Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I wish to speak about the cut of 120 temporary positions in Our Lady's Children's Hospital in Crumlin. It is a disgrace that it has come to this. Short-term contract workers will be greatly affected, especially agency staff and dieticians. This has occurred in the same week that a diabetes and endocrinology unit was opened. Last year the Minister opened a new medical wing in the hospital, yet the HSE is now laying off staff and claiming that this is due to cost containment measures. No jobs have been cut at the top of the HSE, yet staff that are already over-burdened are being cut.

What will be the state of Our Lady's Children's Hospital if nearly 10% of the staff are laid off? The Minister of State needs to tell us. Will it be downgraded? Will it be closed or relocated? Will it suffer death by a thousand cuts? The staff, the patients and the public are entitled to know what the future holds, so that they can make alternative arrangements. We cannot have continual cuts such as those occurring at the moment. The Minister of State will tell us that there has been increased investment in this hospital for the last number of years. That has occurred after generations of severe under-funding, but these increases do not take into account the increased workload of staff and the ongoing modernisation programme.

The only reason these are agency jobs is the HSE freeze on full-time jobs. The Minister for Health and Children should step in and ensure that these cuts are reversed and that the hospital has enough staff to carry out its work.

Mary Upton (Dublin South Central, Labour)
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I welcome the opportunity to speak on this important matter for the staff at the hospital in Crumlin, as well as the parents and the sick children who will be most affected by these cuts. Our Lady's Children's Hospital is widely recognised as a quality hospital for paediatrics. People across the country avail of the services and the very high quality facilities there.

The hospital has been forced to employ agency staff because of the recruitment freeze by the HSE, and now it is being forced to let them go. Cutting front-line services is not the way to deliver a quality health service and to ensure the best outcome for patients. That must be the bottom line. Cutting front-line staff numbers in the HSE will only lead to further pressures on the remaining staff. Ultimately, it will mean longer waiting times for the children who urgently need treatment. It is inevitable that the service to sick children will be affected if 100 staff are removed. There is no question about that.

Parents with sick children cannot afford to wait for treatment and they do not want to be told that there is a two-year waiting list for essential treatment for their small child. They do not want to know about service planning and they do not want to know about meeting efficiencies. They simply want their sick children treated as quickly and efficiently as possible.

I urge the Minister for Health and Children to review the HSE structure to allow for cuts to be made in areas that do not affect patients. The logic of spending €19 million on a report on the hospital service in the north east does not stack up when compared to cuts of 100 temporary and agency staff in the leading children's hospital in the State. There is a question of priorities when deciding where to impose cuts. The Minister of State and the Minister should find a way to ensure that front-line staff are not sacrificed for what is effectively a book-keeping exercise.

Máire Hoctor (Tipperary North, Fianna Fail)
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Our Lady's Children's Hospital in Crumlin provides acute, secondary and tertiary hospital services for children. The hospital receives a significant proportion of its funding from the Exchequer via the Health Service Executive. In 2008, the hospital has an allocation of €137 million, up from €128 million in 2007. The hospital's budget has risen by over €38 million since 2004, which represents a 38% increase.

Each hospital funded by the HSE is required to deliver services within the financial allocation provided. The HSE is fully aware of the financial challenges faced by the hospital. It is involved in ongoing discussions with hospital management regarding its 2008 financial allocation and service plan. The hospital has an overrun of €10 million from last year and a projected overrun of €14 million for this year. As part of the discussions on the budgetary position, the HSE has made an agreement with the hospital, on a once off basis, to provide a further €7 million this year. The hospital must now work within its budget, which will be amended from €137 million to €144 million for 2008. The priority of the HSE and the hospital management is to ensure that services for children at the hospital are maintained at an optimum level.

There has been an increase in activity at the hospital in 2008. The hospital is ahead of its service plan targets. The number of day cases is up by 12.3%, outpatient activity is up by 7.7% and the number of inpatients treated has increased by 1.6%. The number of staff employed at the hospital has increased by 433 whole-time equivalents since 2004. At the end of March the number of whole-time equivalents employed at the hospital was 282, or 20% above the approved employment ceiling.

The initial focus of the discussions between hospital management and the HSE is on ensuring that all areas of non-pay expenditure are critically examined. Pay costs represent over 70% of the hospital's expenditure. The hospital has indicated that there will be a need to reduce the number of temporary and agency staff numbers, but it is not in a position at this stage to confirm the number of posts involved.

Significant investment has been put into developing services at the hospital in the last number of years in areas such as cardiac, haematology, oncology and MRI services. Discussions are also at an advanced stage to create additional intensive care facilities at the hospital. The development of the national paediatric hospital is a priority project for the Government. Our objective is to provide a world class specialist paediatric service for children. The McKinsey report to the HSE recommended that the population level and projected demand can support only one world class tertiary paediatric hospital which should ideally be co-located with a leading adult academic hospital. Each of the three existing paediatric hospitals, including Our Lady's Children's Hospital, expressed strong support for the development of a single national paediatric hospital. In October the HSE announced the details of the high level framework brief for the new hospital which will be built on a site at the Mater Hospital. The brief was prepared by RKW, an established UK-based health care planning company.

The brief includes a detailed assessment of the capacity of the selected site at the Mater Hospital. The analysis indicated that all the requirements can be accommodated on the site and still allow expansion capacity beyond the year 2021. The total projected bed requirement for the hospital to 2021 ranges between 352 and 454 beds. The estimated space requirements have been calculated on the upper figure. The brief sets out the recommended model of care, the core services to be delivered at the new hospital, and the additional range of services to be provided outside of the main hospital through an ambulatory urgent care service. The first of these centres will be developed at Tallaght. The services to be provided will include urgent care consultations, outpatient appointments and day surgery.

The national hospital development board was established last year to develop the new hospital. The board is in the process of procuring professional project management support services. Following this, the next stage of the project will involve the preparation of a detailed development brief for the new hospital. The target of the board is to have the development brief completed by the end of the first quarter of 2009. The Minister looks forward to continuing progress on this important development.