HSE Capital Plan 2019: Statements

I welcome the Minister to the House. At least one colleague is en route to the Chamber and we will have more people here shortly. I invite the Minister to commence his contribution.

I thank the House for the invitation to attend the Seanad for statements on the Health Service Executive Capital Plan 2019. I am pleased that the Government will invest over €2 billion in capital funding in our public health services between 2019 and 2021. In the company of the Taoiseach and the Minister for Finance and Public Expenditure and Reform, I had the pleasure recently to launch the HSE capital plan, which is the first capital plan to be approved by the new board of the HSE. In accordance with the relevant legislation, the plan has been approved by me, as Minister for Health, with the consent of the Minister for Public Expenditure and Reform and represents a continued sign of the investment taking place in our health service. The plan should be viewed in the context of being the first phase of our ten-year capital investment programme, Project Ireland 2040. We have committed under the plan to 250 projects nationally over the next three years. The plan includes 480 new beds, 30 new primary care centres, 58 community nursing units and a significant investment in mental health and disability projects in communities.

As we reform the health service in line with Sláintecare, it is vital to continue to invest in capital infrastructure and, crucially, in community and social care settings. The capital plan is based on an increased investment budget of €642 million in 2019 for the construction and equipping of our health facilities. This represents an increase of €224 million on last year's capital provision. While the health service has been well invested in over many years from a current spending perspective, we have fallen down, in particular during the lost decade arising from the recession, in our investment in capital infrastructure, including more hospital beds. We had a bizarre situation in which previous Governments were reducing the number of hospital beds long before the troika came to town. A great deal of our infrastructure is old and we need to move beyond Florence Nightingale style wards to single rooms with en suite facilities. As such, a significant modernisation programme is required.

The capital plan provides for the spending of just over €2 billion on hundreds of health capital projects, with over €1 billion on Government priorities, including our new children's hospital. I am amazed at the number of people in this and the other House who speak about the new national children's hospital but have never visited the site. I repeat what I said on the record in the Dáil yesterday. I say it on a nearly weekly basis. It is that any Member of these Houses of the Oireachtas who would like to visit the site of the national children's hospital and meet the construction people and doctors to understand the difference the project will make is welcome to do so. It is a pity that only two members of the Joint Committee on Health have so far bothered to visit the new hospital site. I am proud that Senator Colm Burke was one while Deputy Harty was the other. I encourage people to do so in the context of having an informed debate. Senator Devine, in fairness, knows the project very well as it is in her local area. I encourage people to go out and visit the site to see the significant difference this massive project, which has been talked about since I was a child, will make to the delivery of children's healthcare in Ireland.

The funding plan will also cover the national rehabilitation hospital. We were out there recently with regard to the significant upgrading of that facility with single en suite rooms, a new hydrotherapy pool and a new gym area. We will also invest in a new national forensic mental health facility in Portrane to replace the very out-of-date mental health hospital in Dundrum with a modern world-class facility which will open next year. The capital plan also covers radiation oncology facilities in Cork, Galway and Dublin to continue our fight against cancer with a view to improved cancer outcomes. We will provide €265 million over the next three years to replace and refurbish residences for older people and people with disabilities. When I talk about our infrastructure being old, there is nowhere that is more evident than in the case of some of our facilities for older people or those with disabilities or mental health difficulties. These residences are, in effect, their homes but we are asking them to live without the space, dignity and privacy they deserve. We will provide €300 million to maintain and upgrade facilities, equipment and ambulances nationally. Over €335 million will be provided for a wide range of capital projects at individual hospitals and primary community facilities to provide modern health accommodation and equipment.

The major win of the health capital plan this year is as follows. It is easy enough to produce a health capital plan for one year but it took me a while to agree with the Department of Public Expenditure and Reform a three-year plan to allow us to provide our health service with the certainty to invest knowing it will have the funding in 2020 and 2021. That provides the service with clarity on funding levels. As we manage and develop new capital projects, we must learn the lessons of past projects. We will be guided by the report of PricewaterhouseCoopers in that regard. Capital funding for our health service will be 165% higher for the next ten years than it was in the previous ten years. In real money terms, that means we will spend almost €11 billion on capital in the next decade versus €4 billion for the previous one. That is a significant increase, thankfully, in funding for our health capital infrastructure.

We must ensure that as we develop capital infrastructure, we align it with Sláintecare. We want to see more facilities in our communities and we want to see a decisive shift towards primary care. We want to see investment in the relocation of our stand-alone maternity hospitals to have them co-located with adult hospitals. The funding has been put in place to do that. I am conscious that a number of colleagues will raise important regional projects today. I see my colleague and friend, Senator Coffey, is in attendance and note the important body of work we have to do in Waterford to provide a second cath lab. I have had some excellent meetings with Oireachtas Members from Waterford, led by Senator Coffey, over a number of months and years. At our last meeting, we had a good update from the HSE, which is on track to lodge the relevant planning application shortly.

I suggest to the Senator that perhaps the week after next week's recess, we could convene a meeting of group of Waterford Oireachtas Members and myself to take stock of where the project stands. It would be a very important development.

Senator Lawlor is in regular contact with me regarding the new endoscopy facility that has been long-promised for the people of Naas. There is now funding to proceed with that. I have asked the HSE to come back to me very quickly with a detailed timeline for the delivery of the project. I will revert to the Senator on that as well.

We have many exciting projects under way for Cork too, particularly recognising the fact that Cork does not have an adequate bed base for the population of the region, as Senator Colm Burke reminds me regularly. We need to deliver a new hospital for Cork and I hope significant progress will be made on the agreement for the site by the end of this year and I will certainly work with the Senator in that regard.

I acknowledge Senator Joan Freeman's work in the mental health services area. I am interested in her views and perhaps we could discuss them with regard to our new mental health hospital, which will mark a very significant shift from the facility in Dundrum to that in Portrane. I am very conscious of the fact that the model of care must be about community services and provisions in the community. We have much work to do in that regard and I am sure we will speak about that.

I had the pleasure of meeting Senator Swanick in Mayo at the opening of the new Mayo-Roscommon hospice in Castlebar on Friday. Should there be any doubt, I should say that every single cent of the money to build that hospice came from fund-raising and incredible dedication in the community. People have waited for this for 20 years or longer but the good news is we will provide current funding to run the hospice and meet its operating costs from 2020. It is good news and it is something on which Senators worked with me. I should not forget the projects brought to my attention by the Acting Chairman, including the new Beaumont accident and emergency department and the cystic fibrosis unit, which will make a difference.

Senator Devine is regularly in contact with me about the children's hospital and many other matters.

There is much other stuff.

Yes. The Senator always raises many health issues. She regularly brings the concerns of residents to my attention with respect to the national children's hospital. As we discussed at the health committee meeting a couple of weeks ago, it is very important that residents are kept informed and communicated with. Senior people from the construction company and the HSE turn up at those meetings. There will be disruption when one lives near the site of any major project but people must be good neighbours when it comes to construction and the HSE must be good neighbours to the local community as well. I will keep in touch with the Senator in that regard.

My message to the Seanad this afternoon is that we have a significant increase in capital spending for our health service for the next ten years. We must spend this wisely and learn lessons from what has happened in respect of some of the other major capital projects. We must also get on and deliver. We need a significant increase in the number of hospital beds in our community right across our country and I am pleased we now have the funding to drive on those projects. They cannot come soon enough and I look forward to keeping in touch with the Seanad on them.

I welcome the Minister and thank him for his recent visit to Mayo. There was a fantastic day last Friday in Castlebar with the opening of the Mayo-Roscommon hospice. It is truly a fantastic facility, full of hope, and somebody described it as a sacred place. It is a facility where the size of a bank balance makes no difference and the facility is there for people in the counties of Mayo, Roscommon and Galway. I also welcome the Minister's announcement last week regarding the funding of the facility for 2020.

Fianna Fáil welcomes the proposed developments in the HSE capital plan and hopes it can be delivered on time and on budget. However, the children's hospital debacle and delays in nursing home upgrades demonstrate that the Government's record of timely delivery on key projects is simply not good enough. There are many genuinely important projects listed in the plan that are welcome and which will improve public health care services. However, it is impossible to know why these projects have been selected over others. There is no analysis of the value of the various projects, how investment is being allocated or supply and demand of healthcare services.

The plan includes using public money to build private facilities at the new maternity and children's hospital. This directly contradicts the way the Government voted in the Dáil and its public utterances on the matter. The Government has stated that this is the first phase of a ten-year capital investment programme. Over the next three years, there is a commitment to 250 projects across the country, including 480 new beds, 30 new primary care centres, 58 community nursing units and significant investment in mental health and disability projects in the community. The capital plan provides for the spending of just over €2 billion on health capital projects from 2019 to 2021, with €335 million pledged for a wide range of capital projects at individual hospitals and community facilities to provide modern health accommodation and equipment to improve service provision.

We all welcome the new children's hospital but the issues surrounding its cost overrun are not going away. The State's chief procurement officers, who failed to flag the spiralling costs of the hospital with the Government, has resigned from the hospital development board. The resignation of Mr. Paul Quinn, who led the procurement reform programme, is one of a spate of high-profile resignations from the board this year in the wake of cost escalation. In a recent letter, the Taoiseach confirmed to Deputy Micheál Martin that BAM Ireland, the construction company involved, is seeking additional money for work not included in the original scope of work. The Taoiseach has refused to indicate how much this would cost the State, claiming that the "individual details of these claims are commercially sensitive". Fianna Fáil has called on the Government to come clean about new potential overruns given the burden it imposes on the taxpayer. We need full transparency around the potential cost overruns because they need to be budgeted for. It is taxpayers' money that could be put to so much good use in the healthcare system. The PricewaterhouseCoopers, PwC, report on the construction of the new children's hospital was a shocking indictment of a badly managed project, one of the most expensive undertaken by the State. Nevertheless, there has been no accountability. Red flags were missed and the public spending code was not adhered to. The project has been poorly co-ordinated and controlled, with fragmentation, poor communication and poor flow of information. It is a far cry from April 2016, when the Taoiseach, who was then Minister for Health, announced that the project would, taking account of contingencies and inflation, cost approximately €650 million.

New information supplied to my colleague, Deputy Mary Butler, has revealed that almost a third of nursing home upgrades announced in 2016 have missed their completion date. Once again we can see that the Government is big on promises but maybe behind the curve in the context of delivery. These upgraded, refurbished and new facilities are urgently needed so we can comply with HIQA standards around the country. I was personally disappointed that more investment was not attributed to the district hospital networks but I acknowledge the recent visit by a Minister of State, Deputy Jim Daly, to Belmullet hospital in County Mayo. I am a medical officer at the hospital. I have spoken about this matter many times in the Seanad. The district hospital networks play a vital role in the delivery of a modern healthcare service. They should not be seen as a relic of a bygone era. A failure to invest in the services provided at district and community hospital level is counterintuitive and counterproductive.

These hospitals play an important role in step-down facilities, preventing admissions to acute hospitals and facilitating discharges from the acute hospital sector. With appropriate investment in the community hospital network, we can facilitate respite care and GPs and public health nurses can admit patients to these facilities in order to prevent patients from having to go to acute hospital sectors. Many of these hospitals have palliative care beds. There are two at the hospital in Belmullet. These hospitals are a vital cog in a modern healthcare system.

I welcome the developments in the mental health facility at Portrane. I worked as a senior house officer at Portrane when specialising in psychiatry. It is a fantastic facility, as it was back then, despite much of the negative connotations in the media coverage relating to the institution.

I had a very fruitful six months there and met some great people. The new infrastructure in Portrane is welcome. I look forward to visiting it. I have visited the children's hospital. I was given a tour by BAM Ireland a few weeks ago. If the Government is interested in controlling costs, there must be a ground up policy. We must tackle the meltdown in our healthcare system. We must get a handle on spending and cost control to prevent the yearly ritual of announcing Supplementary Estimates.

I am delighted to see the Minister here. On a personal level, his enthusiasm, knowledge and belief in what the HSE can deliver are commendable. I apologise for being a little late getting to the Chamber. When I got here, the music from the film "Jaws" came into my head. It is a case of me being Jaws, incidentally, because I seem to attack every person who is involved with mental health.

The Minister could probably sing what I am about to say. It all sounds wonderful but the big problem at present is staffing levels. We will have 480 new beds, 38 new primary care centres and all these wonderful things, but who will work in them? Members of the Psychiatric Nurses Association were outside Leinster House today. They have been fighting for two years. I told Mr. Peter Hughes that it was a waste of time standing outside because we are in a bubble in the Houses. We are unaware of the trauma many people are going through. The core issue in resolving the problems, particularly in the mental health services, is to look at what we have and fix that first. That is far easier than spending millions on something that might be lying idle or God knows whether it will happen in the three years the Minister specifies.

This is probably not the time, but I will raise this matter because of the Minister's courteous manner. I am being equally courteous to him. I have asked on several occasions if the Committee on Future of Mental Health Care can be resumed or recreated. The Taoiseach said he would do so, but it has not happened. A year later we are still no further. This committee is vital and I am putting my question directly to the Minister. I can see that he cares deeply about people with mental health issues. We need that committee because it makes the HSE accountable, something Minister cannot do publicly. We brought members of the HSE before the committee and asked them about their budgets. Their answer usually was that they did not have the software to show what they spend, item by item. We can give out stink about it publicly but the Minister cannot. It is important to have that committee to hold the HSE accountable. I ask the Minister to please consider what I have said.

The next question probably shows my lack of knowledge about politics. The Minister has put a policy or structure in place and says it is going to happen over the next three years. It might be a silly question but what if the Minister is not the Minister for Health? What will happen then? What if Fine Gael is not returned to office?

I thank the Minister for coming to the House to discuss the capital plan. It is important that we continue to develop and improve our healthcare facilities. One of my concerns relates to the negativity about our health service. I attended a health committee meeting this morning and the way some members of the committee were speaking, including Senator Swanick's colleague, one would swear that the 135,000 people currently working in the HSE are sitting twiddling their thumbs all day, with no healthcare being provided to anybody. I will outline the simple facts. Each week, 63,000 people go through outpatient departments, 16,000 go through day care procedures and 23,000 go through emergency departments. That is aside from the inpatient care that is being provided in all the hospitals across the country. It is a clear indication of the dedication and commitment of the 135,000 people who work in the HSE. The current negativity about healthcare is not helping them in the work they are trying to do. We must give far more acknowledgement to the work done by the doctors, nurses, support teams, carers, cleaners and porters because the vast majority of HSE workers go way beyond the call of duty in delivering healthcare in this country 24-7 throughout the year. It is important to acknowledge that. It is also important to acknowledge that life expectancy has improved by seven years compared to what it was in 1990. On average, people are now living seven years longer.

There are also challenges and we must confront them. With regard to the children's hospital, there is a cost overrun and that must be reined in to ensure that we are getting value for money, but one should look at the overall cost of this care facility. I did a comparison. It is worthwhile to tune into the SickKids Foundation in Canada and look at the building cost of the children's hospital there. The total project is costing $3.7 billion, which is approximately €2.6 billion. It is interesting to watch the costs for that rising. I am not saying we should allow costs to rise, but this is what one is dealing with in the building industry. In Canada, the average building cost is going up by 1% per month. It is worthwhile looking at that project to see what the people there are doing and the value for money they are getting.

The issue with our children's hospital is that we have talked about it for 25 years. The wrong site was picked for four years and there was massive delay. We are getting on with it and it is being built. It is important to build it for the children of this country, both this generation and the generations to come. It is also important to look at the cost of it and do a simple comparison, and I realise that Members might criticise me for using this comparison. Social welfare this year will cost us €21.2 billion. In real terms, the children's hospital is costing one month's social welfare. We are building this facility to serve the next 50 years. We should get on with the project, deliver it and ensure it is the best possible facility for the children of this country and for the difficulties families must face if they have a sick child. Every possible mechanism should be available for the proper treatment of those children.

With regard to the capital projects, I must refer to the elective hospital in Cork. I am a little concerned that many things are going on behind closed doors. We are not getting any information about what is happening or about consultation. I understand there has been very little consultation with the two local authorities. The Minister might clarify that. Cork County Council and Cork City Council should play an important role in that from the perspective of developing infrastructure and developing access to the facility, not only for those who will be using it but also for the people who will be working there. The population of Cork city and county has increased by 130,000 people in the last 30 years and it is continuing to increase. For example, there will be over 10,000 extra people working immediately alongside City Hall within the next three years. That is 10,000 people moving into new jobs. They are not moving out of existing premises as these are new jobs that will be created. There will be a huge and continuing increase in the population in Cork so there is a need for an elective hospital.

Even if we decide the site in the morning it will still take two years to get planning and another three years to build it. We are now talking about five years down the road. This is why this project needs to be prioritised.

On fast-tracking and the use of our hospitals, one of the big issues is when, for example, a person has gone through a medical procedure and is detained in hospital for a period of ten days or two weeks while they really only need to be there for four days but there are no appropriate step-down facilities. Can a lot more be done in this regard? Step-down facilities can be built faster than anything else. Should we be looking at trying to develop or acquire step-down facilities so we can use our hospital facilities better? If somebody needs to go through surgery, there are a number of key components that need to be in place such as the consultant, the back operating team, the operating theatre and a bed. In some cases this needs to be an intensive care bed. If one of those components is missing, the procedure cannot go ahead.

I was in Cork University Hospital recently where a man had been in the Mercy Hospital for three weeks with a heart problem and needed surgery. The patient could not be transferred to CUH because it did not have a bed. When he did get to CUH, the man was another week in a bed there because they could not operate due to not having an intensive care bed available.

When one of those components is missing, they cannot do the surgery. This is one of the reasons we should look at developing further step-down facilities. They are faster to develop, the cost of running them is far less and we could get better value in the use of our hospital services, which is very important.

With regard to the primary care centre facilities, I understand there are 127 primary care centres in the State, 57 of which have been built over the past four to five years. Another 70 are in the planning and design stage or building stage. How many of these will actually be finalised and up and running over the next three years? This is not only about being built but also about making sure we have a sufficient number of staff to cover all of the additional facilities that will be brought in at the community level. I would like to see our target for those facilities over the next three years.

There is another issue with the employment of staff. I have raised this at the Oireachtas Joint Committee on Health and believe we need to get clarification on how we are putting in place more community healthcare. I have done the comparison with administration management. While that area needs to be developed and supported as well, it has seen an increase of 24% but public health nursing has seen an increase of only 3.7%. We need to have a clear plan regarding how we are going to roll out community healthcare. Sláintecare representatives were before the committee this morning. I am aware that they are working on this but I believe it needs to be outlined to us as Oireachtas Members. I am very concerned that so few public health nurses have been recruited in the past four to five years. If nurses are out in the community, they can deal with a lot of the problems rather than people having to go into hospital for care. We need to reduce the numbers of people who require hospital care when they can be dealt with in the community.

I put it to the Minister that we have a lot of work to do in healthcare. A lot of work is being done but it is also about making sure we can get value for money.

Will the Minister outline to us the computerisation of the whole healthcare centre system rather than using paper files? What progress will be made on that over the next three years? This is a huge cost saving and we need to put serious money into that area as well.

Cuirim fáilte arís roimh an Aire. I have been hunting the Minister down, as it were, but unfortunately for a while now I have not been able to bring back the bacon, so to speak, on the questions and responses I try to elicit.

On the capital plan for the HSE, some UCD academics revealed just days ago the growing number of private hospital beds as public facilities dwindle. This shift to private healthcare delivery is concerning. Since 1980, the number of public beds has fallen from 7,000 to 6,000 and the number of public hospitals has dropped from 43 to 31.

We also need to discuss issues about St. Vincent's hospital. I am aware that many of the for-profit and not-for-profit facilities pride themselves on following the terms and conditions of the HSE, which is how they attract some of the staff. The sector can be described as a highly private sector because the private for-profit sector accounts for half of Ireland's bed stocks. The way in which we are going to provide this is concerning. It is against the Sláintecare cross-party document for the future of health that is based on need and not on ability to pay.

I commend the expansion and construction of the primary care centres in our communities that we hope will take some of the burden away from the nightmare that accident and emergency departments often are, but they are to be commended.

There will not be a lot more condemnation from me in the next bit of my speech but I am completely underwhelmed by the capital plan. Many of the projects have already been announced or are under way. Senators are only getting to speak on the plan ten months later. It is now ten months into the year, and this is within the context of the absolute chaos of the national children's hospital project. It is difficult. The national children's hospital is at the end of my road. I lie awake until after midnight and lie awake again at 5 a.m. with the whirring of the ten cranes on that site and the noise of the construction. It goes on over seven-----

Progress is being made.

I think the Senator might like to talk to the locals within a mile radius of the national children's hospital-----

It is indeed a hospital.

-----construction site instead of taking the P-I-S-S out of their concerns. Shame on the Senator.

I would like some further clarification from the Minister on the national children's hospital. Do we know yet what the costs will be for outfitting? What about the required IT systems? BAM went under the banner, which was recently taken down, of the Considerate Constructors' scheme. Its revised costs are with the Minister, as are the revised timelines. We need to get a clearer idea of that. It is one of the biggest investments in health and it also feels as though an awful lot of extra money is being requested. BAM is coming on site and saying, "This was not agreed or that was not agreed." That might well be the point, but it seems as though it is putting the hand into the public purse all the time.

There is an excellent building already on the St. James's Hospital site, the Mercer's Institute for Successful Ageing, MISA, building, which is situated near the Rialto Luas stop. It cost €48 million and is three or four years old. I do not know the number of beds there. I have visited the facility in a Seanad capacity, but I would like to work out what that cost was per square metre. BAM also had that contract and then it got the contract for the national children's hospital. It seems that the MISA building was much more budget friendly and more prudent in the spending. With the children's hospital it seems to have gone off the Richter scale.

There is also the big cost associated with the homes that are being destroyed by the children's hospital construction. I know that people have had to go back to the courts. The houses have had three years of back wall cracking, which cracks are widening daily, and the backs of their houses are subsiding and falling into the ground. They were told and I also was told that this ground was black soil that could not be built on, and what would architects or surveyors have known 100 years ago, but they were indeed right. Those people have had to go back to the courts - I take Senator Coffey's point - to try to get their homes fit for purpose.

It affects about 40 or 50 homes at the moment but it is expanding to that small historic estate. That is not to mention the rest of the surrounding areas. Residents are elderly. Many have lived there all their lives. People can put up with intrusion when it is necessary for an end result such as a health service fit for our children, however the way it has been done and the wait of three and a half years for home reconstruction is too much for elderly people who want to live their lives out in peace in their homes.

There is a worrying lack of detail in the capital plan. It reads more like a political wish list than a roadmap to better public health services. Some projects have vague timelines and figures attached. The plan states that the new mental health capital programme will be developed with a focus on upgrading existing facilities, replacing an appropriate community residential and non-residential, and continued expansion. Will this come from the overall capital budget or will it be new money? When will it be published? When will work commence? The lack of detail is worrying given the state of our mental health services and the state of the mental health budget for 2020. There are 4,000 children on CAMHS waiting lists, there are no child psychiatrists in the Wexford and Waterford area. They resigned en masse because of the facilities. These people were conducting assessments on young vulnerable children in corridors, store rooms and box rooms. Will that be addressed?

The plan does little to address massive overcrowding in our hospitals. Project Ireland 2040 gave a commitment to increase bed numbers by 2,600 over ten years, a commitment of 260 beds per annum. However the capital plan outlines delivery of 480 over three years. It is only 160 additional beds per annum. We know capacity is the issue. Wards are lying empty because of problems with recruitment and retention, something that is hardly addressed in this plan. That is also the case with mental health services. I welcome the national forensic mental health service's move to the Portrane site. It is about time that the old Victorian, caged prison-type of institution will become a forensic unit which hopefully will rehabilitate and help foster the well-being of those who have committed crimes. I have visited several times. The landscape in Portrane is quite haunting. The site is some 50 acres, with 15 acres taken over by the forensic hospital. What will happen to the rest? This is public land. It belongs to the people. I have never received a satisfactory answer as to what will happen to the site. When St. Brendan's in Grangegorman was closing we in the Psychiatric Nurses Association, PNA, tried to ensure that site would be used for psychiatric services. It is now the Grangegorman campus. We were promised the devil and all but nothing came of it. It returned to the ether.

We need an update of Project Ireland 2040, the capital tracker with the definitive detail of when exactly projects will commence and finish. We must be certain of delivery and timeframe.

The Minister of State referred to public nursing homes. I did not catch how many beds were involved. During the 1980s, Denmark realised the futility of building nursing homes. I like Senator Swanick's idea of going back to smaller community-based hospitals which catered so well for local communities. These were very much part of the community. Someone in Dublin would be lucky if they found a nursing home bed as close to them as Kildare.

Finally, I support Senator Freeman. We have been given promises. We would have to read between the lines and perhaps it is a bit naive that we did not. However, we did believe that the Future of Mental Health Care was to be re-established. It did fabulous work under Senator Freeman's guidance and gave voice to those who would not have been heard otherwise.

I welcome the Minister to this important debate on the capital plan, the HSE and health services. I note his opening statement contained a commitment to continued capital investment in our capital health infrastructure. He mentioned an increase of over 165% in the next ten years on the previous ten years. That is a substantial commitment. We need to see the various projects progressing.

I acknowledge the issues on the ground at the national children's hospital around the building, which must be listened to. Despite the issues and the controversies around cost overruns we are all agreed that it is in the best interests of the country and its sick children that the hospital proceeds with haste. It has been kicked about for many years until the Government and the Minister bit the bullet and moved it on. It is critical. It will be world-leading infrastructure. It is a substantial site with multidisciplinary care for sick children and it will have to progress.

The Minister referred to some regional projects. I will focus on some in the south east and Waterford. It is important that we acknowledge progress where it is made. There have been capital projects in my own area including the new primary care centres. One was built and is open at St. Otteran's in Waterford city, another is built and due to open in coming weeks in Dungarvan and another on the border of Waterford and Carrick-on-Suir which serves the people in that area. A further primary care centre is at advanced planning stage for Ferrybank on the outskirts of Waterford city and there is another in Lismore in west Waterford where expressions of interest have been sought. This is vital infrastructure in our communities across both urban and rural areas. I commend the Minister on advancing these projects. I know there are challenges in getting the teams and staffing but the Minister is advancing them. He needs to be supported in that and I acknowledge the progress in the area because the communities will benefit from enhanced primary care when these centres open.

I also acknowledge the new state-of-the-art emergency department which opened at University Hospital Waterford some years ago. That often goes under the radar. It is a top of the range trauma centre. The new Dunmore wing is a five storey block which has been built and handed over to the HSE. Plans are afoot to move in wards and staff. The Minister recently announced that a new hospice will be open there in the new year. These are all significant advances during very difficult times and I want to acknowledge them.

The big controversy in the south east is that of 24-7 cardiac care. The Minister decided to provide funding for a second cath lab at University Hospital Waterford. We cannot have 24-7 care without a second cath lab. I acknowledge the work of the Oireachtas Members and, indeed, Members from the south east who have worked with the Minister in delivering on this. I welcome that the planning application is to be complete by year end. I look forward to the construction of this critical infrastructure in the next year. The new mortuary in University Hospital Waterford will go into construction by year end. This has been another cause for controversy but the Department and Minister have responded and the HSE is now at a very advanced stage in tendering. We hope that construction will start there by year end. People mentioned acute hospitals and waiting lists. Unless we have more community beds, waiting lists will not reduce. There is more positive news in the pipeline with a 100-bed community nursing unit for Waterford city at St. Patrick's hospital and a 95-bed community nursing unit in Dungarvan for west Waterford is now going to design. These projects are critical. The roadmap is there for them to be designed and built. All that we await is their construction. It is good to see these projects advancing.

Finally, I raise facilities for children with both physical and intellectual challenges and disabilities. In Waterford and the south east, children attend the Sacred Heart unit in the heart of Waterford city which was built in 1974. It is not fit for purpose. It urgently needs a new facility. The good news is that there is a great charitable organisation called Touching Hearts which is very active on the ground campaigning and fundraising. Is it putting its money where its mouth is to build a new facility?

It is working with the HSE and its objective is to build a new facility on the grounds of St. Otteran's hospital, which is next to the new primary care centre. The business plan has been put together, the groundwork has been done and all the jigsaw pieces are in place. We now need it to be included in the 2020 capital plan. These people deserve and need help. It will benefit both the children and their families, and will provide a whole suite of facilities for existing HSE staff who currently work in substandard facilities. This will respond to their needs and provide an excellent facility. Touching Hearts is standing up and is willing to deliver, but it needs support. The HSE has approved this project, and funding needs to be in place for next year in order that it can get under way. I look forward to the Minister's response.

I thank the Minister, who is a neighbour of mine. I am incredibly concerned about where money is being spent in the HSE. We pay for a health service through our taxes, but it seems more and more money is being spent on the national children's hospital without fixing the problem, which is a worry. I read yesterday that there is a €455 million overspend, which the Taoiseach expects will increase. That is huge.

Hundreds of people are on trolleys, and even more are waiting to be discharged without adequate step-down supports. I have previously raised concerns about people with mental health issues being treated in accident and emergency departments, as they have nowhere else to go. Entire regions have zero access to life-saving medical help on evenings or weekends, which is probably the biggest issue I face. Despite having one of the youngest populations and being one of the highest income countries in the OECD, we spend much more per person on health than the average. We should be getting more for our money and value for money. There is a massive recruitment crisis in the health service. More than 2,500 additional staff are needed for the full provision of mental health services across the country. I join with Senator Freeman and other colleagues in asking the Minister to reconvene the mental health committee. I beg that of him.

We are all alarmed by the recent damning report from the Mental Health Commission, which makes it clear that the State is guilty of long-term neglect of people in need of services. The department of psychiatry at University Hospital Waterford had a mere 57% compliance rate this year. There are few or no CAMHS services available in counties Carlow, Wicklow, Wexford, or Kilkenny. The nearest place our young people can be seen is Galway. Our young people are repeatedly being admitted to adult units in St. Luke's hospital, which is not acceptable. A helpline number was released last week, which is welcome. It is only a start, but I welcome it.

Everywhere we turn there are massive problems in capital funding in health. I have repeatedly submitted a Commencement Matter, which has never been selected, seeking a status report on the building for the Holy Angels Day Care Centre for children with special needs in Carlow. I raise this again in light of the recent Tusla report highlighting the corrective measures required for the physical and material environment of the current building. I have brought this up repeatedly in this House because we have been waiting over four decades for a building which is fit for purpose. I was never in government and so never had a say in this, but I am raising this issue with the Minister today because things are getting more difficult. I asked the Minister about this in person and he was gracious enough to grant funding for emergency purposes. Only two years ago he gave €150,000 for the roof of the school. I met him during the summer and he committed to a further €25,000. The HSE is waiting on that money, so I know he will give it to the staff of the Holy Angels school. I have to give credit where credit is due. Holy Angels has been on the priority list-----

It is the way she asks.

It is the way one asks. We are neighbours.

Constituency neighbours.

The Holy Angels centre has been on the priority list for a new school building for over five years. The HSE was supposed to make land available at Kelvin Grove for a new school. I ask the Minister to check that for me as I would like to know what is happening. It disturbs me that local councillors in Carlow have noted that this promised site, which is supposed to be earmarked for the Holy Angels school, remains on the vacant properties list. Can the Minister check that for me? The school cannot wait any longer due to the current condition of the building it is in. It is not good enough. The staff in the Holy Angels school are absolutely excellent and the conditions in which they are working are unfair. I worry about these kinds of capital projects because these issues are huge.

There is also a massive need for a scanner in St. Luke's Hospital, of which the Minister is aware.

I have two other points which I will make quickly. Today I met with the National Ambulance Service Representative Association, NASRA, and the Psychiatric Nurses Association, PNA. One of the issues they raised was that €7 million was spent on private ambulances through the HSE in the last eight months. That is a concern, as they feel they are not being listened to. I ask the Minister to set up meetings with those organisations because they feel no one is listening to them.

I have raised this next issue with the housing committee, but the HSE is also involved as it relates to a women's refuge. There has been massive confusion in Carlow lately because Carlow County Council, Tusla and the HSE are not working together. There is a lack of communication, on which we need to work. More than 300 cases of domestic violence were recorded in Carlow from January 2019 to the middle of this month. A Tusla report originally stated that we did not need a women's refuge, but we do. The HSE seemingly said it would look into committing a site, but I am not sure about that and am open to correction. Everyone must work together on this. I will get Carlow County Council and Tusla together and I ask the Minister to get CHO 5, which is part of the HSE, on board in order that we can sit down and talk. If all of us work together we can deliver a women's refuge for Carlow. Overall, the Minister has been most gracious whenever I have gone to him. He has always listened to me and made time for me. The one commitment I ask of the Minister today is to come back to me about both the women's refuge and the Holy Angels school for children with disabilities. It will not survive another year or two in its current building and is still using prefabs over 40 years on. I ask the Minister for a commitment on that.

I, too, welcome the Minister. It is great to have a debate on the capital plan. The capital budget is €11 billion over the next ten years. It is fascinating that people are knocking that at this stage as it is a positive outcome.

Having done a project myself, I have issues with the overruns for the national children's hospital, which should be more closely monitored. I will make a few other points about the hospital. The building's design has led to problems. Whenever a curve is added to a building, it increases the cost by 10%. People inside the building do not worry about whether it is curvy or straight. The building should have been straight, but some architect will probably win an award for it. Kildare County Council also has a fantastic looking building, for which the architects won awards, but the people of Kildare will be paying for it for the next 20 years. We should be smart when we appoint architects.

Fianna Fáil has forgotten very quickly that when the port tunnel was completed in 2005 it was 48% over budget. Now we see it as an amazing piece of infrastructure. Sometimes when we look back at such projects, the criticism seems unwarranted once they are being used. In ten years' time we will say the national children's hospital is a marvellous piece of infrastructure which was badly needed. It will be a world-class facility.

I hate negative terms. People say we have a third-world health service here, which is absolutely ridiculous. Has anyone here ever visited or worked in a hospital or facility in an African country? Some 20 years ago I brought a young child to a facility in which I was working, where the cicatrin powder which had been donated was four years out of date. Do not talk to me about such things. People are comparing how much we spend here and the problems we have, but we only have to look to the North of Ireland or across the water to the UK, where the problems in the NHS are not too dissimilar to the problems we have here. We are putting ourselves on a pedestal to be knocked down. We should look elsewhere before we start criticising.

The Minister previously mentioned Naas hospital and sent me a follow-up on it. It is a huge part of the capital plan. I met with the nurses there and confidence is required within the staff. Even seeing diggers on the site would give them a boost. The hospital has planning permission but I am worried it will run out. It is hugely important that the hospital has an endoscopic unit, but a number of day wards are also being built onto it. I hope we can start on that as soon as possible as it has been on the agenda for a good while.

Recently, I attended the opening of an Affidea ExpressCare clinic in a primary care centre. As Senator Coffey said, these primary care centres are a positive development. The ExpressCare clinic would love to be linked with Naas General Hospital. These clinics cater for many of the people who would normally attend accident and emergency units but do not need emergency treatment. In the old days, a general practitioner would stitch cuts and wounds but nowadays GPs will not do that work and send people to hospital, thus taking up space in accident and emergency wards. Clinics would like a service level agreement under which people assessed in triage in an emergency unit and deemed not to be a serious case would be directed to them. This would avoid people having to wait between six and eight hours in accident and emergency.

I very much welcome the extra 1 million home help hours, which will free up hospital beds.

The Little Way cancer support service in Clane is very close to my heart. As the Minister will know from his visit to the centre, it provides therapy to people who have been diagnosed with cancer. The service has sought funding. Like Senator Murnane O'Connor from County Carlow, I beg the Minister to provide some of the funding promised for the service. It would be great if he could do that.

I welcome the Minister for Health to the House. Without doubt, he has the hardest job in government, although overseeing the housing portfolio is another hard job. We all know that the Government, politicians and the political system will be judged on how they deliver on health in the short term. I say short-term because we do not have much time. At best, we may have months. People are impatient for improvements. In many cases, they are impatient due to their personal experiences of the health service. If a family member or loved one is sick or waiting, we share his or her concern. We are talking about somebody's son, daughter, mother, father or grandfather. We become frustrated when we see family members or people who are close to us having to wait or suffering. A change in Government will not change that. The solution is planning and creating a solid foundation for the future. This is a slow process, which will have its disappointments and setbacks but also gains.

I acknowledge that the Minister has a very hard job to do. Sometimes we do not give credit where it is due but many positive things have happened. I thank the Minister for getting the National Rehabilitation Hospital, NRH, project back on track. Under the Fine Gael-Labour Party regime and different Governments, a state-of-the-art NRH facility was promised. The project suffered setbacks and was suspended for financial reasons so morale was low. People waited years to access rehabilitation services, which meant they were stuck in acute hospital beds when they should have been getting rehabilitation treatment. I am glad the project is now back on track. I hope there will be no further setbacks.

I ask the Minister, through his contacts with the board of the hospital and the HSE, to ensure there is greater focus on this project. Half the problem is that good stories are not getting into the public domain. People are still saying they may not get budgets or funding will be cut. There are three phases in the roll-out of the NRH project. It is important that we use the health services and the boards of these organisations, hospitals and healthcare services to share good news. It is a good news story that the NRH is back on track. I thank the Minister for overseeing the project. The Taoiseach and the Minister attended the ceremony to commemorate the turning of the foundation stone to mark the second phase. As the Minister may not have the information to hand maybe in the next week or two he could drop me, or anyone else for that matter, a line on the current status of the national rehabilitation hospital project.

He should do it today.

I welcome the additional home help hours. We need more home help hours because people want to remain in their own homes, if they can, and be supported. We know that when people go into hospital care for a prolonged period, particularly older people, they lose confidence and find it hard to return home. They do not want to return to a home that has been empty for some months. They lose their daily contacts and routine and feel afraid. We must provide proper support to people so they can remain in their communities and I do not mean just a few hours. I mean comprehensive hours that support a person's specific medical needs while he or she remains at home.

The final issue I raise is not directly related to health. I am acutely aware of the enormous landbank and assets of the HSE and other State health services that lie idle up and down this country. For the life of me, I cannot understand why there is no comprehensive inventory of these lands. If lands are surplus to requirement, they should be sold and ring-fenced for health services. We have institutional hospital lands that are worth billions of euro. The Land Development Agency has a role to play in all of this and there is a general view on how we can deal with the issue. We must also consider the potential to use the moneys outstanding from the religious orders under the national redress scheme. Many of these orders were involved in the provision of health services. Can they transfer lands or assets to support health? We must focus on identifying the landbanks owned by the health services in order that they can be disposed of, where not required, specifically with a view to ring-fencing the income for reinvestment in essential health services.

I welcome the Minister and commend him on his work. Senator Boyhan is right that the Minister has the most difficult job in government. I can testify to that as I chaired the Joint Committee on Health and Children for nearly five years.

Something in the Department of Health always causes me to worry. To be fair to the Minister, given that the health budget stands at €17 billion, there is something rotten in the state of Denmark. It is time the vested interests in the health sector were called out. Those who purport to advocate for them should make an honest observation about their role and what they are doing. Senator Boyhan is right that healthcare is about patients, those who needs treatment or to be seen to. There is a paralysis in the health service that has been caused by vested interests. There is €17 billion for health expenditure and €11 billion in capital investment. Can somebody explain to me why we have people on trolleys? The reason is vested interests and let us start calling them out.

We have had more reports on the reform of the health service than we have had Ministers for Health. To be fair to the current Minister, the Sláintecare report is a good one. The roadmap he has put forward for new regional health boards is a good one. I could list a heap of projects in Cork that are being funded or need to be funded. I welcome the new second hospital because the development will be transformative wherever it is located. My only request to the Minister is that we get this done. Let us stop the political gamesmanship in the HSE and the Department of Health and let us get this done.

To be fair to the Minister, he has driven many projects in Cork. Senator Murnane O'Connor made the very good point that the Minister gets the political blame for what goes wrong. Apportioning blame to him is unfair in many cases because money is not going from A to B to C within the HSE circle. It is about time we called all of this out. We are held to account politically. To be fair to Senator Swanick, who is a GP, he made a very impressive contribution in which he spoke about primary care and its importance. The HSE's capital plan provides investment in community hospitals that will be of immense benefit and will help to achieve what we all want, namely, to keep people at home and out of acute general hospitals, as bed blockers, where they have no place. Healthcare is about people and patients.

It is not about the vested interests. I could have come in here and delivered the speech I prepared, welcomed projects in Cork such as the primary care centre for Douglas and called for particular measures, which are all very important. However, the fundamental problem with the health service is that it has been paralysed by vested interests with the consequence that delivery to patients in many areas is being affected, and that is a disgrace. The Minister has made himself accountable to the Seanad, the Lower House and the committees. The children's hospital will be his legacy because it will be built on his watch after 30 years of monumental failure and a lack of delivery on the vision of a children's hospital. When I was in Taiwan, I visited a children's hospital. I was envious that it had such a facility. The Minister will deliver the children's hospital.

I will make a very simplistic point on an issue referred to by Senator Lawlor. Some Senators may watch the "Room to Improve" television programme presented by Dermot Bannon which is broadcast on Sunday evenings. None of his projects comes in on budget. I had a job in my house priced over the summer. The price started at €30,000 - I was not building the Taj Mahal - and ended up at €50,000. I told the builder to get lost. Good luck to him. The price to knock a wall, put up a few beams and create a bit of light started at €30,000 and ended at €50,000. Let us get honest about this. Do we want to have a children's hospital? Do we want to come in here every day of the week complaining about the lack of a children's hospital? Let us get it done. Let us deliver it. The capital plan includes this investment. Let us do it for the patients of Ireland.

I thank the Minister for coming to the House for this important debate. I concur with much of what Senator Buttimer had to say. I was going to briefly address certain issues he raised but I will instead speak about issues affecting my constituency. The Minister in his introduction referred to the improvements that will be made to Beaumont Hospital, particularly its cystic fibrosis unit. For patients suffering with cystic fibrosis it can be fatal not to have 24-hour access to a unit. As all present are aware, it is a very difficult disease to live with. For that part of north Dublin and beyond, the commitment to a cystic fibrosis unit is of crucial importance and much appreciated. I would like to see it tangibly delivered. I would be interested in any feedback the Minister may have on how the planning process is going and when the sod is likely to be turned on the new unit.

The new emergency department provided for in the capital programme is badly needed for the benefit of adults and children throughout Dublin Bay North, which I represent, and beyond. The upgrade of the ICU and the radiation oncology project are also very important. These are all included in the capital plan. On delivery, I will steal the words of Senator Buttimer, or perhaps those of Boris Johnson: let us get it done. Let these projects become a reality in Beaumont. I am unsure whether the Minister can provide a timescale for delivery today, but I am very interested to know when the sod will be turned on the project.

I thank Senators for their very informative contributions and the questions they posed. I thank Senator Swanick for his comments. I agree with him on the importance of the district hospital and community hospital networks. I see a role for community and smaller hospitals in alleviating the pressure on larger hospitals. That is not about putting an emergency department into every hospital; to do so would not be appropriate, safe or needed. Rather, it is about trying to transfer some work from busy acute hospitals to smaller hospitals. We are seeing good examples of this being done. Within the RCSI Hospitals Group, of which Beaumont Hospital is a member, more and more endoscopies are being done in Cavan hospital using the hospital network and trying to keep Beaumont for very serious and major acute traumas. There is an effort to use Drogheda, Cavan and Monaghan hospitals. Working as a network of hospitals is the way forward. There is a role for every hospital and there is definitely spare capacity in some of our smaller hospitals, while we know some of our larger hospitals have queues out the door. I agree with Senator Swanick in that regard.

I disagree with very few, if any, of the remarks made by Senator Freeman. It is above my pay grade to restore the Committee on the Future of Mental Health Care, but I believe that should be done. The committee had a very useful role to play and I welcomed its role in terms of governing in the sun, as it were, and shining a light on what goes on. When the Oireachtas decides to allocate €1 billion to mental health services, that is the headline figure and the big announcement. However, the committee did excellent work exploring what happens when that money goes out into the system. It is important from a public accountability point of view and its reports were insightful. I will discuss the matter with the Taoiseach. The decision is above my pay grade, but I believe the committee should be re-established and I will communicate my views in that regard to the Taoiseach.

Senator Freeman made a valid point on the issue of staffing, which was also raised by several other Senators. One area of mental health in which we have made good progress is the introduction of the new assistant psychologist grade. I know that not from a briefing note but, rather, from my travel around the country. I was in County Mayo on Friday and met some assistant psychologists. I have been in several parts of the country where I met assistant psychologists at work. They seem to be freeing up CAMHS slots for more acute cases. The grade of assistant psychologist is newly created. It is not an alternative to psychologists, but it is making sure we do not funnel everybody through what can often be a very narrow tube. Progress has been made in that regard. Funding was made available in the budget for 1,000 additional front-line community health service staff by 31 December 2020. The challenge for us all, and on which I am happy to work with the Oireachtas and, perhaps, Senator Freeman's committee if it is re-established, is how we map that out. Where do we need those 1,000 staff? How many of them are psychiatrists or psychologists and how many are public health nurses or therapists? I acknowledge that there is a pay parity issue with some consultants. I have started talks with the Irish Medical Organisation and written to the Irish Hospital Consultants Organisation. I accept there is a pay issue which arises in the context of global recruitment. I hope that Senator Freeman's committee can get back up and running and recommence shining a light on these matters.

I thank Senator Colm Burke for his contribution and his comments regarding the constant negativity about the health service and the impact that may have on people working in it. It seems that it has been decided that we should only measure health on one or two metrics. I am not saying they are unimportant metrics - of course, access and overcrowding are very important. However, another important metric is how long the average person in Ireland lives. Our life expectancy is now higher than the average European life expectancy. A man or woman in Ireland will live longer than the average European citizen. A baby girl born in Holles Street Hospital today has a 50% chance of living to be 100. A person has a better chance of surviving cancer, a stroke or heart disease in Ireland with each passing year. That did not happen by accident. It came about thanks to a health service that is making improvements and progress as a result of significant investment over many years and the lifetimes of successive Governments.

I agree with Senator Burke on the children's hospital. The message I hear from parents across the country is that we should get on with it and build the bloody thing. How many Ministers for Health have promised to build it but not done so? How many debates have there been over an appropriate site? How much money was wasted on the Mater site without a hospital being built? A total of €40 million was wasted, in case anyone is interested. The children's hospital is now open. It has started treating children in Connolly Hospital. The section at Tallaght Hospital will open next year and the building at St. James's Hospital will be finished towards the end of 2022 with an opening in 2023. I do not intend to be in any way flippant about the very serious lessons highlighted by the PwC report, but similar issues arose with the Dublin Port tunnel and terminal 2 at Dublin Airport. My party criticised such overspends. Whoever is in Opposition tends to throw rocks at the Government. The easiest thing for a Minister is to do nothing. We will not regret the construction of the children's hospital. No one knows who will be Minister for Health in 2023. There may be an extension of the confidence and supply agreement. I jest.

I think that confidence and supply is waning all the time in both directions. On a serious level-----


No. I pressed the right button. Whoever is the Minister for Health will be very proud to open that facility. I have no doubt if I am looking on from a distance at the photographs of the people at the opening, there will be many people there whooping, hollering, clapping and cutting ribbons who probably criticised and threw rocks at the project through its entire gestation. On that day I will quietly chuckle, knowing that we did the right thing by the children of Ireland.

I agree with Senator Colm Burke's comments on the elective hospital in Cork. I will keep in touch with him about the collaboration between the local authorities in that regard.

Senator Devine made a point about private hospital beds. I want to tie that in with a point Senator Buttimer made about vested interests. Everybody in this House and the other House and everybody everywhere says they are in favour of Sláintecare. We will have to get real soon and stop being in favour of only the nice and fluffy stuff in Sláintecare. There are some real hard decisions we are going to make.

It is wrong if an elderly person in an emergency department on a trolley cannot get a bed while upstairs in the hospital a consultant is being paid a private income for using our public beds, public salaries and public electricity. Meanwhile, Mrs. Murphy in the emergency department cannot access a bed because she cannot afford private health insurance. We will stop that. We will decouple private practice in public hospitals. Consultants can continue to do their private practice in a private hospital. We will need to pay our consultants more and have more resources.. This is not easy to do. The de Buitléir report shows us how to do it. I was fascinated and a little alarmed watching the proceedings of the Oireachtas Joint Committee on Health today and noting that not every member of that committee and not every spokesperson on health would say, as I will say here, that it is wrong that private practice is taking place in public hospitals. We would not tolerate that in our education system. Donogh O’Malley , a reforming Minister for Education, called it out with respect to secondary education and said it was not right that a person could not access secondary education if he or she could not afford it. We now need to say it is not right that private practice is going on unabated in our public hospitals. We need to show leadership in that regard.

I thank Senator Devine for her comments about the primary care centres. The challenge, as she rightly put it to me, is that we have to make them busier. That will be some of the work of the Sláintecare and 1,000 extra staff that will be recruited. We are ten months into the year as we are talking about the capital plan, but I would rebut that by pointing out we are not just talking about 2019 capital plan. We are talking about a three-year horizon in that regard. The Senator will not be surprised that I disagree with her comment that it is a vague capital plan. There are 250 projects outlined in it. People want to keep talking about one project, the national children’s hospital. There are 249 other projects in it spread throughout the country. Just like the education capital plan or anything else, it is a list of all that we intend to do over the next three years.

I am conscious of my time but I want to respond to some of the points colleagues made. Moving on to the comments of Senator Murnane O'Connor, my neighbour, who I think keeps saying she is my neighbour because she is getting a bit of my constituency back into her constituency and she must want to get my votes in Rathvilly and Hacketstown, but so too does my colleague, Deputy Deering, I acknowledge the fact that the Senator manages to find me no matter where I go in Ireland and to advocate on behalf of her constituents.

I will hunt the Minister down.

I met her last when I was on a family day out at the Tinahely Show. She was there with her troops in hand to lobby me and advocate on behalf of her constituents. I thank her for the effective way she does that. I will follow up seriously on the issues she raised related to the Holy Angels centre. I know it is an important issue for her and she has a sincere interest in it. I will also be happy to work with her and colleagues on the women’s refuge for Carlow. I ask her to keep in touch with me on these matters.

I am working my way through my notes. I thank Senator Coffey for his comments on the national children’s hospital. I am delighted we are making so much progress on delivering health infrastructure for Waterford, be it the primary care centres either delivered or planned for Waterford city, Dungarvan, Carrick-on-Suir, Ferrybank or Lismore, or the hospice in Waterford that will open in 2020, in respect of which the Senator and I met the HSE and provided surety of funding so that it can get on with recruiting.

I know the issue of 24-7 cardiac care is a very sensitive and serious one in Waterford and the south east. I get that. A national review of those services is under way and we will be led by that. The Senator is right in saying that 24-7 cardiac care cannot be provided in the area without having a second cath lab. He and I took the decision to go ahead and provide that infrastructure. I hope the planning application for it will go in quickly. We have had the mobile cath lab there in the past to try to make progress. The Senator and I will meet the HSE on this again in about two weeks to check progress.

The new emergency department in University Hospital Waterford is another example of investment by the Government. The Dunmore wing will not just see additional space but a better level of care in terms of single rooms for patients in the Waterford region. I thank the Senator for his advocacy on behalf of people in Waterford and the south east and we will continue to work together to try to progress a number of those issues.

I thank my colleague Senator Lawlor for his work regarding Naas hospital. I agree with him on the endoscopy unit. With respect to the express care clinic and any partnerships that can happen, I have no role in service level agreements and the likes but I like the idea of people partnering and collaborating. The extra home care hours will make a real difference. We have worked together on that issue. With the provision of one million extra home care hours in 2020, we will start to see reductions in the length of time people have to wait. I was delighted to visit the Little Way Cancer Support Centre in Clane with the Senator and we can see what funding the HSE can provide as part of its 2020 service plan.

I thank Senator Boyhan for his kind comments. Being the Minister for Health is a difficult job but every day we get notes and letters from people around the country who talk about the good experience they had in the health service, so there is good and bad in that respect. We need to keep on working to fix the bad but recognising that not everything is bad. I thank the Senator for his leadership on the National Rehabilitation Hospital. I was delighted to be out there with the Taoiseach recently to see phase 1 almost completed. We want to push on with phase 2. We will keep in touch in that regard.

Senator Buttimer is right that if we want to fix health, we need a long-term reform plan. We have worked very hard in a minority Government with parties across the Dáil and the Seanad to see if we can agree a plan. We have never done this before. We now have a plan on which we have all agreed, even if the Minister or the Government changes, God forbid. That has provided certainty to people working in the health service. It is not my plan to be replaced by some shiny plan by a new Minister. It is one plan called Sláintecare that we have all said we will deliver. That really will make a difference.

I acknowledge to Senator Noone that major progress that has been made in Beaumont Hospital in terms of trolley numbers. We all remember it used to pose difficulties in terms of trolley numbers. It still has its pressures but we have seen major progress in terms of access. I thank the dedicated staff there. They need a new emergency department. We need the cystic fibrosis unit there. We are delivering for cystic fibrosis communities, whether through new medication like Orkambi, the new model of care we launched very recently, or these new facilities. I will keep the Senator updated on the timeline for that and for the ICU radiation oncology centre.

I note a number of Members from the mid-west are present. Senator Kieran O’Donnell is rightly constantly on my case regarding the need to support the Limerick hospital. I want to see the installation of a second MRI scanner there. I have met officials from the National Treatment Purchase Fund, NTPF, the HSE and my Department to see how best to make that happen. We have provided additional funding for transitional care, fair deal care and home care for this winter. I hope that will help the region. Most importantly, we will deliver 150 extra beds for Limerick. Work on a 60-bed unit in the hospital is under way. I made an unannounced visit to see that work. That unit will open next year. We have 90 more beds provided for in the capital plan. We are providing 150 beds that the people of the mid-west were promised years ago that nobody ever bothered delivering, but we are delivering them. I know they would like them today, as we all would, but we now have the funding to get on and deliver that.

Senator Coffey raised the issue of the Touching Hearts facility for children with physical and intellectual disabilities. I would be very happy to meet that group with the Senator and see if we can progress it. I am very much in admiration of the work it is doing in terms of the funding for a new facility on the grounds of St. Otteran’s Hospital. I would be delighted to convene a meeting for the Senator with that group in the coming weeks and see if we can work together on it. I thank the Seanad for providing me with this opportunity to update the Members.