James Reilly (Dublin North, Fine Gael)

I move this motion on behalf of Fine Gael but, more importantly, on behalf of our children. A fortnight ago, we discussed the Ryan commission report, which outlined dreadful inhumanity and cruelty to past generations of children. All of us, one after another, expressed our shame and horror at what was done to them while nothing was done about it. While the wrongs were committed by the religious orders, the State was complicit in allowing it to happen, and the broader society turned a blind eye.

The cutbacks in Crumlin Hospital will once again inflict needless pain and suffering on children. The big difference is that this time there is something we can do about it. We know what the implications of our decisions will be; they have been outlined very clearly for us by the relevant medical experts.

Let me give a few facts about scoliosis. This is a condition that causes increased curvature of the spine. In the bulk of cases, this is of little concern, but for the small percentage of progressive cases, it affects children severely leaving their backs twisted and deformed. In this country we put people on the operating list when they reach 68o of curvature in their spine, because of our lack of resources. The international standard for intervention is at 48o. Nonetheless, at 68o one operation will correct the situation. By the time children here get to theatre, they will be at 75o of curvature.

The budgetary cutbacks at Crumlin will result in patients being left longer on waiting lists. This could mean up to three, four or even five operations for a patient who otherwise would have needed only one. This is unacceptable. Not alone is it unacceptable because of the need for five general anaesthetics, five admissions and five episodes of post-operative pain where one of each of these would have sufficed, it is unacceptable because these children are then left with, perhaps, their entire spine fused, resulting in reduced ability to rotate or to flex their spine, giving them life long disability where they might have had virtually none. It is needlessly cruel to cause extra pain and suffering where it can be avoided. It is also financially inane, because it costs the State so much more money in terms of repeated surgery time, theatre time, hospital time and then a life of reduced capacity and all that implies for the child when he or she becomes an adult.

In the area of cardiac surgery, the situation is equally serious for children with cardiac anomalies like a hole in the heart, incomplete valves or other rare conditions like hypoplastic heart. These conditions, some of which were not amenable to correction by surgery in the past, are now amenable to correction through advances in surgery and other techniques, particularly extra corporeal membrane oxidisation, ECMO, which has reduced by 50% mortality from cardiac procedures. This has, of course, saved the lives of many young babies, but some of the corrections require repeated procedures as the baby's heart grows.

Even a more simple condition like a hole in the heart is a dynamic situation that changes. Sometimes the hole will close over itself, sometimes it will stay stable and other times it will deteriorate. When doctors realise the defect is getting worse rather than better, they will plan to do surgery in an urgent fashion. This does not constitute an emergency, but it will rapidly become an emergency if not corrected. Therefore, the foolishness of believing that one can delay such procedures, as will be the case due to these cutbacks, is just that, foolish. It is foolish because it endangers the life of the child and because it may well end up costing the State more money. Emergency surgery is never deemed to be an ideal solution, or a substitute for planned surgery. The outcomes are very different. When patients develop complications, this means further suffering for the patient and further worry, anxiety and emotional distress for the family. It also means further costs for the State. Everybody loses.

The list of procedures that have been delayed as a consequence of these cutbacks goes beyond these areas. However, every effort has been made to protect children, particularly those requiring cardiology and oncology services, but in urology there are many children with serious defects, such as hypospadias, which need to be corrected, especially before they go to school where their condition can cause them tremendous psychological problems if left uncorrected. Again we see a penny wise, pound foolish health policy from this Government. While a 3% cut across all hospitals might on the face of it seem sensible, surely it would be more sensible to examine the efficiencies of each hospital, reward the ones that are efficient and penalise those that are inefficient?

Let us consider some of the facts on Crumlin Hospital. In 2004 the budget was €98.6 million and in 2009 it is €134 million, an increase of some €36 million or 37%, but what we have to examine here is what happened to the €36 million. A total of €24.3 million went in pay awards, which were outside the control of the hospital and were awarded by this Government. The balance of some €12.4 million, or 13%, was available to deliver increased volume and complexities.

The increased budget enabled Crumlin to see more patients, to treat more patients and to treat more complex problems, and this it has achieved. It can now perform life-saving operations on heart conditions that were untreatable before and is now treating many more patients. This is not surprising because our population has increase. This is acknowledged by the Department through increased allocations to the maternity hospitals, but the very hospital which has to treat the rare and more serious conditions and the increased number of children requiring treatment has its budget cut.

Today members of the Oireachtas health committee visited Crumlin Hospital. I had already visited it in the previous week and had an in-depth tour. I have statistics which are worth reading into the Dáil record. All hospitals have been asked to be more efficient, to cut down bed days stayed, to do more day cases and fewer inpatient procedures. We have had an increase in our population and our birth rate and this has been acknowledged, but Crumlin Hospital is not being acknowledged in the same way.

With an increasing population, more children will need treatment, but inpatient figures for 2004 and 2008 show no percentage change. Day case surgery, however, has increased by 30%, so Crumlin is following Government policy and there is a greater emphasis on day care. It is right and proper for children to wake up in their own beds in the morning, go to hospital for treatment and go to their own beds at night, where that is possible.

The number of total bed days used has increased by 14% and outpatient activity by 23%. Theatre procedures have increased from 10,000 to 13,000, a 34% increase. ICU bed days increased from 4,600 to 5,600, a 21% increase. At every level of measure for efficiency, increased activity and greater emphasis on day cases, the hospital has done all that it has been asked to do, and did it within the increased budget of €12 million, or some 5%, afforded to it. The figures show a pretty good return. To ask it now to cut back the budget by €9 million will have a detrimental effect. It will delay cardiac surgery. It will turn many urgent cases into emergencies. It will delay orthopaedic surgery, with life-long consequence for children. This is not acceptable. We have been told Crumlin Hospital is overstaffed by comparison to other hospitals. Nothing could be further from the truth. There are 63 whole time equivalent consultants in Crumlin, representing 3.7% of the workforce. Non-consultant hospital doctors account for 6% and nurses 43%. Administration accounts for 13.6%, which compares very favourably with other hospitals - in particular Birmingham Hospital - which generally have a figure of 16%.

It is disingenuous, to say the least, to compare Crumlin Hospital with Birmingham, when the figures for Birmingham included its day case surgery as well as its inpatient surgery, but the figures for Crumlin included only its inpatient surgery. When one compares like with like, one finds Crumlin compares very favourably. International recommendations for oncology cases state that if a hospital sees more than 50 new patients per year, it needs another consultant. The three oncology consultants in Crumlin are seeing 100 new patients a year between them, double the international standard. There are five paediatric surgeons in the country. In the North there are six, serving a population one-third the size of Ireland

We have debunked the thoughts the Government had, namely, that the cutbacks were necessary because of overstaffing and unproductive doctors and nurses in Crumlin. It was a needless insult to the staff at Crumlin. It is bad enough to be understaffed and have one's budget cut, but to have it suggested that it is because one is inefficient, overstaffed or not producing the goods is grossly insulting.

The staff at Crumlin Hospital, however, are not particularly concerned about that hurt, rather, they are concerned about the hurt to their patients, to small babies in their mother's arms who have serious, ongoing cardiac conditions and who are having their treatments delayed causing great anxiety to their parents and extended families. They are concerned about the children who have scoliosis, whose spines are starting to press on vital organs, whose longevity may be shortened and whose lives will have needless additional disability imposed upon them.

The reality of this is that the closure of St. Joseph's Ward resulted in 25 beds being lost. While we welcome the news that there will not be further cuts, one theatre remains closed and 25 beds are lost, representing 4,000 lost bed days. With an average bed stay of approximately five days this could cause up to 800 patients to have their treatments delayed. We know one theatre will be closed. This will delay surgery for many children with very worrying conditions, not just scoliosis and cardiac surgery, but also other urological conditions like hypospadias. All of this is done for what? For the sake of €9.6 million.

It is clear to me there are billions for the bankers but cutbacks for the children. This is real. These are not statistics. These are real children, such as a young girl from Galway who had surgery in Crumlin where rods were inserted into her back, and has had two lengthening procedures since. She was due another lengthening procedure within the next two weeks, but she has been advised it will now take place in September at the earliest. She was nine months on the waiting list to have her surgery. Her sister was diagnosed at the age of 15 with a 66° curvature of her spine in April 2008 and today is still waiting for surgery, despite the fact that when she was reviewed in April 2009 the curvature had increase to 80°. She has been on the list for 15 months. Her breathing is affected and her lung capacity is diminished. She is an Irish citizen.

These are real people, real children and they are our citizens. How can we do this to our own? The many thousands of children now who will wait for an outpatient appointment because of the delays and cutbacks in the outpatients in Crumlin will rightly ask why them, and why they must suffer the delay in diagnosis. Disabilities that could last for life might have been cured.

There has been tremendous spinning and management of the media on this and the latest twist is that there will not be any further closures of theatres over the summer. However, that does not address the serious issue of St. Joseph's Ward being shut, the lost 4,000 bed days and a theatre being shut, while fully trained specialist anaesthetists and spinal surgeons stand idly by, being paid for their services by the State and unable to do the work they have been asked to do, are paid to do and want to do.

The idea that Cappagh can be made available was welcomed by the staff, but only if Crumlin was working at full capacity to allow them to tackle the existing backlog. However, to close Crumlin and open Cappagh is foolish nonsense, will not save a penny and will cost the State money. The children of this nation are our future. Their parents will not be deflected from their responsibility to protect and care for them. I will not be deflected from my responsibility to protect them from cutbacks. The Minister should look elsewhere. She should look at the €16.5 million spent on outside consultants and PR gurus, or the €60 million spent on taxis and transport - a 10% saving through better logistics would yield €6 million there alone. Fine Gael will not stand idly by while this happens. It is our responsibility to cry halt and to use whatever democratic mechanisms are open to us.

In closing, this motion is about preventing cutbacks at Crumlin hospital which will result, make no mistake, in needless suffering for children, whom we vowed to protect only two weeks ago. This is a test for us, and it is a test for the Fianna Fáil-Green Government and the Independents who support them on their commitment to children. I ask the Government not to fail them. I commend the motion to the House.

See this speech in context