Simon Harris (Wicklow, Fine Gael)
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I will take the South Tipperary General Hospital in Clonmel and Our Lady's Hospital Cashel together, since the Deputy and I visited both of them together. The HSE and I believe we can do more in Cashel. I will ask the HSE to comment on that. I expect to receive a paper in the next couple of weeks about what we can do in Cashel while admitting that will require funding and it will be my responsibility to try to find that funding. There has been a tender competition in Clonmel. I will ask the HSE to update the Deputy on that. Clonmel and Cashel have to be a priority and have to work together. The Deputy asks if it should be a temporary offering or if a longer capital plan should be waited for. If there is a temporary solution that can alleviate pressure in Clonmel, that should be progressed, because the situation in Clonmel is not acceptable. I acknowledge that it has made good progress through its own efforts on overcrowding.

I am glad that the Deputy raised the issue of management because I did not get through all of my statement. I have travelled to nearly every hospital in our health service and I have met some brilliant managers. I do not accept that everybody is the same in any organisation. There are some really good managers, and we want everybody to be really good. The performance and accountability framework agreed with the Departments of Public Expenditure and Reform and Health and the HSE talks about the four metrics against which a manager should be measured. It includes such things as budgetary control, access to services, quality, safety and the harnessing of the workforce. I have written to the director general and he will be reporting back to me shortly with an important piece of work on how that framework is being abided by and implemented by each manager. I want to see a health service in which we point out excellence and say we would like more of that. I could give a number of examples of excellence. It is important that this becomes the norm and the expected benchmark across the health service. That is what my comments were referring to. They were not that all managers are bad because that is not my experience in the health service at all.

The Deputy picked an important issue on waiting lists and how we can be sure they are accurate. I asked the National Treatment Purchase Fund, NTPF, through its audit function, to look at the waiting list practices in each of the hospitals that featured in the "RTE Investigates" programme. That is prudent and an important step. The NTPF is not an arm of the HSE. It is an independent statutory agency that reports to me.

Validation is a word at which people sometimes shudder but if we are targeting limited resources, it is important that we know that the lists are accurate, that there are not people on the list twice, who are deceased or who have been referred to more than one consultant for the same procedure. The individual health identifier proof of concept piece has a role to play in this as well. It will be important if we can track everybody by individual health identifier, rather than by finding Mrs Murphy.

Funding is an issue for the national maternity strategy. I know the Deputy is a strong advocate for it and that this committee has taken a big interest in it. Extra funding was provided, some in the Deputy's own time, of €2 million extra in 2015, €3 million in 2016 and another €6.8 million in 2017. There is a need for more funding.

The Deputy has outlined some of the important related capital projects, including those associated with University Hospital Limerick, the Coombe, the Rotunda, and the move of the National Maternity Hospital from Holles Street to St. Vincent's University Hospital, in respect of which move I hope and expect to be able to lodge a planning application in the coming days. It is not just a question of funding. With the exception of Holles Street, all have to be considered in the context of the capital plan.

It is also a question of implementation. The doctors and clinicians who appeared before the committee talked about that. The new national women and infant health programme in the HSE is important. One of the things we have done very well in this country was the cancer strategy. It was implemented by my predecessors in the face of a lot of political opposition at the time. The cancer control programme was set up as an independent, distinct body working within the HSE. It had its own director and really drove change. We now have a director appointed to head up the national women and infant health programme and implement the national maternity strategy. The programme director is in place. There will be a clinical director for that programme taking up office on 1 March.

I appreciate the raising of the national children's hospital because it provides me with an opportunity to clarify this. I am frustrated that some of the information circulating on costs is somewhat misleading. I have not received the definitive business case so I cannot confirm commercially sensitive figures. It has not come to me to bring it to the Government. I expect that to happen within a very short number of weeks. It is currently with the HSE and is to go to my Department. What I can say, however, and what is important to say is that the figure of €650 million, which was referred to by the Committee of Public Accounts, was a core construction cost figure. The documents at the time in question will show that it did not include equipment or the education facility for students, nor did it include some shared infrastructure and services to be used by St. James's Hospital in addition to the children's hospital. It did not include retail. Therefore, there are a number of issues that were not included in the €650 million. It did not include ICT but it was always expected that, at some point, we were going to arrive at this. The €650 million included the building of the children's hospital and the two satellite centres. The other pieces need to be appraised by the Government. The Government has yet to make a decision on this. I expect to bring the definitive business case to the Government shortly.

People who are working very diligently on this project are accused, as professionals, of overruns, etc., and this is not fair. If construction industry inflation were factored in at a rate of 3%, it would have a bearing on the matter. According to the figures given to me, we are now, in 2017, seeing construction industry inflation of more than 9%. It is absolutely right and proper that the Committee of Public Accounts scrutinises this entirely. There is a very competent bunch of people heading up this project. I look forward to being able to bring this matter to the Government shortly and sharing what is currently commercial information. I hope I am being helpful in putting that information on the record of the committee.

I have corresponded with the Deputy on the ambulance service. I will ask the HSE to answer the question further. We are investing additional funding in our ambulance service this year. The budget increased by over €3 million this year but €1 million of that is for new developments within the service.

On scoliosis, the Deputy is right. When I came to office, we did make targeted investments. More than €2 million was spent on scoliosis and 50 additional children and teenagers had procedures carried out in 2016 who otherwise would not have had them done. There was outsourcing to other public hospitals and to private hospitals. Was it enough? No. Should it have taken a "Prime Time Investigates" programme? No. Did I mean it when I said I was ashamed? Yes. What are we going to do about it now? We are going to have the action plan on scoliosis. We are going to make sure that when people say theatres will be open in April, they will actually open. We are going to share with this committee the action plan on scoliosis at the end of this month to show how we are going to arrive at a point where no child or teenager will wait longer than four months by the end of this year.

On the issue of Orkambi, I understand it is still being considered by the HSE leadership team. The legislation in 2013 was very clear. The HSE has to make a decision. If there is a funding requirement, the question of where it will be found is my responsibility. I am awaiting to hear about this. I hope and expect the consideration of the matter will not go on for long. Patients need certainty and answers.