John Moloney (Laois-Offaly, Fianna Fail)

Last week I responded to the Private Members' motion and listened with great interest to Deputy Mary White and Deputy Simon Coveney. On that evening I refuted the allegation that critically ill children have had their service withdrawn. I reiterate that this evening.

I support the Minister and her commitment to reforming the health services. We see that again in this particular area. I have in mind what has taken place previously, particularly the initiative she took to reform cancer services. The same arguments were made by Members on the other side of the House, yet we have seen the progress that has been made. I am more than pleased with it. Other developments were the consultants' contract and progress with accident and emergency services. However, that is not the argument before the House.

I do not intend to be drawn into the remarks thrown across the floor that we are more interested in bankers because, clearly, people who are knowledgeable would not say that in the first place. I do not accept it. The strategic view the Minister has taken is the one on which we should focus. I also share her view about throwing out the same old remark about the money for every area coming from the same small pot of money. I cannot buy into that. It is nonsensical to include the issue of taxi fares when it is clear that most of the taxi expenditure goes to provide transport for essential services in the HSE. It is not worth responding to in the context of this debate.

The real issue is the Minister's strategic policy. While Crumlin hospital is central to the debate before the House, the most important issue is the sensible initiative taken to establish one hospital, instead of three, to serve paediatric needs across the city. With regard to the saving of €6.5 million, it must be put on record, because obviously it is a position that is not being taken up, that the issue is to protect front-line services, which is so important. It is also important to delve into the background to this debate and take the longer-term point of view. We are talking about initiatives for the appointment of new clinical directors. This is quite important and should make the public realise that the Minister has total command of the issue of providing essential services.

The issue we are debating is the €6.5 million. The HSE has advised that based on the financial performance for the first five months of 2009, the hospital should achieve a break even position at the end of the year. This assessment takes account of cost saving measures totalling €6.5 million, which have been agreed with the hospital and which are to be implemented over the remainder of the year. Much of the focus of the discussion between the hospital management and the HSE has been on ensuring that all areas of non-pay expenditure are critically examined and that costs are reduced where possible. The allocation for Crumlin hospital for 2009 is €139 million, an increase of more than 39% over the past five years. As with all expending facilities, the reduction that is expected is 3% over the 2008 figure. A particular challenge for the hospital is that it has been operating with 91 posts above its ceiling and employs 641 whole-time equivalents.

The point was made during the last Private Members' debate that apparently the issue was purely to deal with life threatening illnesses. It should be pointed out that when the orthopaedic services in Cork were severely disrupted in 2007 by the early retirement of the consultant paediatric surgeon, efforts were made to recruit a replacement without success. At that time arrangements were put in place for Crumlin hospital consultants to provide the outpatient clinic service in Cork, with patients requiring surgery transferring to Crumlin. It should be noted that the HSE pays €0.5 million per annum for the service. It also pays the consultants separately. The HSE intends to advertise again for a paediatric consultant with a special interest in orthopaedics.

I heard the criticism last week of the National Treatment Purchase Fund. The fund has identified a number of cases from the waiting lists for treatment at Cappagh hospital. Two operations have been carried out for scoliosis patients as a result. Further cases are being reviewed. Discussions are ongoing with the three paediatric hospitals with regard to the provision of orthopaedic services generally and, in particular, the treatment of children suffering from scoliosis. The National Treatment Purchase Fund strongly rejects the recent media claim, which I was alarmed to hear on the radio one morning, that scoliosis procedures arranged by the fund cost two to three times more than similar procedures performed in the public hospital system. The claim is entirely incorrect. No evidence has been offered to support the claim which comes, of course, from unnamed sources. The prices the National Treatment Purchase Fund pays for operations are as competitive as the published prices for the public hospital system and no premium is paid for work through the fund. Achieving value for money for the taxpayer throughout the process of arranging faster treatment for the longest waiting public patients is a matter of the highest importance for the fund.

The commitment of the Minister is not just the short-term one of reducing and dealing with the overspend. Hospital care for children is provided across the three hospital sites in the city. Significant progress has been made over the years in developing paediatric services in Crumlin. There has been development of the national paediatric hospital, a priority project for the Government. It is of strategic importance in the development of paediatric services in Dublin and nationally. Work has been ongoing to move towards that model of care in terms of closer integration and co-operation of the existing three hospitals and the most effective use of resources.

It was claimed this evening that the cut was made without any concern. However, the Minister outlined the overall strategic position for providing paediatric services and made the point that the reduction is expected not just of Crumlin hospital but of all hospitals so they can remain within their service plans. I do not wish to make political points and I accept that dealing with health issues in children is important. However, when one considers that 40% of taxes go to the health service it does not make sense to suggest that we can just allow continuous overspends without a service plan being agreed as well. The HSE is fully aware of the financial challenges faced by the hospitals and is involved in ongoing discussions with hospital management regarding its 2009 financial allocation service plan. The priority is to ensure that services are maintained at an optimum level, in agreement with the Department and the HSE.

Our Lady's Hospital Crumlin is no different from any of our hospitals. In common with all other hospitals, Crumlin is faced with the challenge of delivering a high-quality service to its patients while remaining within budget. A top priority will be to protect patient care. It has proved necessary for Our Lady's Hospital to stay within budget. In that regard I agree with the Minister who made the point that Professor Drumm, who has known expertise in the area, clearly supports the notion that all hospitals should live within their service plan.

Having clinical directors is a tremendous initiative. Regarding the integration of the three hospitals, this key initiative is the same as the appointment of Professor Tom Keane in the cancer area and is the specific way forward. The appointment of a new clinical director to operate across the three hospitals is pivotal to the success of the integration of current paediatric services. The appointment of a director in the near future who will have responsibility for all three paediatric hospitals in Dublin in preparation for the advent of the new paediatric hospital shows the surety of the policy proposal. I re-emphasise that this post promises to contribute significantly to the achievement of more efficient and effective services, in Crumlin and the other two hospitals. It will draw the medical professionals together with greater co-operation and integration in respect of the critical service they provide.

The new consultant contract also allows the model of clinical director to operate in a way that is internationally recognised as effective. This was not possible in the old manner, before the new contract was negotiated and went into operation. The new model allows equitable access to care based on medical need, more efficient use of public resources and a requirement to support patient safety initiatives in high-quality acute sector services.

I shall deal with some of the issues regarding the service provided at Crumlin. So far this year, the hospital has delivered more treatments to patients than in the same period last year. In the first four months of 2009, there were 3,704 treatments for children as in-patients, running approximately 6% ahead of the service plan target. There were 5,095 day places. Staffing levels at the hospital have increased by 24% since 2004. This percentage reflects the increase to the approved ceiling of 1,550 but the actual increase is higher, at 31%. Day care activity has increased by 26% since 2005, outpatient attendance by 16% and elective admissions by 12%.

The issue of cancellation of operations has cropped up, creating the notion the hospital is not keeping to its service plan. It is important to establish some of the reasons-----

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