Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The planning permission is in and the money is available in the capital plan. These are the kinds of decisions that have to be made in the health service. We are always trying to choose between one child and the other but if a commitment is made, it should be honoured as soon as it can be funded. An issue also remains outstanding in respect of academic contracts, however.

I will ask Mr. O'Brien to address the issue of speech and language therapy. Deputy Mitchell O'Connor's suggestion that we should assign speech and language therapists to schools should be seriously considered.

The chief nursing officer's office is engaging with Nursing Homes Ireland to develop solutions on the shortage of nurses. When it comes to nursing, everyone is poaching from each other. The hospitals poach from the nursing homes and I even hear advertisements from Beacon Hospital offering hello money to nurses if they come to work for it. That is a general symptom of the shortage of nurses in the country. I will be investing considerable effort into the UK recruitment campaign in the coming months, as well as developing a package of measures to encourage this year's graduate class to stay here. It is a good thing that people go overseas for a year or two to get experience but we want more to stay this year than was the case last year.

Senator Crown is correct that 2,000 births per year is an adequate volume to provide safe care in low to moderate risk pregnancies. Some units are below that threshold. However, it is not an adequate figure for tertiary or national specialty units. Recruitment remains a struggle for smaller units. The solution for Portlaoise is to put it under the governance of the Coombe, which allows joint appointments to be made. I am not sure if a joint appointment has been made yet but we have given approval for two joint appointments in obstetrics and two joint appointments in paediatrics. As the Coombe is only an hour away from Portlaoise by road, they are feasible as a joint appointment. NCHDs will also rotate between the two hospitals, which means that if somebody has a two-year post in the Coombe, he or she might spend six months of it in Portlaoise. The Coombe has been very helpful in this regard and I thank the master of the Coombe, Dr. Sharon Sheehan, and the board of the hospital for taking this on. If it is successful, it might become a model for other smaller units.

I do not want to dwell on the primary percutaneous coronary intervention issue but I understand that St. Vincent's proposed to work together with the Mater to provide a 24-7 hour rota between the two sites. The ambulance service had a problem with this aspect of the proposal in particular because of the risk that confusion would arise as to where patients should be brought on a particular day of the week. This is why the decision was made to operate from two sites in the greater Dublin area, St. James's and the Mater.

There are no plans at present to end 24-7 emergency department services from Navan hospital but the hospital groups will need to develop strategic plans for reconfigured services in the future. A regional hospital in the north east only makes sense if the five existing hospitals are closed or downgraded. That would be a politically difficult and controversial decision but it would also be questionable given that we are investing considerable resources into Our Lady of Lourdes Hospital. One would wonder if it is a good idea to build a regional hospital in Navan if it means downgrading or closing Our Lady of Lourdes. There is no funding in the budget for such a proposal but it has not been ruled out as a possibility in the future.

The number of people with health insurance increased by 80,000 so far this year, including 76,000 who signed up in the past few weeks. We have received the results of the HIA's initial work on universal health insurance but I do not yet have a report from the ESRI, although I am due to receive it shortly. Regardless of whether universal health insurance is in place, loadings can still apply. One could argue, on the one hand, that as universal health insurance is compulsory there should be no loadings or, on the other, loadings can be applied to those who did not have health insurance for a period of time before its introduction in order to reward those who have already paid into the system.