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Tuesday, 21 Jun 2005

Priority Questions.

Health Services.

Questions (30)

Liam Twomey

Question:

51 Dr. Twomey asked the Tánaiste and Minister for Health and Children the number of services (details supplied) for the elderly, that were promised in the national health strategy 2001, which have been delivered since 2001; and if she will make a statement on the matter. [21184/05]

View answer

Oral answers (8 contributions) (Question to Minister for Health)

The national health strategy, Quality and Fairness: A Health System for You, was launched in 2001 by the former Minister for Health and Children, Deputy Martin. The strategy is centred on a whole system approach to tackling health in Ireland and goes beyond the traditional concept of health services. It is about developing a system in which best health and social wellbeing are valued and supported. The strategy sets out a blueprint to guide policy makers and service providers in the planning and delivery of health services over a seven to ten-year period. It sets national goals for better health for everyone, fair access, responsive and appropriate care delivery and high performance.

There have been many reforms to our health services since the publication of the strategy, most notably the enactment of the Health Act 2004 which transferred responsibility for the management and delivery of health and personal social services to the Health Service Executive. The strategy outlined a number of action points regarding services for older people which the executive continues to implement. The Department has requested the parliamentary affairs division of the executive to arrange to have this matter investigated and to have details of the specific services for older people being delivered now to be collated and to reply directly to the Deputy.

I would like to highlight a number of developments since the publication of the strategy. Additional revenue funding of approximately €121 million was allocated for services for older people between 2002 and 2004. Some €15.228 million in additional funding has been allocated for services for older people this year. That money is being spent on a variety of services, such as nursing home subventions, home care grants, elder abuse and the home help service. Following the publication of the O'Shea report on the nursing home subvention scheme, a working group of all stakeholders was established by the Department to review the scheme's operation and administration. The review was launched in 2003, at the same time as the report of the Department of Social and Family Affairs on the financing of long-term care.

An interdepartmental group comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs and chaired by the Department of the Taoiseach was established in January 2005 to identify the policy options for a financially sustainable system of long-term care. The group is due to report to the Tánaiste and the Minister for Social and Family Affairs this summer. Home care grant schemes have been piloted in a number of areas as an alternative to long-term residential care, to assist older people living at home in the community. Older people being discharged from the acute hospital system and those living in the community are being targeted under the schemes. Funding of €2 million has been allocated to the Health Service Executive for the scheme this year.

The ten-point action plan aimed at improving the delivery of accident and emergency services, which was announced by the Tánaiste, is being implemented at present. Additional revenue funding of €70 million has been made available to the Health Service Executive in 2005 for the initiatives, which include measures to facilitate the discharge of patients from acute hospital beds to a more appropriate setting.

Additional information not given on the floor of the House.

There are three specific proposals relating to services for older people in the plan. An additional 500 older people will receive intermediate care for up to six weeks in the private sector. Some 100 high-dependency patients will be transferred from acute hospitals to private nursing home care. The home care package scheme will be expanded to support 500 additional older people who have been discharged from the acute hospital sector to their own homes.

I will remind the Minister of State of the kind of details I was seeking when I tabled this question. I wanted to know how many of the promised 600 additional day hospital beds were provided. It was planned to provide such beds in facilities offering specialist services to those affected by falls, osteoporosis, fractures, Parkinson's disease, strokes, heart failure and incontinence. Have the promised 1,370 additional assessment and rehabilitation beds been put in place? How many of the planned 7,000 day care places for the elderly have been provided? What has happened to the Government's intention, as outlined in the strategy, to establish 800 places each year in additional extended care and community nursing units? It is not unreasonable, almost four years after the publication of the strategy, to want to know how many of the places in question have been put in place in the health care system.

What is happening in respect of long-term beds? I tabled a question six months ago looking for information about the number of long-stay beds in public nursing homes under the control of each of the six HSE subdivisions. I learned that the number of such beds is decreasing in each of the subdivisions which bothered to reply. I did not receive a response from some of the subdivisions to my parliamentary question.

Do I understand correctly from the Minister of State's reply that the Government did not initiate a review of its policy for the care of the elderly until recently, even though such a review was promised in the health strategy? Is it the case that no policy will be in place until the review has been completed? Can the Minister of State explain why just 5% of people in this jurisdiction who suffer strokes have access to rehabilitation beds, according to the Irish Heart Foundation, when 70% of people in Northern Ireland enjoy such access in such circumstances? I would like the Minister of State to tell me why many of the statistics relating to care beds are terrible. We have heard many announcements of what is planned.

We are running out of time for this question.

I would like to get answers to the questions I have asked. We all hear about spin, but——

I suggest that the Deputy submit a question.

I am looking for an answer to the clear question I originally submitted. The former Minister for Health and Children, Deputy Martin, and the Minister of State, Deputy Callely, spent two years discussing the planned provision of 850 community beds. Now it has gone into a puff of wind.

As I have said, the 2001 health strategy outlined a number of measures which could be taken to improve services for older people. The Government has implemented a number of the strategies. The HSE will continue to implement the strategies and to make the improvements which have been commenced. I have given details of the finances which have been made available to support the measures in question. The Department has contacted the parliamentary affairs division of the HSE to get the specific figures sought by Deputy Twomey.

When the Minister of State writes to the HSE, he should ask it to reply promptly to the questions asked by Deputies. I refer to questions which have been submitted.

Cystic Fibrosis Incidence.

Questions (31)

Liz McManus

Question:

52 Ms McManus asked the Tánaiste and Minister for Health and Children the steps she proposes to take to deal with the fact that Ireland has the highest incidence of cystic fibrosis in the world and, as highlighted by the Pollock report, dangerously inadequate staffing levels for the treatment of cystic fibrosis, which fall below internationally accepted norms, as well as the gross underfunding of isolation facilities, which leave patients at risk of cross-infection; and if she will make a statement on the matter. [21025/05]

View answer

Oral answers (5 contributions) (Question to Minister for Health)

I have seen the report that the Cystic Fibrosis Association of Ireland commissioned from Dr. Ronnie Pollock. The report confirms that Ireland has the highest incidence of cystic fibrosis in the world. It reviews existing hospital services for people with cystic fibrosis in the context of accepted international standards and concludes that the services available for such people are not of the required standard. The report includes an assessment of need for current and future cystic fibrosis patients. It makes recommendations about the numbers and categories of staff which are appropriate for a modern and multidisciplinary cystic fibrosis service.

The Health Service Executive established a working group following the publication of the report, at the request of the Cystic Fibrosis Association of Ireland. The working group is reviewing the configuration and delivery of services to persons with cystic fibrosis, in hospitals and in the community. The working group will make recommendations about the reconfiguration, improvement and development of such services. The multidisciplinary working group, which includes representation from the Cystic Fibrosis Association of Ireland, held its first meeting in early April. I understand that it hopes to complete its work in the next few months.

The Pollock report is one of a number of reports about cystic fibrosis services being considered by the working group. The working group's endeavours will result in an agreed proposal for the development and reconfiguration of services for cystic fibrosis patients in Ireland. I will be glad to meet representatives of the Cystic Fibrosis Association of Ireland and the Health Service Executive to discuss the development and reconfiguration of services for persons with cystic fibrosis.

I welcome the Tánaiste's agreement to meet representatives of the Cystic Fibrosis Association of Ireland. They have sought such a meeting for some time, but have been unable to extract a commitment to that effect from the Tánaiste. I look forward to the meeting.

Having read the Pollock report, does the Tánaiste accept that conditions are so severe and acute that it is not enough to establish a working group to put in place the short-term measures which are needed? She is simply not facing up to her responsibilities in this regard. Dr. Pollock has warned that the conditions in St. Vincent's Hospital, which is this country's major cystic fibrosis centre, are so acute that there is a serious risk of cross-infection from virulent organisms. If such an outbreak arises, it might result in litigation similar to that associated with the hepatitis C infection scandal. Such a warning deserves a response from the Tánaiste. She should not hive off her responsibilities in this regard to a working group that might produce a report or a national plan at some point in the future that could be months or years away. We face a serious risk in the meantime. Acute problems such as insufficient staffing, gross overcrowding and a lack of isolation, protection and safeguards are being encountered in St. Vincent's Hospital, where most cases of cystic fibrosis are dealt with. What is the Tánaiste doing to relieve such risks and pressures?

I have met the CEO of the Cystic Fibrosis Association of Ireland as part of my dealings with another group. I would be more than happy to meet other representatives of the association. The Department of Health and Children receives approximately 600 letters, including many invitations, every four days. I assure Deputy McManus that I would be happy to meet representatives of the Cystic Fibrosis Association of Ireland and any other group. The working group to which I referred in my response was established at the request of the association. Some €300,000 has been made available to St. Vincent's Hospital for minor works. The hospital authorities are making new facilities available. I have allocated over €42 million under this year's capital programme for the purchase of the equipment needed at the new hospital building to which St. Vincent's Hospital will move as soon as possible.

I share the Deputy's view on this matter. The working group will need to consider the reconfiguration of services, which are far too disparate at present. Six different areas are covered at the moment. I will not give details of the plans to bring together the facilities currently offered at Beaumont Hospital and Temple Street Children's University Hospital. There is a need for a specific group to sit down to work out how to bring the manpower and facilities together. The €300,000 that has been allocated to St. Vincent's Hospital will facilitate the appointment of a locum consultant. The working group is anxious for that appointment to be made. While some resources have been made available, I agree that we have to do more. I hope we will see significant improvements at St. Vincent's Hospital, which is the national centre in this field, when the new hospital building is in operation and after some further decisions have been made later this year.

When the Minister meets the association, will she be in a position to say to the family members of those who suffer from cystic fibrosis that the gross risk of infection is being dealt with, that the provision of care at St. Vincent's Hospital will meet the best standards and within what timeframe? It is very easy to talk about working groups being set up to deal with national plans but commitments need to be made on consultant cover at the hospital. I understand that when the consultant goes on holiday, there is no one to cover the position, which is extraordinary. What timeframe is the Minister talking about in terms of dealing with the acute problems at St. Vincent's Hospital? When can people be secure in the knowledge that their family members will be in safe conditions and will be cared for with sufficient staffing to meet their needs, regardless of the time of year? What timeframe is the Minister talking about?

This year. The money was provided to recruit additional staff, including a locum consultant, a physiotherapist and other nurse specialists, and also to provide additional bathroom facilities to avoid the infection issues to which the Deputy referred. Together with what is currently happening, additional space is being made available at St. Vincent's Hospital for cystic fibrosis patients. This is happening as we speak.

Hospital Services.

Questions (32)

Caoimhghín Ó Caoláin

Question:

53 Caoimhghín Ó Caoláin asked the Tánaiste and Minister for Health and Children the funding for capital projects for acute hospitals she has approved since she took office; the funding for capital projects that is proposed for the remainder of 2005, including projects in Monaghan General Hospital and Cavan General Hospital; and if she will make a statement on the matter. [21185/05]

View answer

Oral answers (9 contributions) (Question to Minister for Health)

The Deputy will appreciate that, on taking up office at the end of September 2004, the bulk of the capital programme for that year had already been committed. This included prior approvals under the multi-annual health capital programme to progress major developments in the acute hospital sector. In addition, significant investment had already been approved earlier in 2004 in respect of minor capital works in acute hospitals throughout the country.

Notwithstanding the above, there remained some flexibility in regard to further capital approvals during the latter months of last year. In that time, a number of approvals issued in individual cases that ranged, for example, from €5 million approved for a new integrated imaging management system for St. James's Hospital, Dublin, to €660,000 for Waterford ambulance station. The health sector drew down all capital funding available in 2004 and funding for capital projects in the acute sector for that year exceeded €320 million.

The Health Act 2004 provided for the Health Service Executive to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for progressing the bulk of the capital programme. Capital funding for the health service is now largely provided through the Health Service Executive in line with the capital investment framework. This amounts to €564 million in 2005, of which in excess of €250 million will be directed towards the acute hospital sector.

I am pleased to inform the House that I have written to the HSE to convey my agreement to allow for the progression of its capital programme in 2005. The capital provision for my Department in the current year amounts to €20 million. This relates directly to funding for a small number of agencies such as BreastCheck, the Health Research Board, the Health Information and Quality Authority and the Adoption Board.

In regard to the two hospitals referred to by Deputy Ó Caoláin, I can confirm that the capital investment programme makes provision for particular works to be advanced during this year. These projects are currently at planning stage and include the upgrade of existing ward accommodation in Monaghan General Hospital and the fit-out of existing space to provide for an additional 25 bed ward and a fourth operating theatre in Cavan General Hospital.

At this stage, one almost knows off by heart the section in the reply referring to the HSE. It is the standard reply we get to all parliamentary questions submitted on health-related issues.

Does the Minister recall that in September last year, just before her predecessor, Deputy Martin, left office, following a meeting with representatives of the North Eastern Health Board, he agreed to progress as a matter of urgency a range of measures for Cavan General Hospital and Monaghan General Hospital? Does she recall also that some, but not all, of the commitments of the Minister, Deputy Martin, were repeated in her reply to a Dáil question from this Deputy on 12 October? I understand some of the commitments have been fulfilled, which is welcome. However, I want to ask the Minister about the outstanding commitments. First, there were to be ten additional day beds at Monaghan General Hospital, which have not materialised. This is a cause of great concern to staff and patients. Why have these extra beds not been delivered? When will they be delivered?

In a statement following the September meeting, the former Minister, Deputy Martin, promised to provide a CAT scan facility at Monaghan General Hospital. The Minister omitted to mention this in her reply in October. I would like her to address the fact this did not follow through between the departure of the former Minister, Deputy Martin, and her taking up office. What has become of that commitment? When making further inquiries recently in regard to this matter, a staff member stated that the lack of a CAT scan facility is crucifying the hospital. This is the reality with which the staff is dealing. Is the Minister aware that an average of six patients per day, and sometimes more, many of them on ventilators, are brought by ambulance or transported by whatever means to Cavan for CAT scans? Nurses must accompany these patients, which means the complement of nurses available at Monaghan General Hospital is severely reduced on a daily basis where there is already a shortage of nursing staff. Will the Minister commit to provide a CAT scan facility, as promised last September?

Finally, the 19 additional beds at Cavan also committed to, and followed through in the Minister's statement in October, have not been provided. When will that commitment be delivered on?

The Deputy will be aware that some of the works at Monaghan General Hospital have been completed, therefore, there is a gap between the approval of funding for capital infrastructure and the use of whatever improvements take place. I must come back to the Deputy on the CAT scan question. There is no CAT scan facility in Dundalk which has a higher number of patients who travel to Drogheda. I do not know whether it is feasible for every hospital in the country to have a CAT scan facility. There are significant revenue implications in terms of staff, including radiographers and others, for a CAT scan facility. I am not in a position to comment on whether a volume of six per day is realistic. Even though it may be difficult and traumatic for the individuals involved, CAT scans are expensive. It is intended that Cavan and Monaghan general hospitals will operate as a single hospital on two sites. Because of the population in the catchment area and other factors, it is not feasible that they can operate totally independently of each other as fully functioning hospitals. There have been many discussions with the Deputy on this matter.

The commitments made last September and October are being honoured. The capital funding necessary to make these commitments a reality has been put in place. Presumably it is a question of staffing to ensure the 25 beds in Monaghan General Hospital are equipped.

On the larger emergency room to operate on a 24 hour, seven day, basis, I understand completion is expected within the next two weeks. I hope this proves to be the case and that it will be operable as soon as possible. For the Minister to make comparisons between the journey from Dundalk to Drogheda with that from Monaghan to Cavan——

The Deputy must be brief as we have exceeded the time limit.

I am being brief. One is talking about two different realities for patients on ventilators travelling for CAT scans. The Minister should make no mistake about it, there is absolutely no comparison whatsoever. It is imperative for the patients concerned to have a CAT scan facility. It is worrying that she is advising us that she has no such knowledge of the CAT scan facility proposal. I ask her to re-inform herself of the commitment of the former Minister for Health and Children, Deputy Martin, and ensure it is re-affirmed by her and delivered at the earliest opportunity.

I tabled a parliamentary question on women-centred services at Monaghan General Hospital on 10 May, which was referred to the HSE at some time, but I only received a reply yesterday, six weeks after the question was tabled. Why was there such a delay? Will the Minister answer the part of the question not addressed in the reply I received yesterday, that is, the plans for further development in women-centred services at Monaghan General Hospital, which must include the recommencement of maternity services?

The HSE is putting in place a parliamentary affairs division. The functions of the health boards only transferred to the HSE on 15 June. By the autumn, a fully resourced and well functioning division will be in place, which will provide speedy responses to parliamentarians. This was sought and discussed during the passage of the relevant legislation.

Four hospitals are located in Drogheda, Dundalk, Monaghan and Cavan, which is an area with a relatively small population, and two of them do not have CAT scanners. I accept there are issues when people have to travel but the jury is out on whether it is feasible to provide a CAT scan facility, not just the equipment, which costs between €1 million and €2 million, but the staff to ensure it functions properly and the number of patients to use it. I am not in a position to make a commitment nor am I in a position to say that maternity services will be restored at Monaghan General Hospital.

Will the Minister outline the plans for development of women-centred services at the hospital?

I call Question No. 55 because Deputy Neville is not present for Question No. 54.

Question No. 54 answered after QuestionNo. 55.

Nursing Homes.

Questions (33)

John Gormley

Question:

55 Mr. Gormley asked the Tánaiste and Minister for Health and Children if she will respond to criticisms from nursing home operators that her Department has delayed more than four months in responding to a request for service level agreements for contract beds and that no staff level rules exist for nursing homes even following such high profile cases as Rostrevor and Leas Cross; and if she will make a statement on the matter. [20980/05]

View answer

Oral answers (10 contributions) (Question to Minister for Health)

The issue of a service level agreement for the supply of contract beds was raised by representatives of the Irish Nursing Homes Organisation, INHO, at a meeting with me in February 2005. The Department pursued this issue with the HSE and was informed that the INHO had been in discussion with the former Eastern Regional Health Authority for some time on the development of service level agreements in the eastern region. The HSE has confirmed a response has issued to the INHO enclosing a draft service level agreement and addressing the issues raised in this connection by the organisation. The INHO has acknowledged receipt of this response and has undertaken to revert to the HSE on the matter.

The staff levels for nursing homes are set out in the Nursing Homes Regulations 1993. However, having regard to the level of public concern about the registration and inspection of the nursing home sector, it is imperative immediate action is taken to ensure current systems and processes are as robust as they can be within the context of the current regulations. Responsibility for the inspection and registration of the nursing home sector was assigned to the HSE national care group manager, older people's services, from 15 June 2005. Steps are being taken to evaluate current processes and to agree and oversee the implementation of a national standardised inspection process. A progress report on this review will be available by 5 September 2005. Recommendations arising from this process in respect of the amendment of legislation or regulation will be addressed in consultation with the Department of Health and Children.

The social services inspectorate was established in April 1999, initially on an administrative basis. Regulations to establish the inspectorate on a statutory basis and legislation to extend its remit will be introduced in both Houses later this year. The inspectorate will be charged with the inspection of the public and private nursing home sectors and with the setting of standards against which these homes will be inspected. Establishing the inspectorate on a statutory basis will strengthen its role and will provide it with the necessary independence in the performance of its functions. It will also serve to increase public confidence in State and voluntary social services. Work is in progress in the Department to allow the necessary legislative requirements to be put in place as soon as possible.

The health authorities have confirmed they wish to close Leas Cross nursing home. Is it not the case the Minister of State, the Department, the former health boards and the HSE knew about the appalling conditions in which elderly people lived in nursing homes but did nothing? Does the Minister of State agree that to allow the most vulnerable people in our society to endure such torture was shameful? Does he further agree his inaction was absolutely shameful?

Will he confirm 33 nursing homes received adverse inspection reports? Will he name them? Will he take the same action against them as was taken against Leas Cross nursing home? Does he agree a geriatrician must be deployed in these homes and reports and action are needed so that the same scenario does not occur with people suffering? When will the new legislation and regulations be introduced? The Taoiseach made promises and gave undertakings. When will action be taken?

It it totally incorrect to say we did nothing. Communication has been ongoing with the Leas Cross nursing home for some time and while progress was made, it was not happening quickly enough. We took action and sent in a new management team to rectify matters in the home. Unfortunately, it was not possible to provide the necessary changes that would have ensured the patients received appropriate care in the proper environment. In view of that, we decided to take further action and the HSE released a statement yesterday confirming the action we took.

The system in place for inspecting nursing homes was not functioning properly and did not achieve the desired result. On foot of that, we decided to take further action and will bring forward legislation later this year to put an inspectorate in place, which will cover private and public nursing homes.

Will the Minister of State reply to the question about the 33 nursing homes? Will he name them? What does he intend to do about them, given that the Leas Cross scenario applies in many different nursing homes throughout the State? I do not want to depend on "Prime Time" to tell me in a few weeks that there are other cases, I want the Minister of State to take action.

We have taken action and Leas Cross is not the only nursing home in which such action has been taken. The inspectorate has difficulties regarding nursing homes and a number of issues might need to be addressed. Some could be minor while others are severe and critical. I cannot outline the names of all the nursing homes with which the Department has had difficulties in the past.

I do not have the information with me but I can provide the Deputy with that information.

Will the Minister of State give me the names?

I certainly will, that is not a problem. It is not our intention to defend nursing homes which do not provide an acceptable level of care, particularly where the Department has assisted people to move into long-term care. We demand a certain level of care because it is the least they deserve. We will make the necessary changes to ensure older people receive appropriate care in nursing homes.

As we are still on Priority Questions and Deputy Neville has arrived, Question No. 54 may be taken.

Mental Health Services.

Questions (34)

Dan Neville

Question:

54 Mr. Neville asked the Tánaiste and Minister for Health and Children her plans and programmes for the provision of services for persons suffering from eating disorders; if her attention has been drawn to the fact that eating disorders are serious psychiatric illnesses, with a 20% mortality rate; and if she will make a statement on the matter. [21183/05]

View answer

Oral answers (5 contributions) (Question to Minister for Health)

Responsibility for the management and treatment of a person with an eating disorder rests with the individual patient's clinician. However, persons presenting with eating disorders are generally treated through the local psychiatric services. Outpatient psychiatric services are provided from a network of hospitals, health centres, day hospitals and day centres. Where inpatient treatment is deemed necessary, it is provided in the local psychiatric unit or hospital, beds being allocated on the basis of patient need at any particular time. A tertiary referral service for eating disorders is available to public patients in St. Vincent's Hospital, Elm Park, Dublin, where three inpatient beds are designated for this purpose.

An expert group on mental health policy is currently preparing a national policy framework for the further modernisation of the mental health services. The expert group has a number of sub-groups looking at specialist issues in mental health services, including eating disorders. The expert group is expected to report later this year.

There are three main eating disorders — anorexia nervosa, bulimia nervosa and binge eating. In addition, there is another category of eating disorders not otherwise specified which has a high rate of psychiatric and general medical co-morbidity that often conceals, clinically and statistically, the underlying eating disorder or condition. There is little evidence that anorexia nervosa is increasing but there is a perception that cases are presenting at younger ages, sometimes as early as seven or eight years. It is estimated that there are 80 deaths per annum from eating disorders, that is, approximately 20% of the total number of eating disorders referred to the health services. It is also estimated that 60% of eating disorder patients recover while the remaining 20% partially recover.

There are three designated specialist beds for the treatment of eating disorders in the public psychiatric service. These are at St. Vincent's Hospital, Elm Park. There are also two eight bed units in the private sector, one in St. Patrick's Hospital and the other in St. John of God Hospital, Stillorgan. Due to the denial aspect of an eating disorder, it has been difficult to orient patients towards early treatment. It is not unusual to encounter first presentations in the accident and emergency department due to some other medical condition. The issue of early detection, therefore, is important.

There is strong evidence that general practitioners here are ill equipped to deal with eating disorders because of a lack of education in the area. Due to the complexity of eating disorders, inputs are required from many different professional skills delivered by medical, psychological, social work, nursing and dietetic personnel. These can only be provided through full multi-disciplinary teamwork.

I thank the Minister for his comprehensive reply. He dealt with many issues I had intended to raise. When will the report on the mental health services be produced?

Given that 400 people are admitted to hospital each year with eating disorders, does the Minister accept that there should be a specialised service in each regional health service area to deal with this rather than just the three beds in Dublin? The Minister said there are 80 deaths each year or 20% of the eating disorder patients admitted to hospital. That is a significant number of deaths.

Perhaps the Minister will deal with another matter that has concerned me for some time, which is the eating disorder of obesity and the connection or influence it might have on those who have an eating disorder as outlined by Bodywhys. I congratulate Bodywhys on its work. The messages from the obesity campaign, which are important and correct and which I do not seek to criticise, might have an effect on those who have a starvation disorder such as anorexia nervosa or bulimia. The message being conveyed to the people with those conditions is that eating too much is bad. Should the campaign not focus on having healthy eating habits and attitudes rather than on reducing the amount of food one eats? I am concerned there will be an increase in the number of eating disorders as we know them as a result of the message being conveyed about obesity, which is an important matter in itself. There should be balance in how this is dealt with.

With regard to the obesity campaign, my colleague, Deputy Seán Power, is doing a great deal of work in the area of health promotion and promoting positive and proper eating habits. Much of that work is done through the schools and that is only right. It is the best place to get the message across to children. If they get the message at that stage, they will have it for the rest of their lives.

It is a complex matter, as Deputy Neville is well aware, to convey the message of healthy eating while taking account of how that affects people with anorexia nervosa and other eating disorders. The people we are discussing obviously have psychological and psychiatric problems. I will discuss the matter with my colleague, Deputy Seán Power, to ensure that everything we do will encourage positive eating and not have the side effect of adding to the problems of the people mentioned. I understand the point made in this regard by the Deputy.

The Deputy also mentioned the possibility of having eating disorder beds in each of the four HSE areas. That is a good suggestion. It is not acceptable for young people in remote areas, or their parents or guardians, that they should have to travel long distances to get treatment. I will consider that suggestion. However, a sub-group of the expert group is considering this matter and I wish to be guided by that sub-group, as the Deputy would wish to be.

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