Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Hospital Consultant Recruitment

Stephen Donnelly

Question:

1. Deputy Stephen Donnelly asked the Minister for Health his views on whether Ireland has a severe shortage of hospital consultants; his further views on whether a major reason for same is new entrant pay disparity; his plans to rectify same; the number of consultants employed at post-2012 pay rates; and if he will make a statement on the matter. [21143/19]

As the Minister and I are both aware, the waiting lists for public access to hospital consultants across the board are at the worst levels since records began. Does the Minister accept that one of the main reasons people have to wait so long is that we have a severe shortage of hospital consultants? Does he also accept that one of the core reasons for that is the significant discrepancy in pay between new entrants and existing consultants?

The number of consultants working in the public health service continues to grow year-on-year. It increased by 119 whole-time equivalents, WTEs, or 4% in the year to the end of March 2019. In the five years to the end of March 2019, the number of consultants increased by 529, more than 20%, and now stands at 3,110 WTEs. It is important in any discussion of this issue to acknowledge that while there is a recruitment and retention challenge relating to consultants, the impression is often given that the number is declining when it is increasing. There are 119 more consultants working in the health service at the end of March this year compared with last year.

The public health service in Ireland operates in a global market for medical specialists and there is a worldwide shortage of specialists. Notwithstanding the shortage, progress continues to be made in attracting consultants and addressing improvements in the training, working environment and career pathways for non-consultant hospital doctors in Ireland to encourage the supply of future consultant candidates.

The issue of new entrant pay is being addressed in general terms under the terms of the Public Service Stability Agreement 2018-2020. The issue has also been examined by the Public Service Pay Commission in relation to consultants. The commission found that evidence of recruitment campaigns with very low levels of applications was indicative of ongoing difficulties in regard to recruitment of consultants. The commission also acknowledged that the difference in pay between the pre-existing and new entrant consultants is greater than for other categories of public servants. It did not view the measures announced last September for new entrant public servants generally as being sufficient to address the degree of pay differential which exists for consultants and I share that view. Ultimately, the commission proposed that the parties to the public service stability agreement jointly consider what further measures could be taken, over time, to address this difficulty.

I understand that the Department of Public Expenditure and Reform has noted the commission’s views. The recommendation made by the commission in relation to addressing the pay differential is viewed as one which does need to be addressed. We acknowledge that brokering a solution will be a significant challenge, in particular within the context of broader public sector pay policy. It should also be acknowledged, and I am sure the Deputy will agree with me in this regard, that while pay is a factor, there are a number of other factors, as many reports have shown. I refer, for example, to opportunities for career development, training opportunities and location. The commission stated it was strongly supportive of the full implementation of the recommendations of the Strategic Review of Medical Training and Career Structures, known as the MacCraith recommendations, as they have the potential to resolve many of the issues. As I said at the Irish Medical Organisation, IMO, conference, we must now put a process in place to engage with consultants on the issue.

The concern is speed because we are facing a crisis. As some senior hospital consultants said to me just last week, the public hospital system is now on fire. It is great that we have, notionally, 3,100 consultants but there are approximately 400 unfilled positions, more than are 300 locums included in the number and there are at least 150 non-specialists acting in specialist roles. When one counts all of that, there are not 3,000 but closer to 2,000 consultants. Even if we had the 3,000 posts all filled by full-time, fully qualified specialists, which we do not, the number of consultants would still be approximately 43% below the EU average. We have a chronic shortage of doctors and the reality is that people are waiting longer in Ireland than in any other country in Europe to see doctors. It worries me when I hear language to the effect that "we will put a process in place" because these are the kinds of things that can take years. Does the Minister accept that we have an immediate crisis in terms of a shortage of hospital consultants and that something needs to be done urgently to address that, including dealing with pay disparity?

I outlined my position very clearly in that regard at the IMO conference in Killarney a couple of weekends ago and I am happy to outline it again here. Addressing consultants and their concerns is the next major issue we need to resolve. I say that from the position that we have just reached an agreement with general practitioners, which is still being considered by the Irish Medical Organisation. There was scepticism in this House as to whether that would happen. It has happened and it has been warmly welcomed by many GPs. An agreement reached with nurses was accepted by more than 60% of nurses in a ballot for a new nurses' contract. The next obvious area that we must work on is consultants. That will require a process. I have had talks with the Irish Hospital Consultants Association, IHCA. I have also had talks with the IMO in recent weeks on those matters and I will work with Government colleagues to work out how best to design a process, one that respects the public sector pay parameters within which we have to operate.

There are other factors above and beyond pay, including, for example, some of the factors that the Sláintecare committee highlighted in relation to the de Buitléir report and the concept that we should not have private practice taking place in public hospitals. There is a multitude of issues when it comes to the point Deputy Donnelly makes regarding access.

The question then is "When?". We know there is not much competition for open posts. Between 2015 and 2016, a total of 44 consultant psychiatrist posts were advertised. A quarter of them did not even attract one applicant and another 30% of posts had only one applicant. We know that many hospitals are running out of specialists. In Kerry, for example, they are running out of any individual consultant to provide services in histopathology, rheumatology and urology in some of the more rural hospitals.

Sláintecare requires consultants. The national children's hospital will require consultants. Serious pressure is being put on the system justifying the specialists to fill the satellite centres for launch in one or two months' time. As I said, the question is "When?" We need to ramp up the number of consultants all over the country, not just in the big hospitals.

Can the Minister provide a broad outline of when he expects the process to be concluded and pay disparity to be addressed, rather than when he hopes the process will start? When might the consultants see a solution to pay disparity implemented?

I cannot give a definitive timeframe for that because these processes require two sides being willing to negotiate an outcome. When we engaged with the GPs, for example, a massive amount of intensive work was required. When we engaged with GPs and then with nurses, after they took the significant step of industrial action, which they did not take lightly, both sides had requests. It will be similar in this instance.

The Deputy correctly referred to the Sláintecare report. The country absolutely needs more consultants and we must examine the pay of those consultants, but we also must examine how we provide our health services and implement the recommendations of the Sláintecare report. I expect both sides, including the health service management side, to have a list of requests regarding how to ensure that we can recruit and retain more consultants, pay them properly, respect them and give them good working conditions, and also on what the health service will look like over the course of the delivery of Sláintecare. The question of when will be a matter for the Government to consider. I am currently engaging with my colleagues on that.

Health Services Staff Recruitment

Louise O'Reilly

Question:

2. Deputy Louise O'Reilly asked the Minister for Health the reason there has been a persistence with a recruitment embargo in the midst of a recruitment and retention crisis in the health service; and if his attention has been drawn to the fact that persons who were offered jobs are now being told that the positions are no longer available [20932/19]

The question hardly needs explaining because it is quite simple. In the context of a recruitment and retention crisis, ever-escalating waiting lists and a seemingly endless budget for agency staff and the national children's hospital, why has an embargo been placed on the hiring of staff in the health service? It was wrong when such an embargo was implemented by the then Fianna Fáil Government - I fought the move at that time - and it is equally wrong now in light of the ongoing recruitment and retention crisis.

I thank the Deputy for this important question. To clarify, I would not describe what is happening as a recruitment embargo in the health service, nor did the new director general of the HSE do so in his first memorandum to his HSE leadership team, which I read about this morning. The issue can be accurately described as individual hospital groups and community health organisations across the HSE needing to live within their allocated budget. It should not be seen as a radical concept that when the House passes a budget which allows for the hiring of a certain number of additional staff, hospital managers and others are expected to live within those budgets. Where individual hospital groups or CHOs have not submitted staffing plans in line with their budgets, certain measures and controls regarding recruitment have been put in place. If a hospital or CHO puts a plan in place that is in line with its budget and the plan is approved, it can conduct recruitment but if it has not bothered to produce a plan it cannot simply make up its recruitment plans willy-nilly.

The HSE will proceed with filling approximately 2,000 additional approved and funded development posts. These are posts that Members of the House voted to fill through the service plan. It will mean extra nurses, doctors and therapists. However, the reason the HSE decided to introduce these measures relates to the high level of unfunded recruitment in 2018. Many Members were rightly critical of significant cost overruns in the health service in previous years and of the impact overruns have on other things we may wish to do. The director general has pointed out that this is for a period of three months, which ends next month. Posts that have been approved in line with development posts for which there is funding are being filled, but one cannot have a situation - and it would not occur in any other Department or agency - where people are hiring staff with no relationship to the budgetary reality which Members of this House have given them.

It is like déjà vu all over again. The Minister's predecessor when Fianna Fáil was in government did not call it an embargo either, but we all know that is what it was. I am little shocked. The Minister will state that he pays hospital managers very well, but they simply have not bothered to submit a plan. They are his words, not mine. He is happy that there are people at a very high level in the health service, earning very high wages, who are not bothered to do parts of their job. That is wholly unsatisfactory. We are spending €300 million per annum on agency staff, so staff are still coming in but via the most precarious and expensive route. They are not being employed permanently. Nobody is suggesting that there is no need to have sensible and controlled budgets. However, the budget that is out of control is that relating to agency staff. Clearly, these staff are needed. The managers who cannot be bothered to do some parts of their jobs, as the Minister indicated, are hiring staff and doing it in an ineffective and expensive way. The Minister must make a decision at some point. Will services be cut back? Will he be honest and tell people the services that will have to be cut or will we be in a position to offer people full-time, permanent jobs when there are full-time permanent vacancies being filled by expensive agency staff?

I agree with the Deputy on the need to tackle agency staff. That is why in the new deal we have with nurses and the new nurses contract both I and the Irish Nurses and Midwives Organisation, INMO, believe that the new measures will help reduce a dependency on agency staff and help to recruit and retain more nurses in full-time, permanent posts. That is the view of the union that has just accepted the new nurses contract. We are hiring additional staff and will hire approximately 2,000. My record on increasing front-line staff in the health service should not be misrepresented. When I was appointed Minister for Health, 109,124 people worked in the health service. Last March, the figure was 118,984. That included 346 additional consultants, 501 additional registrars, 1,124 additional nurses and midwives, 188 additional personnel in the ambulance service, 110 additional psychologists and 599 additional therapists. We are increasing the number of staff every year. However, when the House provides a budget and when we tell a hospital or a CHO that it has a particular staffing budget for the year, there must be a situation where there is a plan within that budget, not with figures that do not match the budget. Otherwise we will get into a very difficult situation.

The Minister is putting words in the INMO's mouth. He knows well that what it stated-----

I was at its conference.

-----was in the context of hiring full-time staff to replace agency staff, but that is not happening. I can give the Minister examples - I have engaged with the HSE on this - of young nurses who were living in England who came home and want to work here. After receiving letters of offer, they spent weeks waiting and they are now considering returning to England because they cannot get permanent contracts. There is a need for these nurses and the hospital managers are bothered to recognise that need, but in the meantime they are paying agency staff to fulfil that role. There is a recruitment embargo in place and its result will be an escalating spend. The Minister cited his record of increasing staff. What is increasing, in fact, is the spend on agency staff. That is not decreasing and the reason is that the staff are not being converted from agency staff to full-time, permanent staff. It is costing more money per hour. The Minister and I know that, yet a young woman will return to England next week. She had a letter of offer but she will return to her job in England. Quite frankly, she feels the NHS wants her to work there and does not feel that the HSE wants her here.

One cannot describe a situation where we will hire 2,000 additional staff this year as a recruitment embargo. An embargo suggests that we are not hiring any more people. In other words, that we are stopping recruitment. We are not doing that; we are going to hire 2,000 more people. However, what we are expecting hospital groups and CHOs to do is something that every other public service agency, every Department and certainly every other business and private sector employer does, which is live within their budget. The House votes on the budget and debates and passes the service plan. When it leaves this House it must be delivered across the country. We are offering full-time jobs. At the INMO conference last week, I was able to offer, for a third year, every graduate nurse in the country a full-time, permanent job in the health services. That will help, with the new conditions, to reduce the number of agency staff. That is what happens over time. We were unable to do that when I was appointed Minister, but we have been able to do it now.

The measures that have been put in place by the HSE, which I believe are sensible, will end at the end of next month. It is an important period if we are to ensure we have more resources to spend on the delivery of more public services this year, which we all want.

Disability Support Services Funding

Margaret Murphy O'Mahony

Question:

3. Deputy Margaret Murphy O'Mahony asked the Minister for Health the action he will take to address issues in the voluntary and non-profit sector which have been brought into focus by the difficulties currently being experienced by the Rehab Group; and if he will make a statement on the matter. [21142/19]

Alan Kelly

Question:

5. Deputy Alan Kelly asked the Minister for Health the amount of the deficit in funding for section 38 and 39 disability organisations; if an organisation (details supplied) is the only organisation that has informed him of difficulties in funding and service provision; and if he will make a statement on the matter. [21004/19]

Deputy McLoughlin looked well on this side of the House. If he is watching in his office, he is welcome here at any stage if he manages to see the light.

The clock is ticking.

How does the Minister of State intend to address the issues in the voluntary and non-profit sector that have been brought to light recently by the difficulties being experienced by the Rehab Group, and will he make a statement on the matter?

A Leas-Cheann Comhairle-----

No, Deputy. One Member poses the question and the Minister replies. I will give the Deputy an opportunity to come in. That is custom and practice.

He is not but-----

I was also expecting him to come in at this point.

I am not going to set a precedent now.

How can the Chair improve priority questions?

It is possible to do it. This is not the first time.

I have never seen this happen before in all my years in this House.

The Deputy will get his full time allocation.

I will get to speak later but I have already lost 30 seconds.

I will give the Deputy extra time.

I propose to take Questions Nos. 3 and 5 together. The Government’s priority is the safeguarding of vulnerable people in the care of our health service. We are committed to providing services and supports for all people with disabilities which will empower them to live independent lives.

Significant resources have been invested by the health sector in disability services during the past number of years. Since our Government took office, the budget for disability services has been increased by €346 million. This year alone, the Health Service Executive has allocated €1.9 billion to its disability services programme, which represents an increase of 7.5%. The voluntary sector provides up to 75% of disability services on behalf of the HSE, through sections 38 and 39 service level agreements.

A number of service providers, including the body referred to by the Deputies, Rehab, have written to the Department of Health highlighting their individual challenges, which include deficits accrued over many years. My Department and the HSE continue to put significant effort and resources into assisting the disability sector to manage priority needs within the funding available.

As the Minister of State with responsibility for disabilities, my primary concern is to ensure the continuity of appropriate person-centred disability services is maintained and delivered in an equitable manner consistent with the care and support needs of individuals.

Arising from the 2019 report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal services, I intend to establish a new dialogue forum between the Department, relevant health agencies and representation from voluntary organisations in the health and social care sector to provide a mechanism for engaging with the sector on the proposed Sláintecare reforms and other policy initiatives and to consider the group's recommendations on governance.

More broadly, I am continuing my examination of the recommendations of the report in the context of strengthening the relationship between the State and the voluntary organisations in the best interests of the service users. My focus will always be on the service users, the persons with disabilities and their families.

I raised this issue as a Topical Issue matter last night and put one question to the Minister of State which he failed to answer. Therefore, I will put it to him again now. Does he believe the HSE could provide the services that RehabCare provides and is he prepared to state that the HSE would provide a better service? Even if Rehab provided a year's notice in terms of service delivery that it would be obliged to provide if it were to terminate its service provision, it seems unlikely the HSE could step in and provide the services in a timely manner. Does the Minister of State believe the HSE could provide the services in a more cost-effective manner than Rehab? Does he expect there will be a resolution from the meeting he and the Minister, Deputy Harris, will attend today? I sincerely hope this is not a box ticking exercise and that everybody comes out of that meeting with a resolution that is good for service users of Rehab.

This is the next big crisis in the health service. It has been brewing for a number of years. We know the Minister of State is due to meet the representatives of Rehab today. I presume the Government will find the €2 million required; if not, it will have a serious problem. Three thousand people are affected, 222 of whom are in my county, which is the largest number in any county in Ireland.

There is a bigger issue behind the disability sector and section 39 funding. Funding alone is simply not enough. I want to state publicly in the Dáil that I believe there is a deficit across section 39 organisations which are dealing with the disability sector. Collectively, they are operating with a deficit of approximately €30 million. That raises a range of issues. Some of these organisations have got advanced loans from the HSE. That shows the scale of the issue involved. There are also questions related to operations and company law and how the HSE is working with them on this. These are serious issues. This is about to explode.

The Minister of State is reacting today rather than having dealt with the issue during the past number of years. The Health Information and Quality Authority, HIQA, which all these organisations came under in 2016, and we all know the issues related insurance costs, has escalated the expense and cost involved for all these organisations. We all know these organisations effectively are doing what the State should be doing but they are not being provided with enough funding. This is a crisis that is about to explode. The Minister of State need not tell me that he was not told about it. I can guarantee him that this is about to happen in the coming months.

The Deputy will have another opportunity to speak, and he was not deprived of those 30 seconds.

I wish to advise Deputy Kelly that I do not react. I am well aware of the situation and I am not seeking to score points. I am trying to find solutions. I have been dealing with this issue over the past 12 months. I have had the representatives of the service providers come to my office. I am well aware, as will many of the Deputies in this House will be, of the current financial difficulties they have.

Regarding Deputy Murphy O'Mahony's questions, I have a strong belief in the voluntary sector providing the services funded by the State. That is my personal position. The voluntary sector provides up to 75% of disability services on behalf of the HSE. It should be noted, and this is where some of the problems come into play, that the disability service providers are operating in a heightened regulatory environment while at the same time charged with demonstrating efficiencies and cost-effectiveness in terms of the outcomes for the service users.

On the deficit issue, we accept the reality of that and are trying to find solutions. We are working with the HSE, the Department and the voluntary organisations. We are well aware of the impact of achieving and maintaining HIQA regulatory compliance, the decreased financial resilience owing to the issue of reductions in State funding, and the changing needs of service users.

On the issue of Rehab, the Minister, Deputy Harris, and myself met the representatives of Rehab last week. We will meet them again at 5 p.m. today with a view to making substantive progress on the understanding by the HSE of Rehab's financial position and cost base. That is the position in terms of where we are at.

In going public on its funding difficulties, the Rehab Group is highlighting a developing crisis in the independent, not-for-profit sector, on which the health service is so reliant for disability services. This crisis has brought many organisations to the edge of financial sustainability and it is one which must be addressed directly and that needs to happen now.

The report of the independent review group on the relationship between the voluntary sector and the State, which was published in February, endorsed a new funding approach be adopted by the State for the provision of social care services. Included in it were recommendations for multi-annual funding rather than the year in, year out battle to secure sufficient funds to simply survive.

On the publication of that report, the Minister, Deputy Harris, said he intended to establish a new dialogue process between the Department, relevant health agencies and the representation from voluntary organisations in the health and social care sector to provide a forum for engaging with the sector, in particular, on the proposed Sláintecare reforms and other policy initiatives. Can the Minister of State update me on that? How many formal meetings have taken place with the sector during the past three months? Will the recommendations on multi-annual funding be taken on board and does the Minister intend that this process will start with the next budget?

Approximately a year ago I raised the issue of a young man in Waterford who needs full-time residential care. His family cannot manage him any more. I am ashamed I cannot do more for that family, and I know there are many other such cases. It has become a crisis in this State as to how we treat these people. I state on the record that this is something that will come knocking very seriously on the Minister of State's door at a level he has never seen before soon. I want him to answer the following questions. What is the operating deficit of all section 39 disability organisations?

Why does the HSE insist on these organisations signing contracts which show they are breaking even? If they do not sign the contracts, and we all know they are signing contracts while they have deficits, a 20% cut is automatically imposed upon them. Will the Minister of State stop that practice? Will he acknowledge they are signing contracts while operating in a deficit? Are some of these organisations signing contracts with the HSE where there are issues in regard to operations and company law? Will the Minister of State immediately bring forward a plan to deal with the deficit, which I have outlined in the House and on which I want the Minister of State to give us a figure? We can then look together at implementing the recommendations Dr. Catherine Day has put forward.

We need a plan for this year. This is about to explode. There are families who cannot survive and cannot deal with their loved ones any more. It is a very emotional situation.

I am very concerned about the main part of my job, which is looking after families and people with disabilities who are worrying about this debate. I emphasise that I am very concerned about that.

On the particular issues, as I said, the Minister and I met Rehab last week and another meeting has been convened for today. The understanding with regard to Rehab's financial position and cost base is that it has agreed not to issue any notice of termination of service provision, so let us get that dealt with. Second, I am well aware of the issues raised by Deputy Kelly. Individual organisations and the HSE have commissioned consultants' reports and we know about the issue of deficits. We are sitting down and talking to them on a regular basis and this is something we understand and accept. We accept the deficits are caused by improving standards. I regularly meet service providers which are spending extra money to improve facilities because of requests by HIQA. We understand those issues. We are trying to put together a package to resolve that particular issue and I am confident we can do so.

Paediatric Services

Louise O'Reilly

Question:

4. Deputy Louise O'Reilly asked the Minister for Health if the necessary staff have been recruited to ensure that the paediatric outpatient department and urgent care centre at Connolly Hospital can be operational from 8 a.m. until midnight, seven days a week, as was previously committed. [20933/19]

Like my previous question, this relates to staffing. It concerns commitments given that the paediatric outpatient and urgent care centre for Blanchardstown will open from 8 a.m. until midnight. I want to know if the requisite staff have been recruited because, at this stage, these are probably people who are already in the system or, hopefully, coming from abroad, so they will have given notice. We know the centre is due to open in a couple of weeks. These people are either on their way or, if not, I would prefer if the Minister was honest and told us it will not have enough staff to open at the requisite time.

I thank the Deputy for this important question. Children’s Health Ireland has advised that recruitment is well under way to secure the required staff for the opening of the outpatient urgent care centre at Connolly Hospital and that the majority of staff have been recruited, with start dates over the forthcoming weeks and, in some cases, months. A total of 13 consultant posts are required and, to date, I believe ten of these positions have been filled - six paediatric emergency medicine consultants and four general paediatric consultants - and recruitment is ongoing for the remaining posts. As we said, there are recruitment challenges nationally and internationally in certain specialties, such as radiology. I am assured by Children’s Health Ireland, which I met in recent weeks, that plans are in place to ensure Children’s Health Ireland at Connolly will open at the end of July 2019.

Children’s Health Ireland has also advised that all nursing positions have been successfully filled and, as the Deputy rightly said, these are generally nurses working within the health service agreeing to move to the new facility. Health and social care professions and administrative posts are also being filled internally. The delivery of services at the centre will be provided on a phased basis based on community need and patient volume, and the initial hours of operation are still being determined. Children’s Health Ireland will make an announcement on the initial hours of opening. I too asked it that question in recent weeks. Very good progress is being made in regard to recruitment.

During the initial opening phase from July to December 2019, two specialties - general paediatrics and orthopaedics - will deliver outpatient services at Connolly. Importantly, this will provide an additional 3,600 fracture orthopaedics and 2,750 general paediatric outpatient appointments, which means more than 6,000 additional children will be treated between July and December as a result of the opening of this new facility. When fully operational, it is projected that Connolly's urgent care centre will provide 33,000 outpatient appointments annually, contributing to significant reductions in waiting times and waiting experience, as well as 25,000 urgent care assessments, 30,000 X-rays and 6,000 ultrasounds.

It is still intended to open the facility at the end of July. The operating opening hours will be decided by Children’s Health Ireland in the coming weeks and announced. It has made very good progress with recruitment.

It is clear the centre will not open from 8 a.m. until midnight, although perhaps the Minister can confirm to me that he expects it to open at those times.

With regard to consultants in paediatric emergency medicine, paediatric radiology, histopathology, haematology and orthopaedics, those are areas where, if we do not have the requisite number of consultants, we will not be able to run the service. Equally, if are taking those consultants from either Temple Street or Crumlin hospital, what we are effectively doing is taking that service away and shuffling people around. We will still have backlogs, waiting lists and intolerable working conditions for consultants.

I met the consultants who are sceptical about the level of recruitment. The Minister cited a figure of six consultants in emergency medicine. I do not believe that number will actually start and my estimate is that it will be closer to four. If those consultants are taken from the other hospitals, effectively, we are just shuffling around the deckchairs but there will be no improvement in service. I fully respect the projected figures but, in truth, and I know the Minister will not disagree with me on this, they will be nothing but a pipe dream if we do not have the staff to deliver them. I do not believe the staff will be there and if the plan is to take them from the other hospitals, I do not believe we will see any material difference.

Specifically, will the Minister tell me if he has confidence that this service will open from 8 a.m. until midnight? A lot of downgrading of services will happen in the other hospitals, which are depending on this service being open from 8 a.m. until midnight.

I have no doubt this service will see additionality from July in regard to paediatric healthcare. I take the points the Deputy makes that if we are just taking a doctor from here to there, that is not additionality. I genuinely have no doubt it will bring additionality in terms of extra appointments for children. I outlined in my last answer the volume I expect as a result of this centre opening, which is roughly 6,000 additional appointments for children in the Irish healthcare service between July and December of this year compared with last year.

I can only take people at their word. I met Children’s Health Ireland recently and I also met the consultants, perhaps the same ones the Deputy met. In any case, I have had similar conversations and that is one of the reasons I scrutinised this a bit further. Children’s Health Ireland has told me it has filled ten consultant posts, six of them in paediatric emergency medicine and four of them in general paediatrics. What it has said in terms of the initial opening hours is that it wants to look at community need and patient volume before deciding what are the best hours to open the service. That is what it has told me and it has said it will revert to us in that regard.

The Deputy is quite correct to make the point about radiology and the like. It has plans in place in that regard, be it locum cover initially or the outsourcing to imaging services, should that be required and I not saying yet that it will be required. I am confident it has plans in place, including contingency plans, to ensure this facility will open in July.

All I heard from that was locums and outsourcing.

I thought that might be the case.

I will disregard much of the rest of the fluff. The Minister said ten consultant positions have been recruited. How many of those are coming from the other hospitals? Are they all coming from abroad? Are they all new entrants into the system? Will they provide the additionality the Minister says will be provided? We have just agreed that without additional staff, there will be no additionality.

There was a commitment to operate seven days a week from 8 a.m. until midnight. When will we know what the opening hours will be? Obviously, people need to plan. The health service does not run on a 24-hour cycle and it needs to plan in advance. The other hospitals will also need to know. When does the Minister believe we will know whether the opening hours will be as committed to, namely, from 8 a.m. until midnight seven days a week, or, as I suspect, office hours and only five days a week? I sincerely hope I am proved wrong on that but I do not have confidence at this stage. The Minister might tell me how many of the ten posts are whole-time equivalent and how many are coming from other hospitals.

I expect we are likely to know in the month of June but I will confirm that with Children’s Health Ireland and write to the Deputy. The Deputy is entirely correct that this requires a lot of planning. I make the point that, thanks to the legislation passed in this House, which the Deputy co-operated on and supported, we now have Children's Health Ireland, which is one hospital structure, albeit operating over three facilities, so there is already joined-up thinking.

There is one chief executive officer for Children's Health Ireland, which takes in Crumlin and Temple Street hospitals, as well as the paediatrics aspect of Tallaght Hospital and that helps significantly with the planning. Often when a new facility is opened there are a number of hours on day one and, a couple of weeks or months later. Those hours have been expanded. That is a matter for Children's Health Ireland to decide as the statutory board with responsibility for children's health in Ireland and it will make that known as soon as its plans are finalised.

I am satisfied, based on what I have been told, that there is serious additionality here for children. We are talking about 3,600 additional fracture orthopaedic appointments and 2,750 general paediatric outpatient appointments for our children in Connolly Hospital between July and December as a result of this new facility. We have had a lot of debate about the cost of the new children's hospital and this is a really tangible example of the benefit. I will check for the Deputy where those ten consultant posts have come from because I do not have that information available. I will write to her.

Question No. 5 answered with Question No. 3.