Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I will table supplementary questions on the three priority issues I raised, namely, questions Nos. 7, 8 and 9 in the pack, dealing with dental, mental health and audiology services. I also wish to make reference to the non-consultant hospital doctor recruitment process.

Regarding question No.7 and what I believe to be a crisis in dental treatment services, it is very disappointing that in the reply I received to the aforementioned question there is not a single word of acknowledgment that there is any difficulty in dental treatment services, let alone a crisis. It must be acknowledged that we saw advances in dental health and dental treatment services in the early 2000s when there was a marked improvement in services. However, these improvements have been steadily eroded by cutbacks. The Irish Dental Association reports a rapid reversal. I cite from its recent commentary in this regard: "We do not believe the cuts to dental care make sense and will ultimately cost the State more in the long term". How does the Minister respond to the position taken by the Irish Dental Association? We are told that primary care is crucial and cost effective. If so, will the Minister restore the dental treatments previously available to PRSI patients and medical card holders? When one looks at the range of services previously available to these groups, it is alarming to see what has actually been cut.

On mental health services, I refer to an article published in The Irish Times last Friday in which the mental health reform group stated that in 2013 mental health services were still staffed at 24% below the level recommended in A Vision for Change. That is very alarming. I commend the group for its work.

In the context of the commitment to an investment of €35 million last year and this year, I have no hesitation in acknowledging progress in the filling of the promised 414 additional posts. It is very welcome. However, these posts were promised in 2012, with further posts promised to be filled this year. What is the net position in this regard? The reply from the Minister contains a tabular outline of the recruitment of the promised 414 additional staff. However, in the same period, staff have left the service through retirement and for other reasons. I want to know what is the net position, taking into account those who have left the service. According to the HSE's health service personnel census in December 2012, mental health service staffing levels dropped by 12.1% between 2009 and 2012. I welcome the appointment of a new national director of mental health and wish Mr. Stephen Mulvany well in his new role.

Regarding audiology services, I wish to focus on the bilateral cochlear implant service which we still do not enjoy in this jurisdiction. I understand the Minister of State at the Department of Health, Deputy Kathleen Lynch, yesterday met representatives of parents coping with children with severe hearing challenges. The introduction at Beaumont Hospital of the bilateral cochlear implant programme is absolutely essential. When is it expected that the expert report, sought from Professor Gerry O'Donoghue of the University of Nottingham, will be available? When will the Department be in a position to agree to the business plan? Will the Minister commit today to the provision of the required funding? I know that initially it will cost a little more because there will be a backlog to address in terms of those who will require sequential introduction of their entitlement to a second implant. Of course, we will then want to see work commencing on the bilateral approach in terms of the introduction of both implants at the same time. There is an estimated additional initial outlay of some €7 million. Will the Minister indicate that it is his intention to introduce the programme in the context of the budgetary provision for 2014? I appeal to him to do this. I have met many of the parents and some of the children affected and it is tragic that their lives are being impaired because their hearing issues are not being fulled addressed, something children in other jurisdictions enjoy.

On the recruitment of non-consultant hospital doctors, I have heard the reply from Mr. O'Brien, but I wish to know what the position will be in July. I raised this issue at the committee some months ago, at which point I was reflecting concerns already expressed by a number of hospitals.

Is he in a position to tell us what the shortfall will be? How will this affect patient care? I was concerned that the five-page report that we received in addition to the replies did not mention patient care once across the five pages. There are hospitals in which the predicted deficit of NCHD manpower for July will be in the region of 20% to 40%, not 2% as indicated in the response. Maintenance of services in the worst-affected hospitals will be extremely difficult and there is a real and genuine fear among management and lead clinicians in some hospital sites that some services will be impossible to sustain and will, at least for a period, cease.

The HSE centralised applications process does not have the confidence of all hospitals across this jurisdiction. This is a simple fact. The late indiction that local recruitment could get under way, something that had been forbidden up to sometime in the middle of last month, April 2013, was much too late. Remember the doctors who were recruited from India and Pakistan in 2011, when we introduced the emergency legislation; the great majority were not in a position to take up their posts until the month of December, some five months after the shortfall presented. We could be looking at a similar situation, although perhaps not as catastrophic in terms of scale and numbers, but most certainly a number of hospitals, particularly those that do not enjoy the allocation of trainees, experience traditional recruitment challenges. Hospitals such as those in Drogheda and Letterkenny are excluded from the allocation of trainees by the training bodies, which is leaving them at a distinct disadvantage.

Will the Minister address the scandalous issue of the training posts in private hospitals? Will he ensure that large regional hospitals receive a minimum? The regional designation is not a necessity. They are performing the role of a major general facility and have a minimum of 50% trainees, given that 80% of all NCHDs in the country are now said to be in training programmes.

Will the Minister undertake to publish the service level agreements so there is an opportunity for public scrutiny? The members of this committee will have sight of them and will have a understanding of what is involved.