospital Galway. With the management team he set about trying to structure a pathway that would allow that to happen, but it has not happened in a seamless, safe way to date. As a result, he could not advise the patient of a definite time or date for the operation to take place. It seems that operations were to go ahead in University Hospital Galway but the team has not been put in place to carry them out. It is not good enough for patients to wait so long for urgent surgery, in particular when one patient has a curvature of more than 70%.

I thank Deputy Collins for raising this matter. All Members are dealing with at least one or two cases of people with scoliosis who are encountering difficulties. Waiting times for scoliosis surgery are unacceptably long. There has been an increase in the number of outpatient spinal review referrals, and a consequent increase in surgical demands. Hence, waiting times both for outpatients and for those awaiting surgery are indeed challenging. The Government is determined that this problem will be addressed. The HSE is examining all options to reduce scoliosis and other waiting lists as soon as possible. It must be pointed out that Galway University Hospitals do not carry out paediatric scoliosis surgery. That type of surgery may only be carried out at Crumlin, Temple Street, Tallaght and Cappagh hospitals and is predominantly managed at Our Lady's Children's Hospital, Crumlin. Approximately 5% of cases, predominantly those with neuromuscular disorders, will require post-operative access to a high dependency unit or paediatric intensive care unit. Surgery is provided through two full-day theatre sessions per week and ten specialist orthopaedic beds at Crumlin. Currently, there are two orthopaedic consultants jointly appointed between Crumlin and Tallaght hospitals to provide paediatric spinal surgery in Crumlin and paediatric, adolescent and adult spinal services at Tallaght hospital.

Saolta University Health Care Group has assured the Department of Health that the waiting list for spinal surgery is one of its main priorities. To facilitate the level of complexity involved in relation to spinal surgery for patients with scoliosis, access to inpatient beds, diagnostics, purchase of specialist spinal equipment and access to theatre for significant periods of time must be considered. When the key elements required are in place, potential surgery dates for this cohort of patients can be identified and scheduled accordingly. Funding has been allocated in the 2015 HSE service plan for the appointment of a consultant orthopaedic surgeon with a special interest in spinal surgery at Galway University Hospitals. Funding has also been allocated for the appointment of an orthopaedic surgeon, anaesthetist and support staff at Crumlin. This will maximise the use of available theatre sessions in the hospital. These allocations are part of a total of approximately €5 million available for the overall development of orthopaedic service infrastructure nationally in 2015. This funding will also allow for the development of a 24-7 spinal theatre and allocation of consultant anaesthetist and additional 5.5 nurse posts at the Mater hospital, the appointment of an orthopaedic surgeon to provide for up to 100 cases of degenerative spinal surgery a year to be undertaken in Tallaght hospital, the appointment of a consultant orthopaedic surgeon with a special interest in paediatrics in Cork, the opening of current closed and under-utilised capacity at Cappagh hospital, and the appointment of an additional orthopaedic consultant as part of improved services for paediatric spina bifida.

The Department will continue to work with the Health Service Executive to ensure service needs and waiting times in this area are addressed, having regard to the overall level of resources available to the HSE.

Last year, when I tabled parliamentary questions on Our Lady's Children's Hospital, Crumlin, I was informed there was a service level arrangement in place, money would be provided and work was being done with the children's hospital group, etc. Nine people have been waiting for surgery in Galway University Hospital for between three months and more than one year. One patient has been waiting for surgery since July 2014, when an infection caused her to have an operation done to remove rods from her back. She has not been given a date for surgery, and we have been informed that the reason for the delay is the lack of beds for post-operative care. It is unacceptable that patients with curvature exceeding 70%s are waiting for surgery.

According to a reply I received from the Minister, a number of cases involving children were transferred to the Blackrock Clinic. While it goes against the grain for me to advocate private care, in emergencies such as these, the use of alternative facilities, including private hospitals, should be considered. I am aware that consideration is being given to having these patients treated in Cappagh Hospital. The two people to whom I referred are serious and urgent cases. I do not understand the reason an alternative has not been provided for them on the basis that their cases are emergencies.

We have all seen children and adolescents who have a high level of curvature. This is a serious issue, and one cannot simply put something in place and then take it out, as we all accept. The provision of funding to recruit additional consultants and support staff is expected to allow for an additional 25 procedures to take place in Crumlin hospital this year. This will be in addition to the 58 cases currently treated per annum.

There are 37 people waiting.

I understand that. Despite the additional capacity to be provided this year, the number of surgeries at Crumlin hospital will still fall short of what is required to deal with demand. The Health Service Executive is working with Crumlin hospital and the children's hospital group to explore all options to increase capacity for spinal surgery.

The Deputy and I both understand that a structure for emergency surgery cannot be easily put in place, even if cases involving persons with a curvature of 70% cannot be delayed any longer. The issue is much more serious. The new consultant posts in Galway and Cork and the opening of beds in Cappagh hospital will contribute to addressing the problem, as will the provision of additional support staff such as nurses and anaesthetists. Given the type of surgery involved, which takes a long time, the role of the anaesthetist is as important as that of the surgeon. We are not dismissing this issue and we know full well how important and urgent it is. I hope considerable improvements will be made in the next few months.