2007 Output Statement for Department of Health and Children.

On the committee's behalf, I welcome the Minister for Health and Children, Deputy Harney, the Minister of State at the Department of Health and Children with responsibility for children, Deputy Brian Lenihan, and their respective officials. Today's meeting is to consider the Revised Estimates for the Department of Health and Children, the Health Service Executive, and the Office of the Minister for Children, Votes 39 to 41, inclusive.

In line with the expanded budgetary process, an Output Statement is being provided. Members will be aware that, as part of the budgetary process reforms announced by the Minister for Finance in his 2006 Budget Statement, this year will, for the first time, see publication by the Departments of annual output statements for the consideration of Oireachtas Members. That important initiative is intended to facilitate greater parliamentary involvement in the budget and Estimates process.

A proposed timetable for the meeting has been circulated. It allows for opening statements by the two Ministers and Opposition spokespersons, followed by an open discussion on the Revised Estimates by way of a question and answer session. Is that agreed? Agreed.

I invite the Minister for Health and Children, Deputy Harney, to make a ten-minute opening statement.

I am delighted to be here to deal with the Estimates for 2007. As the Chairman said in his opening comments, this year, for the first time, we have the Output Statement required by the Minister for Finance's new transparency and accountability procedures. The idea is that money will be aligned with output and eventually with outcomes, leading to greater transparency and accountability. I will deal with Votes 39 and 40, the Votes for the Department and the HSE. The Minister of State with responsibility for children, Deputy Brian Lenihan, will deal with Vote 41.

Votes 39 and 40 cover gross expenditure of €14.566 billion, some €587 million of which is for capital, and €13.869 billion for current expenditure. The Department has €479 million and the HSE €13.977 billion. The HSE gets €11.474 billion from the Exchequer, while appropriations-in-aid for 2007 are worth €2.503 billion. The underlying increase for the Department is 8.72%, for the HSE 10.79% and overall, including the Office of the Minister for Children, 11.35%.

If one compares Ireland with other countries, particularly those in the OECD, whose membership is wider than that of the EU, one sees that in real terms spending here rose 9.1% per year between 1999 and 2004. The OECD average was 5.2%. Total health spending in Ireland as a proportion of GNP, which is especially relevant here owing to the large gap between GNP and GDP, was 8.5%. The OECD average is 8.9%, meaning that we are now very close.

Health spending per capita in 2004, adjusted for purchasing power to take account of the different monetary systems, was US$2,596 in Ireland, while the OECD average was US$2,550. Alongside Norway, Ireland has the highest level of public per capita investment in health as a proportion of national income, at 0.6% of GNP. That is twice or more the level of most OECD countries. In Ireland, 80% of health spending is funded by Government revenues — public spending — while the OECD average is 73%. In the 1990s, the Irish figure for public health spending was 71%, and private spending was higher.

I will focus on certain key issues, since I always enjoy taking questions from members rather than making a long opening statement. We have seen terrific results in Ireland in the area of cancer, although we still obviously have a long way to go. There has been a 15% decrease in mortality from the disease in the under-65 age group. We have recruited an extra 100 consultants over the past ten years, and 245 clinical nurse cancer specialists.

We have established a new national screening service to deal with cervical and breast screening, which is to be rolled out on a population basis. Breast screening will be rolled out to remaining areas this year, and we hope to begin a cervical screening programme in the latter half of this year and the first months of 2008. I believe that colorectal screening will be next, and any other screening programmes will also be implemented by the cancer screening service.

Since 1997, the number of people receiving treatment in acute hospitals has increased by 380,000. Some 68,000 were inpatients and 312,000 day patients. The number of new beds in our hospitals over the past ten years has been 1,620, some 976 for inpatients and 644 for day patients. There are 852 more consultants, taking the total to 2,144, an increase of 66% since 1997. Some 55,000 patients have been treated through the National Treatment Purchase Fund. There has clearly been a substantial shift in Government policy in recent years regarding disability. For 2007, there will be 255 new residential places, with 535 new day places. There will be 80 new residential places for people with physical or sensory disabilities and 250 extra hours of home support.

In 2007, the HSE proposes to treat 1.2 million patients as overnight or day cases. Some 2.7 million people will be seen at outpatient clinics and 1.3 million people will attend accident and emergency departments. There will be 65,000 births. During the past 12 months and into this year, we have been providing €60 million to open new units. Of that sum, €35 million is being provided in 2007 for capital investment to open, for example, Cork Maternity Hospital, cardiac surgery at University College Galway and additional beds or theatres at Wexford, Cavan, Crumlin and Drogheda, as well as a new hospital in Tullamore. When fully operational, these facilities will provide an additional 170 beds. In 1997, 11,727 acute beds were available in our 53 hospitals. Since then, we have increased bed numbers by some 200 per year, and we now have 13,771 beds in the acute hospital system. I acknowledge that there are issues in terms of long-term and rehabilitation beds. It is not merely a question of numbers but also how those beds are used. We propose to provide an additional 1,000 beds through the co-location model. This initiative has been debated with the Deputies opposite on numerous occasions and I am sure it will arise again today.

The HSE recently published its strategy for infection control. Although Ireland compares favourably with other countries such as England, Wales, Scotland and Northern Ireland in terms of the prevalence survey, we cannot be complacent. A detailed strategy to reduce the incidence of health care acquired infection by some 20% in the next five years, and 30% in the case of the MRSA, has been outlined by the HSE.

Some €4 million in additional funding has been provided to the executive in 2007 for neurology and neurophysiology services, and a national needs assessment of neuroscience is under way.

An area to which we have devoted much attention in recent times is care of the elderly. In addition to more beds being contracted in the private sector and more community and nursing home facilities being put in place in Dublin, Cork and elsewhere, we have also greatly increased the number of home care packages. It is Government policy, as implemented by the HSE, to support as many older people as possible to remain in their own homes. With low to medium levels of dependency, some 28% of those in long-term care could be in a home environment if home supports were available at the point at which they entered long-term care. This year, we will support up to 5,000 people through home care packages. An additional €85 million is allocated for nursing home subventions. This stood at €160 million last year and the increase brings the total allocation to €245 million for 2007. The new policy of supporting people in long-term care becomes operable on 1 January 2008.

An additional €7.9 million is allocated for the provision of child and adolescent mental health services. An increase of €2 million is provided for the national forensic mental health service and €1.85 million for the national office for suicide prevention.

I have exhausted the time available to me and I do not wish to offend. I look forward to answering members' questions. I am accompanied by officials from my Department and from the HSE. The latter will be able to deal with specific issues relating to service delivery.

Like the Minister, I intend to be brief in my comments and I look forward to members' questions. I will deal with Vote 41, which is specific to the Office of the Minister for Children. We discussed this briefly last year but I wish to bring members through the subheads because it is a new Vote.

The Government announced an expanded role for the Minister for Children in December 2005 whereby a range of matters relating to children were brought under the single focus of the Office of the Minister for Children. The office addresses issues that affect children in areas such as early childhood care and education, youth justice, child welfare and protection, children and young people's participation, research on children and young people, and cross-cutting initiatives for children.

The office supports me in implementing the national children's strategy 2000-10 and the national child care investment programme announced by the Minister for Finance, Deputy Cowen, in budget 2006. It also assists me in developing policy on child welfare and child protection and in implementing the Children Act 2001. It is a cross-cutting Government office located at the headquarters of the Department of Health and Children. Staff include those working on child care, who were formerly with the Department of Justice, Equality and Law Reform, and youth justice, who remain part of that Department. Staff working on child welfare and protection come from within the Department of Health and Children, while those working in the area of early education come from the Department of Education and Science. We also have staff from the National Children's Office.

These various staff are now co-located under the one roof. I am pleased to say it is no longer a metaphorical roof but accommodation located at Hawkin's House, comprising a floor and a half refurbished for our purposes. We have managed not only to bring together these public servants who were scattered across seven different offices but to accommodate them in one location. It is a valuable direction to take in co-ordinating policy and ensuring a joined-up approach to the delivery of services for children.

The total of funding allocated in the year ending 31 December 2007 under Vote 41 is €540.594 million. Almost €464 million of this relates to current funding while slightly more than €76 million is allocated for capital funding in respect of several programmes and other specific requirements the office will incur in 2007. Members should note that provision is not made in this Vote for the administrative costs associated with the day-to-day running of the office, which are provided within the overall administration budgets of the relevant Departments. Significant elements of the work of the office in the areas of child welfare and protection, youth justice and early years education are funded through the Votes of their respective Departments. Personal and social services for children and support services for children and families continue to be funded through Vote 40 — Health Service Executive, which the Minister has outlined.

Subhead A of Vote 41 provides for the 2007 allocation in respect of the early child care supplement, which was introduced with effect from 1 April 2006.

Subhead B1 makes provision for the equal opportunities child care programme. Ensuring that the full range of child care options is available to families is a great challenge. The programme, which has an overall budget of €449 million, funded jointly by the EU and the Exchequer, led to the creation of more than 34,000 new child care places. Although the programme no longer accepts new applications, the roll-out of funding for projects continues to the end of 2007. More than €113 million has been provided for the programme this year under this subhead. It is expected that by the time all the funding for the programme has been exhausted, 41,000 new child care places will have been created.

Subhead B2 of Vote 41 provides for the National Childcare Investment Programme 2006-10. While provision is made in B1 for the equal opportunities child care programme, in order to ensure a seamless transfer between the two programmes a decision was taken to begin the new national child care investment programme announced in the 2005 budget for the calendar year of 2006. The old programme expired on 1 January 2007 and this ensured a seamless transfer between the two programmes. The new investment programme will run until 2010, with a target of creating 50 additional places. There will be a new emphasis on providing school age child care and a greatly expanded child care labour force. Some €29 million has been provided under this subhead for the new programme.

Subhead C provides for the establishment of an early intervention programme for children, for which an allocation of €2.872 million has been provided in 2007. This programme aims to promote better outcomes for children through innovation and improved planning, integration and delivery of services. It uses international evidence of best practice to support activities chosen, and this requires a range of statutory and non-statutory agencies working across sectors to collaborate in both service design and inter-agency delivery.

The programme is being managed by the Office of the Minister for Children, and the administration of funds will be overseen by it. It will run for a five-year period with a fund amounting to €36 million in total. Some €18 million of this will be provided by the Government and the balance by Atlantic Philanthropies. I acknowledge the support the latter has provided for this project. I do so particularly in view of ungracious comments made in some newspapers during the summer when the programme was announced.

The national children's strategy is dealt with in subhead D. An overall sum of €9.652 million is allocated under this subhead to support the national longitudinal study and other programmed activities by the Office of the Minister for Children in the context of leading and co-ordinating the national children's strategy. The strategy has various roles in regard to consultation with children, research and various initiatives relating to children's development.

The landmark national longitudinal study of children in Ireland was recently launched by the Government. It involves more than 18,000 children and their families and is one of the most important research exercises ever undertaken on the lives of Irish children. The Government has committed almost €24 million to the first phase of the study which will span seven years. Longitudinal data is essential to answer many of the questions facing policy makers and researchers today. In 2007, €7.6 million has been made available for the study.

Subhead E contains a provision for possible expenditure in connection with the holding of a constitutional referendum on the rights of children. Members will be pleased to hear that the sum of €1,000 which has been inserted in the subhead is purely indicative. The provision is made to facilitate further provision in the event that the referendum proceeds. While the Twenty-Eighth Amendment to the Constitution Bill was published on 19 February 2007, it is not possible at this time to set out an indicative date for the holding of the referendum. Consequently, the full likely expenditure has not been included in the Revised Estimates. I thank the parties opposite for their co-operation in this matter. A great deal of progress has been made on coming to an all-party agreement on the way in which it will be progressed.

Subhead F provides for appropriations-in-aid in respect of Vote 41 which are expected to amount to €20.155 million in 2007. I mentioned earlier that the equal opportunities child care programme is co-financed by the European Union. The funds are paid out by a national exchequer in the first instance and a portion can be claimed back by a member state from the EU. Amounts repaid by the EU appear in subhead F and expected recoupment from Brussels this year is €17 million. An additional €2.872 million has been provided subhead C from the dormant accounts fund. A corresponding appropriation-in-aid is recorded in subhead C in accordance with the provisions of the Dormant Accounts Act. Through the decision to establish an office with its own Vote and the additional funding being delivered to support families, the Government has demonstrated a strong commitment to the improvement of child care services and the delivery of better outcomes for children.

I am pleased to have had the opportunity to present the Revised Estimate for Vote 41 to the committee and look forward to questions on it.

When one considers the overall budget for the health system, it does not appear that there is much scope to develop additional services. The additional increase of 7% does not represent a great deal of extra spending power in 2007 when inflation and wage increases are taken into account. Where has the Department made savings and where does it plan to make savings in order to provide the additional services?

How are home help hours being measured? I received an answer from the HSE to the effect that it had no way to provide me with an accurate figure on the home help hours provided under the old health board structure. Do we have an accurate measurement of home help hours? We were always given the impression that the Minister knew how many home help hours were being provided when we asked these questions at committee two years ago. We have now found out that the health boards were not really sure.

I have looked at the annual Output Statement from the Department of Health and Children on the care of older people. What has gone wrong with nursing home repayments? Why is it taking so long to make the repayments? The Department gave the contract to a private company to speed up the repayments, but it has been over a year since the HSE identified at least 10,000 living people who were entitled to the repayments. I have no doubt that people have written to the Department in significant numbers to inform it of their entitlement to repayment for illegally imposed nursing home charges. People have made contact with me to say that they have twice written to the private organisation appointed by the Department and received no response.

Why are repayments being made into separate accounts? They are not necessarily paid directly to people. It seems an account has been opened which is also in the name of the KPMG consortium. It seems incredibly bureaucratic and has slowed the repayments process significantly. Can the Minister of State explain what has gone wrong? My impression was that KPMG was retained to speed up repayments, which is not what has happened.

Programme 4 relates to care for people with disabilities. One of the output targets for the Disability Act 2005 is the commencement of Part 2 for children from birth to five years of age. I was taken aback by the Taoiseach's speech at the recent Ard-Fheis. He made a commitment that every child under five would receive speech and language and occupational therapy within three months, the standard period set out in the promises the Government is making nowadays. Does the Minister of State agree that to make such a commitment at an Ard-Fheis is to promise the impossible? It is reminiscent of the promise on a children's referendum which the Taoiseach made last November.

Even if therapy were to be provided under the National Treatment Purchase Fund, it would be impossible to fulfil the Taoiseach's commitment within three months. According to a parliamentary reply I have received, there are at least 5,000 children in the Dublin area who are waiting for occupational therapy assessment. Most people will not have understood as they listened to the Taoiseach what exactly he meant. The Minister of State and I know that any child seeking special assistance at school or at home must have a complete assessment carried out before his or her needs can be met.

One of the greatest stumbling blocks to proper assessment is a lack of occupational therapists nationally. If 5,000 children and 3,000 adults are waiting for occupational therapy assessment in the greater Dublin area, the figures when the rest of the country is taken into account may approach 20,000. I have received a number of representations from parents who have become extremely frustrated with the process and the inability to have their children's needs assessed due to the lack of occupational therapy provision. Can the Minister of State make it clear that the Taoiseach's commitment is not achievable within three months no matter what happens?

The HSE is attempting to employ occupational therapists from abroad to make up the deficit, but the problem is also faced by local authorities. Any elderly person seeking a disability grant or a grant for house renovations must also undergo assessment by an occupational therapist. Even where local authorities have sought to have assessments carried out by private occupational therapists, an applicant may still have to wait between three and six months. I would like to know what the Minister of State's thoughts are on the unachievable goal and current provision? Does the Minister of State consider the output target under the Disability Act 2005 to be achievable or realistic?

Programme 5 relates to mental health services. No real additional funding has been provided for mental health services according to the figures before us. An increase of 6% will quickly be consumed in pay and non-pay issues. When Bodywhys came before the committee a few weeks ago, it hit on some of the issues. The Revised Estimates refer to completion of the initial development of eight community adolescent mental health teams and the development of a further eight five-person child and adolescent mental health teams. Reference is also made to the provision of an additional 12 beds for persons aged under 16 years, an initial 24 to 32 beds for those aged 16 and 17 years, the completion of the development of 18 multidisciplinary teams and the enhancement of the existing 16 teams. There is also a requirement for an additional 3,000 mental health tribunals under the provisions of the recent Mental Health Act. How will the Department achieve all that development when the money in the Vote is insufficient? Providing such services costs a great deal, and realistic funding has not been made available.

Programme 6 deals with primary care, which on the basis of these figures is probably worse off. The Minister is not being particularly straightforward regarding a great deal of what is happening. Has anyone ever left the Minister's office to inquire at the HSE regarding the 100 extra primary care teams promised on top of those already supposed to have been developed? I do not believe the development of an additional 100 such teams is really happening. The 100 primary care teams supposed to have been developed are also unrealistic. They are not the primary care centres envisaged under the primary care strategy. They are simply virtual teams whereby people are supposed to remain in close contact by means of ICT and regular meetings.

I would like the departmental officials to give us a proper report on what the HSE is doing. Someone is seriously misleading the Minister regarding those primary care teams, which are not a presence on the ground. In my constituency I certainly cannot find the sorts of close connections about which the Minister is talking. There are a few, and even the Taoiseach has admitted that there are only ten primary care centres to show for a five-year strategy. Based on those figures, it seems that development of the primary care teams of which the Minister speaks will simply not happen.

Another interesting issue is that of acute hospitals and associated services. It is quite clear that running acute hospital services costs €4.9 billion per year. I found that interesting, since the Minister will know that I have always been concerned at her plans to co-locate private hospitals. However, I am also concerned about the National Treatment Purchase Fund, NTPF. It is impossible to get any information on it, since although we are suppose to scrutinise services provided by the Department of Health and Children, whenever we ask serious questions regarding the NTPF, we are fobbed off with the excuse that the information is commercially sensitive.

What the Department of Health and Children provides for the acute hospital sector, €4.9 billion, gives a good indication that the NTPF is not providing great value for money. Public hospitals are caring for 600,000 inpatients per year, and almost 600,000 day-case discharges. They are also dealing with 2.7 million outpatient attendances. There are also 1.2 million attendances at accident and emergency departments.

Let us take the budget of €4.9 billion and compare it with the €80 million spent on the NTPF. For every €1 spent by the latter, some €60 is spent on the public health service. The Minister always says that the public health service is not particularly efficient. However, if the NTPF were as efficient as public hospital services, it would care for 10,000 inpatients, 10,000 day cases, and 40,000 outpatients, while dealing with perhaps half that number of accident and emergency department attendances. It is quite clear that the NTPF does nothing of the sort.

Since the Minister will not give us the information on what is her baby, there is a need for someone to conduct a cost-benefit analysis or value for money audit of the NTPF. I know the Minister has tried to portray me as denying the 55,000 who have used the NTPF. However, it becomes apparent that some 80,000 extra people might have been seen in the public health sector at the same cost if the Minister had taken the reforms seriously. Looking through some of the services it provides, one sees such procedures as the removal of moles. Removing lesions or moles is a basic, day-case dermatology procedure, all relatively straightforward. They are certainly not all complex orthopaedic or other major operations. A quite significant proportion of work done under the NTPF is relatively low-cost, and that is what concerns me when I examine these figures. Perhaps the NTPF is not really securing value for money.

I do not have the figures to which the Minister has access, but there are serious concerns. Since one of the highest paid Government-appointed advisers also chairs the NTPF, the Minister should have a serious discussion with that person regarding the value for money that the fund provides. I know the Minister has been responsible for a great deal of publicity in this regard in recent years, but it does not seem to provide the value for money we might have expected. It should be seriously examined, since that is the matter in hand.

Perhaps the Minister might contact me this week with the sort of information she can access quickly. Someone queried me regarding the HSE, which seems now also to pay for cosmetic surgery. Can the Minister tell me how many cases of cosmetic surgery are being dealt with by the HSE and the reason for that?

This is a briefing note for the select committee. It is for the Department of Health and Children. In drawing up the Medical Practitioners Bill 2007, the Minister has changed the way in which postgraduate medical and dental training is administered. The Postgraduate Medical and Dental Board has been subsumed into the HSE, and the Minister has also granted the new Medical Council, over which she exerts considerable influence, control over medical training. I wonder why the Minister should subsume the board into the HSE.

In the list she gave us, a range of other organisations seem to have been reconstituted. For instance, the National Council for the Professional Development of Nursing and Midwifery was established by the Minister for Health and Children in 1999. Will that too be subsumed into the HSE? It seems to have much the same function as the Postgraduate Medical and Dental Board, except that it applies to nursing. The Pre-Hospital Emergency Care Council deals with the training of paramedics and also provides similar services. Will that be subsumed into the HSE? The Minister has established the National Cancer Screening Service Board, but is there a need for it, or should it also come under the HSE?

Like the Minister, I am against setting up new organisations. The only new organisation that I propose for the health service is a patient safety authority. When I speak in that regard, I mean amalgamating the social services inspectorate with the Mental Health Commission, which would give the two more authority than at present and help protect patients. I cannot see any clear reasoning behind some of the moves the Minister has made in recent years or in what she has done when it comes to establishing new organisations while subsuming others into the HSE. There is some concern that medical and dental training might suffer from the relevant budgets now being part of overall HSE funding.

Subhead G2 concerns payments to persons claiming to have been damaged by vaccination. The Minister has provided an estimate of €1,000, but the issue has been with us for some time. The heading covers the payment of compensation to persons permanently damaged by whooping cough vaccination as decided by an expert group established by the Minister in 1977. I have asked the Minister about this on several occasions. She repeatedly tells me that an expert group will report on whether these people are entitled to compensation. The expert group was established in 1977, however. I am not even sure who was Minister for Health and Children at that time, it may have been Charlie Haughey.

It was. Does the Deputy not remember it was the era of the toothbrush?

The Minister was around at that time.

Yes, I was a Member of the Seanad.

After 30 years, it is amazing that no decision has been made on compensation for those who were administered this whooping cough vaccination.

I remind Deputy Twomey that he has exceeded his allocated time by ten minutes.

I will hold back the remainder of my questions.

I am pleased to have the opportunity to make a brief contribution to the committee's consideration of these Estimates. It is regrettable that the Government has secured such poor value for the additional funding allocated to health services. There was much waste and incompetence and this is particularly regrettable from the perspective of patients. In 2006, the total voted expenditure was €13.487 billion and the provisional outturn was €13.056 billion, leaving a whopping €431 million unspent. Will the Minister explain this underspending?

The Minister is of the view that services are improving, and that is the impression given by Government posters across the State. While I acknowledge that some improvements have been made, the reality for many patients is completely different. In all my time in politics, I have never seen people so angry as in recent days. I spoke to a lady last night whose daughter waited more than six months for the result of a smear test. I understand the test had to be sent to Britain for analysis and the result, when she finally received it, was not good. She must now wait for an appointment to follow up on this diagnosis.

Another woman to whom I spoke was incredibly angry. Her 82 year-old mother had to wait for 11 hours in the accident and emergency unit of Beaumont Hospital, for seven hours of which she did not even have a chair. I accompanied a colleague who broke his ankle while canvassing to that hospital a fortnight ago. We spoke to an elderly man there who had arrived at the accident and emergency department some seven hours earlier but had not yet been seen by any medical staff. I spoke to the nurse in charge and he was eventually seen by a doctor.

The situation is getting infinitely worse. My constituency forms part of the catchment area for Beaumont Hospital, where acute operations are postponed on an ongoing basis. This is done to massage the figures to ensure the numbers on trolleys and chairs in the accident and emergency unit look better than they are. People are sick and tired of it. Services have disimproved despite all the moneys allocated and all the commitments made.

Will the Deputy confine his comments to the Estimates?

My comments are relevant to the Estimates. The Minister spoke about new measures to support older people to remain at home as long as possible and, where this is not possible, to provide them with access to appropriate residential accommodation. However, I understand €325 million was unspent last year. Of the capital allocation, some €20 million was unspent. Can the Minister explain these figures?

Some €360 million of the 2007 allocation is set aside for the repayment of public nursing home charges. Will the Minister indicate the percentage of claims this represents? Despite all the talk of care for the elderly, the reality is that the number of long-stay community beds has dropped significantly since 1997. What has become of the Government's commitment to the provision of public long-term beds? In the last ten years, not one public nursing home facility has been provided.

We were told public private partnership schemes would deliver such facilities, but that has not happened. Research shows that purchasing beds in the private sector does not reduce the incidence of inappropriately placed patients. Whether the Chairman likes it or not, I must refer once again to Beaumont Hospital.

It is not a question of whether I like it or not. I again remind the Deputy that we are discussing the Estimates.

This issue is relevant to the Estimates. More than 100 people are currently inappropriately placed in Beaumont Hospital. Nobody is impressed by the rhetoric in regard to step-down facilities and community beds. Those facilities are not being provided and the situation is getting worse. Where in the Estimates is the commitment to providing the new community and public beds that are desperately needed?

Elderly people who must leave their own homes to be cared for in long-term stay facilities are the most vulnerable members of our society. Any objective assessment of our care system must be harsh in its conclusions. We have a stated policy that favours community or home care but a practice that makes this extraordinarily different and which effectively supports institutional care more than it does home care. We do not have a clear and transparent set of rights and entitlements. Nor do we have a clear policy and appropriate service for combating abuse of the elderly. There remains a considerable delay in providing disabled persons grants and home help. The Estimates provide funding for 780,000 additional home help hours. This is welcome. We should remember, however, that between 2002 and 2004, there was a reduction of 730,000 in the number of home help hours nationally. This means we will merely return to the position as it was in 2004. It is a ridiculous situation.

These Estimates essentially maintain existing levels of services in our hospitals. We cannot run away from the issue of bed capacity in the acute sector. In its 2001 health strategy, the Government committed itself to providing 3,000 new hospital beds, not day beds or chairs. Where is the funding in these Estimates for the extra beds desperately needed in certain hospitals throughout the State?

We all agree there must be changes in the acute hospital sector. The Minister has committed to reversing the ratio of 2,000 consultants to 4,000 non-consultant hospital doctors. How many new consultants were appointed in 2006? How many additional consultant posts have been created?

On mental health, will the Minister explain the lack of provision for young people with eating disorders? The number suffering from these disorders is rising every year but there is currently no specific public service for management in childhood and adolescence. The recommendations in A Vision for Change, the Government's policy document on mental health services for people with eating disorders must be fully implemented as a matter of urgency. We must have immediate investment in community and primary care services as well as specialist eating disorder services. A Vision For Change recommended that 24 beds be available nationally for specialist eating disorder services but currently there are only three beds.

I referred earlier to smear testing and screening. The divide highlighted yesterday in the National Cancer Registry's seven year study on cancer treatment in Ireland is one of the largest challenges facing the national health service. While the NCRI highlights significant improvements in survival rates for sufferers of breast and prostate cancers over the period from 1994-01, it also highlights the totally unbalanced spread of cancer services.

If I had time, I would ask the Minister more questions about the difference between what she indicates to the public and the reality on the ground.

As Deputy McManus pointed out a few days ago, it is difficult to keep up with all of the activities of this committee. It is overstretched with so much legislation and the lack of back up, particularly if the secretary is ill.

I am available to help. If the Deputy contacts my office, we will be delighted to help him find his way around the system.

I will take the Minister up on that offer.

I know the Deputy does not want to be Minister for Health and Children, he told me that some time ago.

If I could cope with being an Opposition spokesperson with three different portfolios, it would be wonderful.

I know that.

I will take the Minister up on her offer.

Anecdotal evidence on health spending suggests it is either a feast or a famine. There are increases in spending but I have come across cases where people are being told in hospitals in the city that they cannot use post-it notes, apparently to save money. They cannot get computers to write up reports. It is disconcerting, particularly when wastage elsewhere in areas like PPARS and iSOFT is taken into account. I had hoped the HSE would allow for a thorough look at how money is being spent within the health service, cut out the real wastage and provide the obvious requirements for those on the ground but we still need that.

When we look at these figures, the conclusion is that the more we invest, the more lives are saved. The Minister says there has been a 15% decrease in mortality from cancer among under 65s. I welcome that but it comes from investment. We are looking at increasing life expectancy through investment. Would the Minister accept that basic point?

On the co-location of private hospitals on public hospital sites, there are areas that must be clarified. The Minister has promoted this but I am not convinced at all by this strategy. The Minister made the point that she is doing this, and the Taoiseach has reiterated it, because it will provide beds at a far cheaper price. Why, then, can the public service not provide these beds? What are the prices in terms of public versus private for bed provision? In Sweden, the private sector will be asked to provide the public beds. Is that not possible?

The private sector there runs the beds as well. After the election, I will bring the Deputy to see what his fellow socialists, including the Green Party, are doing over there.

That is the second offer from the Minister this morning, she is being very generous.

I want to be nice.

It would be nice to do that after our election success. Can we have a breakdown of the costs of the private sector providing public beds? The Minister, however, is not doing that. She wants private beds to be built on public land. How many private beds in total will be built on the public land in the next five years? Has the Minister given the HSE a specific direction that private patients will no longer be accommodated in public hospitals after a certain date? When we look at the figures, if there are 1,000 additional beds for public patients over five years, that is not the 1:1 ratio, so private patients will still be treated in public hospitals. How many patients are we looking at?

I heard the Minister on the radio discussing her trip to Sweden and it obviously made an impression on her.

I was very impressed. The way it is represented here is completely wrong, that is why I was so impressed when I saw it for myself and that is why I would like to bring Deputy Gormley with me next time.

I have no problem with that at all.

That will push up the total spent on travelling so Deputy Gormley should be careful.

The Deputy might like to go after the election.

I must be careful about my carbon footprint so we must be aware of that.

We will cycle there.

The Swedish have managed to bring about a significant reduction in levels of MRSA. The Minister says we are doing a little better than Britain but one of the reasons the Swedish have been so successful is that they have dealt with the prescribing of antibiotics in a real way, unlike ourselves. Does the Minister accept that we must invest in education for GPs working in the community? Some GPs will not write a sick certificate if a person is able to work; they are conscientious. Others will have no difficulty signing a certificate. Similarly there are GPs who are conscientious about prescribing antibiotics and feel their use should be significantly reduced. Where is the money for education of GPs and the public in dealing with MRSA? The prescription of antibiotics cannot be divorced from the MRSA issue. I accept that it is about clean hospitals, but there are other aspects to it as well.

The point has been made repeatedly that there will be a great increase in waiting times for cancer treatment services over the next 15 years. While the Minister is increasing investment in this, it will not come near to what will be needed according to the projections. Some forms of cancer will increase by over 100%. This is an astounding figure and we are replicating the situation that exists in the US, where there is a virtual cancer epidemic. I believe that cancer is on the increase because 80% of cancer cases are environmentally linked, as the WHO has pointed out. We have been exposed to so many chemicals in food and in the air that we will be faced with a great increase in cancer cases. This will require very significant investment. I obviously feel that we should look at the root causes of this and clean up the environment, but we are faced with a situation where people will get cancer and we must deal with that. The investment is not adequate and the various reports show this to be the case.

Deputy Twomey spoke about the increase for the National Treatment Purchase Fund. I have seen the publicity around the city that we have decreased waiting times. Will the €10 million investment to which the Minister refers decrease waiting times for public patients? How much will those times decrease? What is currently the difference in waiting times between public and private patients?

The front page of the Irish Examiner this morning contained an astounding statistic that one in eight people in this country have been taking some form of sedative or anti-depressant. Can we make savings in this area? With the greatest respect to my colleague, Deputy Twomey, there are too many GPs handing out sedatives and anti-depressants. Is there a way to make significant savings in this area? It seems to be out of control.

They can be bought over the counter in Spain.

This is wrong. We are becoming a drugged up nation and there are other ways to deal with the problem.

Many members of this committee were heavily lobbied yesterday on the Pharmacy Bill 2007, as there is much disquiet among GPs about the primary care strategy. They have pointed out anomalies within the Bill, such as the fact that those GPs whose practices are above pharmacies feel they will suffer discrimination. They point out that many of the promises made to them on primary care have not been honoured. The subsidies they were promised have not come on line and they doubt the sincerity of the promise made again this weekend by the Taoiseach that we will have a further 100 teams. The centres will not be up and running. They make the point that they have taken the initiative because of their concern for patients. They have taken out substantial loans in many cases and they feel that their future is under threat.

I was also struck by the subhead dealing with payments in respect of persons claiming to have been damaged by vaccination. The subhead contains more or less a blank space on this and I would like an explanation. If a committee was set up, as has been stated here this morning, it seems that it was somewhat redundant and the situation has not been resolved. If the Minister could explain that, I would be very grateful.

Thank you, Deputy. In this section of the meeting, we will hear responses to the opening statements and then there will be a 30 minute questions and answers session.

Thank you, Chairman. I wish to begin with the vaccination issues. A committee was set up in 1977 and 93 cases were presented to that committee. The committee felt that the vaccine was responsible for damage in 16 cases. In 1982, an offer of an ex gratia payment of £10,000 was made in 14 cases, with a further two offers in 1984. Thirteen families accepted the offer between 1982 and 1988, while one family accepted the offer in 2000. An ex gratia payment of £18,070 was paid in 2000, adjusted in line with inflation since 1982. In one case, a family took a court case against the manufacturer and the Supreme Court found that the manufacturer was liable. As one family has not accepted the offer, the subhead of €1,000 is there to allow us to put money through it. That is why something that happened in 1977 is still alive, as one family has still not accepted the offer. In the event of the family coming back to agree an offer, we will have to—

Did the family win the court case against the manufacturer?

Yes, the manufacturer was found liable.

What sort of damage did the family suffer?

I do not know what damages were awarded in the case.

What were the symptoms they suffered?

I do not have the details. Perhaps one of my officials will follow that up and we will make the information available. There was never acceptance of liability on behalf of the State, which is why the payments were made ex gratia. The report on childhood immunisation to the Oireachtas Joint Committee on Health and Children recommended that legislation be drawn up to provide for a no fault national vaccine injury compensation scheme. There is a steering group currently looking at that issue.

When will that committee report?

It has just been established. I do not have a date for when it will report.

Deputy Twomey raised the issue of cosmetic surgery. Reconstructive or restorative surgery is provided to women who have mastectomies or to people who are seriously disfigured after accidents.

That is reasonable.

We do not provide plastic surgery for purely cosmetic purposes. We only provide it in situations which people would accept as reasonable.

I will not argue about co-location as we have had so many discussions about it, but I will ask Mr. Finn, who is here from the HSE and who is responsible for the co-location initiative, to address the committee shortly. There are 13,700 acute beds and we have been increasing that stock by 200 per annum since 1997. In the period when Deputy Seán Ryan's party was last in power, the stock was being increased by 60 per annum. In the Labour Party manifesto, which I have carefully read, there is no distinction between day beds and inpatient beds. That is very wise because half of all hospital procedures are done on a day-case basis, and that figure is rising rapidly. Procedures that used to require an overnight stay or even a few days in hospital can now be done on a day-case basis. The plan is to convert 1,000 of the 2,500 private beds in public hospitals to make them available to all patients, including private patients. Everyone would have access to the beds on an equal basis, not on a preferential basis. As the beds are ring-fenced for insured patients, only insured patients can access those beds. Recently, because of infection control and the need for isolation facilities, these are generally single rooms or rooms with small numbers of beds. I wrote to the HSE to say that for infection control purposes, these beds should be used in our public hospitals where required. I hope that can be implemented.

The cost of these beds, on average, is less than 50% of the cost of providing them in the traditional way, even when capital allowances are factored in. The HSE carried out a value for money audit, which Mr. Finn will deal with, that was enlightening and useful.

The Minister said she can withdraw private rights of consultants in public hospitals if she so decided.

There are currently negotiations—

Can the Minister withdraw the consultants' private practice rights in a public hospital at her discretion?

I cannot unilaterally change anyone's contract of employment but two issues arise. On the ring-fenced private beds, hospitals are required to have a ratio of 80:20. In Tallaght Hospital in 2005, 46% of elective work was private, which is not in line with the hospital catchment area and out of sync with the requirement. That changed radically in 2006, something I welcomed, but in addition to the patients in the private beds, when a patient comes on to a ward from accident and emergency, consultants can get a fee for that patient in any bed in the hospital.

The co-location plan is sold on the basis that 1,000 private beds are being removed from public hospitals to the private sector.

Yes. We are in contract negotiations but the idea is that the consultants will work in the private facility.

The Minister is going to sign tender documents for the construction of these hospitals before the consultant contracts are sorted out.

I am not signing anything; it is a matter for the HSE, which is the implementation group. Mr. Finn can deal with all of that.

The Minister is responsible for the health services and this is a serious issue, she cannot just say the HSE is signing contracts.

It is. I am not signing any contracts or making any choices. We devised a policy that was endorsed by the Government and given to the HSE for implementation. The reason for co-location, which has worked well in Australia—

No, it has not.

It has. The main advantage to having them on-site is that the consultants are on-site instead of travelling to two or three hospitals, as some do. We will reduce the number of private beds in the public hospitals, but those private beds will be provided in a co-located facility.

The consultants can maintain their private practice in the public hospitals because up to 20% of the beds in the public hospitals will be private. This measure will simply build private hospitals on public hospital grounds. Unless the Minister has changed the consultants' contract, the status quo remains except there are private hospitals in the grounds of public hospitals. There has not been any change to the consultants’ contract at present so existing consultants can keep their private practice in 20% of the beds in public hospitals and, now, work in the private hospital.

It will not be additional capacity in terms of private practice.

How will the consultants not work in the private hospital as well as having the 20% in the public hospitals?

The consultants can work in the private hospitals but the beds are being substituted from the public to the private sector in the private facility.

Their contract allows them to work in 20% of the beds in the public hospitals because they are private.

The contract does not say that. There is the existing contract, and I hope the new contract will be attractive to existing consultants.

The existing contract gives them 20% of public beds.

We are in negotiation and if we cannot agree a new contract with the existing 2,144 consultants, we must red circle the current contract around those consultants.

Even if that happens, these new hospitals are strictly new private hospitals on the grounds of public hospitals.

If the Deputy is asking if the current crop of consultants can do more private work on the co-located facility, the answer is "No".

Why not?

It will not be allowed and it will not be facilitated.

If they are category 1 consultants, they may possibly get away with it, but if they are category 2 consultants, they can certainly do it.

If they are category 2, they can work wherever they like whenever they like, that is the problem. That is why the HSE board made a decision, with my full support, not to have any more category 2 consultants. I am a strong fan of private investment in health and elsewhere but that does not mean private operators should not have their own staff. We cannot allow a situation where private operators in private hospitals, that could be miles away from public hospitals, require for their main staff those who are employed in the public health system. That is not desirable for the future and that is why it will not be pursued.

We are in negotiations and will know their outcome in three weeks. New consultants will be appointed on a completely different basis that suits the needs of our health care system.

The HSE will sign the contracts.

What proportion of beds in public hospitals will be given over?

In the eight hospitals that are the subject of the process under way in the HSE, the idea is that 1,000 extra public beds will be provided.

The proportion was 20% so what proportion will it be in future?

In Waterford, the consultants have said they will move all of the private beds from the public hospital and put them in the co-located facility. They say they will cover the additional 70 public beds without any additional manpower. That is part of the proposal from Waterford hospital. There are different numbers for different hospitals, with an average of 100 beds for each. Mr. Finn from the HSE has all the details and he will address specific questions.

The questions are specific. The way I see this, it is nothing more than building eight new private hospitals. There is no change to the consultants' contract.

Deputy Twomey is wrong. The condition of the additional 1,000 beds is that 1,000 private beds will become public. I cannot make it any clearer. It is not a question of increasing the number of private beds on the site, it is a question of increasing by 1,000 the number of public beds. That is the plan and that is why the Government supports it. In an ideal world everyone would go into a public hospital on the same basis.

We are dealing with contracts as they stand. If the consultants have contracts that state they can use public beds for private patients, those contracts are legally binding. There is no agreement from the consultants, apart from a verbal agreement in Waterford, to say they will give up their contractual rights to private beds in public hospitals. The HSE, however, will go ahead in three weeks time and sign tendering documents to build these new private hospitals. As soon as those hospitals are built, the existing consultants can apply under category 2, and possibly category 1, to work in these new private hospitals.

There is no contractual arrangement that stipulates consultants in one hospital could do 46% of elective work on private patients. It is a matter for me, the HSE and the Government to change that.

That is an issue the Minister also left-----

If the 20% was even enforced, it would lead to major improvements, but it is not being enforced. If we are to follow the letter of the law in the contractual arrangements, that is a different matter. The purpose of this proposal is to convert those private beds for public use and not to take away consultants' rights, but to provide private beds on the site that consultants can work in. Deputy Twomey seems to say that the consultants will not move into the private facility and will insist on having it as part of their contractual arrangement, but that cannot happen and it will not happen. If that happened, they would not be allowed to work in the new co-located facility. The intention is not to increase private activity on the site, but to—

Good intentions have fallen on less.

—make those beds funded by the taxpayer available to public patients. All of us are public patients because everybody in Ireland has universal coverage and everybody is entitled to health care in our public hospital system, unlike in some other countries. That should be provided to everybody on the same basis in an ideal world.

The Minister acknowledged that she could not enforce the 20% limit, so what makes her so confident she can implement this?

I am delighted to acknowledge that Tallaght Hospital was able to enforce it in 2006, once attention was drawn to it. I saw the figures for 2006 and 79% of patients were public and 21% were private. That is a major improvement on 2005 and I welcome that. It was enforced on the ground by the hospital.

The Minister seemed to indicate that Tallaght Hospital was not the only guilty hospital in this case.

I think it is roughly 70:30 around the country.

Is the Minister saying that as part of the negotiations, the consultants will still be eligible for 20% of beds for private patients in public hospitals?

I am not saying that. It is not the case for the co-located facility.

Is she saying that co-location will not go ahead unless the consultants do away with 20% of private beds?

The co-location will go ahead. It is a question of who can work in the co-located facility.

The Minister said it will go ahead even though she does not know the arrangements that will be in place. She is giving away public land and she does not know what-----

We are not giving away anything. We are in negotiations with the current consultants on their contract of employment. In particular, we want a new contract of employment for new consultants. The Government and the HSE want to see as many as possible of the current crop of 2,144 consultants opt for the new contract, as it will meet all our health care needs. The views of the chairman were expressed yesterday in a letter to the Government, in which he stated he was cautiously optimistic that agreement can be reached. We are moving ahead on that basis and I remain optimistic that we will reach agreement.

Yet, the Minister will still go ahead and sign contracts for the new private hospitals.

Signing contracts for the provision of these facilities is a matter for the HSE.

The Minister is washing her hands of it.

The Deputy's party policy is to build the private hospitals anywhere but close to the public hospitals, which is crazy.

It is actually about value for money for the taxpayer.

Let Mr. Finn deal with that.

If the Minister goes ahead and builds private hospitals on the grounds of public hospitals without a new consultant contract, she will have no idea about the future of the health service. She will not know whether the consultants will be in the private hospitals or not. There is no plan.

There is a plan.

The meeting is scheduled to last until 11.30 a.m, and it is now after 11.00 a.m.

That is a waste of taxpayers' money and it provides no major benefit to the patients for whom the Minister is responsible, namely, those patients in the public health service on which €14 billion is spent every year.

That is where the Deputy is wrong. The purpose is to create additional public capacity.

If the consultants hold on to 20% of the beds — it looks like they could — there will be no such thing as additional public bed capacity. It is simply new private hospitals. When I ask the Minister can she unilaterally change the consultants' contract or unilaterally withdraw private rights to these beds, nothing she says has convinced me that she can. If consultants currently in public hospitals decide to stay put with 20% of the beds and the private hospitals are built across the way, they can keep their 20% and let the private hospitals do whatever they like.

It is a matter for the hospital authorities to decide what beds are designated public or private, not for any other individual. It is a matter of who pays for what in a particular bed. It is not just designated beds. Consultants get fees for other beds as well.

It is quite a good deal for the consultants.

Yes, it is.

That is all the more reason for crossing the t's and dotting the i's before new hospitals are built.

That is why we are taking such a long time to change. In future, consultants will be employed on a different basis. I think that has the Deputy's support.

Absolutely. Therefore, does the Minister agree that she should have the consultants' contracts sorted out before she builds new hospitals?

No. I think the two can happen together.

The consultants' contract being made is pivotal to the so-called reform of the health service, which the Minister says she supports. It is not just about changing their rights within the public system, but also about changing their working day. It seems crazy that the Minister will sign contracts committing the taxpayer, to whom she is responsible, to pay for these private hospitals. The people who will be forced into these private hospitals are also taxpayers buying private health insurance as they cannot get access to the public service. In spite of all this, the Minister might change nothing in public hospitals. There is too much ambiguity for the Minister to sign off on €600 million to €700 million of taxpayers' money.

The Mater Hospital and St. Vincent's Hospital are co-located facilities. When such a facility exists, it is a matter for the hospital authorities to designate which beds are private and which beds are not. When the co-located facility exists, it will be a requirement that the beds being replaced in the private facility will be designated as public beds. That will be a matter for the hospital authorities. Otherwise, the proposal would not work. This is not about additional private capacity on the site. It is about converting some of the capacity on the site for public patients. I would have expected the Deputy to support that, but he clearly does not.

The Minister should not put words in my mouth. The courts might decide differently to the grandstanding in this committee. We cannot withdraw consultants' contractual rights.

We are not withdrawing any rights.

Our legal system enforces contractual rights whether they are good or bad.

Beds change in hospitals all the time.

The hospital management cannot withdraw those rights from consultants.

We are not withdrawing any rights. There are no rights being withdrawn.

That is the problem. What will the Minister do about it? She is basically not changing anything if the consultants do not agree with her. Her point about the co-location of the Mater Hospital was that management can somehow tell consultants that they cannot have those beds for private patients. It does not work like that. The Minister referred to Tallaght and the high number of private patients. One of the main reasons for the high percentage of private patients in our hospitals is that half the country has private health insurance. There will always be 30% of patients in our hospitals on private health insurance. Beaumont Hospital has 620 patients, 80 of whom are public patients and would be more appropriately dealt with in nursing home care. Therefore the percentage of private patients treated in our hospitals is in excess of 30%. The reason for that has much to do with the fact that so many people here have private health insurance.

We should be careful of throwing that figure about. It is not as if the consultants are somehow bringing in private patients in preference to their public patients. That happens and I accept that it happens, but we must also bear in mind that 52% of the population avails of private health insurance. When we are planning the public health system, for which the Minister and this committee have responsibility, it seems crazy from the point of view of the taxpayer, the public patient and even the private patient that the Minister is implementing a policy that is not clear. It is not clear on the working conditions of the people who will be dealing with it after the contracts have been signed by the Minister.

It is very clear.

Not to me.

The Deputy makes a valid point on long-care facilities. We need more long-term care facilities. I said in my opening comments that 28% of those in long-term care need not be there if more home supports are put in place. That is why we have been developing more supports for older people in their homes in recent years. When people are finished their acute phase of treatment, we need to make sure that we have facilities for them so that we can use the acute beds for the purpose for which they were intended in the first instance. That is a very important issue for us. I was asked how many we are building. This year, we are building 220 in the greater Dublin area, 100 in the south and 40 in the west. In 2006, provision for 1,050 extra beds, mainly concentrated in the Dublin area, was made for 2007. Many of these beds were procured from the private sector, as members will know.

Before we move on, I will let Mr. Finn deal with some of the co-location issues.

As he is an official, I will have to go into private session to allow Mr. Finn to contribute to the meeting.

A Member

Why is that?

It is the part of the rules as the select committee is an extension of the Dáil. I must be bound by the rules.

The select committee went into private session at 11.10 a.m. and resumed in public session at 11.42 a.m.

We hope to increase the number of people in training for occupational therapy. Currently, we have three colleges offering 25 places each. There is a shortage in this area. It is not a matter for me as Minister for Health and Children to comment on a political speech of the Taoiseach, but I think what he was saying is that we must use whatever capacity exists in the private sector where necessary if we do not have the capacity in the public system to get an assessment for children for occupational, speech or language therapy, etc. We all acknowledge there are significant delays and we must be innovative in how we seek to address them.

Deputy Ryan asked about smear tests. Some 50,000 smears were outsourced to deal with the backlog and long wait for results.

Is it still a six-month wait and is there any way of reducing that?

It has reduced and no further backlog is anticipated as there is now a mechanism in place to provide results in three weeks. The outsourcing was done to clear the backlog of 50,000. The plan now is to provide results within a three-week timeframe.

There is no place in the country where people will get a smear test result within three weeks.

I understand the HSE is currently putting in place capacity at national level to deal with smear tests. In the area of mental health and eating disorders, some €750,000 was provided in the Estimates this year towards putting in place additional capacity to deal with these. Deputy Twomey asked how much was available for new services after taking wage increases into account. Approximately €350 million is available for new services.

I expect that during the debate on the Pharmacy Bill I will deal with some of the issues raised by Deputy Gormley on the issue of primary care. Primary care is not just about a building or facility, but about putting in place a team at general practitioner level, including therapists, public health nurses, etc. It brings together a team of people to provide the range of services people expect to get at that level. I have been advised by the HSE that 97 such teams were in place by end-2006 and that 100 extra teams will be put in place during 2007. Provision was made for 300 staff in 2006 and 241 posts were offered. The balance will be recruited this year along with a further 300 staff for the additional 100 teams.

Deputy Twomey also asked about postgraduate medical and dental training in line with the Buttimer and Fottrell reports. He also made a valid point about what we are going to do with regard to midwifery training and some of the other training bodies. The jury is out on that. The Medical Council approved the places and training facilities where education will take place for medics, but the HSE must deal with the logistical and co-ordinating aspects, in particular the provision of intern places for doctors, where there is currently a shortage. It was suggested earlier that we use some of the capacity in the private sector for training given that we are increasing significantly, more than doubling, the number of doctors in training.

When the HSE was established, BreastCheck was on a tight target in terms of roll-out and as a result was kept as a stand alone organisation. Therefore, screening is not included in the remit of the HSE, although it is intended to move it under its remit. The HSE is currently in the process of putting its new cancer control policy into effect. I understand the position for national director of that policy will be advertised in the next couple of weeks. It would be appropriate that both screening and the provision of service would be available within the HSE.

Deputy Gormley mentioned MRSA. I agree the Scandinavian countries are impressive in this regard as a result of their low level prescription of antibiotics. The HSE has a plan to deal with the issue which includes the involvement of general practitioners. In addition we must have more public education on the issue because many people who visit doctors would be disappointed if they were not prescribed antibiotics. In tandem with the involvement of general practitioners we need greater public awareness and education. This is part of the programme put in place by the HSE. In Sweden, one of the significant measures taken is the thorough enforcement of hand-washing. Also, in some hospitals there doctors do not wear ties and their uniforms must be changed daily. In some Scandinavian countries the uniforms of health personnel are washed and cleaned through the workplace. That is not done here, although it may be done for some doctors or surgeons. We need to learn from the good practices followed in Scandinavian countries with regard to MRSA and health-acquired infections.

Deputy Ryan mentioned specifics with regard to patients he has met during his election canvass. I am the first to acknowledge there are challenges and difficulties. We have invested significant amounts of money, but the challenge now is to change the way we do the business to ensure we get better services. Notwithstanding the difficulties and challenges, every day I hear of the good experiences of critically ill people who receive outstanding service. The challenge for us is to make that the experience for everybody. The waiting times for accident and emergency services have improved significantly, but there are still challenges. As long as we do not have sufficient long-stay places for older people, capacity in the acute hospital system will be inappropriately used.

On repayments, the legislation requires us to establish an account for each resident and to ensure the money is put into that account. Some €13.8 million was paid out in 2006 and up to end-February 2007 €22 million has been paid. The administrator has issued 1,763 letters to individuals and people have a month to accept the offers. I accept the process is much slower than any of us anticipated. The HSE recently met me and the Department officials. The scheme administrator attended those meetings and a strategy is being put in place to expedite the payment. In the first instance we want to pay those who are alive, and subsequently estates. It is important to pay as quickly as possible. The residents in long-stay homes are anxious to get their money and the question they ask most frequently when I visit is when they will get it.

We are appointing 32 officers around the country to deal with elder abuse. I hope we have dealt with all the questions.

We have run well over time. I will take a further minimal contribution. Keeping the members happy here is a challenge to the Chair.

It is a pity that we have to finish because we have plenty of other questions for the Minister. She does not have to answer this question now.

We will be taking questions in the House tomorrow.

The Minister of State with responsibility for children has sat silently all morning and I was hoping to ask him a few questions about children from Riga to Cahirciveen.

We will have to do that some other day.

Could the Minister send me a note explaining why the non-pay issue for the corporate HSE has gone from €10 million to €36 million? It is under subhead A1, salaries, wages and allowances and other administrative expenses of corporate HSE, including insurance, which have gone from €31 million in 2006 to an estimated €57 million in 2007. That seems to be quite a dramatic increase.

I am told it is something to do with the national insurance scheme but I will send the Deputy a note because I am not sure.

The Minister of State committed to something which I have pursued for years and thought I would see it before retiring as a Deputy.

What is that?

The foundation being dug for the St. Joseph's facility for people with intellectual disabilities at St. Ita's Hospital. It is a 60 unit building. I would appreciate if the Minister could send me a reply to that.

I will check that issue.