Dáil Éireann díospóireacht -
Tuesday, 7 Feb 2017

Vol. 937 No. 3

Leaders' Questions

Deputy Micheál Martin

Last night's edition of "RTE Investigates" revealed very deep suffering among men, women and children across the country because of the lack of proper funding and strategies to address waiting times in hospitals. We saw the human stories behind the figures and they were quite harrowing, particularly in the case of young children with scoliosis. The programme was a shameful and disgraceful illustration of how those children were failed. It is not today or yesterday that the issue pertaining to scoliosis patients was raised. Less than two years ago, we were given assurances that the issue would be resolved but that has not happened.

The people who volunteered to be interviewed showed great courage and were articulate and brave. We owe them a great debt of gratitude. We saw Dara from Kilkenny, a very bright child of seven who has scoliosis and who is exhausted on a daily basis because of the lack of action to address his needs. His mother, Clare, described the physical impact on his breathing, his ability to eat and so on. We saw how Megan Halvey Ryan found it impossible to attend school because of her scoliosis. We heard from Colette, John and Betty, all of whom are living in chronic pain because of the lack of access to vital surgery. It is difficult to comprehend how a person with a brain tumour could be waiting so long for surgery at Beaumont Hospital.

The National Treatment Purchase Fund was mothballed by the then Minister for Health, now Senator James Reilly, in 2012. It was not the solution to everything but while it was in operation, between 2002 and 2011, it dramatically reduced waiting times to six months or three months for the vast majority of people waiting for elective surgery. For some reason, however, it was mothballed and the figures began to deteriorate rapidly from 2012 onwards, particularly for those waiting beyond 12 months, of whom there were up to 12,000 in 2016. The figure in 2010 was a fraction of that. It is easy to track what is going on, as well as the lack of capacity and investment in our system. Many people resisted the re-establishment of the National Treatment Purchase Fund for the purpose of surgery. Even in our talks on a confidence and supply agreement, many Fine Gael Ministers did not want it brought back. To be fair, the current Minister for Health has said that he has €20 million for this year and €55 million for next year.

If anything comes out of the programme, I would ask that the Government make it a certainty, no matter what it takes, that no child with scoliosis has to wait beyond when it is medically important for that child to have the operation and that the curvatures do not get so extreme that it damages the child and causes more clinical complications. Parents want nothing less for their children. I cannot understand why private capacity was not sourced for those children or why might and main was not moved to ensure those children's operations got done if they could not be done in Crumlin.

An Ceann Comhairle

I thank Deputy Martin. The time is up.

Deputy Micheál Martin

It happened before in the case of other disciplines when children underwent operations elsewhere if they could not be done in Crumlin. That at least should have happened with instances of scoliosis because many Deputies were bringing those cases to the attention of the Government over the past three to four years. We were told it would be sorted and it was not.

The Taoiseach

I thank Deputy Martin for his question. I, no more than the Minister, found it difficult to watch this programme, and the stories of Betty and Pat, and Peter and Kate and Patricia, and Elaine and John and Alan, and Kira and Darragh and Megan speak for themselves. This is 2017 and nobody wants to see a situation like this.

A perception that there was an attempt to cover up figures is not true. Since the National Treatment Purchase Fund started in 2002, this was always the way, according to best international standards at that time, that these figures were presented. Patients would get a call to say they would have an operation or a treatment. Those who have had one treatment but need a second were never counted in the figures. Irrespective of that, it does nothing for the parents of children who have curvature of the spine, which Deputy Martin mentioned. This is a serious issue, and Deputy Martin raised it in that spirit.

The €2 million that was provided in 2016-2017 specifically for surgery for scoliosis has meant that 133 spinal fusion treatments for scoliosis have been conducted in 2016 for children under the age of 16 years and adolescents between the ages of 16 and 18 years, of which 44 were outsourced to the independent or private sector or the UK under the HSE winter initiative funding.

Deputy Martin himself has been through this. During the previous Minister for Health's time, the big question about scoliosis was whether we had the theatre capacity. A sum of €3 million was found and invested in a theatre specifically for this purpose in Crumlin and it is still not open. The Minister is meeting the chief executive later today, as well as the NTPF and the HSE. He wants to make it clear that the scoliosis issue is an absolute priority, that he will do more and that he will refer again to the question of the private sector to assist with this. The opening of a brand new theatre is dependent on the recruitment of adequately trained staff and exceptional efforts are being made to recruit staff who are qualified to do this work. This is an issue the Minister was upset about.

In respect to the situation that applies generally, €900 million more has gone into the health system this year than last year. It is now €14.5 billion. The strategy of health reform is correct in the decision in respect of the National Maternity Hospital, the decision in respect of the national children's hospital, the provision of primary care centres throughout the country and the reduction in the waiting list for routine colonoscopies by 90%. These are all improvements in the health service which of themselves and in respect of the staff who deliver them are also to be commended. However, this is not something that we can stand over.

I found it difficult to watch the programme but it is very necessary that these programmes and patients' stories be heard in 2017. I would point out that the function of the Minister for Health, on behalf of Government, is to set the overall policy and strategy and to provide funding within what can be provided, that is, €14.5 billion or €900 million more than last year. Those charged with delivering the services differ in their opinions. I heard opinions today about bringing in business people. I heard opinions today about doing a lot of small things together.

There were also other opinions. None of them deals with the issue of the child who is waiting for scoliosis treatment. Today the Minister, in seeking a whole-of-Government response, will examine what it takes to open a theatre which the taxpayer paid €3 million for but which is not open and was designed specifically for dealing with children with scoliosis.

Deputy Micheál Martin

The way the waiting lists are calculated was changed in many years - 2005, 2007, 2009, 2010, 2011 and 2014. The most recent change has been to extend the targets to 18 months, which is extraordinary. Why did the Government bury the National Treatment Purchase Fund in 2011? We could never get an answer as to why the former Minister, Senator James Reilly, did that. He took away a capacity that got operations carried out for citizens. Money was allocated and the individual got the hip, cataract or whatever operation was required. The Government buried that at a time when there was increasing pressure on the public sector. The Government was warned time and again about the lists getting worse but the former Ministers, Senator Reilly and Deputy Varadkar, were in denial about that and, in particular, the length of time on waiting lists. That is a key metric here. The time was down to six and three months for the vast majority of disciplines and procedures, but now the new target is 18 months and 12 months in some cases.

On the scoliosis situation, the Taoiseach says 44 surgeries were outsourced. All of them should be done, whatever it takes. The Taoiseach knows about the nursing crisis; he has known about it for three years. We pointed out in the Dáil that the recruitment of theatre nurses was the greatest crisis in nursing recruitment over the last three years, but nothing has been done to incentivise the recruitment and, critically, the retention of theatre nurses. That exacerbated the situation that already existed due to closing down the treatment purchase fund from 2011 and the stress and strain on capacity in the public system up to recent times. There is also the issue of clinical prioritisation. The growth of C contracts, for example, will put greater strain on public sector capacity to carry out surgery as well. These issues must be examined.

However, it is urgent that the money not be drip-fed to the treatment purchase fund but fast-tracked and accelerated so there are early significant amounts of money going to the purchase of operations for people such as those we saw last night. It is unacceptable, as the Minister and everybody say. Those people should not be waiting any longer in their current chronic pain. There is a way to deal with it - go out, find the capacity and have the operations carried out for those people. That is the immediate first step, after which there are wider issues to be dealt with.

The Taoiseach

That is exactly what the Minister is going to do. The fact is that when this came to light a number of years ago due to the length of the waiting list and the numbers on the list, a new theatre was provided but it still has not opened. There is money in the budget to recruit 1,000 nurses this year. There are talks today between the Department, the HSE and the Irish Nurses and Midwives Organisation, INMO, about this. I heard somebody with considerable experience in the medical profession say this morning that the NTPF was a waste of money. I agree that it has a role to play here. Clearly, the 133 spinal fusions carried out last year and the 44 in the private sector speak for themselves.

Deputy Micheál Martin

It did the job. Some people did not like it that it did the job.

The Taoiseach

The counting of the list has been the same since 2002. In fairness, when Deputy Martin introduced that list in 2002 it was best international practice. The counting of the list has not changed to any extent. There is no intention to hide anything in terms of numbers. Some of the people have already had an initial treatment and will be called back. They were never counted in the past. They are counted now. That is fair enough but it does not do anything for those who suffer with the difficulties and challenges of scoliosis. The Minister will be talking to the chief executive of Crumlin hospital, the HSE and the NTPF today and the focus will be on scoliosis, as the Deputy quite correctly requests, in order that no children will be left in their current difficulties and pain. It is not acceptable. We have all said that and everybody understands it. The problem is how to get the theatre, paid for by the taxpayer, open to provide relief and comfort to the children with this problem.

Deputy Gerry Adams

I am not impressed by the Taoiseach's reply. Last night, the "RTE Investigates" programme showed that tens of thousands of patients waiting for operations and procedures are not even included in the official waiting list numbers published by the National Treatment Purchase Fund.

I commend the programme makers. It appears that over 80,000 patients have been excluded from the official figures. In addition, 81,000 others are on waiting lists, some in great difficulties. The total is twice the capacity of Croke Park. God knows how many more are waiting to see consultants. The Minister for Health was aware of the scandal. How could he not have known? All of us here have made representations on behalf of citizens who are on waiting lists. We are not talking about a small number of patients. We are talking about the lives and well-being of more than 80,000 citizens, some of whom, including children, are, as we saw on last night's programme, languishing in tremendous pain.

This is just another example of a health service that is in a state of perpetual crisis. I disagree completely with the Taoiseach. It is not just about misleading the public about waiting lists, it is about the 587 people who are on trolleys today, cancelled surgeries, thousands of hospital beds removed and a two-tier system in which health workers, particularly nurses, are not properly treated, and where patients suffer. The plight of patients, especially children with scoliosis, and the bravery and anguish of their families, captured so graphically on last night's programme, has further eroded confidence in the Government, our general politics, our political system and our health service.

There is a complete lack of accountability. The Minister is not accountable. The Taoiseach, while he has Fianna Fáil's support, is not accountable. We should dispense with the pretence that anyone present will get any real answers from the Taoiseach today - not me, not the patients, not their families, not the people working in the health service. Instead, I propose a single, integrated hospital waiting list management system. We published this as part of our Better for Health policy. In December 2015, we presented it to the Taoiseach and the Minister at the time. It is a plan for a public health service. While we do not pretend it is an easy fix, we show it can be done. On the issue of management of waiting lists, we have proposed a new system called "Comhliosta". This would replace the current system and be responsible for generating maximum waiting times based on a single, integrated hospital waiting list system.

The Sinn Féin health spokesperson, Deputy O'Reilly, wrote to the Minister for Health, Deputy Harris, on 17 August last requesting a meeting to discuss the proposal. She is still waiting for him to reply. The Minister may well grin.

Deputy Simon Harris

I am not grinning.

Deputy Gerry Adams

Yes, the Minister is grinning.

Deputy Simon Harris

I have spoken to Deputy O'Reilly.

Deputy Gerry Adams

All I ask is that the Minister consider the proposal, take it away, read it and come back with a reply.

The Taoiseach

One of the first things the Minister did on his appointment was to ask the House and everybody involved to debate a ten-year programme for the health system that would remove the political imperative from much of it. Last week, I spoke to Deputy Shortall and she asked me for another meeting, which we will hold in the next week or ten days.

The list system is nothing new. It has been in place since 2002 and the counting of the list has always been the same. It is nothing new under this or any previous Minister in the 15 years since it was established. A total of 70% of patients are seen within eight months. The Deputy's proposal for a single list may have merit. His spokesperson is on the committee dealing with a ten-year programme for the health system. It deserves some consideration. However, what we need is a system that does not change from month to month or year to year.

We have had a counting system since 2002 without changing it. The other elements, the pre-admittance and people who have had a procedure and who need to be called back for a second one, have never been counted as part of those lists, although they have been published on a monthly basis.

The new orthopaedic unit was completed in 2015. While it is in use, it has not added to capacity in Crumlin because of rolling closures. In that sense, two international nurses commenced in Crumlin in January. Two more are due to commence in March and a further 16 have been offered posts which allows the registration process to commence which can take four months. The adaptation programme used to be six weeks but has been reduced to two days, which is progress.

Every opportunity in recruitment and retention is followed through diligently, including working with the HSE and the international recruitment drive to support additional capacity at the hospital. As of 31 January, there were 193 patients awaiting spinal procedures in Crumlin, of which 143 were for new spinal fusions. On average there are additional 250 patients every year, 200 additional patients to Crumlin and 50 to Temple Street. The children’s hospital group has confirmed there were 133 spinal fusions for scoliosis conducted in 2016, of which 44 were carried out by the private sector.

Deputy Gerry Adams

The idea for a committee to look at a ten-year health plan did not come from the Minister but from an Teachta Róisín Shortall. Both Deputies O’Reilly and Buckley, on behalf of Sinn Féin, play a full part in that committee. The waiting list figures were kept away from that committee, however.

I asked the Taoiseach to consider the proposition for a single integrated hospital waiting list system. I even sent him a copy of our initiative again today. It is not an accident that our health service is in perpetual crisis. The fact is neither the Taoiseach’s Government nor its predecessor in Fianna Fáil are committed to a public health service. The Taoiseach is ideologically against that proposition. He does not believe citizens have an entitlement to a wraparound health service from the cradle to the grave as well as one which is of the highest possible standards.

Instead, the Taoiseach’s ideological position favours the two-tier system and the privatisation of those sectors which can make profit. Last month, the chief executive of the National Treatment Purchase Fund, NTPF, said the private sector is the most efficient and clinically effective way of having patients seen quickly. No one who saw last night’s television programme could call it efficient or clinically effective. From 9 January 2017, the NTPF claimed key targets for the HSE’s 2016 waiting list action plan had been achieved. That is the boast. That is the reason for the manipulated figures.

Will the Taoiseach take our proposition - some of us will raise it next week - and come back with a considered response to it?

The Taoiseach

That can be done in the context of the ten-year proposal being examined by the all-party Oireachtas committee. Deputy Adams is to be commended on putting forward a proposition like that.

However, it is important that the system used in which the lists are counted should not change. They have been counted in the same way since 2002 when the NTPF system was first introduced.

The Deputy is completely and utterly way off the mark when he says the Government’s intention is to introduce a private health system. The Government’s absolute priority is a public health system which delivers for patients when they need treatment and as close to them as possible. Despite what the Deputy thinks, that is a fact of life.

Deputy Gerry Adams

The Taoiseach also wants to keep the recovery going.

Deputy Patrick O'Donovan

The Deputy could use the service himself some time.

The Taoiseach

Two new consultant paediatric orthopaedic posts were approved for 2016 for Crumlin. This has increased the work rate to a current total of more than three whole-time equivalent posts, an increase since the end of 2015. One person has taken up a post providing some less complex spinal surgery along with other orthopaedic work. The second post was filled by a surgeon who was already working full-time in Crumlin and will now be working full-time on paediatric surgery. This creates a vacancy for the children’s hospital group in Crumlin and Tallaght. They are now discussing how that post should best be structured.

When that vacancy is filled, it is envisaged that at the end of this year there will be six people in posts of particular specialty in this case. The increase in consultant manpower is intended to enhance the overall service for children. It will be further discussed by the Minister with the chief executive today.

Deputy Brendan Howlin

Individual harrowing tales set before us last night by the "RTE Investigates" programme revealed a deep malaise at the heart of our national health service. The idea that Governments going back to 2002 were misled about the state of our waiting list is troubling. I echo the call made by my colleague, Deputy Alan Kelly, who wanted and is calling for an independent probe into how these lists are compiled and published. The critical issue is what we do into the future. The work being done by the Committee on the Future of Healthcare is absolutely critical now. I urge its members to ensure three things. First, they should finalise the report as quickly as possible so we can begin implementation. Second, ensure the recommendations are not focused on short-term fixes but on long-term proposals that will expand capacity and increase outputs. Third, ensure whatever is recommended is accompanied by a clear implementation plan and detailed costings in order that the recommendations can be achieved.

Against this backdrop, we also learned from media reports over the weekend that the cost of the national children's hospital has spiralled by almost 50%. As we know, when the planning application for this facility was lodged in 2015 we were told the cost would be €650 million. Less than two years later, and after much continued controversy about the location of the hospital, we now have a successful bidder but with a significantly higher cost. That is without taking into account the more than €200 million cost of the fitting out of the hospital. Some serious questions arise. Why have costs escalated to such an extent in less than two years? Where will this extra money come from?

Such additional expenditure comes against a backdrop of other health pressures. Will the cost of the new Central Mental Hospital in north Dublin, which is a similar project, be on budget? What about the cost of the new maternity hospital, the planning permission for which we still have not seen lodged yet? When will we have answers to these very clear control issues in health care costs? Where will the Taoiseach find the additional €300 million base cost or €500 million, including the fit out cost, for the national children's hospital?

The Taoiseach

The Deputy mentioned three points. First, the committee should finalise the report at an early time. I support that. Second, the recommendations should be focused on the long term as distinct from the short term. I support that. The third point the Deputy made was there should be a clear implementation plan to deal with it. If we can have an all-party agreement from an Oireachtas committee on a ten-year fix on issues that will remove politics from that, then so much the better. The Minister will be very happy to follow that. The three recommendations the Deputy made are helpful.

In regard to the national children's hospital, which the Deputy was involved with in the beginning, the project was turned down at the Mater where significant moneys had been spent on excavating the underground car park. The move now to the current site is one I support. We expect that to be under way very quickly. The original cost was €450 million, which was estimated when the Deputy was Minister. That rose to €650 million and we now have speculation that it is somewhere under €1 billion. It is true to say there are few firms that actually have the competence to build a hospital as complicated and as major as this. It is also true that during the recession, many construction firms tendered under price and many of them went bust as a consequence. I am not suggesting that is the reason for the inflation now but there is an element of construction inflation here. It may well be that in order for the health services to get Government on board they will say they could build for a particular amount. In any event, once we get on that treadmill, things can rise. My understanding is that planning permission has been issued.

The group involved is appointing a committee of experienced personnel to constantly monitor what will be a fixed contract. It should be remembered that this will serve 25% of the people of this island - the children - for the next 50 years. We have been talking about an incapacity to open surgical theatres that were designed specifically for that purpose.

Deputy Brendan Howlin

That is shocking.

The Taoiseach

This is a building that will not be finished until 2021. Last year's estimate in respect of the cost of the project was €650 million. It will be four years hence before the facility will be completed. My understanding is that a very significant experienced committee will meet and carefully monitor that fixed price contract. We hope it will serve the children of the island of Ireland for the next 50 years.

Deputy Brendan Howlin

I had hoped that the days when vitally important infrastructure was left lying idle were in the past, but apparently not. Is that not shocking? Why is that happening? Who is accountable for it? We have major infrastructural projects to be built in this country. Will the Taoiseach agree to the suggestion by my colleague, Deputy Burton, that the additional costings should be referred to the Oireachtas Committee on Budgetary Oversight or the Committee of Public Accounts, whichever the Taoiseach deems more appropriate, in order that we might obtain answers to our questions before we embark on building more major infrastructure that we need? Separately, will the Taoiseach agree to an independent probe into how our waiting lists are compiled and reported?

The Taoiseach

The Government will have to receive and assess the formal business case being put by the group in respect of the hospital. The point the Deputy made is not irrelevant by any means. I had a meeting with a senior medical person yesterday who told me that on many occasions there are cancellations of complex operations in hospitals. This means that a consultant and his or her team are ready to carry out an operation, however complex it might be, and they discover that it has suddenly been cancelled because a bed is not available. Who is responsible for this? The waste of public money, not to mind the stress on the patient involved, speaks for itself.

Deputy Brendan Howlin

We need the answer to that question.

Deputy Darragh O'Brien

The Taoiseach is responsible.

The Taoiseach

Deputy Howlin is right in what he said. It is a question of having a policy position set out by Government and money - serious money - provided through that in order to deal with very specialist operations.

Deputy Brendan Howlin

Somebody has to be accountable.

The Taoiseach

To find that an operation can be suddenly cancelled means that seriously competent medical-----

Deputy Ruth Coppinger

There are too many people coming into casualty the night before. It is very simple.

The Taoiseach

-----professionals become completely frustrated when they find they have to wait for half a day due to a cancellation as a result of a bed not being made available in the first instance. There are many people who have serious complaints and who are in hospital but who are not receiving any further treatment. These individuals could possibly be moved to different locations - thereby freeing up beds - and they would still, despite their difficulties, have the same quality of life. When we consider Our Lady of Lourdes Hospital in Drogheda or the hospital in Galway and see the major operations taking place in terms of construction, clearly, we need a ten-year strategy. However, we must also get agreement on what has to be done during those ten years and that will not be an easy task.

Deputy Michael Lowry

My question relates to health issues, particularly as they relate to Tipperary. Last night's programme was disturbing and distressing and it reflected poorly on the health care system and its inability to respond to serious urgent care needs. I am delighted with the response from the Taoiseach and that this matter will now be treated as urgent. However, the message in last night's television programme has been conveyed consistently to the HSE by the consultants and doctors of the patients who featured in it. I guarantee that every patient had representations made on his or her behalf by probably every Member of this House at some stage and that our recommendations have been ignored. It takes a television programme to get action. Where is the response from the HSE to representations made by elected representatives?

The issue I wish to raise with the Taoiseach is the principal health care issue in County Tipperary. It revolves around the disgraceful situation at South Tipperary General Hospital, which has a grossly inadequate number of acute beds to manage the crisis in acute services. It routinely has 140% occupancy, whereas the desired occupancy rate for hospitals of its size is approximately 85%. Therefore, when there is a surge in demand, there is no flexibility in the system, as a result of which we regularly have the highest trolley count in the country. In South Tipperary General Hospital there are only 150 acute beds per 100,000 of population. This contrasts with the national average of 230 beds per 100,000. That speaks for itself. We have a problem in Clonmel. It is like a battle zone. On any day one goes into the hospital there, one will see the walking wounded. It is completely overcrowded with trolleys literally coming out the door. There are mixed wards of male and female patients where there is no dignity in the patient care. There is intolerable pressure on the management and staff of the hospital. They have been seeking help and looking for support. The Minister visited the hospital, and we came to the conclusion that an interim solution is required, namely, a modular-type complement of beds, and that South Tipperary General Hospital should be included under the capital programme review. Many people are criticising the Minister. My view is he is accessible, approachable, sincere and knowledgeable. However, he needs the support of Government because this is a national crisis and it needs a collective response from Government to address it.

The Taoiseach

It is a national situation and requires a whole-of-Government response, which it will get. In the case of South Tipperary General Hospital, Clonmel, and Our Lady's Hospital, Cashel, the Minister has recognised that addressing the capacity issues there must be a priority. My understanding is that a tender is due in the coming weeks requesting proposals for temporary accommodation in Tipperary. The HSE has been asked to maximise the use of the Cashel campus and is considering every option to support South Tipperary General Hospital with both community and primary care services, as referred to by the Deputy. I am also advised that the HSE is working towards providing extra capacity through the fit-out of additional space on the first floor of the hospital to alleviate pressure on the emergency department. This extra capacity is expected to be available from early May of this year and I understand it could be used to accommodate up to 11 beds.

Also as part of the winter initiative, South Tipperary General Hospital has been identified, as the Deputy is aware, as one of the nine focus sites experiencing the greatest challenge in terms of emergency department pressures. Consequently, under the initiative, additional measures have been put in place to support the hospital to respond to increases in demand for emergency care over the busy winter period. These actions include improvement in early discharging and increased access to community intervention teams and to diagnostics. The winter initiative has allowed for a further additional three home care packages per week at the hospital until the end of February this year.

The winter initiative also recognises that there are specific capacity challenges at South Tipperary General Hospital. As such, additional options are being considered, including the use of the national framework for alternative accommodation on hospital sites, to which the Deputy referred, to provide additional capacity through a temporary inpatient solution at that site. The site in Cashel, which includes Our Lady's Hospital, provides mainly primary care services. There is a small residential facility on the site, together with other services, including day and outreach services. The residential unit, which includes elderly mental health and intellectual disability beds, is currently fully occupied. The development of the campus as a centre for non-acute health care services arose from the decision by the former South Eastern Health Board to centralise acute hospital services for the south Tipperary area on one site in Clonmel. This took place, as the Deputy is aware, in 2007. The Cashel primary care team is based on the campus. A range of services are provided on and from the site, including physiotherapy, occupational therapy, public health nursing, social work and disability services, as well as home help co-ordination and community mental health nursing. Among other services facilitated are the south Tipperary community intervention team, a nurse-led service supporting early discharge and the avoidance of hospital admission. An ambulance station is also located on the campus.

Deputy Michael Lowry

Many people in County Tipperary cannot understand why major surgery is cancelled in Clonmel with early discharges because of lack of beds, not enough step-down or convalescent beds, insufficient home care packages and reductions in home help hours. People are baffled and bewildered because while this is happening in Clonmel, there is a magnificent building up the road in Cashel, which was refurbished at a cost of €20 million in 2007. Three of its floors, which could take between 30 and 35 beds, are empty. They are in excellent condition. I ask that Cashel be reopened and developed as a primary, community care centre. It is a premium facility lying idle. It is shameful and mind-boggling that the Health Service Executive, HSE, is not using the building to its maximum potential at a time when the other problems exist in Clonmel. Will the Taoiseach and the Minister for Health give priority to reopening Cashel and making it available to deliver health care services to the people of Tipperary?

The Taoiseach

The Minister was surprised at the scale of what he saw in that building when he went to Cashel. He has given the HSE an instruction to come up with a list of proposals for better and more use of what is there. I expect he will have that report shortly. Given the scale of investment the Deputy mentions, much more could be done with it than is currently planned. He has instructed the HSE to revise that.