Dáil Éireann debate -
Thursday, 27 Sep 2018

Vol. 972 No. 6

Children's Health Bill 2018 [Seanad]: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Anne Rabbitte

Fianna Fáil supports this Bill. It puts the new national children's hospital on a statutory footing. The Bill is long overdue, having been on the Government's legislation list for three years. It is disappointing that the new children's hospital will not be operational until 2022. When the St. James's Hospital site was chosen in 2012 it was expected that the hospital would be built by now. It is five years since the Higgins report and this is the first hospital to be put on a statutory footing. My local hospital group, the Saolta University Health Care Group, is not on a statutory footing so perhaps the Minister of State, Deputy Jim Daly, will seek clarification from the Minister, Deputy Harris, on when the Government is planning to bring forward legislation to put other hospital groups on a statutory footing. Good corporate governance is important, as was clearly highlighted in the Scally report. We look forward to the HSE board being formed and to legislation being introduced in that regard.

Earlier the Minister referred to two or three issues which I wish to discuss. One was the naming of the hospital. I welcome that there will be a process whereby political parties and the general public can have an input into the naming of the new children's hospital. It was a little premature to name it before there was proper consultation, so many bodies will be happy about that.

With regard to arrangements being made with fast food companies in respect of play or recreational areas within the hospital grounds, I have a clear viewpoint on that. It is hard to have a fast food outlet in a prominent position in a major new innovative hospital if we are promoting healthy living. It should not be done if we are trying to achieve a balance. That is my personal viewpoint although I am sure that when it reaches that stage we will be delighted to see that the hospital is nearing its opening.

It has taken six years for us to get to this stage and, like others, I welcome it. As we have said all along, the most important thing is to get the hospital built. Why is that? The Minister of State is well aware of the waiting lists that have fed into this. There are currently 44,000 children on the waiting lists for Temple Street, Crumlin and Tallaght for various appointments. With regard specifically to cardiology and ophthalmology, there are over 2,000 children waiting for specialised cardiology treatment and 2,277 are waiting for ophthalmology treatment.

I am glad the Minister acknowledged that along with this hospital, which is the subject of this Bill, he is going to look at other centres which he intends to improve. He mentioned Galway specifically and I welcome that. There is a great deal of concern that all roads are going to lead to Dublin and that a regionally balanced approach in respect of caring for children, be it in Galway or Cork, might be forgotten. We must ensure a balance in that regard.

As I said, we support this measure and I wish the staff and the new boards of management, when they are established, the best of luck. Most importantly, we must make every effort to ensure that we meet the final deadline that has been set. That is imperative. We cannot wait any longer. Children have to be front and centre in this. They are our future and we must protect them. Anxious parents need to know that we will have a centre of excellence not just in respect of the quality of care that will be delivered but also in respect of research and the training of the staff there. That will be very welcome. I have nothing further to say aside from wishing everybody the very best of luck.

Deputy Louise O'Reilly

I welcome the Bill. I watched with interest how efficiently it passed through the Seanad. Given recent events here it was quite refreshing to see it progressing quite quickly. The Bill relates specifically to the board of the children's hospital but the construction of the hospital is progressing quite well. I wish it every success as it is much needed. I commend the work on the project to date by all those involved, from the Department to those constructing the new hospital as well as those who worked on the legislation. The Bill focuses on the structure of the new board to take over the running of the children's hospital and on the transfer of employees and property rights and liabilities to the new board. The transfer of contracts and provisions for preservation of contracts in this manner is always a tricky thing to do but, having spoken to the workers and members of the unions, I accept there has been some dialogue and engagement.

I wish to raise a number of points and I seek some clarifications which I hope will be provided on Committee and later Stages. First, with regard to the name of the hospital, I ask the Minister to agree to naming the hospital the "Kathleen Lynn Children's Hospital". That name would be recognition of her important role in delivering medical care for the women and children of Dublin, particularly the poor, in her pioneering St. Ultan's hospital, which was only down the canal from the St. James's Hospital site. It also would be appropriate in this commemorative period that her role as a suffragette and a volunteer in the Irish Citizen Army during the 1916 Rising would also be marked. This would be appropriate at the St. James's Hospital site given that it is the site of the republican strongholds during the 1916 Rising in the South Dublin Union.

Dr. Kathleen Lynn was a Mayo woman who challenged many of the norms in society at the time in regard to women. She was a suffragette, a fellow of the Royal College of Surgeons in Ireland and the first resident doctor in the Royal Victoria Eye and Ear Hospital. She was instrumental in the roll-out of the BCG vaccine, a soup kitchen worker during the Lock-out of 1913, an Irish Citizen Army volunteer and the officer commanding the City Hall garrison at the end of Easter Week 1916. She also was a prisoner of war, a Deputy, a councillor and the founder of St. Ultan’s hospital, where she worked until she was over 80 years of age. There is no more appropriate name for this hospital than the Kathleen Lynn children's hospital. I hope this proposal will at least start a discussion on the naming of the hospital.

On section 6 of the Bill, I suggest that a reference be included therein to medical and health professionals, under objects and functions, ensuring that their well-being is prioritised and that there are no barriers in their way as regards training or services. At a time of crisis among our healthcare professionals, it is imperative that the objects and functions of Children's Health Ireland ensures this.

Section 9 makes provision for borrowing for capital purposes against the income and the assets of the hospital, which I understand. This provision is similarly used by many universities across the State. However, I do not understand why the hospital would need to borrow for current purposes given that the State should be funding the hospital to deliver in line with demand. Hospitals run by the State should be funded for the provision of current services by the State from the Exchequer. If this provision remains in the Bill, any Government can underfund the hospital and instruct it to borrow money to provide paediatric healthcare services. Its inclusion would allow for exploitation, and we should all be wary of this.

Section 8(3) is questionable. It exemplifies what is called "mission creep", which is a gradual shift in objectives, often resulting in unplanned longer-term change. I do not understand why Children's Health Ireland would need to acquire, hold and dispose of shares or other interests in a company, or become a member of a company. The hospital and board has a mission, namely, to provide paediatric healthcare to children across the State. I do not understand why the board of the children's hospital would need to become a member of a company. The board has the scope under other subsections of section 8 to establish subsidiaries and so forth and it has room to take part in the formation of a company. Therefore, I find it a little curious that Children’s Health Ireland would require the power to become a member of a company. I do not feel this is appropriate and there is more here than meets the eye.

As regards the board of the hospital, there could be more of a role for the Oireachtas in this process. There is a history in this State of Ministers appointing to boards people who are completely unsuitable to be members of such boards. To ensure that candidates are satisfactory there may be an oversight role for the Oireachtas in this process. If people have a problem with that, I assume they have a problem with transparency and ensuring accountability. As regards the board, I propose that membership with non-voting observer status be given to a representative of ICTU, a patient advocate and a member of Dublin City Council. Sinn Féin believes that a representative on behalf of ICTU would be important in relaying the concerns of staff across the hospital and would also guarantee a healthy working link between the board and the staff in the hospital.

Dr. Scally has highlighted the need for more patient advocates within the health service and I believe the inclusion of a patient advocate on the board would strengthen the relationship between it and the parents and their children in the hospital. There is a Dublin City Council representative on the current board of Crumlin children’s hospital and I believe this practice should be continued. With regard to the current children’s hospitals that will move to the new hospital, I would welcome an assurance that the existing facilities will remain in use for health service purposes. Has the Department considered turning the Crumlin site into an elective-only hospital, a step-down facility or to using it for some form of health use given our capacity problems?

On section 24, will subsidiaries be added here in order that the Committee of Public Accounts will have powers to ensure public accountability of the subsidiaries of the children’s health board? The Committee of Public Accounts often has been precluded from examining or asking questions in respect of subsidiaries because they are not covered under the legislation which established them. The inclusion of subsidiaries would be both sensible and practical and would ensure transparency when it comes to public moneys.

Sinn Féin supports the Bill and asks that the Minister consider its suggestions prior to Committee Stage. As a former trade union official, I have some experience of what happens in the aftermath of hospitals amalgamation. While this is not an issue material to this Bill it is one that requires consideration. In the amalgamation process in which I was involved, only some staff members were consulted about the process. It appeared to be the case that the higher one's professional grade the greater the level of consultation, despite the necessity for all staff to move. The remaining staff, often referred to as ancillary staff - a term I do not like - were not consulted until close to the end of the process. I do not think this should be allowed to happen. The process needs to be inclusive so that everybody is involved and when the move happens everybody believes they have been consulted and involved in the process.

Deputy Gino Kenny

This Bill provides for the transfer of the land, property, rights and liabilities of the three children's hospitals to the proposed body. It is a very technical Bill, which gives continuity to the incumbent Children's hospital group board. I have reviewed the board membership of the national paediatric hospital development board and the Children's hospital group board. As mentioned by the previous speaker, there are not many union representatives, worker representatives or lay people on those boards, which is an astonishing omission in terms of membership of these boards. I hope that this new board will take cognisance of lay people, union representatives and worker representatives who work in the hospital. The hospital location in the form of the St. James's Hospital site is fantastic and it has been the subject of discussion for a very long time.

I refer to the juxtaposition of the glitter of the new hospital and the manner in which we are treating children in today's Ireland. Like many other Deputies, I have engaged with parents on access to child and adolescent mental health, CAMHS, services and other services. The lack of services is beyond belief. Parents are so stressed and put to the pin of their collar that this is having an affect on both their daily lives and those of their children. These are determined parents who want the best for their children. They have organised into a new group called Enough is Enough, where every voice counts. The Minister of State, Deputy Jim Daly, will be aware of the crisis surrounding assessments of need. Owing to the suspension of the proposed new standard operating procedure, the system is in a mess. I am sure the Minister of State will agree that without diagnosis, children and their parents remain in very difficult situations. The current waiting time for an assessment of need is up to two years, which is unacceptable. Some parents have resorted to paying privately for speech and language services for their children, at a cost of approximately €120 to €140 per week. The Minister of State will, I believe, understand the point I am trying to make. On the one hand we are building a new hospital and new boards are being established and provided with statutory powers while at the same time thousands of children are waiting for elementary services, which are so important to their development, but they are not able to access them. The point I am making is that what is going on in terms of hospital building is in contradiction with what is happening in children's services.

As a member of the Joint Committee on the Future of Mental Health Care, I am aware of the ongoing crisis in our system in terms of staff and so on. I support the Bill. It is important it be progressed quickly, given construction of the new children's hospital was first mooted in 2007.

There is a big demonstration called by Enough is Enough on 6 October at 2 p.m. in the Garden of Remembrance for our parents and children who are awaiting vital services. It is important that people who are extremely frustrated by waiting times for their children come to this protest.

An Ceann Comhairle

Deputy Mattie McGrath is swapping with Deputy Joan Collins.

Deputy Mattie McGrath

Deputy Joan Collins is on her way; she is at another meeting. I am happy to speak on this Bill, which seeks to provide for the enhancement of children's health services and to establish a body that will be known as Children's Health Ireland to plan and deliver paediatric services. Goodness knows that development is needed in that area and we know that the saga of the new children's hospital went on for decades and we still have no deadline for when it will be delivered. I must declare that my late brother was a paediatrician who worked in many hospitals in Ireland and abroad. He finished up working in South Tipperary General Hospital and he was a wonderful advocate for sick children and children with special needs such as dyspraxia, dyslexia and autism. The lack of support services for these conditions causes trauma, pain and anguish to families.

The Minister of State knows better than anyone about this seeing as he has met some parents with me and he has tried to sort out the child and adolescent mental health service, CAMHS, situation in our area and especially in Cork. I would like a progress report on that because the service is not there at the moment. The Minister of State is well aware of my thoughts on this issue of the children's hospital ever since we in the Rural Independent Group tabled a Private Members' motion on the national children’s hospital in late March 2017. As part of the motion, we called on the Government clarify the exact mandate and the statutory and legal standing of the Children’s hospital group board and the National Paediatric Hospital Development Board. That matter remained shrouded in vagueness.

I said at the time that it was a national disgrace that the interests and vanities of medical academics, certain third level institutions such our neighbours out the road, Trinity College Dublin, and the political inability to admit a mistake took precedence over the pleas of parents and sick children. Previous speakers talked about the lack of consultation with staff and I agree that there should be meaningful consultation at all levels. It should not be the case that the higher up the pecking order one is that he or she would get more consultation. There should be proper and meaningful consultation and the people who should have been consulted were the sick children's parents and the likes of the Jack and Jill Children's Foundation and other organisations that do so much to fill the gaps and provide some semblance of service for very sick children and babies. "Gaps" is the wrong word to use because it is not a gap; it is wide open. They do not have the services. As Jonathan Irwin so excellently recounts in his tale of when he took his little baby home from hospital, "You are on your own", and it has become much worse in the 20 years since that happened. There is no support for the care of special needs children.

None of the arguments put forward by the Minister of State, the Minister or his party has allayed the fears of the parents of all of these sick children because they are hollow. I saw it here myself when we had a briefing in the audiovisual room. We were being supported on all sides that it was the wrong site but then when the party Whips came in, everything changed and there were only a few of us left standing. However, a wrong decision is never right. The location is not right and will never be right. I do not like to think of sick children in ambulances trying to access that hospital. Deputy Gino Kenny says it is a wonderful development. I have not seen it lately but I know where it is. I have been there and access is just not viable. We had a saga about whether there would be a helipad there and then I found out that the Sikorsky rescue helicopters are unable to land there. They will have to attempt to land on the three or four-storey side of a building. Pure, sheer and utter contempt and madness are being used to justify bad decisions taken by successive Governments.

What is equally galling is that we know that Members in each of the main parties explicitly accepted that this was the wrong site but have somehow convinced themselves that getting the hospital built now is more important than getting it built in the right place. That is sad because it will never be the right place in an expanding and overgrown city. A silk purse cannot be made out of a sow's ear and that is what it is. The staff have to have security going out to their cars at night as well. I am not trying to demonise the people living in that area but that is the sad fact. Nurses have been attacked and threatened on the way to and from work and the car park is not safe.

I asked questions at the time about the tender for the site, the process and the price. I know this from my small amount of experience in construction that the price will double because of the costs of demolition. Nice buildings with heritage value are being demolished but the cost of disposing of them and taking them out along with the noise and the interruptions to a hospital with sick children will be high. The cost of asbestos disposal will also come into it, not to mention the problems with the neighbours who have to be respected. It is difficult to undertake any construction project in the inner city. It doubles the cost because of the lack of landfill space and the legislation that we rightly have around that. We had a greenfield site out the road where anything could have been designed with ample green spaces and therapeutic gardens for sick children. Instead they will be looking out on concrete all their lives and at the moment they are looking out at cranes, jackhammers, noise, dust barriers and God knows what for the duration of the construction. There will be no outdoor therapeutic space with flowers, fauna, water and everything else that we know is helpful to children with many difficulties.

That should have been thought of as well but the stubbornness and buy-in from some of the medical profession had to have this. When they came in to brief us after they got scared about our motion, I counted them the evening that I was here sitting in the audiovisual room. There were 24 officials of all levels here from the HSE. Why three or four could not come in and tell us what they were doing is beyond me and they did not answer any questions. We thought it was a mighty crowd when we went in but the room was half full if not two thirds full with officials from the HSE along with the consultants who were proposing this. Considering the zeal with which they promoted it, one would wonder what vested interests were there because, as I said, a silk purse cannot be made out of a sow's ear. It will never be the right site and it will never be a site where people can go in with their child or their family and take them out for a stroll in a pram and sit for a while in a nice garden with a nice atmosphere away from noise and the hustle and bustle of the city with their specially trained dogs and everything else with them. We cannot do any of that on this site.

It was totally reckless to carry on the project at all costs. After many years of delay and threats of court action the people from Connolly for Kids came together to try to expose the madness of this project but they were rubbished, vilified and not listened to. The power of the system and senior officials in the HSE was brought to bear against them. Ministers who are afraid to stand up and give proper scrutiny and evaluation of proposals that are brought about by others rather than their own system the HSE and that is why we have it. I was over at the Irish Nurses and Midwives Organisation, INMO, this morning and the people there said that they are never listened to. They go into meetings with the Department of Health and they think that they are getting engagement but the next thing is that the Department of Public Expenditure and Reform just rubbishes it and they do not get listened to. I am an employer myself and if an employer does not listen to its employees, it is on a shaky road because they often have valuable information to impart and it is nice to respect them for their thinking. Deputies mentioned engagement and consultation with them. They should be consulted. They work there and have to drive there. It is their career and their vocation in many cases and they should have been properly listened to but, like many other things in this country today, what is big is wonderful, powerful people get their way and to hell with all ordinary people and their views and ideas even though they make common sense.

The Minister of State was not in the role at the time but he is continuing with this. It is the wrong site and I cannot the imagine the disruption that is there at the moment. I have met nurses who cried in front of me and I am sure other Deputies have met them. They told me how long it takes for them to get in and out of work.

Some of them have to get up at 5 a.m. They arrive there at 6 a.m. to get ahead of the rush and then sleep in their cars for an hour or an hour and a half. They do it to avoid the rush. It was a crazy decision. I salute Jonathan Irwin and the Jack and Jill Children's Foundation and the other people who led the campaign. They have been crushed but they have not gone away. It will be proven in the fullness of time that they were 100% right. They had no vested interest. They were concerned with the interests of the sickest and weakest children in our State and future generations and nothing else. They did it selflessly. They were joined by some eminent professionals whose names elude me. They came in here and they were vilified and demonised as if they were crackpots. They had experience of building children's hospitals in other countries. They had experience of these kinds of very delicate developments. This will be one of the costliest in Europe according to the projected figures. I am sure it will be two - if not two and a half - times the price in the contract.

There were questions when BAM got the contract. It had issues straight away. Much negotiation had to take place before a sod was turned or any machinery went on site. I would love to know how it is going on with the quantity surveyors and risk assessors regarding the issues with the structures that had to be removed and the damage done to the structures left behind and the reinforcement which was required. It is a difficult job. We all know, for example, what a major reconstruction of a home can involve. We often ask why we did not just build a new one. Many people look at a greenfield site and they cannot get planning permission so they do up an old house on the farm. They have wide walls and structural problems with roofs and drains, for example. A greenfield site can be adapted by bright and intelligent architects and engineers.

We had the model put before us. We have the space to do what we want. We could have a helicopter pad. A helicopter will have to land elsewhere and the patient will have to be transported by ambulance through traffic on the final leg of the journey. It is daft to have a national children's hospital without a helipad. It would not happen in wartime, when one would be under pressure. The first thing to do is secure the airspace and have some place to get people in and out fast.

The craziness continued and all the assurances of the National Paediatric Hospital Development Board rang hollow for the parents. They still ring hollow and will be proved loud in the fullness of time. It is my great fear we will be back here in a few short years talking about completely avoidable deaths. I do not say it lightly. I am not scaremongering. I fear we will be back here in a few years talking about completely avoidable deaths that unfortunately will have taken place when vulnerable high-risk babies had to travel from rural Ireland or some parts of Dublin to gain access to the congested St. James's site. I met the ambulance drivers and the specialist nurses. The Minister of State met them too. Did he listen to them? In such situations, the nurses scream at the drivers asking how long more when they are clogged up in traffic despite the sirens and Garda escorts. No one listened. That was four and five years ago when traffic was low on account of the downturn in the economy. The nurses were screaming and trying to do their best, for example for a very sick baby transferred from Clonmel, Cork, Donegal or anywhere in the country by ambulance. There was no helipad. These were our children and loved ones and perhaps the family was following behind them in a car or perhaps the mother was with them while the nurse was shouting to the driver, "How long more?" and the driver was in a cold sweat, doing his best. Advanced paramedics do their best to drive in those conditions in no-go areas.

It was madness. It was disgraceful. I do not know how one would describe it. They bulldozed the project through and insisted it go ahead in spite of the parents, the nurses, paramedics and people such as Dr. Finn Breathnach, who had unquestionable expertise in building projects such as this in the UK and elsewhere. It has been brushed under the radar. No doubt there will be more Supplementary Estimates passed to build it. It is draining resources from all the other services. It is reckless spending. One would think there was an unending purse. CAMHS and many other children's services, including orthodontic treatment services, are starved. There are children with all kinds of different issues and there is no place for GPs to refer them onto. Other Deputies referred to the fact that people have to go private when they cannot afford to do so. They have to pay €125 or €150 for a consultation. The CAMHS waiting lists are shocking. There are young adolescent children with mental health issues in the paediatric ward. It is causing untold trauma to their parents who have to stay with them. We have to hire agency staff to come in and sit with them at night but no one is thinking of their massive trauma. I spoke to the Minister of State and he agreed to intervene for one or two of them but I should not have to speak to the Minister of State and he should not have to intervene. The wonderful paediatric ward in South Tipperary General Hospital won an award last Friday night. No cognisance is taken of the interference and disruption it is causing the other sick children that are in there with medical issues and not mental health issues. One has to ask oneself why 12, 13, 14, 15 and 16 year olds have those serious issues but they have them.

The Minister of State told me that half the beds covering our area in Cork are unopened because of the vagaries of consultants who will not agree and play ball or do their duty. They have a hippocratic oath and a duty. They should cut out the nonsense. The Minister of State told me he was powerless to do anything. I accept that but it should not be the situation in a modern democracy. The buck should stop with the Minister and the red tape should be cut out in this dispute with consultants when sick children with mental health issues are languishing in children's wards. They are adolescents and should not be there at all. It is a terrible situation. It causes trauma for the whole hospital. It causes trauma in the children's ward. Some decisions have been taken lately by the management that they will not take these sick or distressed children anymore. Where will they go? I understand they are not being admitted into the hospital in Tipperary. I do not have proof of that. Where will they go? Their parents are desperate and frightened and they need support. They need psychiatric help. The parents have been traumatised. We are wasting the money. I was told today by the Minister, Deputy Regina Doherty, that the budget will increase by €600 million this year. It increased last year and the year before and we keep increasing it. The result is worse outcomes and fewer outcomes. There are some great outcomes in the HSE but the most vulnerable children of all are being denied access. I do not know what the Minister of State thinks of it but I look forward to his reply.

I hope the day never comes - I fear it will because we have persisted in the madness of pursuing the present location of the national children's hospital - that lives will be lost as a result of the inaccessibility of the hospital and its lack of a helipad. There is some kind of a helipad on the third or fourth floor. I cannot understand why. It will cause noise and disruption to the other sick children in the hospital who should be treated in a tranquil, sanitised, peaceful and calm area. Children love quiet. They love fun and games too but they love the quiet. Sick children are very special to me as they were to my late brother.

I am just saying that the train left the station and nobody had the power or the gumption to stop it. It is almost a full-time job trying to counter the professional spin and aggressive tactics used by the National Paediatric Hospital Development Board to push the project over the line. I salute the foot soldiers, the volunteers, the people who cared and the ordinary people, daoine na hÉireann, the Jack and Jill Children's Foundation and others that came together to form that group. I spent lots of time with them. Nobody wanted to listen. This was a vanity project for some professionals. No doubt the name of the Minister, Deputy Harris, will be on the door but if people cannot get into see it, it is not much good to them.

I have many serious questions on the legality of the National Paediatric Hospital Development Board and I will frame those after I review what the Minister says on the matter. There are serious question marks over the way it was pushed through and the way they would not countenance any engagement. To hear from Deputy O'Reilly, who was a trade union official, certain elements of staff were consulted more than others. They can consult all they want but if they do not listen it is very sad. I believe Mahatma Gandhi said it is bad enough to make a mistake of doing the wrong thing but to persist in doing the wrong thing is appalling.

I hope the Minister of State will have some answers and some accountability, which is very scarce in the Government, the Department of Health and the HSE these days. I hope he will clarify some of those issues and that we will get an update.

Why are any of us who want to be brought out not brought out to get a site report, to see the mayhem, the bedlam and the progress? We will know for ourselves when we arrive on site how close to completion it is because dates have come and gone, announcements have come and gone but it does not matter because we should be representing sick children not big business and not consultants with big egos. We had that experience in the last debate on the Bill we are going to discuss next week: big egos and consultants. The truth did not matter, it got crushed. Today the Government has decided to bring the legislation forward without pre-legislative scrutiny, more bullying tactics and more irresponsibility on the part of the Minister for Health, Deputy Harris. He is quoted in the Irish Examiner today saying that he wanted full scrutiny of that Bill but he has proposed to introduce it without pre-legislative scrutiny. That is totally arrogant, juvenile and childish on his part.

Deputy John McGuinness

I understand the importance of the Children's Health Bill 2018 but there are issues I wish to raise about the care of our children and our young population's health. The Department of Health under the Minister, Deputy Harris, has the handy knack of creating a smokescreen such as the introduction of this Bill when there are so many major issues being debated publicly around the provision of health services: 1 million people on waiting lists of one kind or another, the problems around cervical cancer and the availability of new drugs. As all of that is being debated and the controversy continues, the Minister introduces this Bill. Forgive me if I doubt his sincerity about the timeframes involved. He says there are nine sections in the Bill, all of which will be commenced at different stages by ministerial order. One would imagine if the legislation was that urgent it would be specified in the Bill where the legislation is going and there would be less use of ministerial order.

The Minister's reference to the new board shows exactly where the Department and the HSE are. They have approved a new consultative approach to agreeing a brand image, an operational name for the new entity. The naming process to be undertaken by the children' hospital group will be a shortlist of names for the Government's endorsement, prior to announcement. There seems to be more weight given to the creation of a corporate entity and the concern around that than to dealing with the real issues in the care of children's health. The waiting lists for Temple Street, Crumlin and Tallaght hospitals in 2018 is 44,615. Of those 16,862 have been waiting for more than 12 months and 10,304 have been waiting more than 18 months. Outpatients is a disgrace because that waiting list increased by 33% from 33,492 to 44,615. It is absolutely outrageous. The Bill we are debating will deal with something in the future commenced by ministerial order. The date has been shifted time and again. This has been generally on the books for consideration since 2012. The Government promised this hospital in the last term of 2011. The then minister and current Taoiseach promised it for 2019. Now we are being told it will be 2022.

I welcome the hospital because I believe that overall it will improve the healthcare of the youngest in our society but I cannot understand the emphasis on this corporate structure and the turning of a blind eye to what is currently happening in respect of the care of those children. Parents around the country will want to know what is going to happen my child who is on the waiting list between now and 2022 when the Minister says this will be delivered. I would like to see the Minister of State address that issue and give some sort of timeframe to those parents for the care of their children because that is the biggest concern in their lives. I would not say there is a Member in this House who would disagree with prioritising the health of young children. To deprive them of their healthcare, as he is with the waiting list of approximately 16,000, is to deprive them of the quality of life that they are entitled to now and not in 2022. Can the Minister of State address how he will deal with the waiting lists that are currently there, with no waffle, no bluff, just facts? The Minister of State should give us the facts in a given timeframe so those parents can plan for the future healthcare of their child in a different and more positive way. Every child who is sick or who may have a poor health future is of huge concern to their parents and siblings. It has to be dealt with and explained.

I understand this new entity will come under section 38. The Minister states that the chief executive officer will be the Accounting Officer. There has been serious difficulty in the past in dealing with section 38 and section 39 organisations and their accountability to the Committee of Public Accounts. I appeal to the Minister of State to ensure the language in this Bill makes it crystal clear that section 38 and 39 organisations in general are accountable to the Committee of Public Accounts. The Minister of State has to clarify the language, otherwise they will duck and dodge and avoid accountability and transparency, which has been the history of that sector as long as I can remember because the HSE within its own culture believes it is above accountability.

This year, with all that is required to keep it going and that it has spent, the HSE will be €1 billion over budget. That is not an exaggeration. The Department will bluff the figures again and massage them to make them look okay but every single year it has gone from a bad position to a worse position and then to a position of almost not being able to deal with the overrun. If the Minister of State does not get that in hand he is not serving the Department or the health of the country very well and he is allowing it to happen. That is my concern about the accountability of this new structure.

The other concern I have is around the amalgamation of these hospitals into one unit with other services to be provided.

The Minister, in his statement today, stated it provides a "unique opportunity to introduce a new model of care for all paediatric services". What does that mean? How will that new model of care impact on the current waiting lists? They will remain, and stubbornly so, because the Government lacks the vision, humanity and compassion to deal with those lists. Will the Minister of State tell me what that means? What will be the tangible result for the children on those waiting lists? There is an obligation on the Minister of State to explain this. There is an obligation on the Minister for Health, Deputy Harris, to ensure that all of this happens.

Forgive me for using the word "bluff" but the fact of the matter is the Government bluffed the Irish electorate into believing that it was going to rectify the health services. It bluffed them into believing it was going to burn down every quango in the place. Then, in the last term and this term, the Government put further quangos in place without any bother or any understanding that it had given a promise to the people it now represents. Is this management system being put in place just another quango? Could it have been done differently and in a more financially beneficial way and at the same time achieve the same or a better result? I would like to hear what the Minister of State has to say on why that has happened.

In the few minutes I have left, I have been asked to raise directly with the Minister the care of a constituent of mine, Ms Alice Taylor. This young woman, together with her mother, went public about the drug pembrolizumab, which she requires. It has been said to her that it will make a difference to her life and will prolong her life. The cold and inhumane response from the Department of Health and the HSE simply beggars belief. We are dealing with the life of a young woman. I ask the Minister of State to check out this case. I raised it in a parliamentary question recently. Will the Minister of State do something to help prolong the life of this young woman? Will he ensure that the drug she has been advised she should take is approved for her? She is supported by Ms Vicky Phelan, who is one of the bravest women to come from Irish society in recent years. She is now not only dealing with her own case but is advocating for others. She is taking on the system and dealing with the disgraceful cases that have come before the courts and the use of the confidentiality clause.

The second case I want to bring to the attention of the Minister of State is again that of a young person, namely, Isaac Brennan. He also went public outside of the gates here seeking the use of the drug for spinal muscular atrophy. I do not know how any Government, as hard as it could be, could turn a child away from the care and treatment he or she deserves. I know it costs money but one should sit at meetings of the Committee of Public Accounts any week and listen to how the HSE squanders vast sums of money, not on patients but on the administration of a dysfunctional system. How can the Minister say "No" to Alice Taylor or to Isaac Brennan? If he does and if that is his position, thereby abandoning all understanding of humanity and compassion, then he should not be where he is. His interest and his actions should be for the common good. It is a shameful Government that would ignore not just those two cases but also cases that are similar to both of those young people.

I will turn finally to scoliosis. I have watched very young children being abandoned by the State in the context of their care. I have watched their deformed bodies plead with the State to provide the health system and actions required to give them a better quality of life. I have, frankly, been less than impressed by the action of the Government and the HSE. Similar to this hospital and the management system being set up, the HSE has shown no regard for health. It would seem that the general message from the HSE - I hope it will not happen with this hospital - is, like the Department, to bluff and fumble its way through a dysfunctional system.

There is much to be learned on the care of our children from what has happened in the past. There also are many questions that need to be answered in the context of the delivery of what is outlined in this Bill. I do not see much content in the Bill that gives an indication as to what changes are going to be made directly for the care of the children on the waiting list from this day onwards to 2022. I give a general welcome to what the Bill is trying to achieve. I have raised the questions I need to raise with the Minister and I have personalised some of them to specific cases and healthcare. I ask the Minister of State to acknowledge the efforts being made by Members of this House to get acknowledgment of the rights of within our society who are sick and are not receiving the care and attention they deserve within the current health system. The system has failed them and refuses to acknowledge what is now perhaps better practice than before in the care of a specific medical condition.

Deputy Eugene Murphy

I wish to make a short contribution to support this Bill, as my colleagues Deputy McGuinness and Deputy Rabbitte have already done. It is important to get this hospital put on a statutory basis. As already has been noted, we have been waiting for a long time for it. I was doing some research on our hospitals and some facts on the national children's hospital, now incorporated in Tallaght Hospital, came up earlier today. It was founded in 1821 and was the first children's hospital in Ireland and Britain. It is one of the oldest in Europe. I was equating that with the 13 years that have elapsed since a Government decision was made to build a new hospital. A child that was one or two years of age then is now 15. That is since we decided to build a children's hospital.

It is shameful that this would happen because of our system and delays within it. I am surprised that people are not angrier. We do have to deal with planning issues and objections and we have to give everybody a fair crack of the whip but imagine that 13 years have elapsed since the decision was made to build this hospital. The Taoiseach and the Minister are now announcing a date of 2022. One wonders if we will not have that date pushed out again. I hope that will not happen again but it is possible that it will. We have heard what Deputy McGuinness and Deputy Rabbitte said about the appalling waiting lists for children in many of our hospitals.

The figures are shocking; 44,000, including 16,000 waiting for more than 12 months and 10,000 waiting for more than 18 months. It shocks and hurts me, as a new Deputy, that families have been so badly treated in our society. We have all helped families with sick children. We have all had the calls late at night to contact a consultant or a hospital to get something done. One has to pay tribute to the outstanding work done in hospitals such as Tallaght and Crumlin, and the outstanding care given there. There have been great breakthroughs in terms of children's health in this country. We have the medical people. We may have shortages of them in some areas but the brains and the commitment are there. However, the system has let those families down desperately, and let many people in the health sector down as well. I am talking about the people who work within the system.

An Bord Pleanála has approved the choice of St. James's Hospital as the site for the new national children's hospital. There were many battles around that, and many different points of view were expressed. We can all look at it and agree that perhaps there will be some shortcomings with the site. There was a lack of consensus among clinicians and other stakeholders around that choice. We should remember that it would have been impossible to have unanimous agreement on a site. There was always going to be a group of people, including individuals and politicians, who had different views or who had a different site in mind. Nobody could guarantee that any alternative site would have got planning. We are where we are, and I am not as pessimistic as Deputy Mattie McGrath. While I foresee some problems, people should wake up and realise we are talking about our children, the future generations of citizens. Early years are so important when it comes to dealing with illnesses and it is essential that we move as swiftly as we can. Nobody, whether politician or clinician, should put any roadblock in place to cause further delay, which would cause further anger to many people in our society.

Many people from rural areas have had their children rushed to Dublin and looked after very well. They slept on the floor if it had to be done; they stayed with their children and hospital staff to help their children through very difficult times. The children's hospital is long overdue. I am hopeful that it will be finished quickly. As the development of a site progresses, I acknowledge that issues will arise.

I recently had experience of hospitals due to an issue in my own family. My mother, who is now 82 years old, had a terrible experience in Portiuncula Hospital in Ballinasloe. The staff were brilliant and outstanding. My mother was referred there by a doctor and got to the hospital at 6.30 p.m. She was left sitting in a chair until 7 a.m. the next morning. Fortunately one family member was able to stay with her. She sent me a text message the next morning to say that she had just got a bed and that she was extremely tired. She was not worried about herself, however. She said to me that she was concerned about sick children, two or three years of age, in buggies waiting for a bed. Parents were trying to keep them as settled as possible, and staff were doing their best. Doctors were not able to see those children of two and three years of age because they had no bed. An 82 year old woman, in good health, who had been referred by her doctor but otherwise in good shape, was left sitting for a long time. Her concern was the youngsters. The experience really made me think about how we treat these issues, and consider the delays in place. We all must think about those situations.

We have seen the figures for the waiting lists for children, which are desperate, and not improving. The outpatient figures are particularly shocking. It is so important that there are no delays when children are being treated, because it is often the case that the illness can be dealt with swiftly and that the child can be restored to health and back to participating in society, able to attend their schools and play games. When things are prolonged and children are left waiting in outpatient departments, illnesses deteriorate and the children get sicker. It costs the State more money, but it might also cost a child more, including worse illness and even death.

I will not hold up the debate any further. Like my colleagues, I am delighted that we are moving. However, I want to say again that sick children being forced to wait for treatment is unacceptable to me, and to most people.

Minister of State at the Department of Health (Deputy Jim Daly)

I thank Members for their comments on this legislation and the children's hospital programme. I assure Members that all of their comments have been recorded and noted, and the Minister for Health, Deputy Harris, will respond on Committee Stage to the concerns raised, and at later Stages.

The transition of the existing paediatric services to a single entity is a complex matter, involving considerable forward planning and work, and as such an effective governance structure is required to implement service reorganisation, including staff deployment, around the hospital outpatient and urgent care centres when they are built, and to oversee the complex work of integration and transition to the new facilities. The board and CEO of the administrative Children's Hospital Group already overseeing this complex body of work are to become the first board and CEO of the new entity. The board members, appointed just over a year ago, were selected on foot of nominations and an open, competitive Public Appointments Service process to ensure the board has the correct mix of skills, experience and expertise. The board includes a member from Northern Ireland and an international expert, representatives from the boards of the three children's hospitals, and expertise in patient safety, change management, law and corporate governance. The establishment of the new children's hospital provides a unique opportunity to support the implementation of the HSE's new model of care for paediatric healthcare services in Ireland that will optimise how paediatric services are provided in Ireland. The model aims to ensure that all children can access high-quality services in an appropriate location within an appropriate timeframe, irrespective of their geographical location or social background. The model supports Government policy, with outcomes outlined in the future of the national policy framework for children and young people for 2014 to 2020, which sets out transformational goals for achieving the best outcomes for children, young people and families. The model also aligns with the aims and objectives of the Sláintecare report, the ten-year plan published by the Oireachtas Committee on the Future of Healthcare, which seeks to transform the delivery of healthcare in Ireland.

The new hospital outpatient and urgent care centres, along with the regional paediatric units in Limerick, Cork and Galway and local paediatric units will all work together to deliver this new model of care for paediatric services. In addition, for those who need to access specialist services in Dublin, the co-location of the hospital with adult acute services, and the eventual tri-location of the hospital with maternity services, will result in patients from infants to adolescents being able to avail themselves of the best clinical expertise on one campus. The new children's hospital has been designed to meet projected child population growth and unmet clinical need. The design is based on meticulous healthcare planning, which will result in a facility which is able to provide for very significant expansion - up to 30% - in the delivery of healthcare, and will help deliver on improving, promoting and protecting the health and well-being of children and young people. The new entity will be an element within a larger public health system, and accordingly it will have to take account, in its activities, of the paediatric healthcare services provided in other hospitals across the country in the primary care system, child and adolescent mental health services and in the community. This includes performing its functions and utilising its resources in the optimal way to achieve its objective of children's healthcare. As a single national tertiary and quaternary care provider, the new body will have to take on a national leadership role in terms of paediatric healthcare and the national model of care for paediatrics, and deliver on its remit for education, research, philanthropy and advocacy on behalf of children's healthcare in this country.

I am confident that this legislation will put the correct structure and approach in place in order to integrate the existing services and prepare for the delivery of the best possible paediatric healthcare in the new facilities. I am confident that the Bill as proposed will provide this new entity with the powers and functions it needs, both now and in the future, to manage the transition into the new children's' hospital and provide services for children's healthcare wile ensuring appropriate accountability for the use of State funding. It is our hope that the Bill will progress through the Houses in time to allow the new entity to be established and operational by year's end and before the opening next year of the first outpatient and urgent care centre at Connolly Hospital.

I reiterate the comments of the Minister for Health, Deputy Harris. I commend and thank the staff and boards of the three hospitals coming together and also the board of the Children's Hospital Group, for the vision and commitment they have shown to this project in getting it to the stage we are at today. Finally, I thank Members for their contributions and I look forward to the Bill being considered further on Committee Stage.

Question put and agreed to.