Dáil Éireann díospóireacht -
Wednesday, 21 Nov 2007

Vol. 642 No. 1

Priority Questions.

Community Pharmacy Services.

James Reilly

Ceist:

43 Deputy James Reilly asked the Minister for Health and Children if she will report on recent discussions with pharmacists; if progress has been made; if not, the plans her Department has to ensure continuity of supply of medicines to pensioners, social welfare recipients and other patients on medical cards and various refund schemes that may be affected by the pharmacists’ threat to withdraw from such schemes on 1 December 2007; and if she will make a statement on the matter. [30306/07]

Jan O'Sullivan

Ceist:

46 Deputy Jan O’Sullivan asked the Minister for Health and Children if she will instruct the Health Service Executive to resume talks with the Irish Pharmaceutical Union to resolve the issues that are leading to the threatened withdrawal of medication to vulnerable patients from 1 December 2007; and if she will make a statement on the matter. [30019/07]

Minister for Health and Children (Deputy Mary Harney)

I propose to take Questions Nos. 43 and 46 together.

I previously outlined in detail to the Oireachtas the legal provisions under competition law which prevent the Health Service Executive, HSE, from negotiating with the Irish Pharmaceutical Union, IPU, on fees, prices and margins for its members. When it became clear that the HSE could not negotiate with pharmacists or wholesalers on fees and margins, a detailed, fair and transparent consultation process, including independent economic analysis and public consultation, was carried out to inform the final determination of the new reimbursement pricing arrangements for drugs and medicines under the GMS and community drugs schemes. These new arrangements were announced by the HSE on 17 September last.

In regard to the new reimbursement prices, the main wholesale companies have confirmed they will charge community pharmacists the same amount for these drugs and medicines as pharmacists are reimbursed by the HSE for these products. Furthermore, no changes are planned by the HSE to the operation of the GMS medical card and community drugs schemes, and all patients continue to receive their entitlements in the normal way.

The HSE has not received formal notification from any community pharmacist regarding cessation of services under the GMS or the various community drugs schemes. In the event, they will be required to give three months' notice in writing of any intention to cease providing this service. To address concerns expressed by the IPU on behalf of community pharmacists about the implications of the legal advice on competition law as regards their right to negotiate fees through the union, a process of dialogue was established, chaired by Mr. Bill Shipsey SC, to explore ways in which their fears might be addressed. Despite the suspension of this process during the recent withdrawal by individual pharmacists of methadone services, there has recently been renewed engagement between the Irish Pharmaceutical Union and the HSE under the auspices of Mr. Shipsey. I am exploring, in consultation with the Attorney General, other relevant Departments and the HSE, the best way of progressing the development of a new contract with pharmacists.

Deputy James Reilly

I state categorically that I and the Fine Gael Party will not and cannot condone any action by pharmacists or the HSE which endangers the well-being of patients. The dispute is dragging on because there is no clear path to resolution. There is no mechanism by which resolution may be achieved. It is clear that the HSE ignored the advice of its consultants, Indecon, who recommended that it should engage in consultation before bringing in this measure and that any change should be introduced gradually. A reduction from 17% to 8% is not gradual.

It is clear that the HSE will not engage with the IPU in a meaningful way and that patient services, once again, are under threat. We in Fine Gael recognise the need, and the right of the taxpayer, for the Minister and the HSE to seek savings. However, it is important this does not come about at the cost of service to patients. Will the Minister appoint an independent arbitrator to get this dispute sorted out so that the most vulnerable people in our society are guaranteed continuity of supply of their medications, particularly coming up to Christmas and the winter period in which the incidence of illness is always greater? Will she postpone the proposed changes until an independent impact study is carried out? This is important because to talk about an independent and fair process is all right, but it will neither be fair nor construed as such unless it is independent, as the HSE initiative in this regard was not so.

Will the Minister outline again what provisions are in place should the pharmacists withdraw services as they have threatened on 1 December? It is not good enough of the Minister to tell the House that she has not received formal notification of withdrawal. If people go out en masse contractual rights will go out the window, the three months’ notice will not be given and we are faced with 1.5 million people being unable to get their medication.

Deputy Mary Harney

I welcome what the Deputy said on behalf of his party and I share his view. As the Deputy is aware, this legal advice came to hand as a result of the negotiations that had begun with the wholesalers. The intention, always, was to negotiate and we respect bodies that organise around trade unions and have always dealt with organisations on that basis. Clearly, we cannot breach Irish competition law or EU law and that is why the Shipsey process was put in place.

I understand there was a very good meeting last night between lawyers representing the IPU and the HSE, respectively. I hope that as a result we are in a position to put a framework in place to resolve the outstanding issues. There are a number of issues to be considered, one of which is the nature of the contract. I am a strong fan of incentivising contract holders, whether they are pharmacists, general practitioners or dentists, towards providing a wider range of services, working longer hours and so on. These are all matters for discussion, and medication management is also important.

As the Deputy is aware we are trying to achieve a number of goals. One is value for money and greater efficiency. Our drugs bill has gone up by 373% in recent years, or 2.5 times greater than the rate of inflation. We are not reducing the wholesale margin gradually. It is being reduced from 1 December to 8% and to 7% from 2009. These margin percentages are in line with what is being paid in other countries. We want to separate from the commodity price the professional or dispensing fee paid for the professional services of the pharmacist. We also want to ensure that there is fair return. I am a strong fan of entrepreneurship and as pharmacists are entrepreneurs we want to see their efforts rewarded. There are a number of legal mechanisms through which prices can be established, one of which is an arbitration system. These matters are being explored by me in consultation with the HSE and the Attorney General.

Deputy Jan O’Sullivan

I welcome the fact that the lawyers re-engaged last night because the news last week was that they had disengaged. I hope that process will find a resolution to the problem.

Will the Minister say whether she and the HSE are willing to accept a neutral chairperson to address this issue, as has been proposed? Specific eminent people were proposed by the pharmacists. She said she was consulting the Attorney General. Is that in relation to the interpretation of the Competition Act? If so, will she be willing to accept consideration of the Labour Party's amendment to the Competition Act in Government time? She will have plenty of time tomorrow because there is no legislation on the Order Paper. Will she consider debating that amendment as a possible step towards resolution of the dispute?

The import of what wholesalers are saying to pharmacists appears to be different from what they are telling the Department of Health and Children and the HSE. The Joint Committee on Health and Children heard last week that pharmacists were being told that wholesalers are not going to bring prices down to what will be paid to them if the new arrangements are introduced. Is the Minister aware of different reports about what precisely the wholesalers might do.

Deputy Mary Harney

To answer the first of the Deputy's three questions, I do not know how one might define "eminent" in this context, but the idea of a neutral, independent, acceptable person is a mechanism for consideration within the legal advice that has been given to me to date.

Deputy James Reilly

The chief executive of the Labour Relations Commission, perhaps.

Deputy Mary Harney

I want to clarify on the record that the Attorney General is not involved in the advice procedure because of a conflict of interest. He has made arrangements for counsel to advise us. Whether the person is eminent or well known, it is the objectivity and acceptability of the incumbent that matters and it may well turn out to be a process for more than one person. Clearly, the same process will have to be put in place for general practitioners, dentists and other self-employed professionals.

As regards legal advice, it is not just a matter of Irish competition law but EU law as well. Price fixing with self-employed professionals on a class basis is prohibited and it would not be desirable to change those aspects of Irish competition law. One might as well tear up the competition Acts if one could engage in such practices.

Deputy Jan O’Sullivan

Will the Minister say why people should not be represented by their union?

Deputy Mary Harney

This is not a question of representation but of price fixing and setting prices and margins, and European law is very clear on this issue. It has wide implications for staff other than health service personnel, including self-employed veterinarians and, perhaps, some members of the legal profession. That is why so much advice is required.

This matter was brought to the attention of the HSE, which entered into negotiations in good faith, by the wholesalers. It was the legal advice of the latter that brought the matter to everybody's attention and it was examined by lawyers of the HSE and the Office of the Attorney General. We are not trying to achieve a reduction in what we pay for medicines since the price will continue to rise, given Irish demographics and new innovations; rather, we are trying to slow down the pace at which the price is rising.

Deputy James Reilly

Will the Minister clarify whether she is prepared to postpone the HSE's changes on 1 December to ensure patients will have continuity of medical supply in the weeks approaching Christmas? Will she agree to the appointment of an independent arbitrator? In this regard, mention was made of Mr. Kieran Mulvey, an eminent person who is very experienced in this area.

Deputy Jan O’Sullivan

Will the Minister ensure a process is put in place in order that very vulnerable patients will not be faced with the fear of not being able to obtain their medication on 1 December?

Deputy Mary Harney

I do not believe large numbers of professional pharmacists will not supply medical card patients and others with their necessary medication. I salute the efforts made by the Irish Pharmaceutical Union when methadone was withdrawn by a number of pharmacists.

Deputy Jimmy Devins

Hear, hear.

Deputy Mary Harney

It was extraordinarily professional and courageous.

I will not state what personalities would be acceptable because it would not be advisable to do so. The contract is between the pharmacists and the HSE, not between me and the pharmacists. Clearly, I have an important role to play in this regard and the meeting last night was very positive, but I do not want to say anything in the House that would jeopardise the positive outcome of the meeting. I understand there will be further talks in the coming days with a view to ensuring the development of a process acceptable to everybody. Mr. Bill Shipsey SC, who has done extraordinarily useful work in this regard, will have an important role to play in putting forward what I hope will be a solution to this problem.

Deputy James Reilly

I remind the Minister that there is a contract between her and the patients who use the General Medical Service to obtain drugs.

National Cancer Strategy.

Jan O'Sullivan

Ceist:

44 Deputy Jan O’Sullivan asked the Minister for Health and Children if Professor Tom Keane has arrived here; when he will commence his work of implementing the national cancer strategy; the audit that has been carried out of the capacity within the service; the budget agreed for the implementation of the strategy; the funding that will be made available for it in 2008; and if she will make a statement on the matter. [30018/07]

Deputy Mary Harney

Professor Tom Keane took up his position as interim director of the national cancer control programme last Monday. Implementation of the programme is a major priority for me and the Government. The delivery of cancer services on a programmatic basis will serve to ensure equity of access to services and equality of patient outcome, irrespective of geography.

The recent decisions of the HSE in respect of four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. Professor Keane will be engaging in detailed planning to facilitate the orderly phased transfer of services between locations.

To ensure we improve our planning and evaluation of cancer needs, my Department has asked the HSE to prepare a robust needs assessment for cancer control for the period to 2012 to reflect priorities in this area. The needs assessment will address regional disparities in cancer treatment, identify gaps in the provision of existing services and develop a national approach to timely access to diagnostic services for cancers.

Professor Keane and the HSE have emphasised the importance of mobilising existing resources and redirecting them to achieve the national cancer control programme's objectives. I understand the HSE is putting arrangements in place to enable Professor Keane to take control of all new cancer developments from 1 January 2008 and, progressively, all existing cancer services and related funding and staffing. An additional €20.5 million was allocated to the HSE this year for cancer control. Further investment will be phased in during the reform programme.

Deputy Jan O’Sullivan

When will the women in Portlaoise who are still awaiting results have those results and thus alleviate their worry?

The Minister did not answer my question on the budget. She has stated what is available for Professor Keane to implement his strategy for this year but not what is available for next year and the year thereafter. It is essential that we know where the money is coming from and that there will be sufficient funds to transport patients when their local centres are closed. We must be absolutely clear that when the Minister is at arm's length from the process, that is, when Professor Keane is reporting to Professor Drumm, Professor Keane will not be scrambling around looking for funds to address this most important issue. What audit has been done of funding and how much will be provided? We cannot buy into the process if we do not know how it will be funded. The Minister has stated existing services will remain in place until the new ones are available. This cannot happen, unless new funds are allocated. How much will they amount to and for what will they be provided?

There are serious geographical concerns over the distances patients must travel in the north west. It takes two hours to travel between Sligo and Galway and even longer for those further afield. I urge the Minister to reconsider her proposals.

Deputy Mary Harney

On the question of women awaiting test results from the Midland Regional Hospital in Portlaoise, all 3,037 mammograms have been reviewed and nine women have been diagnosed with cancer, all of whom are now receiving treatment or counselling.

Deputy Jan O’Sullivan

Are there no new cases?

Deputy Mary Harney

There was one new case.

Deputy Jan O’Sullivan

One.

Deputy Mary Harney

The original number was seven; the figure is now nine. The media were referring to eight women but, as far as Dr. O'Doherty is concerned, she diagnosed nine women as having cancer among the 3,037 tested. When we were debating this matter two weeks ago, we were relying on a figure of seven.

Deputy Jan O’Sullivan

Therefore, two more women have been diagnosed.

Deputy Mary Harney

Two more were diagnosed, resulting in a total of nine, all of whom are receiving treatment and counselling. I reiterate my apology of some weeks ago to the women concerned for the delay in diagnosing their cancers. We are trying to minimise the possibility of this happening again.

An additional €1 billion has been invested in cancer care in the past ten years. This is a considerable investment. The task for Professor Keane will essentially, but not exclusively, involve the redirection of the available resources, just as he did in British Columbia. New resources will be made available also. I had a long meeting with Professor Keane last night and have asked him to identify the new resources he will require in the next year. He will begin to take responsibility for all cancer care developments from 1 January. He is to inform me of his requirements in the next few hours because the Minister for Finance will be making budgetary announcements in this area two weeks from today.

Our cancer service has excellent clinicians. It is, therefore, the manner in which the service is organised that is in question. Transport and accommodation issues must be addressed. When I was in British Columbia, I was impressed by the number of lodges built close to hospitals or treatment centres. Patients can stay in these lodges and do not have to be in the hospital environment. Most prefer not to be in such an environment, unless it is absolutely necessary.

On the Deputy's question on cancer care in the north west, the centres were not selected by me but by an expert group, mainly comprising clinicians but also officials from patient representative bodies such as the Irish Cancer Society and Europa Donna Ireland. They all remain strong fans of the locations selected. Professor Keane is strongly supportive of what we have done. All international evidence, comprising some 250 publications, suggests that volume amounts to quality. I hasten to say it is not a question of the quality of individual centres. To say "centres of excellence" implies the other centres are not excellent but this is not my implication since it is a matter of volume and environment.

In British Columbia all the tests are read at the centre. Those diagnosed at outreach locations experienced a level of diagnostic error in the order of 20%, as discovered when they came to the centre for follow-up treatment or further diagnosis. All the evidence has been compiled. Professor Keane is to put in place a clinical support team. I understand he intends to appoint a medical oncologist, radiation oncologist and cancer surgeon to assist him in the development of the control programme nationwide.

Hospital Services.

James Reilly

Ceist:

45 Deputy James Reilly asked the Minister for Health and Children the action she took to address the concerns raised in a letter she personally received from a consultant in Portlaoise in 2005 expressing their concerns regarding the quality and reliability of services in the radiology department in Portlaoise General Hospital; if she will assure Dáil Éireann that no further such letters lie languishing in her Department from concerned health professionals regarding specific issues of concern in hospitals and care homes; the procedures and action her Department takes to address such concerns; the systems in place to ensure early warnings from such staff are acted upon in order that they are followed up by her Department in a timely manner in order to avoid situations like that of mammogram misdiagnosis in Portlaoise General Hospital; and if she will make a statement on the matter. [30307/07]

Deputy Mary Harney

The Department of Health and Children acted on my behalf in this matter and I am totally satisfied in every respect that the Department acted in a thorough, timely and appropriate manner on foot of the information received. It is entirely without foundation for the Deputy to claim the letter "lay languishing" in the Department.

The facts are as follows. On 5 July 2005, a consultant at the Midland Regional Hospital, Portlaoise wrote to me outlining his concerns relating to the breast services at the hospital. In accordance with normal practice, the letter was passed to relevant officials in the cancer policy unit for examination. They rightly formed the view that the letter required to be brought to the attention of the HSE and management at the hospital. It was duly referred to the HSE national hospitals office for urgent examination and appropriate attention. The Department subsequently wrote to the consultant concerned advising him of this and also brought the letter to the attention of the regional director of cancer services in the midland region. I understand he then had discussions on the issue with hospital management and with the consultant concerned.

There are robust policies and procedures in place in the Department, including in the Minister's office, for dealing with letters, e-mails and telephone calls relating to matters of patient safety and quality of care. If a senior clinician raises an immediate risk to patient safety with me in any respect, I treat that matter very seriously.

In handling communications, administrative and professional staff, the office of the Chief Medical Officer in particular works with executive agencies such as the HSE and the Health Information and Quality Authority, regulatory agencies such as the Irish Medicines Board and professional regulatory bodies, where appropriate, to identify, describe and ameliorate any potential risks to patients or the general public in areas such as systems of care, professional practice or difficulties with medical devices or therapeutic agents. Theses procedures are subject to constant review and refinement in the light of circumstances and evolving best practice.

Deputy James Reilly

The Minister's answer ignores the issue raised in the letter, namely, that the radiology service was a shambles. If she can honestly describe the manner in which that letter and the issues it raised were dealt with as the best way to do so, it is not terribly reassuring to this House and the people who must use the health service.

Can the Minister confirm that this letter was brought to her personal attention? Did she read it? Based on information from the HSE, I understand that the letter was passed to the network manager and on to the hospital manager who interviewed the consultant concerned and ascertained that no unnecessary operations had taken place, which was the end of the matter. An offer to have mammograms double read in hospitals elsewhere from December 2006 was then made.

During statements to the House on 7 November 2007, the Minister said the current review covers concerns raised by medical and nursing staff within the Midland Regional Hospital in Portlaoise and that action was taken on foot of this in August 2007. When the Taoiseach was asked when the Government first became aware of this problem, he answered that it was in August 2007. The Minister did not see fit to correct him and tell him that the letter had come to her in 2005.

It seems that action was taken only 18 months after Mr. Peter Naughton wrote to the Minister. It does not even address the concerns that he raised. I want to ask the Minister a number of questions.

An Leas-Cheann Comhairle

Please do.

Deputy James Reilly

Does she expect all medics who are concerned about the quality and reliability of machinery to walk away from the job and their patients, as she suggested in her response in the Dáil where she said that if the machine was so faulty, why did the radiologists continue to use it? The reality is that faced with the machine with which they must deliver the service, people deliver the service they can.

This unacceptable attitude is indicative of a Minister who is unable to cope with the responsibility of managing the health service. She has relinquished responsibility to the HSE and many would say that she has lost control of it. In a radio interview, the chief executive officer of the HSE cast aspersions on the public for protesting to try to hold on to their services.

The Minister told the House that nine women have been diagnosed and are undergoing treatment. I welcome that news because in the newspapers, it was suggested that six women were still waiting for a diagnosis and treatment, which would be totally unacceptable.

I wish to ask the Minister directly, because she has not answered the question, whether there are any other letters in her Department regarding the quality and reliability of services in the Midland Regional Hospital in Portlaoise addressed to her, her predecessor or other senior officials of which we should be aware. Could she confirm whether the doctor carrying out the current review of the mammograms was one of the doctors on the interview board that appointed the locum consultant in the first instance because if this is the case, it creates a conflict of interest?

Deputy Mary Harney

In response to the last question, I understand that Dr. Ann O'Doherty was a member of the interview panel. It was a Public Appointments Service interview process that appointed the radiologist who is currently on administrative leave. I believe we answered a parliamentary question here recently. We get about 6,000 letters, excluding telephone calls, e-mails, representations from parliamentarians and parliamentary questions, in a four-month period. I believe the Minister for Health and Children sees letters that are addressed "addressee only". I believe the first time I became aware of this was 29 August when I was about to do an interview on the Barringtons Hospital issue. The HSE informed me that it had suspended the service in the Midland Regional Hospital, Portlaoise. That was the first time I became aware of this.

I hasten to add and emphasise that Department officials in the cancer unit who handled this correspondence did so in a very robust, thorough and fair fashion. The outcome would not have been any different or better if I had personally seen the letter at that stage. It was discussed with Dr. Hollywood, who was the medical director.

I wish to set the record straight by saying that when the O'Higgins report was produced in 2000, there was a recommendation that, marginally speaking because it was doubtful in terms of numbers, the midlands could have had a centre. The health board decided that each of three hospitals would have a little bit of the action. Some of it would be provided in Mullingar, some of it would be provided in Portlaoise and some of it would be provided in Tullamore. Even though over €7 million was allocated to develop the O'Higgins guidelines and multidisciplinary care, it was divided between three places, which was totally unsatisfactory.

Following that letter, a radiologist was appointed. Subsequent to her appointment, the hospital advertised for another radiologist. I understand that someone initially accepted the job and subsequently did not take up the appointment. I want to put on record that it is increasingly difficult to get leading specialists with a sub-speciality in something like breast cancer to take up positions in smaller hospitals. That is a fact. It is not just increasingly difficult to do so in Ireland. Based on what Professor Keane and others have told me, I understand it is a problem all over the world. Specialists with a sub-speciality in these areas want to work in big centres where there is a high volume of activity and where the environment for their work is conducive to excellence and good outcomes for their patients because of the sheer volume of activity.

I do not know if there are any other letters. We have in recent times involved the Chief Medical Officer and his team. There is a team of medics in the Department and I want to see them involved in patient safety issues. Regardless of whether the patient safety issue is raised by a doctor or patient — many such issues are raised with me by patients — I want to see the medical team in the Department involved in the follow-up to correspondence that comes to our attention, if that is possible.

Question No. 46 answered with QuestionNo. 43.

Hospitals Building Programme.

Alan Shatter

Ceist:

47 Deputy Alan Shatter asked the Minister for Health and Children if she will implement the recommendation contained in the report from RKW consultants that an urgent care centre be built in Tallaght Hospital to cater for accident and emergency attendances by children; the steps being taken to implement this recommendation; its implications for Harcourt Street Children’s Hospital as part of the Tallaght Hospital complex; and if the recommendation is being implemented to date when the new care centre will open. [30032/07]

Deputy Mary Harney

On 31 October last, the HSE announced the details of the high level framework brief for the new national paediatric hospital. The brief was prepared by Rawlinson Kelly & Whittlestone Limited, RKW, an established UK-based health care planning company. The content of the report was informed by the views of a range of international experts, including architectural and clinical experts.

The brief sets out the range of services to be delivered at the new hospital and the additional services to be provided outside of the main hospital through an ambulatory-urgent care service. The brief will help to inform the work of the national paediatric hospital development board in planning, designing, building, furnishing and equipping the new hospital.

The new hospital will be at the centre of a national paediatric network, linked to regional and local hospitals and to primary and community care services through outreach, telemedicine, joint appointments and staff rotation. The new hospital will be supported by an ambulatory and urgent care service. The first such centre will be developed at Tallaght.

The vast majority of children attending the National Children's Hospital emergency department do not require admission and will continue to access their care locally at the new ambulatory and urgent care centre. RKW estimated in the report that the first centre at Tallaght will have the capacity to cater for up to 48,000 emergency attendances and up to 58,000 outpatient appointments, based on demographic and activity projections up to 2021. A significant level of day case surgery will also be carried out at the new centre. There will be 20 day case beds and three theatres with capacity for up to 9,000 day case procedures. Clearly, this projected level of activity would be subject to change depending on the number and location of any additional ambulatory emergency units. The high level framework brief has been provided to the national paediatric hospital development board. The HSE will be meeting with the board to agree on the operational arrangements for bringing the project forward to the next stage.

Deputy Alan Shatter

What is the timeframe for providing this new facility in Tallaght? When will it open? Can the Minister confirm the report stated quite clearly that it is essential that it opens prior to, or simultaneously with, the new hospital to be built at the Mater site?

Deputy Mary Harney

I agree it is essential they open together because the two are part of the same facility. The ambulatory care centre at Tallaght will be under the auspices of the national hospital. The timeframe we are working to is 2012. I had a meeting recently with the development board, which is working to the same timeframe. There are many projects seeking capital funding in health but this is a priority and capital funding will be made available.

Deputy Alan Shatter

What hours of availability are envisaged for this hospital? In the context of accident and emergency, for example, will the hospital be open 24/7 or will it close at some time?

Deputy Mary Harney

It is envisaged that the hospital will be open 18 hours per day, from 8 a.m. to 12 midnight. It will be closed between 12 midnight and 8 a.m. because the level of attendances during that period would be low. Other issues to be considered include the availability of ambulances at Tallaght so that those patients can be taken to the hospital at the Mater site.

Deputy Alan Shatter

Considering the burgeoning population of south Dublin and the outer regions, for which Tallaght Hospital currently caters, and the investment in the construction of the facility, it is a false economy to close the hospital from 12 midnight to 8 a.m. daily. There may be serious night-time emergencies for children and the proximity of the hospital can be crucial in saving the life of a child. If consultants indicate it is crucial that this facility be provided in Tallaght, it is just as relevant, in the context of access, travel and the major young population in the vicinity, that the facility be open 24/7. It is a waste of that resource to close it at midnight and it places lives at risk.

Deputy Mary Harney

I do not accept that. This accident and emergency unit will deal with 48,000 attendances as opposed to 31,000 in Tallaght at present, 9,000 day cases as opposed to 3,500 at present and 58,000 outpatients as opposed to 30,000. The advice is that it is not necessary to have the facility open between midnight and 8 a.m. because a small number of cases would arise during that period. This is the advice of clinicians, not something I have made up off the top of my head. The staff at the centre will be rotated. The paediatric staff from the centre at the Mater Hospital will be rotated and arrangements will be made between the two hospitals, such as ambulances on standby to transfer those who arrive at Tallaght to the Mater site. These logistical issues must be addressed by the development board in conjunction with the hospitals.

An Leas-Cheann Comhairle

That concludes Priority Questions. We are five minutes over time and I wish to proceed with Ordinary Questions. I remind Members that the questioner and the Minister have one minute each for supplementary questions during Ordinary Questions.