Simon Harris (Wicklow, Fine Gael) | Oireachtas source

Deputy Murphy O'Mahony asked about home help hours, and I hope I answered that when replying to Deputy Kelly's question.

I was pleased to hear Deputy Murphy O'Mahony talk about advice and prevention. We often discuss what to do when someone gets sick but we very rarely talk about what we are going to do to keep them well. I will be launching the Healthy Ireland fund in the coming days. By means of this, bodies will be able to draw down funding if they want to do something to help make the nation more healthy. The latter is not just the job of the Department of Health. There are a variety of ways in which we all have a role to play in tackling obesity. In recent days, the Minister for Education and Skills, Deputy Bruton, the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, and I launched new nutritional guidelines for school meals. A strange situation existed until now whereby the Department of Health said, "Here are the nutritional guidelines that our children should be following", and the Department of Employment Affairs and Social Protection was funding school meals in DEIS schools, but there was no stipulation in the service level agreements to say that the school meals had to comply with the guidelines. All of the service level agreements will be in place by the new year - some are already in place - and this will mean that we will only fund what is in line with the nutritional guidelines. This includes things such as fried food only once a week, only water and milk served with meals, not allowing items that are high in fat, sugar or salt content to be added to cereal and porridge, and greater availability of fruit and vegetables with all meals. Those are some of things we are doing. This is active schools week whereby the Department of Education and Skills is encouraging all children to get active. There is a huge body of work that has to be done across Government.

I know that Deputy Murphy O'Mahony and Senator Dolan are very interested in the area of disability. One of the issues about which my colleague, the Minister of State at the Department of Health, Deputy Finian McGrath, and I are most concerned relates to emergency placements. We are seeing a very high number of children and young adults with very complex needs who, for their own well-being and for that of their families, require emergency care. I do not want to put a cost on it but I will say that these places are extraordinarily expensive. That is the reality with which we must deal in the context of budgets. We must ensure that staff are trained and that appropriate facilities are available, and there must be liaison with HIQA so that emergency placements can be made quickly. This matter is a priority for the Minister of State, who is also working on the task force on personalised budgets, and myself. We spend a decent percentage on disability services. When one meets people with disabilities, however, they do not feel that the funding gets anywhere near them. The task force is due to complete its work by the end of the year.

I have outlined the plan for the winter initiative this year in terms of a bottom-up approach and asking individual hospitals what they want.

I will revert to the Deputy Kelleher on the issue of child and adolescent mental health services, CAMHS, in Cork and his assertion that there may be a lack of a permanent clinical governance structure. I will establish the facts and revert to the Deputy.

Deputies should be careful when referring to numbers of managers because it creates an impression that everybody is sitting around pushing papers and writing letters. When one talks about managers in the HSE, one often means managers and administrators. That may be the person who answers the telephone when a patient is trying to make an appointment. It may be someone working on a public health agenda. It may be a new clinical programme for cancer. I want to see fewer managers in the health service. Sláintecare does too. I want to see an amalgamation or closer alignment of our CHOs with our hospital groups, but we do need to keep a sense of perspective on that.

I have answered Deputy Kelleher's question about the national children's hospital and about primary care.

I want to be very clear on the issue of scoliosis. I have not, in my time as Minister for Health, ever seen the HSE more focused on resolving an issue.

We got there as a country because we were shamed into taking action. The waiting lists for scoliosis have been unacceptably high for children, not just this year but in Celtic tiger times. We have put in an additional €10 million and have hired additional consultants and theatre nurses. More surgeries will be done in Crumlin and Temple Street this year combined than were done in the entire year last year. I was talking to the children's hospital group CEO as recently as this morning. We now have a situation whereby we can put in place a sustainable system which ensures every child will get their procedure within four months, which is best international practice and in line with the NHS.

The problem is that we have a very significant backlog. In fairness, when the four-month target was announced by the director general of the HSE, it was clear that international outsourcing would be part of that. We have had children go to Stanmore in the UK and have their surgeries very successfully. We have signed service level agreements in Germany and with other hospitals in the UK. I am very conscious that it will not be appropriate for every family. However, I can say that absolutely everything that can be done is being done. Deputy Louise O'Reilly will speak in a moment. I am aware of her general concerns about the issue of outsourcing. We want to arrive at a situation where we can provide a maximum waiting time of four months for all children with scoliosis in this country. That is what we are genuinely working to do. That is what the children's hospital group is working to do and is going to do. We are serious about dealing with the backlog and therefore I do not apologise for offering parents an additional route which may be Stanmore or Germany, in circumstances where it may suit. It is not ideal for everybody but we are trying to go with this in every way we possibly can. We want to see the theatre open five days a week. It will require the recruitment of an additional two consultant surgeons but we are entirely committed to that. The theatre is operating at full capacity with all of the resources that it currently has.