James Reilly (Dublin North, Fine Gael)

I will certainly inquire about the case. I know there were a lot of difficulties, but it is my understanding — I have spoken to the Minister of State, Deputy Shortall, who was also very concerned about delays — the position has improved considerably.

On the long waiting list for children who need orthodontic treatment, this has been a long-standing problem. I could read a long answer, but the bottom line is that we have inherited a problem, which is unacceptable; initiatives put on the table in the past have not been availed of and we are looking at implementing them to shorten the waiting time to at least have assessments made and treatments provided more expeditiously. There is a shortage of orthodontists, but we need to use those available in a more clever fashion than in the past. There have been initiatives taken in the mid-west which have resulted in a significant improvement. I will revert to the Senator on the issue.

Senator Leyden mentioned Roscommon County Hospital. He is right that before the election I gave an undertaking to retain services in the hospital and I did so in good faith. Since the election, however, HIQA reported in that regard and stated it was unsafe. I inquired of it, the clinical programmes, the Department and the HSE as to how we could make it safe and was told we could not, that it was not possible to make it so. Therefore, there was no option but to remove the service. I do not want to get overly political with the Senator, but the bottom line is that while money was spent on upgrading the front of the accident and emergency department, as has been explained time and again by clinicians, what one sees at the shop front is not what makes the shop work. What a person sees in an accident and emergency department is not what makes it safe, but the services that back it up — the presence of a cardiologist with the ability to put in a stent, someone to deal with a fracture or a limb that has been severely compromised as a result of a burst blood vessel, or a stabbing. That is what makes it safe, not the new surroundings. It was not possible to provide for this in Roscommon County Hospital and I have no problem putting my hand up on that point. I told the people that I would take that responsibility and I do.

I will follow up on the other undertakings given and ensure Roscommon County Hospital has a bright future, that it will start to deal with more day surgery cases and have new services. Since we last spoke in this House, plastic surgery services have commenced, with outpatient clinics and day surgery cases being dealt with. There will be capacity to provide for endoscopies and colonoscopies. There are a number of other initiatives planned, into which I will not go because I do not want to go down the road of promising what cannot be delivered. I am now in a position where I have full sight of the system. I know what can be delivered safely in smaller hospitals.

This is part of the framework document on which we are working. When we know which of 24 or 25 services listed that can be safely delivered in a smaller hospital, we have to make them fit the geographical and demographical requirements identified. There is a great future for the likes of Roscommon County Hospital, Portiuncula hospital and the hospitals in Ennis, Nenagh, Bantry and Mallow, as well as all other smaller hospitals, but it is of a different type. We cannot have an emergency department operating 24 hours a day, seven days a week in every hospital. That is not possible and it would not be safe. Let us be sure that when we put up a sign with the words "emergency department", patients can expect to receive care to which they are entitled, not a service with significant variations that have consequences, depending on the hospital one attends.

There are two issues relating to the hospital in Waterford. On the provision of palliative care in St. Brigid's unit, a new unit was promised by the HSE, but it was removed from the waiting list. However, it is now being reviewed again for inclusion in the capital budget. It will be examined in the coming months.

With regard to palliative care, the Government's policy is based on a report of the national advisory committee on palliative care and is primarily concerned with quality of life. It is dedicated to a form of active treatment designed to ensure that patients are enabled and encouraged to live their lives to the greatest possible extent in the manner and the setting of their choice. I propose a vote of confidence in the palliative medicine and hospice movement in this country. Before this movement developed people went to the hospice to die but that is no longer the case. Many people go to the hospice and receive the level of care they need that allows them to return home. Extraordinarily good work is done. The Government is very much committed to providing more palliative care in the community.

The capital proposal is at an early stage and not in the HSE plan. An outline development control plan for the Waterford Regional Hospital site has been produced which sets out proposed future developments at that hospital and where they will be located. Phase 1 components of the plan have been identified and are currently at business stage. This will require approval by the HSE capital steering committee before it can be recommended for the national HSE plan. As the phase 1 indicative development cost is in excess of €35 million, it will have to go through a cost benefit analysis. I could give the Senator a full answer later but——