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Seanad Éireann debate -
Wednesday, 11 Oct 2006

Vol. 184 No. 18

Adjournment Matters.

Hospitals Building Programme.

I thank the Cathaoirleach for allowing me to raise on the Adjournment this important matter concerning the National Children's Hospital in Tallaght and the Government's decision over the summer period to recommend that the new national paediatric facility should be placed in the Mater Hospital in north Dublin.

This is in no way intended as a slight on the Minister of State, Deputy Killeen, but I very much regret that one of the four Ministers in the Department of Health and Children has not come to the House to take this matter. That is not only a slight on the people I represent in Dublin South-West but on this House.

I wrote to Professor Drumm on 14 September and asked him, under the public sector information regulations 2005, to forward to my office as soon as possible the overall score of each of the bids on the national paediatric hospital proposal in terms of the nine McKinsey criteria, the relative weighting of the nine criteria by the joint task force and the ranking place of each of the bids on each of the nine criteria. He responded to me on 26 September stating that he noted the contents of my letter and that he would ask the parliamentary affairs division to investigate the matter and reply to me in due course. I have heard nothing since.

I ask the Government and the Health Service Executive to publish, without further delay, the entire scoring regime that applied to all the hospital bids in Dublin city and county when it came to making the decision on the location of the new national paediatric hospital. I want that information published and out in the public domain now because the people I represent are gobsmacked that a decision was taken that flies in the face of medical, geographical and other logic. It is a decision we could regret in the years ahead and one that needs to be explained in a comprehensive way by the Government which meekly took on board the recommendations from the task force.

At an unveiling ceremony on 1 September the chairman of the Mater Hospital, Dublin, thanked the Taoiseach for following through on his promise to bring the new children's hospital to the Mater. The Taoiseach needs to say exactly what promises he gave to the Mater. Why was it the case when an evaluation allegedly was taking place that promises were given in the Taoiseach's constituency that this national facility would, surprise surprise, end up in his constituency. He needs to comment publicly on that, which he has not done to date following the remarks of Mr. Lamont, chairman of the Mater Hospital.

What people want, not only in terms of Tallaght but St. James's and Crumlin, where this decision has a huge impact, is accountability and transparency. They want to know why, in terms of the criteria, accessibility, co-location, an existing hospital site, the ability to extend in the future, and a good public transport infrastructure, the Mater bid seemed to succeed when on so many of those grounds it could not possibly reach the criteria that Crumlin and, especially, the National Children's Hospital in Tallaght have met consistently.

The Government must say what is its preferred solution. Most people in west, north and south Dublin would accept a position where one hospital with two campuses would be established and the existing services would be located in the National Children's Hospital in Tallaght and radically extended. We are not dealing only with west Dublin but west Wicklow, Kildare and the Meath hinterland. There is a compelling case to be made for one hospital with two locations. We need to know whether that is the way the Government will address this issue. What is its policy in this regard?

I welcome the considerable efforts locally on behalf of the people in the community to stand up for a facility that has done enormous work in providing excellent paediatric medicine for the west and south-west Dublin, Kildare and west Wicklow areas. Some of these efforts will be seen at protests this Saturday in Tallaght. People power has spoken and it will speak again on Saturday. The Government needs to respond and to state unequivocally its plans for the National Children's Hospital in Tallaght and also for Crumlin because it is not just a question of people who work in this area — nurses, doctors and others — it is a bigger question for people who depend on a quality service there for themselves and, more particularly, for their children. That is what they expect but have not got following the decision taken. That is the reason we need more public accountability on what has occurred in this area over the past six months.

I am pleased to take the Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Harney. There have been many occasions when I have been pleased to have a Minister from that Department take Adjournment debates on my behalf in the Department of Enterprise, Trade and Employment.

In late 2005, the Health Service Executive, at the Minister's request, undertook a review of tertiary paediatric services. McKinsey and Company was engaged by the HSE and its report, which was presented to the HSE in February, included a number of key recommendations. The population and projected demands in this country can support only one world class tertiary paediatric hospital. The hospital should be in Dublin and should ideally be co-located with a leading adult academic hospital, that is, it should be within a practical walking distance of such a hospital. The hospital should also provide all the secondary, that is, less complex, hospital needs of children in the greater Dublin area. These secondary services should be supported by a strategically located urgent care service.

The HSE welcomed the report as providing a clear outline of how to provide the best hospital care for children throughout the country. It is worthwhile at this point to explain why the principle of co-location of the paediatric hospital with the adult hospital is so important.

The McKinsey report emphasised that best outcomes for children are critically dependent on having breadth and depth in sub-specialist services, that is, a critical mass. To achieve such, it is considered that tertiary centres should serve a population which is large enough to support a full complement of paediatric sub-specialists, co-located with an adult teaching hospital. The collaboration of adult and paediatric specialists creates a larger critical mass of specialists in a particular area which in turn creates the platform for improved outcomes.

Arising from the McKinsey report, a joint HSE-Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital. Each of the six major adult academic hospitals in Dublin, including Tallaght Hospital, made a detailed submission to the task group. The task group concluded that each of the sites adequately demonstrated the feasibility of accommodating the proposed new paediatric hospital and a new maternity hospital. However, the task group considered that three of the hospitals, Connolly Memorial Hospital, St Vincent's University Hospital and Tallaght Hospital, did not offer the necessary breadth and depth of tertiary services to complement the paediatric hospital, and on this ground these three sites were ruled out as co-location options.

It should be stressed that the task group did not invite bids or tenders from the six hospitals and, accordingly, it would have been inappropriate to score the submissions. The submissions therefore were not scored.

Following assessment of the remaining sites, the group concluded that Beaumont Hospital was significantly less suitable, in terms of ease of access, than either the Mater Hospital or St. James's Hospital, especially for the children of the greater Dublin area who will use the hospital for all their hospital care. The task group found that the Mater and St. James's demonstrated their ability to meet all of the assessment criteria set by the group and, on the basis of these criteria, it was not possible for the group to recommend one location on a basis that rendered it clearly distinguishable from the other.

It was the group's view that the selected location would have to develop clear cross-site, team-working arrangements with the corresponding adult specialist teams based at the other adult hospitals. In the context of the current configuration of adult specialties, the group considered the Mater to be in a better geographical position than St. James's to facilitate a clinical network of critical adult and paediatric specialties.

Accordingly, the task group recommended that the new national tertiary paediatric hospital should be built on a site to be made available by the Mater Hospital. The task group's report and its recommendations were endorsed by the board of the HSE and by the Government which mandated the HSE to move forward with the development of the new hospital and its associated urgent care service, and to explore any philanthropic proposals in relation to its development.

The governance arrangements that will arise in the context of the amalgamation of the three children's hospitals will also be pursued, in particular the measures needed to ensure that the new hospital is multi-denominational and pluralist in character.

The Minister is satisfied that the task group undertook a rigorous and robust examination of the key issues in making its recommendation. The task group consulted widely in arriving at its recommendation, and gave in-depth consideration to the key issues of access, governance, clinical values and site suitability. It might be noted that each of the three existing paediatric hospitals expressed strong support for the development of a single paediatric hospital and emphasised the need for decisions on the new hospital to be taken urgently. Consultant representatives emphasised their commitment to move to the new hospital regardless of its location.

A joint HSE-Department of Health and Children transition group has since been established to advance the development of the new hospital. Among the key items to be addressed are the definition of a high level framework brief for the new hospital and the determination of the scope and location of the urgent care service required to support the new hospital. The group will consult with relevant stakeholders, including representatives of Tallaght Hospital.

The Taoiseach, the Minister and the chief executive officer of the Health Service Executive met representatives of the Adelaide Hospital Society, including Archbishop Eames, in June to discuss issues relating to Tallaght Hospital. The hospital representatives expressed concern at the implications for the National Children's Hospital at Tallaght of the Government decision to endorse the development of a single national tertiary paediatric hospital at the Mater Hospital. A number of other matters relating to the provision of hospital services at Tallaght were also discussed. Development proposals submitted by the delegation, which have significant resource implications, have been forwarded to the Health Service Executive for consideration.

In a letter to Archbishop Eames following the meeting, the Taoiseach gave an assurance that the Government wishes the hospital to thrive on a sustainable basis as a particular focal point for the involvement of the minority tradition in the healthcare system and as a key health provider to an expanding local population. These objectives will be pursued in tandem with other compelling objectives, including the achievement of an effective and efficient hospital care system, which will deliver the highest possible standards of care within a framework designed to respond to the needs of patients at national, regional and local level.

Arising from the meeting, it has also been decided that a review will be conducted of decisions taken with regard to the funding and development of the hospital. The arrangements for this review are being finalised.

I thank the Minister of State for his reply. He has just made an astonishing submission to the House. We now know for the first time that there was no scoring regime in place for the submissions made by all the hospitals bidding for the national paediatric hospital. This is new information. I am glad I raised this matter on the Adjournment and I will return to the issue.

This is the first time since the issue of the report that it has been admitted that there was no scoring regime in place for the various bids for the paediatric hospital. Why did the HSE not inform me of that when I sought the information over five weeks ago and why did it refuse to comment on the issue? Tenders were invited and submitted, yet no score applied. The issue must be revisited.

Hospital Services.

I wish to share my time with Senator Daly.

Is that agreed? Agreed.

I welcome the Minister of State to the House and thank him for coming to discuss this important matter. He is familiar with this issue and I am happy he is here, as part of the Clare delegation, to discuss this matter.

As the Minister of State is aware, the Mid-Western Hospitals Development Trust has set aside moneys to purchase a CAT scanner for Ennis General Hospital. The hospital management has prepared plans to accommodate this equipment and has submitted a number of proposals to the Department of Health and Children and the HSE to provide funding for the staffing and operation of the equipment. To date, the project has not been given the go ahead, despite the urgent need for the deployment of this equipment at the hospital. Similar equipment is available in some smaller hospitals throughout the country although they do not carry out the same acute surgical procedures as Ennis General Hospital.

The absence of a CAT scanner has a two-fold negative effect. First, only very urgent cases at Ennis hospital are considered for CAT scanning and these patients must be transferred to Limerick by ambulance and in some cases be accompanied by a consultant anaesthetist. This is an outrageous situation. Consultant anaesthetists are an expensive resource and are not being used to best effect when sent in ambulances from Ennis to Limerick when they would be better employed at Ennis General Hospital. It is estimated that 3,000 scans per annum are required at Ennis hospital. However, due to lack of facilities only approximately 1,000 patients receive a scan by transferring to Limerick. This is a poor service for the patient population of our county and should be addressed without delay. It is not good patient care.

Second, the need to transfer patients to Limerick delays the treatment of patients and affects their prognosis. It also results in a delay in patients being discharged from hospital resulting in their retention for longer than necessary. As the Minister of State is aware, Ennis General Hospital is an 88-bed hospital that operates on an annual patient activity level of 117%. Patient numbers range from somewhere between 100 to 130. This has been achieved through good management, not just of the management staff but also of the consultants and the nursing staff through the tremendous work they do. The hospital has scored well in recent analyses on keeping patients off trolleys, in particular through the work in the accident and emergency unit of developing an admission lounge.

I am sure the Minister of State shares my view that speedy access to CAT scanning would allow for better patient care and speedier discharge of patients thereby leading to best practice which is the target of the Minister for Health and Children. I appeal through the Minister of State, who is working closely with the Department to achieve this, to encourage the Minister to help to move this along.

I am glad to support Senator Dooley on this issue and I know the Minister of State is equally concerned to see the project expedited. My concern is that while funding has been earmarked for the project for almost ten months, it has not yet been spent despite the fact we are almost into another budget. I hope the Minister of State will communicate with the Minister for Finance to ensure the project is speeded up without further delay. If it is delayed further, it is likely the consultants will threaten to discontinue serious examinations and surgery in the hospital which could create further problems. There have already been problems with regard to the delays in the development of the hospital.

It is not necessary for me to underline for the Minister of State the fact that substantial funding is available for the project from the local trust fund. The surgeon, Dr. Burns has been very vocal in recent meetings with us and has made the commitment that local funding is available. The cost of the machine is available locally and all the HSE is required to do is provide staffing and construction work such as the installation of the CAT scan machine. I emphasise the necessity to expedite this project in view of the fact that the finance was provided ten months ago. With the musical chairs currently taking place in the HSE, it appears that nobody is making decisions. I urge the Minister of State to put some pressure on the HSE to act on this.

I thank Senators Dooley and Daly for raising this important matter. I am taking the Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

Ennis General Hospital was the subject on the Adjournment of the Seanad in July when the position with regard to the development of the hospital was outlined to the House. As the House is aware, the provision of services at Ennis General Hospital is the responsibility of the Health Service Executive. The Minister approved the Health Service Executive capital plan for 2006 earlier this year. The plan provides for €555.5 million spending on approximately 400 individual projects.

The provision of a new CAT scanner at Ennis General Hospital is included in the major development at the hospital which is currently at design stage. The development of the hospital at Ennis will be carried out on a phased basis. A project team was set up to identify priority developments at the hospital so that the long-term requirements of the county can be addressed. The priority areas for development in phase 1A include upgrade of wards; the accident and emergency department; the radiology department, including a CAT scanner; the outpatients department; the intensive care unit; the concourse; and general infrastructure upgrade. The priority developments identified will cost in excess of €30 million to design, build and equip.

It is a Department of Finance requirement that when a project exceeds €30 million, a cost benefit analysis must be undertaken before the proposed development can proceed. This cost benefit analysis is currently being conducted by the Health Service Executive.

I thank the Minister of State for the information he has outlined. Will he take back to the Minister a report of the considerable frustration of not just patients but also consultants who find it extremely difficult to operate in the current facility without the availability of a CAT scanner, notwithstanding the fact the moneys are available to provide it? It is not acceptable for the HSE to continue to suggest it should be part of the future development. It could be provided now and I have no doubt the Minister of State will use his good offices to get the Department to meet this important requirement.

Community Employment Schemes.

I welcome the Minister of State to the House. Since their inception, community employment schemes have provided vital services for rural and other disadvantaged areas. When the original schemes were established, the employment situation was considerably different. It is clear from the activities of those schemes that they have provided a very important support service for the communities in which they are based. In the past couple of years there has been a substantial reduction in the number of people employed on community employment schemes. This is due to a number of factors, such as higher numbers of people employed, Government cutbacks on the schemes and their amalgamation.

The community employment scheme in my neck of the woods has been amalgamated with the scheme that existed in the town of New Ross, County Wexford, and which was oversubscribed for the coming year. The scheme in Mooncoin which serves a number of parishes in that part of south Kilkenny has a serious shortfall in the number of applicants.

I seek the Government's support for the continued existence of the community employment schemes and request that they be held at their current levels or even enhanced. They provide crucial back up for many local voluntary organisations throughout the country. Volunteerism is currently at an all time low and this has been discussed in this House and in other places. Many sporting organisations, such as my own hurling club, would find it difficult to function without the help we receive from the community employment scheme. Many other clubs in my area and across County Kilkenny and in the country in general, rely on people from community employment schemes to carry out some basic work. They are not relied upon to carry out the running of the club but they provide basic services.

A study of the make-up of the community employment schemes shows that many of the people involved are in their 50s and 60s. These people would find it very difficult to find employment in rural areas in particular where they might not have access to necessary transport to travel to larger urban areas where jobs may be more freely available. People of advancing years are providing a service in rural areas and may find it difficult to find alternative employment. This is another reason for an extension of the scheme. I ask the Minister of State to outline the Government's future policy direction with regard to community employment schemes and to indicate that this group of people who will always find it more difficult to find employment will be catered for. For a very small sum of money on top of their unemployment assistance, they are contributing in great measure to their communities. The Minister of State is also from a rural area and I am confident he can name his local community employment schemes. He will know at first hand the important service these schemes provide throughout the country.

I thank Senator John Paul Phelan for his positive remarks with regard to community employment schemes.

Community employment is an active labour market programme designed to provide eligible long-term unemployed people and other disadvantaged persons with an opportunity to engage in useful work within their communities on a temporary basis. CE helps unemployed people to re-enter the open labour market by breaking their experience of unemployment through a return to work routine and by assisting them to develop both their technical and personal skills.

As an active labour market programme it has the emphasis on progression into employment. The programme is managed to this end with primary regard to the needs of participants and the community. In addition, this programme with its focus on the needs of disadvantaged persons, forms a major response by FÁS to tackling the social exclusion of such groups as persons with a disability, lone parents, persons who are long-term unemployed and drug misusers, with a view to their re-integration into the labour market.

Changes have been made to CE so that it responds to the needs of disadvantaged people. Community employment health sector places have been ring-fenced from any reductions that have taken place since March 2002 and FÁS makes every effort to ensure places are maintained at the agreed level on ring-fenced schemes. In addition, projects in RAPID areas are given priority. However, it is important to note that the primary purpose of CE is to provide short-term work experience and training opportunities for long-term unemployed persons and other disadvantaged groups with a view to facilitating their progression to work in the open labour market. It is imperative, therefore, that CE positions be vacated on a rolling basis to facilitate new participants.

To cater for older workers in particular, in November 2004 the Minister for Enterprise, Trade and Employment raised the three year participation limit to allow those of 55 years of age and over to avail of a six year period on CE, based on participation since 3 April 2000. This was done in recognition of the fact that older participants may find it more difficult to progress into the open labour market.

In July of this year my Department published its sectoral plan under the Disability Act 2005. One of the key highlights of this plan is to increase participation rates of people with disabilities on CE over the period of the plan and to raise the CE participation limits for people with disabilities to provide additional training to assist progression to employment. For people with disabilities under 55 years of age, the participation limit was raised by one year from three to four years. For people with disabilities over 55 years of age, the participation limit was also raised by one year from six to seven years.

A new individual learner plan is also being rolled out nationally in FÁS. This is designed to track and record an individual's progress from programme entry to exit. Beginning with the identification of learning needs at induction, through to project and progression skills development, this new approach addresses the personal, social, vocational and specific work-related skills needs of each participant.

Funding for CE in 2006 has been provided with a view to maintaining overall numbers on FÁS schemes at 2005 levels. At present there are more than 22,000 people employed on CE schemes nationally, a figure which has been maintained throughout 2006. It is anticipated that FÁS will utilise its full allocation in this area during 2006. In delivering these places, FÁS operates flexibility in the management of this allocation to maximise progression to the labour market while at the same time facilitating the support of community services. This provision of places is managed through a standardised application process between regional FÁS offices and local sponsor-community organisations and any issues regarding the allocation of places are dealt with in this context. FÁS makes every effort to ensure differing levels of demand between neighbouring schemes are equalised.

The aim of CE still remains as an active labour market programme with the emphasis on progression into employment. The programme is managed within this context, with consideration to the availability of resources and the needs of participants and the community.

I agree with most of what the Minister of State has said. However, there is a strong case to be made, particularly as we face into the budget, for the six year limit period to be increased, if not removed completely, for those over 55 years of age. The reason I raised this matter is that I know of a man who does not have access to transport. He is 56 years of age and with no access to transport, he will be unable to find a job outside the rural area in which he lives. There is a strong case to be made for increasing the six year period and if not, removing it completely.

The Seanad adjourned at 8.40 p.m. until10.30 a.m. on Thursday, 12 October 2006.
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