Brendan Smith (Cavan-Monaghan, Fianna Fail) | Oireachtas source

I thank the Minister for his comprehensive presentation. I noted to the representative groups at our meeting with them on Tuesday that we have enjoyed good co-operation over the years. It is more the fault of the political system than the people who deliver health services that such co-operation has not received the attention it deserves. I am a firm believer in responding to service needs rather than devising grand strategies. We are all familiar with the territorial nature of agencies, whether on a national or local basis. It is important to respond to service needs in a practical way, with people on the ground who can take initiatives and work with their colleagues in the adjoining jurisdiction. Ear, nose and throat and urology services for my constituency of Cavan-Monaghan were delivered from Omagh hospital, and there has been good co-operation across the Border. We should consider ways of expanding existing services. I would also like to see progress on improving doctor on call services to the central Border region of Cavan-Fermanagh and Monaghan-Fermanagh. There has been good co-operation in respect of ambulance services, although I do not know whether this is on a structured basis. I presume that we could also make improvements to providing ambulance services on a North-South basis, particularly in respect of the Border area.

Deputy O'Reilly referred to our discussion with the HSE last Friday regarding the huge cost that families face for orthodontic services. Many families purchase services north of the Border. The National Treatment Purchase Fund previously purchased ophthalmology and cataract services from a private hospital in Derry to reduce the waiting list for these services in the Cavan-Monaghan area. Orthodontic services and the dental service for school children are under huge pressure. If there was scope to buy in services on a one-off basis it would be beneficial in terms of reducing the current backlog. This is an area in which we would like to see progress.

I will conclude by asking about the development of new facilities. I believe that when substantial new facilities are being planned or provided in the Northern jurisdiction or in our own State, provision should be made on an all-Ireland basis, particularly in regard to specialties. We are fighting to retain hospital services in our own localities if we can. Many people would willingly go to any part of Ireland to avail of a specialist service in many areas and ensure the necessary intervention is provided when needed. We need to be developing services in many specialist areas on an all-Ireland basis. I hope provision can be made for specialist areas in the national children's hospital. The South West Acute Hospital in Enniskillen was the last major new health service provision to be made North of the Border. To my knowledge, some of that hospital is not being used at present. It is a shame if that is the case. I am sure there are some areas and services which are needed both North and South that could be provided there. We have to look at the development of services, particularly in that respect. As the Minister quite rightly pointed out, Ireland is an island of 6 million people. We cannot have specialist services everywhere. We must try to ensure there is the utmost co-operation. I strongly believe the best improvement we can make in the provision of additional services should involve responding to service needs and driving initiatives at local level, rather than waiting for grand strategies to be drawn up North or South of the Border and finally agreed. I am very conscious that nobody wants to cede territory to some extent.