Mary Harney (Dublin Mid West, Progressive Democrats)

I propose to take Questions Nos. 29, 53 and 71 together.

The National Treatment Purchase Fund was established to tackle the issue of excessive waiting times for hospital treatment for public patients. The fund has been successful in fulfilling this remit. It has arranged treatment for more than 145,000 patients to date. Public patients now wait an average of 2.6 months for operations, compared to between two and five years before the establishment of the NTPF. For reasons of patient safety, highly specialised and complex paediatric cases like scoliosis cannot be provided within the private sector. The NTPF has arranged for a limited number of patients with scoliosis to undergo surgery in a public hospital. No additional remuneration accrued to the treating consultant in respect of these exceptional cases, which involved patients whose medical condition was deemed clinically suitable for treatment in another hospital. The NTPF will continue to work with the HSE and the public hospital system to identify and agree cases suitable for treatment through the fund. In doing this, regard will be had to the patients' medical conditions, to suitability and safety issues and to the length of time the patients have spent waiting for treatment.

Each hospital funded by the HSE is required to deliver services within the financial allocation provided to it. Like all hospitals, Our Lady's Children's Hospital in Crumlin must deliver a high quality service to its patients while remaining within budget. The priorities of the HSE and the hospital management at Our Lady's Children's Hospital are to ensure that services at the hospital are maintained at an optimum level and to protect patient care. Following a meeting between the HSE and the three Dublin paediatric hospitals last week, it was agreed that Our Lady's Children's Hospital would revert to the HSE with its proposals to specifically address the needs of scoliosis patients between now and the end of the year. The HSE will consider these proposals within days and form a plan of action with the hospital.

The incidence of sickle cell disease has increased significantly over the past ten years. Earlier this year, a consultant was appointed to a full-time consultant haemophilia post at Our Lady's Children's Hospital, covering inpatient and outpatient haemophilia services for children. Prior to this appointment, another consultant covered inpatient haemophilia services, in addition to covering sickle cell and other red blood cell disorders and other benign disorders. The new appointment has allowed one of the consultants concerned to focus virtually full-time on treating patients with sickle cell and other red blood cell disorders in Crumlin. Patients who had procedures funded by the NTPF at home or abroad, and require ongoing treatment, are treated within the overall annual funding allocated to the hospital.

The most effective way of providing the best possible tertiary care involves the creation of a single national paediatric hospital, alongside a major teaching hospital. The concept of bringing together all three present services is widely accepted. A report commissioned by the HSE, Children's Health First, indicated that the population and the projected demand in this country can support one world-class tertiary paediatric hospital. It recommended that the hospital should be in Dublin and, ideally, should be located with a leading adult academic hospital to optimise outcomes for children. Following detailed consideration, it was decided that the most appropriate location for the new paediatric hospital was adjoining the Mater Hospital. The development of the new hospital is being overseen by the national paediatric hospital development board, which was established in May 2007.

We must move towards a model of care that involves closer integration and co-operation. More than €250 million has been provided for the running of three paediatric hospitals in Dublin in 2009. Significant cost savings can be achieved if services and practices are more closely integrated across the three hospital sites, even before the new hospital has been completed. With this in mind, the HSE is pursuing ways in which services across the three hospitals can best be co-ordinated to avoid unnecessary duplication and achieve savings that can be put back into patient care. The areas of possible increased co-operation that are being examined include paediatric surgery, paediatric critical care services, renal services, genetics and dermatology services.

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