Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister and his officials and thank him for the presentation. While it is a historical document there are things we can glean from it that may assist us in the months and years ahead in terms of learning from the challenges we face and even the mistakes made from time to time.

A few issues arise, some of which were brought to my attention in advance of this document. The child and adolescent mental health services across the country are under huge pressure and stress from the point of view of recruitment and the lack of psychologists and psychiatrists in the service. That a huge number of children are still being admitted to the mental health services, not into adolescent units but into adult wards, which has been condemned and deemed wholly unacceptable from a clinical and a human rights point of view, is an issue of grave concern.

Regarding the child and adolescent mental health services in Cork, from what I can gather, and I would like the Minister to check this out and address it in a meaningful way, we do not have a permanent clinical governance structure in place in terms of personnel; we have the structure but not the personnel. We do not have a clinical nursing director. The assistant nursing director, which is a level 2 position, is acting in a level 3 position under that. We have no permanent clinical governance structure in the child and adolescent mental health services in the Cork area. That issue was brought to my attention recently by union representatives who are very concerned about it. While I do not expect the Minister to comment now I would like him to revert to me on it. Otherwise, I will have to raise it in the Dáil. It is an issue of huge concern across the country.

We always talk about the inability to recruit psychologists and psychiatrists and that being the main problem, but when I look at the HSE recruitment levels, and I put down some parliamentary questions on that previously, I see that there does not seem to be a ceiling or block in terms of recruitment on the administrative side. That figure has increased from 1,075 last year to 1,159 this year. The Minister will say that the HSE is expanding and so on but we seem to be incapable of recruiting clinicians across all specialties while at the same time the HSE is recruiting up to three managers a week. We would want to reprioritise, while resources are scarce, and ensure that efforts are made to recruit those who will work on the front line and try to make the management system lean as opposed to bloated. I urge the Minister to look at that.

Reference was made to two issues I wanted to raise. On the children's hospital, the legislation to amalgamate the three hospitals is coming forward. Where is the template for the construction of the hospital both in terms of the timeframe but also the funding to underpin it? Will a multi-annual budget be in place in the capital spend for the hospital or will it be very much on an annualised stop-start basis? The Minister might give us clarity in terms of what he envisages with regard to that issue. It is a huge undertaking. Concerns were expressed previously about construction inflation and the cost of the hospital itself but does the Minister anticipate there being a multi-annualised, ring-fenced budget in place so that it can be built in a planned phase as opposed to depending on resources being made available more or less out of current expenditure?

Home help hours were referred to by Deputy Margaret Murphy O'Mahony. Sometimes I think we live in a parallel universe in terms of what we read in official reports and what we experience in our constituency offices. Not a day or a week goes by that we are not hounding people trying to get a half hour of home help care here and there. We now have a deficit of 5.4% in the number of people in receipt of home help hours; it has gone from 49,000 down to 46,339. That is extraordinary when I, along with every other Deputy in this House, are consistently looking for home help hours.

That leads me to the issue of primary care. Admittedly, the budget is down by only a small amount - €5 million or €6 million - in the overall spend of approximately €1 billion but is the HSE serious about trying to ensure we bolster primary care services and lighten the pressure on our acute hospital system? There is an overspend in our acute hospital system of approximately €107 million and there is an underspend in the primary care budget of €7 million. Everybody tells us, including the discussions on finalising the Sláinte Care report, from speaking to people at the coalface, primary care strategies, and all political parties are in agreement, that if we front-load spending in primary care and health and well-being, we should at least reduce the pressures on our emergency and acute hospital system over a period of time. However, we seem to be incapable of planning our primary care system in a meaningful manner.

Reference has been made to the roll out of our primary care centres, which is haphazard. While the building may be there, there is very little activity within. The entire primary care system seems to be an afterthought when it comes to funding. I can understand that the hospitals suck resources.

If we are to be serious, however, we must ensure that primary care investment is at least on profile and that we are spending as anticipated, as opposed to spending less and transferring that to the acute hospital system.

The maternity strategy has been mentioned and I will await the reply on that.

This morning, Patricia Flynn, spoke on the "Morning Ireland" programme. Scoliosis is an issue that I and many other Deputies have raised in the Dáil. Many people are campaigning in respect of it. Scoliosis was also raised on Leaders' Questions yesterday. I realise that the Minister has as much interest in this as every other Deputy and that he feels for people whose procedures are delayed. However, Ian Flynn was born with spina bifida and later developed scoliosis. He has been waiting over a year for surgery. Patricia Flynn spoke on "Morning Ireland" this morning so I am not divulging anything that is not already public knowledge. Ian is twisting in his wheelchair. His upper spinal curvature is now 68% whereas it had been 40% last year, while his lower spinal curvature is 78% having been 62% last year. His scoliosis has progressed enormously in 12 months. Initially, the family was told that his surgery would take place in the summer or the early autumn. His mother has made contact with his surgeons on numerous occasions and been told that they are aware of Ian's condition but that they have no date yet for the surgery.

I accept that the Minister has spoken about this in the Dáil in reply to Deputies, including myself, and explained that the theatre in Crumlin hospital, where there had been difficulties with recruitment, has been opened. However, surely it is not beyond the ability of the State to prioritise surgeries in a way whereby we do not have to listen to mothers of children with scoliosis almost begging on national fora for their children to be dealt with in a meaningful, humane manner? I urge the Minister to do everything in his power in this regard. He has explained that the National Treatment Purchase Fund is in place and that this is increasing the number of surgical interventions, but the waiting lists are still increasing. More people are on the waiting list now than there were last year. If the Minister can do one thing in the next few weeks, he should refocus and prioritise the resource allocation for scoliosis. If he has to front-load for the National Treatment Purchase Fund, he should do so, even if it requires bringing in paediatric and orthopaedic surgeons from outside the State rather than taking patients out of the State. That should be done because this issue is a blight on the health services. It is certainly a blight on the future of many children. I urge the Minister to do that if he can. I accept that he is as compassionate as the next person on this but it is no longer about compassion. It is about action.