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

If the post cannot be filled, perhaps we could examine doing something in the North if there is capacity there. I add my congratulations to Mr. Mickey Brady, MP, MLA, on his recent election to Parliament. All statistics show an association between low income and ill health which is very much linked to lifestyle including higher rates of smoking, alcohol consumption and obesity and much lower levels of physical activity. While some take the view that low incomes make people smoke and drink more and go running less, it is controversial and others argue that these social determinants of ill health are multifactorial and are due to a number of factors including genetics, parental upbringing and the environment in which people grew up. In some cases, they are explained by personality, and one can see major differences in health in the same family between people who were brought up in the same place by the same parents. I do not subscribe to the view that correcting economic inequality will automatically improve public health. While I accept that there is correlation between ill health and low income, the reasons are indirect and complex.

Regarding the new drugs strategy, I do not know if there are plans to do anything on an all-island basis and I will discuss it with the Minister of State, Deputy Ó Ríordáin, in the coming weeks and see if there is anything that would make sense in the area. The same issues would apply as to other all-island strategies.

I have not had a chance to meet Mr. Simon Hamilton, MP, MLA, in his new role. I met him when I was 18 or 19 when we were almost on the same Washington-Ireland programme. I would be interested to meet him. It is an interesting move from finance to health. I have not seen a finance minister become a health minister before. It is new precedent and it will be interesting to see how somebody whose job it was not to give out any money will be in a job where he will be hungry for money. I wish him the best and look forward to meeting him, which I hope to do in two weeks’ time at the NSMC in Dublin and have a side meeting with him there.

There is probably not much of a case for cross-Border co-operation in hip and knee surgery. Hips and knees are relatively straightforward, can be done in relatively small hospitals and do not require a critical mass or a very high level of specialisation. The solution to making them happen is probably to increase the capacity in Cappagh National Orthopaedic Hospital and outsource to the private hospitals in Dublin, which we intend to do, rather than sending people to Enniskillen or Belfast. It is intended that anybody who has been waiting more than a year for a hip or knee operation will have it done by the end of the year. It will be done through outsourcing, by and large. One finds that although people say they have been on a waiting list for two or three years, when one checks the facts one finds that they are not.

I met some of the families from Donegal whose children have rare diseases. Some of these diseases are not very rare, for example, while cystic fibrosis is technically a rare disease, it is not very rare. The same goes for haemochromatosis and a few others. Given that the diseases are all different, although many people are affected, they are all very different and cannot all be seen by one specialist in one specialist centre. This is well understood. There is a case for people from Donegal to attend in Derry or Belfast if the services are available and if they so wish, given that the journey from Donegal to Dublin this extremely long. In some cases, the HSE pays for travel costs from Donegal, including flights in some cases, which is very expensive. There is room for co-operation there.

The planning application for the national children's hospital will be made in the next few weeks, at long last. The planning application will include the satellite centres in Blanchardstown and Tallaght, which will be located at the fronts of the two existing hospitals. Assuming, not supposing, An Bord Pleanála, grants permission, which usually takes approximately six months, we hope to have full planning permission by December or January, begin site works immediately and have the satellite centres and hospital well under construction by this time next year. We hope to open the satellite centres in Tallaght an Blanchardstown first in 2017, which is not very far away, and the hospital on the main campus open in 2019 and fully commissioned by 2020. It will happen, if we stick to the plan. If we do not stick to the plan but return to the old debates about tri-location, co-location and where it should be located, we will be back to square one and I do not know how Temple Street or Crumlin will last. It is intended that while there will not be inpatient beds at Tallaght or Blanchardstown, there will be 23-hour observation. This means wards not currently used in Tallaght could be used for adult patients, however none of it has been planned out or thought through fully. Tallaght needs additional capacity.

While it will be a national children's hospital, not every child in Ireland will have to go there. There will still be excellent paediatric services in Cork, Galway and many other hospitals. It will be a secondary hospital for the greater Dublin area and the only people who will attend from outside this area will be those who need to see a particular type of specialist. Some of the specialties could be done on all-island basis. Compared to the hundreds of thousands of children who will attend every year, the numbers who will need to travel from other parts of the country will be relatively small.