Liam Twomey
Ceist:107 Dr. Twomey asked the Minister for Health and Children her plans to publish the report of the interdepartmental working group on long-term care; and if she will make a statement on the matter. [29757/06]
Priority Questions.
Care of the Elderly.
The interdepartmental working group was established to review a number of complex and fundamental policy issues pertaining to long-term care for older people. Some of these issues were the subject of the Mercer report on financing long-term care and the O'Shea review of the nursing home subvention scheme. Following consideration of the group's report, a series of key principles to inform policy was endorsed by the Government and incorporated into the new social partnership agreement, Towards 2016.
These principles include, for example, that there should be one standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised. Sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.
That agreement also notes the steps which have already been taken by the Government to improve services for older people this year, including the special funding package of €150 million announced in budget 2006. Reflecting the new emphasis on home and day care, almost three quarters of this funding is being invested in community care supports, such as home care packages, home helps and day and respite care.
The interdepartmental group has continued to meet to help draw up proposals for a new policy on long-term care based on the principles endorsed by Government and the social partners. I plan to bring proposals to Government as soon as possible. When the Government has finished its consideration, I expect to be in a position to publish the report of the group.
I wish the Minister for Health and Children, Deputy Harney, well for the future. This is her first public appearance since giving up leadership of the Progressive Democrats. It will take a while to get used to addressing her simply as "Minister". Some people might still consider her the real Tánaiste.
On the question of funding long-term care, the problem is that we have been waiting so long for this report. What is the problem? It was part of the health strategy in 2001, and we have had the Mercer and O'Shea reports since 2003. An interdepartmental group has been working with the Cabinet for the past 12 months, yet the Government still has no policy on funding long-term care. The Minister's reply was generic, covering various aspects of funding care of the elderly rather than simply long-term care. There is a sense that the Department is all at sea when it comes to looking after the elderly, and that is why we ask what is going on today.
This morning, at a meeting of the Select Committee on Health and Children, the Minister of State, Deputy Seán Power, brought forward legislation on funding services for the elderly. The legislation was full of holes, and discussion on it was unbelievable. The Bill as presented is essentially incapable of being implemented.
The same is true with regard to protecting the elderly. We now learn that the Health Information and Quality Authority, HIQA, legislation also promised for this session will not arrive until next year. That means we do not have a social services inspectorate to protect elderly patients or any clear Government policy on how to look after elderly patients or fund their long-term care. There is a sense that the Department is totally lost and has no idea what is happening.
When the Minister of State stands up, he cannot speak of "complex and fundamental" problems. They must be very complex and fundamental if, after five years of thinking and talking about them, he cannot formulate even the most basic policy. When he produces one, I hope it is nothing like the legislation he presented to the Select Committee on Health and Children this morning.
This is Question Time, and the Deputy should ask a question.
We deserve to see this report and learn what is happening in this regard. If this is being discussed as part of a partnership approach and nothing is coming from the Oireachtas on Government thinking on funding care of the elderly, that is wrong in itself. Has the Minister of State any idea what is going on?
We have plenty of ideas, and the notion that we are all at sea on this could not be further from the truth. It is obvious that we have given the matter extremely serious consideration and that the entire issue has been through the social partnership process. That is one reason it has been delayed to some degree. However, it gives one an understanding of the priority we have accorded the matter. I stated to the Deputy what extra moneys were provided in last year's budget, particularly for services for older people, and that is having a major impact.
The Deputy mentioned the nursing home subvention scheme that we discussed this morning. People have difficulties, and there are problems regarding the relationship between public and private providers. Several issues were discussed by the group, which has reported to the Government on progress. In turn, the Government has agreed that several principles should inform the next stage of that work. They will include providing an equitable level of State support for residential care, whether it be provided by a public or private facility. We have made a great deal of progress on it, and I hope to report on that within a few weeks.
What we need is progress. We have no social services inspectorate or eligibility legislation, and major problems are being reported daily regarding care of the elderly. If the Minister of State has policy ideas, perhaps he might share them with us. If he has difficulty working them out, Fine Gael will do its best to help him overcome his problems. However, he should share them with the House and not simply the social partners.
We will certainly share our proposals, and if the Deputy has any views or suggestions he wishes to put forward, we will be more than happy to take them on board. He mentioned standards, and it is intended that the Health Bill 2006, whose heads were published for consultation some months ago, should establish the Health Information and Quality Authority. This Bill will also put the social services inspectorate on a statutory basis and will contain provisions to underpin a much more robust inspection system. The chief inspector of social services will be required to monitor against standards set by the Health, Information and Quality Authority for residential services provided to older people, among other categories. We are making considerable progress in the area and providing extra funds to improve existing services.
PPARS Review.
Liz McManus
Ceist:108 Ms McManus asked the Minister for Health and Children the status of the review of PPARS; the reasons it is under review; the reasons the date for completion of this review extends beyond the date of the next general election; the cost of this review; in view of an ongoing review of this project, her views on the call for tenders on the Government’s tenders website for consultants to roll out the PPARS system; and if she will make a statement on the matter. [29760/06]
I have sought the up to date position on PPARS from the Health Service Executive and it has informed me as follows:
The PPARS system is currently used for recording human resource data for 70,000 HSE staff and is used to pay 30,000 staff each week. The HSE's PPARS project review committee has completed its review. Arising from that, the HSE has decided on a set of actions aimed basically at meeting the requirements of the new unified health service with a single management, rather than those of separate health boards working on an IT project together, which is how the PPARS project started in 1995. These actions involve defining precisely the HSE's human resource, payroll and employee services requirements and maximising the efficiency of the project from its current situation.
This plan of action follows an update to the HSE board from the PPARS review committee, which highlighted that while the project is delivering many benefits, some business issues remain to be resolved. These include the major and ongoing changes since 1995 to the business environment in which the project operates; the need to further standardise processing systems and the need to clarify the project's objectives and scope within the new single structure. It is envisaged that this work will take several months to complete and I am anxious for it to be completed as quickly as possible.
The timing of this work has nothing to do with the general election taking place next summer. To suggest or speculate otherwise is wholly without foundation and an injustice to the HSE board and its management. The estimated costs of the work will have to be determined by the project group being established to progress these actions.
The recent request on the Government's e-tender website related to the HSE's request for assistance with the definition of its information and reporting needs to meet its requirements and obligations under the new unified HSE structure. The assistance being requested does not relate to the further roll-out of the PPARS project, the decision on which is being deferred until the necessary work has been completed.
This really is a right old mess. It is now generally accepted in the public mind that we have a tax and waste Government. We have seen the waste of money on e-voting and on PPARS, which already is about €130 million. We find that some 30,000 people are being paid using this system at the moment. Does the Minister yet know how many people are employed by the HSE and what the precise number is? This review follows after a ten-month period of review within the HSE. Why do we need another nine-month review period? I did not create that timescale. The HSE is telling us it will take up to nine months, which takes us beyond the next general election. How much will it cost? Will consultants be employed to carry out this work? At the end of the day what is the benefit in terms of ensuring we have a system, which has already cost the taxpayer enormous sums of money without any significant results?
It seems incredible, after years of PPARS, that the Minister is now reaching a point where a review is to be carried out in the context of a unified system. The HSE is a unified system. We have had a national health executive since 1 January 2005. How is it that at this point we are now facing another review? The Minister will not tell us how much it will cost, but I ask her to say what the budget for it is and whether yet more consultants are to be employed. It seems to me private consultants have made enough money out of this cash cow without shovelling more money at them. Who will do it? How much will it cost? How long will it take? How many people are working within the health service, which is the responsibility of the Minister?
It was decided to pursue this course in 1995. I do not wish to make a political point, but nobody on this side of the House was in office when this decision was made. It has recently come to light that the money was not appropriately spent at the time. There was a system for the 11 different health boards. The HSE employed outside consultants to conduct its internal review, which cost £99,227 for 94 hours consultancy. In light of that review, it was decided it should not be rolled out until it appropriately specifies what it wants for a unified organisation. The HSE pay 30,000 staff using the system and it has the human resource records of about 70,000 staff. In total, the HSE has about 102,000 staff, when hospital staff are included. That figure can vary from time to time.
The Minister has not answered the question. We still do not know how many people are employed. She has not told us how much the review will cost. I am talking about the review and the plan to which the Minister referred. Will she employ consultants to carry out that work? We have already spent money on consultants for the review since last November. I remind the Minister that the only reason PPARS was halted was because Professor Drumm took action.
He appropriately took action. Professor Drumm is the CEO and Accounting Officer of the HSE. I said in my reply that the HSE had gone to tender on this matter, so I cannot speculate on what it will cost until we see the outcome of the tender. Even if we had an idea, we would not want to influence the tender by suggesting what it might be. The roll-out of IT is fundamental to reform of the health system, at both hospital level and in community services. We will have to spend a considerable amount of money updating our technology to deliver the health system that everyone expects.
Public Private Partnerships.
John Gormley
Ceist:109 Mr. Gormley asked the Minister for Health and Children if her attention has been drawn to the background of companies involved in public private partnerships; and if she issatisfied that the taxpayer will receive valuefor money from the co-location projects. [30010/06]
I presume the question refers to allegations published in a number of newspapers regarding a company which has expressed an interest in operating private hospitals on the sites of public hospitals. The company in question has refuted the charges made in the newspaper articles.
The Health Service Executive is currently engaged in a public procurement process for the co-location of private hospitals on the sites of public hospitals. In view of this, I am not in a position to say anything further about any particular company which may be involved in bidding to build a private hospital on the site of a public hospital. However, I assure the House that bids will be subject to a thorough evaluation by the HSE. There will be a rigorous value for money assessment of any proposal and this will take account of the value of the public site and the cost of any tax expenditure. Any transaction will be on a commercial basis and will fully protect the public interest. In addition, there will be full adherence to public procurement law and best practice. This initiative is designed for one purpose, namely, to achieve up to 1,000 additional public beds at less than half the traditional capital cost. I am fully confident it will achieve this objective and our health services will be enhanced as a result.
I thank the Minister for her reply. She has correctly identified the company in question as Triad, one of the bidders for six co-located hospitals and which is also managing the Beacon Hospital. This company is a subsidiary of an American corporation that pleaded guilty to criminal fraud. This hospital chain, Columbia/HCA, paid a total of €1.7 billion to settle US Government fraud charges. Triad is currently under contract to its parent company for services that include patient accounting, which was the nub of the fraud case taken by the US Government against it. Does this information set off alarm bells for the Minister? In light of this information, does the Minister believe that providing massive inducements in the form of giving public land to such American companies is the right way forward? Instead of cutting costs, could they increase inordinately if the same pattern occurs here? Hence, while I am aware the Minister believes us to be closer to Boston than Berlin, do we really wish to Americanise our health system so health becomes a commodity to be traded in the market place? The Minister must realise that health is much more than that. It concerns people's well-being and using the market model may be ill-advised.
Members must be careful not to abuse their privileged rights. The company in question has vehemently denied the Deputy's suggestions. I understand many newspapers, on receiving correspondence from the company, did not continue to report on the story. I am not an advocate for any company. Any company that might be awarded a contract by the Health Service Executive would be obliged to be subjected to a robust due diligence process.
As for co-location, on which another question has been raised, there has been significant expression of interest. On average, there have been approximately six bidders per site, many of which are Irish companies. The entire purpose of that initiative is to provide additional public bed capacity at less than half the cost of using traditional methods. Furthermore, currently the State pays 100% of the capital cost of private beds in public hospitals and staffs them. It pays all the revenue costs while the insurance or self-payers only contribute approximately 45% to 50% of the cost of those beds. From a patient perspective, this does not make sense.
Health care pertains to the provision of high quality services and I do not believe we should have any ideological blinkers as to how that might happen. We have public provision, not-for-profit provision and for-profit provision. For example, the Bon Secours group is a not-for-profit organisation that provides outstanding health care. Hence, it is not the case that we must go exclusively one way or the other. The different methods of funding health services should complement one another provided the criteria are based on quality of service. Quality of service to patients is my only interest.
Does the Minister agree that leaving health care aside, our experience with public private partnerships has been far from rosy and the customer has not benefited? One needs only to consider the toll roads or the M50 and in my constituency, a public private partnership built a so-called state-of-the-art sewage treatment plant. These projects have not gone to plan and are costing the consumer far more than anticipated. Hence, there is no such thing as a free lunch and the idea that public private partnerships can work out cheaper is a myth. The indisputable evidence regarding this company is that it is a spin-off from Columbia/HCA, which was forced to sell some of its hospitals to pay its fraud bill. By 2003, Triad Hospital's parent company, if it can be so described, had paid the United States Department of Justice a total of $1.7 billion, a great deal of money.
Members have already heard references to other projects such as PPARs and I have raised the question of iSoft. We appear to have got off on the wrong foot from the outset. In light of this information, I ask the Minister to remain vigilant. I also ask her to respond to the initial point, namely, that our experience with public private partnerships has not been good.
We have hardly any experience of public private partnerships. We have experience of public projects being constructed by the private sector. Public private partnerships are about transferring the risk from the public to the private sector, thereby allowing taxpayers' money to be used where one might not attract that kind of interest. As I have frequently noted, the idea that we should fund 100% of the capital cost of private beds in public hospitals and subsequently run them does not make any sense from the perspective of patients in the health care system.
I hold no brief for any company. As for the company in question, I understand the HSE has proceeded to expressions of interest and has not yet awarded any tenders for any co-locations. Obviously, a strict due diligence process is required. However, for fairness, I note the company in question has strongly refuted the allegations made by the Deputy.
Medical Inquiries.
Liam Twomey
Ceist:110 Dr. Twomey asked the Minister for Health and Children her views on the report into the death of PJ Walsh in Monaghan Hospital; and if she will make a statement on the matter. [29758/06]
At the outset, I wish to convey again my sincere sympathy to the Walsh family on the death of Mr. Patrick J. Walsh. Following his death in Monaghan General Hospital on 14 October 2005, the Health Service Executive commissioned Mr. Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University, and Professor John Monson, professor of surgery University of Hull, to carry out an independent and external review.
The HSE published the report of the independent inquiry on 7 September. The report details the difficulties that arose in trying to secure Mr. Walsh's transfer from Monaghan to either Our Lady of Lourdes Hospital, Drogheda or Cavan General Hospital. It also exposes a failure in communications between clinicians and hospitals in the region.
The reviewers considered that making the changes would definitively remove the risk of similar clinical incidents occurring again in the region. Since the death of Mr. Walsh, a new protocol for patient transfer has been put in place. It provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda should be granted and processed immediately. The HSE recently established a steering group and a north-east project group to oversee a programme to improve safety and standards across the acute hospital network in the region.
The Teamwork report makes a number of short, medium and long-term recommendations. It concludes that the present system, where five local hospitals deliver acute care to a relatively small population, is exposing patients to increased risks and creating additional professional risks for staff. The report highlights the need to develop a high quality and responsive emergency and planned service, in line with international standards, by developing local services within existing hospitals and other local centres supported by a new regional hospital.
Led by the HSE's National Hospitals Office, a steering group has representation from key stakeholders such as clinicians and primary care providers. The project group is being led by a consultant surgeon from outside the region, Dr. Eilis McGovern. The HSE has given me an assurance that, in progressing the implementation of these reports, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.
The events leading up to the death of Mr. Walsh were tragic, but what is emerging from the report into his death is equally damning of the Government. The report states that the events that led to Mr. Walsh's death still occur daily in the Monaghan Hospital region. The report also states that the consistent theme that emerged was that neither Cavan Hospital nor Our Lady of Lourdes Hospital has sufficient capacity to deal with current patient demands.
On the basis of those findings, I would like the Minister to answer a number of questions. As matters stand, who is responsible for highlighting new or existing protocols? A failure in making known to people the existing protocols contributed to Mr. Walsh's death. Does the Minister know who is responsible for making new or existing protocols known to all staff working in all these hospitals in the area?
Does the Minister know if all the acute hospitals in the country have a programme of clinical governance and who is responsible for clinical governance? Is Professor Drumm ultimately responsible for making sure every hospital has a programme of clinical governance in place to ensure that such an incident will not occur in another hospital? It is important for the Minister to explain to the House whether such a programme is ongoing.
I have two further concerns. On the basis of the Teamwork report, Our Lady of Lourdes Hospital is expected to take all critically ill patients from the north east, but it has received no additional funding to care for these additional very sick patients. It is fine for the Minister to say what she said in her reply and we all fully sympathise with the family of Mr. Walsh, but as a member of the Government, the Minister is doing nothing to stop a similar incident occurring, unless she ensures that additional funding is made available to Our Lady of Lourdes Hospital.
Another matter of concern that reached my attention is that the proposed extension of Our Lady of Lourdes Hospital under the capital building programme has been suspended.
The Deputy should confine himself to asking questions and not make statements.
I ask the Minister if that is true. Is she aware the capital building project for Our Lady of Lourdes Hospital has been put on hold? Talking about a new hospital for the north east is along the lines of building castles in the sky, when there are currently huge deficiencies in services in the north east. Talking about doing something for them in 15 years' time is absolute nonsense, when there are problems now in Our Lady of Lourdes Hospital and Cavan General Hospital.
I will put a very important question to the Minister. I do not know if she is aware that Cavan General Hospital is subject to an absolute obligation to receive surgical transfers from Monaghan General Hospital. A problem which arose in the case of the death of Mr. Walsh was that nobody took responsibility for his transfer. If Cavan General Hospital is told it must now take every single patient from Monaghan, does the Minister know if restrictions still apply to surgeons in Cavan which preclude them from carrying out major GI surgery? There is no point in a patient having an absolute right to be transferred from Monaghan to Cavan when, upon arrival, he or she will not be operated on and no intensive care services will be available for them. That is the reality on the ground and those are the key questions I would like the Minister to answer.
A new protocol for patient transfer has been put in place. It is the responsibility of the HSE to oversee what happens in the different hospitals in the region. We already know that approximately half of the patients in the region attend not local hospitals but hospitals in Dublin. That is the largest ratio of all the regions in the country for people attending Dublin hospitals rather than those in their own region.
They have no choice.
Then close them.
They have no choice, tell the truth.
Cavan General Hospital has the same number of beds as Mullingar General Hospital. When comparing inpatient activity, day care or accident and emergency activity, there is a huge difference between what is done in Cavan and what is done in Mullingar, and I have said so on the public record on a number of occasions. The authorities in Cavan have visited Mullingar and I welcome that. It is good that hospitals work with each other to improve performance.
The report was produced by clinicians, not politicians, administrators or bureaucrats. Clinicians made the recommendations therein. One of the most worrying aspects of the report was that attention was drawn to a situation in the region where interpersonal relationships among clinicians interfere with patient care.
That is not new. We did not need a report for that.
I only refer to what is in the report. I am not inventing it. It is a huge concern to me as Minister for Health and Children.
It has been known for years.
It is of huge concern if interpersonal relationships interfere with patient safety and care. That is why, as a matter of priority, the HSE has appointed a group, headed by Dr. Eilis McGovern, who is a well-known heart surgeon and well-respected clinician, to oversee the implementation of the recommendations for the region. Clearly there will be difficulties implementing the recommendations because change is never easy but we will ensure that what happens at each hospital is founded on patient safety. Whatever can safely be done in a particular hospital will continue to be done.
There are issues around clinical governance nationally but normally it is the responsibility of the medical board of a hospital. In the context of a new contract of employment we want to move to the clinical directorate model, currently operating very successfully in St James's Hospital in Dublin and representing best practice norms around the world. On foot of the Harding-Clark report the Department of Health and Children has done some work on these issues. There are still huge deficiencies in what happens on the ground and legislation may be necessary for the future.
We must move on to Question No. 111.
Very little of what I asked was answered by the Minister.
I ask the Deputy to be brief.
The question related to matters over which the Minister has control, namely, the current day-to-day spending increase for Our Lady of Lourdes Hospital, which is to look after critically ill patients, and whether the capital project for Our Lady of Lourdes Hospital has been stopped. When the Minister said there were problems in Cavan and Mullingar did she, on seeing such glaring problems, make herself aware as to the reason for them? What are those problems? I have an idea why they exist but if I were Minister for Health and Children, I would try to do something about them rather than just highlight them as though I were a disinterested party. If she knows what the problems are between those two hospitals, she should inform the House why they exist and explain the difference between Cavan and Mullingar so that we can do something about it, not just point out that there is a difference.
One of the problems with Cavan General Hospital is that the surgeons are restricted in the work they can do. There is no point sending seriously ill people to Cavan General Hospital if the surgeons there cannot operate on them. Having a protocol insisting that every surgical patient from Monaghan goes to Cavan is nonsensical. It does not take a medical professional, administrator or bureaucrat to work that out. It is daft.
I have substantially increased the capital funding available to the Health Service Executive this year. Once I approve a capital programme, I do not try to find out how it is spent every week. In light of the Teamwork report and given the decision made and endorsed by the Government that we will have a new, state-of-the-art hospital for the region, any decisions made about spending on capital projects or otherwise should fit in with that overall approach. The region merits and has long deserved a state-of-the-art hospital. In particular, the urgent developments that need to take place in Monaghan, Cavan, Drogheda and Navan will happen and the HSE will ensure they do so quickly. Professor Brendan Drumm and his team are committed to making that happen quickly.
When we examine budgets and bed numbers in Mullingar and Cavan hospitals, the outputs are different. This may be because of some of the issues raised by Deputy Twomey. However, throughout the country we see wide variations and the purpose of reform is to try to have every hospital performing to the highest level of efficiency and effectiveness. Mr. John O'Brien and his team at the National Hospitals Office are working hospital by hospital to try to bring that about. The more hospitals learn from each other and work together, the sooner we will achieve that target.
Hospitals Building Programme.
Liz McManus
Ceist:111 Ms McManus asked the Minister for Health and Children her views on an independent, international, expert peer review of the decision to site the new children’s hospital on the campus of the Mater Hospital; her further views on the fact that a commitment was given to the Mater Hospital that a new children’s hospital would be developed on its campus; her views on whether this throws serious doubts over the independent, non-political nature of the decision; if she or the Health Service Executive received any submission from Our Lady’s Hospital for Sick Children, Crumlin on this issue; if so, the contents of this submission and her response; and if she will make a statement on the matter. [29761/06]
A review of tertiary paediatric services carried out by McKinsey & Company on behalf of the Health Service Executive recommended the establishment of a single tertiary paediatric hospital in Dublin, co-located with a leading adult academic hospital. Subsequently, a joint HSE-Department of Health and Children task group was established to advise on the optimum location of the proposed new hospital. The task group's report was submitted to the board of the HSE on 1 June last, and its recommendation that the new paediatric hospital be developed as an independent hospital on a site to be made available by the Mater Hospital was endorsed by the board. At its meeting on 8 June, the Government also strongly endorsed the recommendation.
Neither the Taoiseach, I nor any other members of the Government had meetings or discussions with the task group during the course of its work. I am satisfied that the task group undertook a rigorous and robust examination of the key issues in arriving at its recommendation. To suggest that the decision was influenced by political considerations is an affront to the integrity of the members of the group.
A joint HSE-Department of Health and Children transition group has since been established to advance the development of the new hospital. Among the key items to be addressed are the definition of a high level framework brief for the new hospital and the determination of the scope and location of the urgent care centres. I understand that the group intends to retain outside expertise to assist it in its work.
I recently met representatives from Our Lady's Hospital for Sick Children and was informed that the hospital has commissioned its own report on the issues relating to the location of the national paediatric hospital. I understand that the joint transition group received a copy of the report in recent days and that it is being examined. A further meeting with the Crumlin representatives will take place when this process is complete. The decision about the site for the new hospital has now been made and it is essential that all those involved focus on implementing that decision. This is in the best interests of the children of this country.
Does the Minister accept that there is a concern that the decision to locate the hospital on this site was politically influenced and that having looked at the site, there are serious questions over it? For example, Our Lady's Hospital for Sick Children would transfer its services from a 15-acre site to one restricted to less than four acres to include all paediatric services. The deal offered to the hospital will be on a flying leasehold under which the hospital would have no ownership or charge of anything underground, including the carparking. Access is difficult and serious concerns have been raised in the report from Our Lady's Hospital for Sick Children, which I thought the Minister would have made it her business to see.
Is the Minister saying she has not seen the report, or that neither she nor the Health Service Executive has received it?
I thought I said I had received it in the past few days.
Has the Minister had a chance to look at it?
I have read only the summary. I intend to read it over the next few days. It is a technical report and I am not a building expert who knows about land size and so on but I will read it.
It will be important for the Minister to comment on it because the indications are that there are serious technical problems in terms of the leasehold, the site, access and services. Is the Minister stating that Government policy is to have only one hospital and that the idea of two hospitals, north and south of the Liffey, is not, and will not be, Government policy?
Before I became Minister for Health and Children I had given little consideration to paediatric services and knew little about them. Since then, virtually every paediatrician I met in this city and around the country said we should bring the services together and have a state-of-the-art hospital. We were planning to build a new hospital in Crumlin, probably on-site, and a new hospital for Temple Street Children's Hospital, and we have facilities in Beaumont, Tallaght and St. James's hospitals.
McKinsey was commissioned to examine best practice around the world. It studied approximately 17 countries and concluded the child population here merited only one tertiary facility bringing all the expertise together. Furthermore, it said that because of the relatively small number of children who would require certain specialists these would have to be shared with adult services.
When the McKinsey report was published last Christmas everybody signed up to it. Our Lady's Hospital for Sick Children, Temple Street Children's Hospital and Tallaght Hospital all regarded it as a good report and were optimistic. The difficulty arose when the site selection began. Several sites were examined. I am not an expert in construction or hospitals but I have visited hospitals in the United States which are on small sites. There are several in Manhattan and I recently saw one in Toronto.
Although Our Lady's Hospital for Sick Children in Crumlin is on a large site it does not fill the site. Obviously the site must accommodate the hospital but the most important factor is what happens in the hospital. I hope everyone will work to make the hospital a state-of-the-art, world class facility for children.
The intention is to have one hospital for the country, not just Dublin. Urgent care centres will be provided in at least one, if not more locations, and the group has been asked to examine how many of these centres are required. Thankfully, these deal with 95% of the reasons children go to hospital in the first instance.
All those who tendered to have the hospital co-located, including St. James's, St. Vincent's, Beaumont, Tallaght and the Mater hospitals, offered sites. That was the basis on which the decision was made and no problems arose about the site. No ethos issues arose because this will be a State hospital. It will not belong to the Mater Hospital, although there seems to be some confusion about that. We will introduce legislation to ensure it is owned by the State.
That is not strictly true because the Mater Hospital will own the car park. That is a significant factor for access for parents and children. Does the Minister not accept that grave and serious concerns are being expressed by the authorities at St. James's Hospital, Our Lady's Hospital for Sick Children in Crumlin and Tallaght Hospital about the decision that has been made? The Minister is saying she is not in a position to judge those concerns, but is she prepared to establish an independent review to assess the difficulties which have been highlighted and exposed in the analysis carried out by the hospitals? It is important that we get this right. It is quite clear there are concerns about political interference. It is believed that problems will arise which will have a significant impact on patients.
I assure the Deputy there was no political interference — that is certain. The group that has been established to make progress with this initiative, which comprises officials from the Health Service Executive and the Department of Health and Children, will examine the submission made by Our Lady's Hospital for Sick Children in Crumlin. I accept there is disappointment in certain quarters. When I met representatives of St. James's Hospital yesterday, they acknowledged during our very positive meeting that the decision has been made. It is clear they want to work with those in the new hospital. Many clinicians from St. James's Hospital are also working at Crumlin at present. There is a great deal of expertise, for example in the burns unit. Some specialist cancer services are based at St. James's Hospital. It is important that those who work in such areas co-operate with the new hospital, as they want to do. I do not want a situation of permanent review to develop because people are not happy with the decision that has been taken. If there are real issues which make it physically impossible for the hospital to be located in the intended location, for whatever reason, that will be a different matter. It is clear that it cannot happen in such circumstances. I have been advised that is not the case, however. The technical expertise available to me in the Department and to the HSE strongly suggests that is not the position. We will certainly give some consideration to the submission that has been made by Our Lady's Hospital for Sick Children in Crumlin.