Kathleen Lynch (Cork North Central, Labour)
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I appreciate the opportunity to raise this issue. This week is national brain injury week. The Ceann Comhairle and I, coming from a part of the country that is some distance from the National Rehabilitation Hospital in Dún Laoghaire, know the difficulties experienced by people who acquire brain injuries. I attended a talk today in the audiovisual room in Leinster House on acquired brain injuries, the definition of which is an injury to the brain that is acquired after birth. An interesting throwaway comment made by one of the speakers was: "Look after your head because your head looks after your mind."

With a serious head injury, immediate intervention is essential to ensure the person returns to normality, if normality can be achieved. A number of years ago, a huge amount of work was put into bringing an outpatient section of the rehabilitation service to the Cork area. In fact, its location was already earmarked, namely, St. Mary's orthopaedic hospital, which has significant grounds, but the plan came to nothing — it simply did not happen. Yet, not a week goes by without public representatives in the southern region receiving phone calls from the parents, wives or siblings of someone who has acquired a brain injury and needs to be in the National Rehabilitation Hospital.

It is conservatively estimated that there are 10,000 new brain injuries every year in this country. When one considers the level of car accidents, building site accidents and assaults at the weekends, we know what is causing them. There are just 110 beds in the Republic to deal with these people. In any man's language, it is not possible to treat 10,000 new cases every year with 110 beds. A recent report tells us that there are 20 neurologists in the country when for our population base there should be 42, and nine neurosurgeons when for our population base we should have 16. The Netherlands has 12 times the number of rehabilitation consultants per head of population than Ireland. At present, there are approximately 700,000 people with acquired brain injury and, because of the process of ageing and with people living longer, it is estimated that there will be 800,000 in ten years.

The stories, one after the other, are horrifying — I am sure we could all relate at least one or two. People with a brain injury may spend three years in a long-stay care bed but if they get the proper treatment and a proper rehabilitation process, they can be up and about, returning to normality and looking after themselves. Without doubt, this is where our resources should be invested because the impact a brain injury has on the individual and his or her family is immeasurable. The cost of keeping someone in long-term care is equally immeasurable when that person could be up and about and returning to productive life.

I raise this issue as a result of an incident that occurred in Cork in the past six months. In that case, the person was very lucky. As a result of persistent pressure, he got a bed in the National Rehabilitation Hospital and is still there and doing extremely well. The staff at the hospital are extremely professional and expert in what they do but for every one person the hospital can accommodate, it is turning away at least ten. We need a rehabilitation service in the south and we need at least double the number of beds that are available at present.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Deputy Lynch for raising this important issue. I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The National Rehabilitation Hospital in Dún Laoghaire is a 120-bed hospital which provides treatment and rehabilitation for patients with spinal cord injuries, head injuries, amputation, traumatic and non-traumatic brain injury, strokes and neurological disorders. The hospital also provides wheelchair and mobility aids assessment, and pre-vocational and vocational training programmes involving a wide range of social, personal and work related skills with a view to enhancing opportunities for each individual for further training, employment and educational options. In addition, there is also a 12-bed hostel to enable patients from outside the greater Dublin area to access day services at the hospital and attend the vocational training unit.

A new hospital is in the planning stages and once built will provide additional capacity at the hospital. This project will increase the bed capacity and the diagnostic capabilities of the National Rehabilitation Hospital. I understand a project team is working with an appointed design team to develop the brief for the new hospital and plan for the development of a new hospital.

The Health Service Executive has also informed the Department that a project team has just completed a needs assessment on the development of an acute medical rehabilitation unit of 25 beds which is recommended to be built at Beaumont Hospital. This unit would provide acute medical rehabilitation services and early rehabilitation for those suffering from brain injury who access the national neurosciences unit at Beaumont and who currently have to access services at the National Rehabilitation Hospital. In addition, plans have been prepared in some regional areas for rehabilitation facilities.

The Department and the HSE are aware of the need to review the potential benefits of a regional network of rehabilitation facilities and services. The development of such a network will be considered in the context of a national strategy for rehabilitation services. The Department and the HSE are developing a national strategy for the provision of medical rehabilitation services. A number of issues will be considered, including an assessment of the need, the structure and location of facilities and services and the nature of the rehabilitation facilities, that is, whether they should be hospital-type, step-down, or preparation for independent living.

Increasing demand for neurology services with the rapid pace of technological advances in neurology were drivers for the strategic review of neurology services undertaken by the Health Service Executive. It was overseen by a multidisciplinary steering group, the aim of which was to identify the current level of service provision and future requirements for neurology and neurophysiology services. The specific objectives were to describe the epidemiology of neurological conditions in Ireland; evaluate current neurology services, including paediatrics and neurophysiology; review the evidence in regard to models of service delivery and make a recommendation on the preferred model for the health system; identify requirements for the development of neurology and neurophysiology services nationally and prioritise service requirements; and report to the director of the National Hospitals Office.

The HSE has advised the Department that work on the review has recently been completed and that the final draft report has been submitted to the director of the National Hospitals Office for consideration. In recognition of the need to develop services in this area additional development funding of €4 million was allocated to the HSE in 2007 to support the ongoing development of neurology, neurophysiology and neurosurgery services. This investment builds on the investment of €3 million additional revenue funding in 2006 for neurology and neurophysiology services.

The HSE has advised the Department that there have been improvements in the number of consultant neurology posts since the publication of a report in 2003 on neurology and neurophysiology by the former Comhairle na n-Ospidéal. There are 24 approved posts of consultant neurologist, an increase of ten posts since the publication of the report. In addition, there are seven approved posts of consultant clinical neurophysiologist, which represents a doubling of the number of posts since 2003. I thank Deputy Lynch for raising this important issue.

Tom Hayes (Tipperary South, Fine Gael)
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I wish to share time with Deputy Mattie McGrath.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Tom Hayes (Tipperary South, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue for my constituents in south Tipperary. A 23-bed unit that was completed in July 2007 lies idle. This is an utter disgrace. It is one of the issues which has been highlighted in the debate on the HSE. Why would anybody spend money on developing a unit only to leave it idle when patients lie on trolleys in South Tipperary General Hospital week in, week out? This is an abuse of public money. It is unfair of the HSE and the Minister to allow this to happen. I impress on the Minister the urgency with which the Department needs to handle this issue. It is unfair to expect HSE officials and management in the hospital in south Tipperary to continue to have to put patients on trolleys. That is unfair and unjust and totally wrong. This unit could deal with asthma patients or patients with chest pains. It could be the first point of care after patients are admitted to the hospital through the accident and emergency department. It could also be a backup unit for the medical and surgical units and for patients with pneumonia, who have had a stroke and a range of illnesses.

Limerick Regional Hospital which is not far away has a unit only one quarter the size of this unit which is left idle. The unit has been fitted out with new equipment. This is a blatant abuse of taxpayers' money. I hope that as a result of my raising the issue jointly with my colleague, Deputy McGrath, something will be done with this unit.

Mattie McGrath (Tipperary South, Fianna Fail)
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I also thank the Ceann Comhairle for allowing us to raise this matter tonight. I further thank my colleague for sharing his time with me.

I, too, am extremely concerned about the situation in South Tipperary General Hospital where a new state-of-the-art 23-bed acute unit lies idle, although it was designed and constructed to the highest possible standards and is fully equipped. I pay tribute to the hospital staff who, from the receptionist at the front door to the top surgeons, are under pressure in trying to deal with the awful conditions under which they operate. Many patients are on trolleys or wait for hours to be seen while this unit lies idle. There are similar cases around the country. I condemn out of hand the HSE's lack of joined-up thinking and the inability of senior HSE staff to visit hospital management to explain why the unit remains closed. It is unbelievable that this unit which has been designed and built to the highest standards is allowed to lie idle. It is a travesty that millions of euro have been spent on the unit but it remains idle. Significant investment has been made in the hospital in general in the past ten years since the decision to relocate all services to Clonmel. This unit was part of the package which the nursing staff, doctors and other medical staff bought into and which is now being reneged on.

I call on the Minister to visit the hospital and meet senior management to give a date when this magnificent service can be put into operation. This would allow staff to deal with patients on a daily basis in the conditions to which they are entitled. A total of 790 staff work in the hospital. We have 247 beds in addition to those in this unit. The staff are doing a top quality job and in need of our support. People in south Tipperary do not need such confusion, which is leading to morale being at an all-time low in the hospital. I do not know how staff continue to work there on a daily basis with decisions like this.

Another outstanding issue is the provision of palliative care beds which were promised but have not been delivered. The situation is unfair to all concerned and the public which supports the hospital. The catchment area includes approximately 80,000 people. I plead with the Minister to come and see the unit for herself at first hand.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank Deputies Hayes and McGrath for raising this issue. I am taking this adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The provision of services at South Tipperary General Hospital and across the south-east region in general is the responsibility of the Health Service Executive. The Government is committed to providing a high quality service for all patients. South Tipperary General Hospital is a key element of hospital services, as outlined by both Deputies Hayes and McGrath. It has 253 beds providing acute services for the south Tipperary population of 82,000 people. It also provides services for the bordering areas of north Tipperary and west Waterford, thus increasing the catchment area to in excess of 100,000 people.

Activity in South Tipperary General Hospital in 2007 included 12,346 inpatients discharged; 4,907 day cases seen; 39,004 outpatient attendances; and 28,139 emergency department attendances. The number of births in the hospital, at 1,138, was the highest recorded since 1987 when 1,202 babies were born.

Following the amalgamation of Our Lady's Hospital, Cashel and South Tipperary General Hospital, Clonmel, in January 2007, major capital development was required to facilitate the transfer of accident and emergency services, general surgery and oncology services from Our Lady's Hospital to Clonmel. The Government has facilitated this strategic development with capital funding of €30 million. Phase 1 of the development included the new radiology unit; the medical emergency room; an ongoing refurbishment programme to upgrade wards, including the maternity ward, and the refurbishment of the new areas for the laboratory and pharmacy services. Other capital works to facilitate the amalgamation of the hospitals included the extension and refurbishment of the staff restaurant, the temporary outpatients building and the extension of car parking facilities for patients and staff.

I understand the national capital steering group will meet shortly to consider the extension of the emergency department and the addition of a ten-bed medical assessment unit. The commissioning of services flowing from the capital developments completed in the recent past, including the 23-bed acute care unit in South Tipperary General Hospital, will be considered within the HSE's overall budget. The National Hospitals Office of the HSE must operate within budget, in common with the entire health service. The HSE will continue to do all it can to ensure the provision of a high quality, patient-focused, service for the people of south Tipperary.

I will bring the contents of the Deputies' contributions on the Adjournment to the attention of the Minister.