Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Acting Chairman for allowing me to raise this important matter on the Adjournment. Pathways, which is a high quality rehabilitation centre set up in Cavan many years ago, is now closed to all intents and purposes. Some three weeks ago I received two different calls from families in County Cavan who raised questions regarding the future of this very important unit. In both cases, they pointed out the tremendous benefit resulting from the use of the centre by the family member in question. In one case the family was very worried about what would happen to their loved one if, or when, he needed to attend Pathways again.

I subsequently contacted senior executives of the HSE and was advised that there was a short-term staffing problem, but that there was no question of the service being removed and that I would be advised of progress by the middle of the following week. Of course, this did not occur, but by Friday of last week two County Monaghan families and a further County Cavan family made contact with me. One of the County Monaghan families were near neighbours whom I have known all my life. I was alarmed at the information I received.

Again, I contacted the HSE to be advised that everything was okay, that the ward was not closed and that those patients who were not in the Pathways ward were receiving the same service as if they had been. On Saturday evening, I visited the Lisdaran unit for the elderly, adjacent to Pathways and found several of the Pathways patients and their immediate families there. I subsequently walked to the Pathways unit and found four of the long-term patients from the Lisdaran unit who were not receiving Pathways-type treatment, but had been moved into it such that it did not seem empty. This meant the HSE personnel were telling the truth and that Pathways was not closed.

I spoke to several of the families who had clients or patients in the Pathways unit before they were removed. They were very worried about their family member who had been receiving treatment. In one case, a person had been in the Pathways unit for four weeks before the service was removed and the family had seen a lack of progress or worse in the patient in the two weeks subsequent and since he was no longer receiving Pathways-type treatment. The person in question is now in the Lisdaran unit. I emphasise that these individuals have no complaints regarding any of the nurses or staff in Lisdaran, other than the fact that they simply do not have enough personnel to give the necessary care and attention that patients in need of rehabilitation require and deserve.

In the past, treatment in the Pathways ward has allowed many people to return to their own homes needing little if any help. Other younger people recovering from accidents have been given a good future. The most worrying aspect of all is the failure of the HSE to plan for the staffing and retention of such a service in Cavan while, at the same time, promising publicly to restructure a brand new 25 bed ward in Monaghan General Hospital and to create a 13 bed rehabilitation unit there. If it cannot manage a six bed rehabilitation centre in Cavan, it is hard to see it getting started in Monaghan.

The people of Cavan and Monaghan deserve at least the truth and some honesty. Above all, we deserve a service and Pathways is one of those excellent services which has given new life to many people. Physiotherapists and speech support staff are still in place and available. However, without the proper personnel and backup for these people, Pathways, as such, is gone. I am sick, sore and tired of being advised by HSE personnel that it will all be sorted out in a week or so. This is not the case. I have been there in person and I have seen at first hand the situation, which is of great concern. I have consistently seen people admitted to the Pathways unit in recent years who were not initially able to walk and who left the unit on their own steam. I saw a young man there who had been in a bad accident and who was brought back to life again despite no hope of his admittance to the rehabilitation centre in Dún Laoghaire. Pathways is the only alternative we have to the Dún Laoghaire service. Will the Minister of State please ensure this valuable service is not taken away from us? Enough has been taken away already and we deserve better.

John Moloney (Laois-Offaly, Fianna Fail)
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I am taking this Adjournment matter on behalf of the Minister, Deputy Mary Harney, who cannot be here this evening. I thank Deputy Crawford for raising the matter and I am pleased to have the opportunity to outline the current position regarding the provision of rehabilitation services at the Pathways rehabilitation unit, located on the grounds of the Lisdaran unit for the elderly in Cavan. The HSE has no plans to close the Pathways rehabilitation unit service. However, the HSE has advised the Department that a staffing deficit exists at the Pathways unit arising from several recent staff retirements. While this staffing issue is being addressed, and to ensure continuity of service provision, patients from the Pathways unit are being accommodated in the Lisdaran unit for the elderly, which is located within the same building.

These patients are availing of the same levels of intensive rehabilitation therapy within the Lisdaran unit as they had received prior to their relocation from the Pathways unit.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That is not fair comment.

John Moloney (Laois-Offaly, Fianna Fail)
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This is the brief I have from the Department and I have to believe the brief I have been given.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I fully understand.

John Moloney (Laois-Offaly, Fianna Fail)
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Either way, the HSE is actively working to restore the staffing levels at the Pathways unit. In this regard a process of sourcing staff nurses is underway to address the current staffing deficit. As Deputy Crawford will be aware, the Pathways unit has been playing a key role in providing an intensive rehabilitation service to patients from Cavan and Monaghan who are recovering from an episode of acute illness such as stroke, amputation, a road traffic accident or acquired brain injury.

Pathways has operated from the outset on a mutli-disciplinary team basis with input from the medical, nursing, physiotherapy, occupational therapy and speech and language therapy professions and ancillary care staff. The rehabilitation unit has evolved since it was established in 2000 and now treats patients between 18 and 95 years of age. The majority of patients have been discharged to the community following treatment. Feedback from patients has been very positive throughout the years.

The issue at the Pathways rehabilitation unit is one of a short-term staffing deficit arsing from a series of recent staff retirements. The HSE is actively engaged in a process of recruiting staff nurses with a view to restoring the service at the unit as soon as possible. I assure Deputy Crawford that the Government will continue to deliver its public health services, including rehabilitation services, in a way which delivers the best possible outcomes within the resources available.

Jan O'Sullivan (Limerick East, Labour)
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Of all the various testimonies I have heard, none has been more moving than that of Orla Tinsley who has outlined the daily struggles of people with cystic fibrosis in Ireland. She has spoken of the issues they must weigh up such as when they know they must go into hospital, but are terrified of the cross infection they may encounter in our hospital system in Ireland.

It is unbelievable and incredible that the promise that there would be a dedicated unit in St. Vincent's Hospital by 2010 has been reneged on. I realise the Minister for Health and Children, Deputy Mary Harney, is not present but she must respond to the matter.

She must find a way to build a unit, as promised, to provide for people with cystic fibrosis.

We all know that Ireland has the world's highest incidence of cystic fibrosis. It also has the worst type. However, we have the worst services among the developed world — Europe, North America and so on. This is incredible, given that it is a life and death situation. The units are necessary to give people the opportunity to be treated safely in isolation. I urge the Minister of State to ensure that the promise be kept.

When the Cystic Fibrosis Association of Ireland heard about this decision today and that there was no definite information on it, the association cited a HSE spokesperson who stated before last week's joint committee that no capital under the HSE capital plan would be made available for construction until 2011 at the earliest. Today, the HSE stated that the unit would be built in 2011. We need clarity. Will it be built in 2011 or is that in doubt? Will the Minister return to the promised date of 2010?

When this issue was highlighted in January of last year, people from the private sector offered to provide funding to build the unit, but they were refused because the Minister and the HSE had given an absolute commitment to have the unit built under the public system by 2010. That promise is being reneged on and the Minister, Deputy Harney, will ask the private sector. This is unacceptable.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Jan O'Sullivan (Limerick East, Labour)
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It is not the private sector's responsibility to provide a public health service for CF sufferers, for whom this is a matter of life and death. In the strongest manner possible, I urge that the promise be fulfilled in 2010.

Finian McGrath (Dublin North Central, Independent)
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I thank the Chairman for the opportunity to raise the matter of the scandalous cutbacks in services for cystic fibrosis patients, particularly at St. Vincent's Hospital. I call on the Government to stop this criminal cut, a term I do not use lightly. CF patients should not need to fight, protest or appear on radio shows to get their services. Some 1,135 CF patients need to be supported and the proposed 30-room national centre at St. Vincent's Hospital forms a major part of the health strategy.

Some 300 patients use St. Vincent's Hospital, approximately 10% of whom are regularly on-site. For this reason, the 30 beds are urgently required. I demand that the project be continued as a priority and I urge the Government to listen to CF patients and their families. I feel betrayed by the Taoiseach, the Minister for Health and Children and the Minister for Finance, who promised months ago that the project would not be touched. They broke their word to me and to the CF families. They are now discussing private backers. Shame on them for this disgrace. The project, costed at €30 million, has already started and the plans are set to go. As well as saving CF patients, it would provide jobs in the construction sector, which comprises another aspect of the scandal.

I commend Dr. Charles Gallagher and the team at St. Vincent's Hospital. I thank Orla Tinsley and every other CF patient for their dignity and bravery. I urge the Government not to turn its back on such great people. Last week in the Chamber, I tabled proposals on funding and taxation in support of the unit. A few cents on a pint would sort out the problem in the morning. It is time that the Minister and the Government got real, listened to the majority of people and taxpayers and funded this necessary service.

It is time for tough decisions. Real courage means standing up for CF patients. I also urge common sense and ask people to consider the future for the patients and their families. I pledge my support to all CF families and I will continue to fight for services. I urge the Government and the Minister of State to reconsider the cut and to support the funding of a 30-bed CF unit at St. Vincent's Hospital.

John Moloney (Laois-Offaly, Fianna Fail)
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I will be taking the Adjournment on behalf of my colleague, the Minister, Deputy Harney, who is unfortunately unable to attend to respond. She has consistently emphasised the need to improve facilities and services for persons with cystic fibrosis. Some 48 additional staff, including consultant, nursing and allied health professionals, have been appointed across the hospital system in recent years to enhance the level of services provided for persons with CF.

St. Vincent's Hospital is the national adult tertiary referral centre for patients with CF. A number of capital projects to improve the quality of accommodation have been completed at the hospital, including last year's refurbishment of accommodation to provide eight single en suite rooms for the exclusive use of people with CF. The single rooms have improved the quality of service for people with CF. It is intended that the proposed 120-bed development will include dedicated facilities for such patients. These facilities will include appropriate isolation facilities. Design work and the preparation of tender documents continue in respect of the development. This is a significant capital project in the acute hospitals area.

The HSE draft capital plan for the 2009-13 period is the subject of consideration. The Minister has confirmed that she will discuss this matter and the overall capital plan with the HSE after the forthcoming budget on 7 April. At this point, she has stated that she will encourage innovative solutions to implement high priority projects so that services, including those for patients with CF, can continue to be developed.

It is important to stress that a series of other developments that will improve the quality of service for CF patients are also in preparation. In the 2008 budget, a special allocation of €2.5 million in capital funding was provided to enable Beaumont Hospital to provide facilities for ambulatory care of people with CF. The project has now gone to tender. Patients with CF will also benefit from additional single room capacity in the new medical admissions unit at Beaumont Hospital, which is due for completion in the middle of this year.

The executive management board of Cork University Hospital has agreed in principle that new facilities for adult patients with CF are to be developed on its main campus. In the interim, plans are being advanced to provide for an interim day care facility, which will provide for dedicated day care space until the site development plan is scoped and developed.

Temple Street Children's Hospital is developing a dedicated respiratory unit, which will be a self-contained floor for the ambulant care of CF and respiratory patients. This will include a new respiratory lab, treatment room, consulting rooms and walk-in access to clinical nurse specialists. This unit is due to open later this year.

The HSE's expert advisory group on children and families produced a draft policy document on the implementation of a CF screening programme for newborns. A steering group will be established in 2009 to oversee the roll-out of the screening programme. An independent register for CF has been established. It is expected that preliminary data to inform analysis relating to median survival will be available by the third quarter 2009.

The Minister is conscious that further improvements are required, including the need to develop community outreach services to facilitate the treatment of patients outside a hospital setting where appropriate. Taken together, the planned developments represent a tangible improvement in the quality of services for people with CF.

Jan O'Sullivan (Limerick East, Labour)
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The Minister of State knows that his answer was not good enough.

Finian McGrath (Dublin North Central, Independent)
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The Government should finish the job. Professor Drumm seems to have an attitude about it.