Kathleen Lynch (Cork North Central, Labour)
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Deputies Pat Breen and Timmy Dooley have a total of five minutes in which to make their case.

Pat Breen (Clare, Fine Gael)
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Will the Chair allow a little more time because of the major mix-up last Thursday when I was supposed to have five minutes and the Minister came in with the wrong reply? That is the reason I am here again this evening.

Kathleen Lynch (Cork North Central, Labour)
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I assume we are starting from scratch.

Pat Breen (Clare, Fine Gael)
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I raised this issue on Thursday last on the Adjournment and I am pleased the matter is recorded in the Official Report.

Kathleen Lynch (Cork North Central, Labour)
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Will the Deputy please stop for a minute? Is the Minister of State, Deputy Haughey, responding?

Seán Haughey (Dublin North Central, Fianna Fail)
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Yes.

Kathleen Lynch (Cork North Central, Labour)
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The Deputy may proceed.

Pat Breen (Clare, Fine Gael)
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I raised this matter last Thursday and it is recorded in the Official Report. I see my colleague, Deputy Dooley, is here to support me. I am delighted the Deputy has seen the light in regard to what is happening in the health services in Clare and is here to assist me. I hope he will not act the Opposition politician but will take political responsibility for this very important issue.

Health issues have been dominating the political agenda for the past few months throughout the county. There is a huge crisis out there. There is a crisis especially in our constituency of Clare. For years, the future of Ennis General Hospital has been called into question. I raised the issue on Thursday last, and particularly the concerns as to whether the €39 million redevelopment would go ahead. The crisis continues this week.

We already know that ambulance crews have been instructed to bypass the hospital for major trauma cases from 1 April. The elderly care unit at Ennis General Hospital has been closed on various occasions in recent weeks. There is a possibility that the unit will close again in the very near future because of cuts by the Health Service Executive. I have also heard that the hours for accident and emergency services are to be curtailed at the hospital. The situation is getting very serious for the people of Clare.

While 27 nurse vacancies have been advertised at Ennis General Hospital, unfortunately, approval has been granted only for six positions. As a result, I understand rosters will have to be changed to address this shortfall, which will affect the accident and emergency services. A CAT scanner, an outdated model, which has been promised for the hospital has not materialised. Ministers, the Taoiseach, our Oireachtas Members in Clare, including Deputy Dooley, are masters at turning up at photo shoots and sod-turning ceremonies. We had the former Minister for Health and Children, Deputy Martin, the Tánaiste and Minister for Finance, Deputy Cowen, the Minister for Health and Children, Deputy Harney, and the Taoiseach in Clare before the election telling us the €39 million extension was going ahead. Only last week, the Minister of State at the Department of Health and Children, Deputy Máire Hoctor, visited the constituency. Prior to the election, former Ministers of State at the Department, Senator Ivor Callely and Deputy Seán Power visited to announce the dementia unit. This is what is happening. We have plenty of photo opportunities and sod-turning ceremonies but nothing is happening in regard to the health services in Clare.

At the opening of the Cahercalla extension last week, the Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Killeen, said there would be good news for the health services in Clare. I am sick and tired of Hanly reports and Teamwork reports. It is time for the Government to come clean on this issue and tell the people of Clare that the €39 million extension, redevelopment plan for the hospital is going ahead. That is the reason I am delighted Deputy Dooley is present to assist me in this matter.

Timmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to participate in this important debate. Towards the end of last week I was approached by a friend who works within the health sector who advised me that the HSE has or is about to remove the planned upgrade at the Mid West Regional Hospital at Ennis from the national development plan of the HSE's capital works programme for 2007-11. I wish to establish if this information is accurate. Who is responsible for this decision? Why has some official within the HSE taken it upon himself or herself to attempt to overrule the commitments of the Taoiseach and the Minister for Health and Children, Deputy Harney, regarding the inclusion of phase 1A of the upgrade project at Ennis hospital for completion under the 2007-11 plan?

As politicians for County Clare we fought hard and were given commitments on the inclusion of this project in the capital development plan. How can these be discarded by what I regard as faceless bureaucrats? I have believed for some time that there has been a force within the HSE, and also within the old health board, that has tried to scupper this project.

This plan was first mooted 20 years ago. It took until 1997 to get a capital plan under way and the control plan that followed. Since then, it has been a constant struggle to get to where it is today. There have been endless meetings with Ministers, taoisigh and HSE personnel. The HSE has tried to block this many times. It has put forward the notion of value-for-money audits, cost-benefit analyses etc. and has tried at every opportunity to block the project. We have planning permission. We await the Teamwork report which, we are informed, we need to go to tender. It is my view that we should be going to tender rather than discussing the delays. What I want is a commitment that this project will go to tender this year. It is not acceptable to take money that is planned for the mid-west to use it to solve problems in Dublin. Of course, there are issues in Dublin but there are also issues in the mid-west and in County Clare. The lives of the people of County Clare and the mid-west are as important as the lives of people in the capital city. This project was planned for completion between 2007 and 2011. Nothing will be acceptable, other than the completion of that project on time.

Pat Breen (Clare, Fine Gael)
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Deputy Dooley is in Government.

Timmy Dooley (Clare, Fianna Fail)
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I will not accept the HSE coming forward and responding to pleas on live radio in respect of particular issues in this city. As far as I am concerned, it is this House that makes decisions.

Pat Breen (Clare, Fine Gael)
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And the Government of which the Deputy is a member.

Timmy Dooley (Clare, Fianna Fail)
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It is the decisions that are taken here that are important. That is what I expect the HSE to respond to, not to what happens on live radio. As an elected politician, I believe the HSE has a responsibility to take on board the views expressed in this House and the commitments given in this House.

Pat Breen (Clare, Fine Gael)
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The Government does not give us any chance; it makes its announcements outside the House.

Seán Haughey (Dublin North Central, Fianna Fail)
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I am taking these Adjournment matters on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The provision of services at the Mid Western Regional Hospital, Ennis, and across the mid-west region in general is the responsibility of the Health Service Executive. Significant developments to enhance the services at the Mid Western Regional Hospital, Ennis, have taken place over the past few years.

The HSE advises that the staffing and budget of Ennis has increased significantly. The revenue for the hospital has increased from a budget of €14.2 million in 2001 to €23 million in 2007. Staffing at the hospital has risen from 250 in 2001 to 289 in 2007.

The additional staffing includes a consultant surgeon, consultant anaesthetists and an accident and emergency consultant with four sessions per week at the hospital. In addition, four emergency care physicians have been employed on a seven-day a week basis to provide medical cover to the accident and emergency department.

Additional nursing, non-nursing, and paramedical staff, have also been appointed. These include extra infection control nurses, a heart failure nurse, as well as general nursing staff, medical scientists, radiographers and physiotherapists. A cardiac rehabilitation department has also been set up. A co-ordinator, cardiac nurse, senior cardiac technician and basic cardiac technician have been employed to provide this service.

The Health Service Executive has indicated that further developments at Ennis include a major upgrading of electrical capacity and the radiology department which is currently under way at a cost of €750,000; the opening of a new admissions lounge following the relocation of the physiotherapy department at a cost of €200,000——

Pat Breen (Clare, Fine Gael)
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Where is phase 1 that was promised?

Seán Haughey (Dublin North Central, Fianna Fail)
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——and the development of outreach physiotherapy, warfarin and surgical outpatient clinics have been developed for the west and east Clare areas. The Health Service Executive has advised that Horwath Consulting Ireland in association with Teamwork Management Services are undertaking, on behalf of the executive, a strategic review of acute hospital services in the mid-west.

Future priorities, including the development of services at Ennis, will be guided by this review. The executive advises that the review will be completed shortly.

On the issue of the Health Service Executive capital plan, I should add that in drawing up its capital plan, the executive is required to prioritise the projects to be progressed within its overall capital funding allocation. The executive has been finalising its capital plan over recent weeks on this basis. A revised draft of the plan has now been completed and has just been made available to the Department of Health and Children, for consideration and approval in the normal way. The draft capital plan reflects the executive's commitments and priorities. The executive is currently reviewing a number of options to enable it to progress further capital projects over the coming years and proposals in this regard are awaited by the Department of Health and Children. The capital plan will be published as a whole upon approval. It is not productive to release information about the status of individual projects in advance.

Pat Breen (Clare, Fine Gael)
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They published it last year. There was no problem then telling us what was included in Phase 1.

Kathleen Lynch (Cork North Central, Labour)
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Deputy Breen——

Pat Breen (Clare, Fine Gael)
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That is the most disgraceful answer I have ever received from a Minister of State in my whole life——

Kathleen Lynch (Cork North Central, Labour)
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I call Deputy Deirdre Clune.

Pat Breen (Clare, Fine Gael)
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——in respect of the future of services at Ennis General Hospital. It is quite obvious that the project is dead.

Kathleen Lynch (Cork North Central, Labour)
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The Deputy can raise the matter another way. I call Deputy Deirdre Clune. I was extremely generous with the Deputy in respect of time.

Pat Breen (Clare, Fine Gael)
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It is a total disgrace. If it was in the constituency of the Acting Chairman, it would be similar.

Kathleen Lynch (Cork North Central, Labour)
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If Deputy Breen was sitting here, he would do as I do.

Pat Breen (Clare, Fine Gael)
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I am angry and sad.

Deirdre Clune (Cork South Central, Fine Gael)
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I thank the Acting Chairman, who has an interest in this area. I am sorry the Minister for Health and Children is not in the Chamber to respond to this matter, namely, adults with special needs who require dental treatment. This may be as simple as fillings or cleaning, which many of us regard as possible within a general practitioner's practice or at a dental clinic without any trouble. For children and adults with special needs such a situation can be traumatic and lead to much anxiety. As the function can be difficult to perform, in many cases the dentist will recommend doing the work under general anaesthetic.

There is no service for adults at present at Cork University Dental School. By adults I mean those over 16 years of age. Services are available for children but none for adults. The lack of services has been highlighted on a number of occasions. Recently, a mother contacted the media about her 25 year old son who needs three fillings and a cleaning. She was told in January 2008 by a clinical dental surgeon that the son needed a general anaesthetic to provide necessary dental treatment. There is much correspondence on this issue and another letter states that as Cork University Dental School does not provide a service for special needs adults to have restorative treatment under general anaesthesia, the HSE is unable to offer an alternative.

When I asked a question of the Minister for Health and Children, I was told the dental school continues to provide a service to adults with special needs and will be completing the waiting list it holds. These are two completely different responses within the past two months, one on headed HSE notepaper, the other an e-mailed response to my parliamentary question. It is scandalous that we are receiving misinformation and conflicting information.

I want the Minister of State to tell me if there is a service. According to the information I have, there is not. There is not even a waiting list on which patients such as this can be accepted. If there is no service, when will it be established? It is urgent and necessary for the hundreds of people with special needs awaiting this service. It is unfair that we treat vulnerable members of our community in such a fashion. It is cruel and not in keeping with the kind of service we would wish to see. That we can tell them and their parents that there is nothing we can do and leave adults, who need something minor such as a filling or cleaning but which can lead to complications, without being treated is unacceptable today. I hope the Minister of State will not tell me that a service exists and that the waiting list is being worked through. I can tell him there is none.

Seán Haughey (Dublin North Central, Fianna Fail)
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I am taking the Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I am happy to have the opportunity to address the issue raised by Deputy Clune. As the House will be aware, the Health Service Executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes the delivery of dental and oral health services. The services in question in the Cork University Dental School were provided under an arrangement with the HSE.

At the outset, I would like to explain the current position. In January 2007 a decision was taken by Cork University Dental School not to accept any further referrals to its existing waiting list for adult special needs patients who required treatment under general anaesthetic. This decision was taken after considering a number of factors, including the length of time for patients on the current waiting list and the capacity of the current services at Cork University Dental School.

In addition to these factors, there were also concerns regarding the appropriateness of the facilities in regard to the treatment of both adult and child patients in a shared treatment environment and the lack of a consultant specialist for adults within the dental school. After considering all of these factors, a decision was taken to cease services and no new referrals were added to the list from January 2007. I would like to point out that patients who were already on the waiting list continue to be treated and will receive all of the dental treatment involving general anaesthetic that has been prescribed for them. Also, this decision by the Cork University Dental School does not affect patients requiring emergency treatment.

The HSE is committed to ensuring there will be a minimal break in service to these patients and accordingly they are actively seeking theatre capacity in Cork University Hospital where they can continue to provide this service. Patients who have been unable to access services at the Cork University Dental School will be contacted by the HSE in due course regarding treatment when the new arrangements are in place.

I would like to inform the House of the recent policy developments in this area. Last October, the Minister for Health and Children announced her plans to develop a new national oral health policy. This new oral health policy, the first in 13 years, will be undertaken by the Department of Health and Children in conjunction with the HSE. The development of this new national policy will allow a critical examination of the many challenges and issues currently facing the dental sector in Ireland. Among the issues which will be examined will be service delivery issues such as the availability of dental and oral health care services for people with disabilities.

In this regard, officials in the Department of Health and Children have met with a number of groups who work in the area of special needs dentistry to ascertain their views on recommendations for improving oral health services to people with disabilities. These groups include the Irish Society for Disability and Oral Health and a group of principal dental surgeons in the HSE with responsibility for special needs dentistry.

In addition to meeting these groups, the Department of Health and Children has sought the views of various organisations who work with people with disabilities in the context of their recent consultation on the national oral health policy. These organisations include the National Disability Authority, which is the lead State agency on disability issues. In addition, views were also sought from People with Disabilities in Ireland, the Disability Federation of Ireland and the Carers Association. As a result of these meetings and consultations, the Department of Health and Children intends to bring forward a series of recommendations to improve the position of dental and oral health services to people with disabilities in its forthcoming national oral health policy report. This report will be available later this year.