Mr. Tony O'Brien:

In a moment I will ask Mr. O’Connell to comment on the implementation of the maternity reports and Mr. Hennessy to comment on the community and midwifery aspects. Deputy Kelleher is no longer here, but this is the first time I have ever been accused of painting an overly rosy picture of the health service. I do not necessarily recognise myself in his description.

I cannot say the memo does not exist. I can say that at the moment I have a very large haystack and I am being asked to look for a very small needle. If the newspaper that published the suggestions can do something to help me find it, that would be very helpful. There is certainly no national-level policy that allows such a memo to exist, and if it does exist we need to find it. If the newspaper has a copy, it would be very helpful if it were made available.

The use of private health providers to provide first appointments for people on outpatient lists is valid. When a doctor refers someone for an outpatient appointment, he or she initially looks for an opinion which can result in the patient’s being maintained or cared for by his or her general practitioner, GP, on a continuing basis, with the concern having been allayed, or it can result in the patient's requiring inpatient treatment. We have acknowledged that the process at the end of last year was flawed in that in some instances when patients were referred back into the public system for treatment there was a requirement for them to be seen again before they proceeded with treatment. We have made a commitment that will not recur. In principle, using private providers on that occasion was not wrong in and of itself.

In relation to the South Infirmary Victoria University Hospital, there is an issue with orthopaedic surgical capacity and there are plans to address that.

In relation to Fair Deal scheme, it is not that the assessment is taking longer but the placement. That is a simple consequence of the demand exceeding the resource available. It is a cash-limited scheme and new placements can only be made available as funding becomes available. Unfortunately, that means someone going out of the scheme, which, typically, is at the end of life. That situation will not improve by itself. All the information we have provided is around the interval to placement, not the interval to assessment. Perhaps Dr. O'Connell would like to comment on the implementation of the report.