Enda Kenny (Mayo, Fine Gael)
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I ask the Taoiseach about reports in this morning's newspapers that Our Lady's Children's Hospital in Crumlin will have to close a ward almost immediately and another later this year because of a cost overrun of €10 million. The Health Service Executive, when it was set up, was purported to be a method of delivering a world-class health service for this country, funded by the Taoiseach, who was then Minister for Finance. Yet he has stood over a budgetary situation in which at the first sign of trouble in any hospital, when the cost base is examined, the answer is to close wards and not to treat patients. This is a policy of lunacy.

Of all the hospitals in the country, the children's hospital, as the Taoiseach is aware, does exceptional work which is extremely sensitive and personal to potentially every family in the country. We are four months into the year and a ward is being closed, with another to be closed later in the year, because of a €10 million overrun. This was announced on the same day as the now absent Minister for the Environment, Heritage and Local Government announced a toothless mayoralty for Dublin. It has the potential to affect every family in the country.

The Taoiseach has been at the children's hospital, as have I and members of all parties, and we have seen the exceptional work done there. What is the Taoiseach's response to this? A ward is being closed, with another to follow, and children denied operations in Crumlin will either go on a long waiting list or be sent to the UK under the National Treatment Purchase Fund. This is a crazy policy. Has the Taoiseach considered the situation? The hospital has expensive equipment, trained consultants and trained front line staff, and it is now being denied the opportunity to treat patients from all over the country. What is the Taoiseach's plan to deal with this?

Brian Cowen (Laois-Offaly, Fianna Fail)
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Every year the service plan devised for all hospitals must be adhered to in the interest of budgetary sustainability and in order to provide services in all our hospitals. It is important to point out that Crumlin hospital was allocated just under €140 million for this year, which is an increase of more than €38 million, or 39%, since 2004. There is a need for greater co-ordination between Crumlin, the National Children's Hospital, Tallaght, and the Children's University Hospital, Temple Street, to avoid duplication in the provision of out-of-hours services and so on. Such an approach would provide the services required while avoiding extra costs. Co-ordination of services across all three hospitals, in the interest of providing services for children in our straitened budgetary circumstances, is the way forward. A meeting has been held between the chief executive of the HSE and the chairman of the medical board of Crumlin hospital, and progress was made in that respect.

As I said, there is a need for a more co-ordinated approach among all three hospitals. Closing wards should not be an initial response; the initial response must be to obtain better co-ordination of services. That is the best way of ensuring we maintain service levels, and it is the approach that will be taken. Savings of €6.5 million have already been identified by the hospital in respect of its budgets and these are being implemented, but it is important to point out that better co-ordination should help alleviate the worst aspects of the problem.

Enda Kenny (Mayo, Fine Gael)
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I accept the Taoiseach's comments about the need for co-ordination. Crumlin hospital has found €6.5 million in cuts from its cost base but that will not solve the problem. A ward has been closed; trained staff and expensive equipment will lie idle and, as a consequence, children will not be treated. The system is all wrong. At the first sign of budgetary difficulty, the hospital looks at its cost base to see what to do. It cut €6.5 million and stopped treating patients. In other systems, the opposite would happen. Fine Gael has proposed that money should follow the patient and hospitals should be paid for what they do. If they are given €140 million for 2009, why is the patient seen as an obstacle, not a resource? Does the Taoiseach believe the system he has stood over for 12 years can deliver the services we need and patients deserve? Four months into the year a children's ward is being closed in this hospital. Does the Taoiseach not accept it would be a far better system if hospitals were paid for what they did, if they saw that instead of closing wards and leaving expensive equipment unused, they should be used more, with theatre times extended? Trained consultants and front-line staff should see patients as a resource, not as an impediment. This has been ongoing for 12 years and it is not working. Will the Taoiseach consider the proposal made by Deputy James Reilly on behalf of Fine Gael, that the "FairCare" system should apply here, where the money follows the patient, rather than the other way round? In the immediate term, to meet the €10 million shortfall in 2009, the Minister for Health and Children has repeatedly spoken about her redundancy programme within the HSE. This would save more than €10 million at any one time and allow the hospital to keep its children's wards open, while enjoying better co-ordination between hospitals.

Brian Cowen (Laois-Offaly, Fianna Fail)
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We have not seen the costings for the "FairCare" plan, that is one of the problems. If Deputy Kenny has it costed, we could chat about it, if it is intelligent.

Paul Connaughton Snr (Galway East, Fine Gael)
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Does the Taoiseach support the principle?

Brian Cowen (Laois-Offaly, Fianna Fail)
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In the meantime, there is no such thing as unlimited resources for the provision of health care in this or any other country.

Enda Kenny (Mayo, Fine Gael)
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It is based on the use of existing resources.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Instead of looking at every hospital as a stand-alone institution, we must look at hospitals as a network providing care, avoiding duplication and maintaining service levels for children's services.

Enda Kenny (Mayo, Fine Gael)
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The Government does not want to know.

Brian Cowen (Laois-Offaly, Fianna Fail)
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In Dublin there are three such hospitals. More than €300 million is being spent on the budgets of Crumlin, Temple Street and Tallaght hospitals. If they were to co-ordinate and act as one in the provision of services, savings could be made without affecting service levels. That is the approach being taken. Under the new consultants' contract, there is a proposal to have a single clinical director for the three hospitals to co-ordinate services and work with professionals within them. The patient, therefore, would not be affected and savings of up to €20 million could be made if there was greater co-ordination between hospitals. That is the approach that must be taken.

James Reilly (Dublin North, Fine Gael)
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The Government has had 12 years to do this but it has done nothing.

Brian Cowen (Laois-Offaly, Fianna Fail)
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That proposal was made following meetings on these matters. It is the common-sense way forward. I hope everyone in the hospitals concerned will agree with that approach and proceed on that basis in order that we can provide the levels of service required, given that we have limited resources available.

Paul Connaughton Snr (Galway East, Fine Gael)
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I hope a lot fewer children get sick.

Eamon Gilmore (Dún Laoghaire, Labour)
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Two years ago the country was shocked by the tragic death of a young family in Monageer, County Wexford. Adrian Dunne, his wife, Ciara, and their two children, Lean and Shania, aged five and three years, were found dead at their home in Monageer a couple of days after Adrian Dunne had inquired about arrangements for their funerals with a local undertaker. Following the tragedy, the then Minister for Health and Children, Deputy Brian Lenihan, established an inquiry to find out what had happened, to look at the appropriateness of the response of the State agencies and to learn from the experience with a view to seeing what could be done to avoid such a tragedy happening again.

The inquiry reported to the Government in October 2008 and the report was eventually published yesterday. When I say it was published, only part of it was published because pages of the report have been completely blacked out. I have heard of a report being a whitewash but this is a blackwash, where entire chunks are blacked out. Extraordinarily, even some of the recommendations are blacked out, something I have never seen in an official report. I have a number of questions about this. The report states that ultimately there is no way to prevent such a tragedy, even with the best intervention in the world. Sometimes these things happen, which I accept. However, the value of an inquiry such as this is to learn some lessons from the event, to establish if everyone in the chain was doing his or her job, if agencies were acting appropriately and if matters can be improved to prevent a recurrence.

We do not have the full report. Is there some way it can be made available to the House? The House has privilege and there were occasions when reports of a sensitive nature were made available to the relevant committee of the House. Will the full report be made available to the Joint Committee on Health and Children? Has the Taoiseach seen it? Is it true the HSE has not seen it? A representative of the HSE was on radio this morning to claim it had not seen the full report and recommendations. How are recommendations to be implemented and enforced if we do not know what they are? The Government has had the report since October 2008. Can the Taoiseach tell us what recommendations made in the report have been implemented or acted upon since?

A central recommendation that we can see concerns the necessity for an out-of-hours child social work service to be established. The difficulty is that if a problem arises with a family at risk or having trouble after 5 p.m. or at the weekend, there is no service available. These are the very times the service is most needed - at night and weekends. The problems that arise in families that lead to tragedies such as this are not normally ones that arise between 9 a.m. and 5 p.m. Monday to Friday. The Minister of State with responsibility for children and youth affairs has said that in current financial circumstances, it is impossible to put in place an out-of-hours service. It may not be possible in the sense of putting in place a fully staffed and resourced replication of the service available during the week but surely it is possible to have some emergency arrangement in place whereby if a garda, a priest or someone in touch with a family comes across something like this, there will be some support and service available to intervene, find out what is happening and try to avoid such a tragedy occurring again?

Brian Cowen (Laois-Offaly, Fianna Fail)
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On the publication of this report yesterday, all of us in this House revisited the tragic situation that happened in Monageer two years ago. We send our deepest sympathy again to the family concerned and their relatives. It is a very difficult issue and time for them whenever this issue comes back into the public domain in the way it has as a result of the publication of this report. All of us are sensitive to those concerns and conscious of the sensitivities of the family members.

The redaction in the report is for legal reasons. The full report would have been seen by the Minister for Health and Children and the Minister of State at the office of children. The report brought to Government would have included the redactions but the Minister for Health and Children and the Minister of State with responsibility for children would have indicated in broad terms the issues involved.

It is important to point out that it is not for the purpose of censoring the report that these redactions were made. There are other points raised in regard to the provision of and the need to improve services, which are clearly part of the report and are published. I want to make it clear that it is for legal reasons only that the redactions have been made.

Alan Shatter (Dublin South, Fine Gael)
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That is rubbish. We had the same problem with the Kelly Fitzgerald report but it was published in this House.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy is not entitled to interfere. He is not the leader of his party.

Alan Shatter (Dublin South, Fine Gael)
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This is an outrage. The Taoiseach is talking rubbish.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am not talking rubbish.

Alan Shatter (Dublin South, Fine Gael)
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We have not had a report with the recommendations blacked out in the history of the State.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption. The Deputy may not interfere.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am not talking rubbish.

Alan Shatter (Dublin South, Fine Gael)
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What is the Taoiseach covering up?

Brian Cowen (Laois-Offaly, Fianna Fail)
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On the question of the report being made available, the chief executive officer of the HSE would be able to see the report in full because he has a statutory duty of care to discharge and that is something that is covered by privilege according to the Attorney General. I am not aware that a Dáil committee would be covered by privilege in the same way in terms of-----

Joan Burton (Dublin West, Labour)
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Yes, we are.

Alan Shatter (Dublin South, Fine Gael)
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Of course it would be. We did that in 1996 with the Kelly Fitzgerald report.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption.

Alan Shatter (Dublin South, Fine Gael)
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The Taoiseach has no historical memory of what has happened in this House.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I want to answer the question I was asked, if I may without interruption.

Alan Shatter (Dublin South, Fine Gael)
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This is a serious issue.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I ask the Deputy not to interfere again.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is a very serious issue.

Alan Shatter (Dublin South, Fine Gael)
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This full report, including the recommendations, should be published.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy is not to interfere again.

Alan Shatter (Dublin South, Fine Gael)
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The Taoiseach is more concerned with protecting individuals than the welfare of children.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption. The Deputy is not to interfere again

Brian Cowen (Laois-Offaly, Fianna Fail)
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There cannot be a mass publication of the report. That is the legal advice that we have. That is why the redactions have been made.

On the question regarding the services being provided, it is true to say that as a result of this report an out-of-hours service has been put in place for children who are at extreme risk in order for them to be taken to a place of safety. That service will be provided between the Garda and the HSE from June of this year. That is an important service that was not in place previously and, clearly, it was pointed out that it has not been in place.

I also make the point, which is made in the report, while not wanting to in any way take away from the need to address the issues as best we can in a comprehensive way, that it appears there was nothing that could have been done in this instance that could have avoided this tragedy. We all know unfortunately that tragedies occur but clearly, whatever lessons are to be learned can also be learned.

James Reilly (Dublin North, Fine Gael)
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We have to take the Taoiseach's word on that.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I call Deputy Gilmore.

Alan Shatter (Dublin South, Fine Gael)
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The Taoiseach cannot have reports and then conceal the recommendations contained in them.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow Deputy Gilmore to proceed without interruption.

Eamon Gilmore (Dún Laoghaire, Labour)
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I am extremely disappointed with the Taoiseach's reply on this matter. Whatever the legal reasons may be, four people died in this tragedy, including two young children who were not given a chance of continuing their lives. We need to know what went wrong here, what went astray. It is not a matter of curiosity; it is a matter of trying to learn lessons from this tragedy in an effort to avoid this type of tragedy occurring again.

There is a way that the report can be published. It can be brought to a committee of the House where it would enjoy the normal privilege of the House. I put it to the Taoiseach that he, the Minister of State with responsibility for children and the Minister for Health and Children seated next to him, should find a way to do that. This is about finding out what happened here and learning some lessons from it.

I have never seen a report where the recommendations were blanked out. How do we learn from a report if we do not know what are its recommendations?

Alan Shatter (Dublin South, Fine Gael)
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Hear, hear.

Eamon Gilmore (Dún Laoghaire, Labour)
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How will the different agencies know of them? About whom or what are these blanked out recommendations? Whatever justification there may be for part of the narrative in the report being blacked out, perhaps to protect individuals or whatever, there is no case whatever I can think of as to why the recommendations should be blacked out. The recommendations at the very least need to be published in order that we know where we stand on them.

The Taoiseach said that the chief executive of the Health Service Executive can have the report. He did not say whether he has already seen or being supplied with it. Can the chief executive officer of the HSE do anything about the report, if it is privileged? If there are issues that require attention within the HSE, issues of a managerial nature which require to be progressed within the HSE arising from the report, how does the chief executive officer of the HSE do that, if he is the only person who can see the report and if he cannot discuss it with the people directly involved? This is nonsensical. This is a cover-up of some kind. I do not know what kind it is, but it is not acceptable. It is something that should be put right.

The Taoiseach did not answer the question I asked him about the out-of-hours service. We have a problem in this country, which is adverted to in this report where, as I understand it, a garda superintendent attempted to make contact with the child care services of the HSE over the weekend but found those services did not activate until after the weekend. I have had reports on that problem in regard to different cases, admittedly not as serious or tragic as this one, where gardaí, those in schools, people who are active in the community and sometimes families who have needed to get the assistance of the social services of the HSE have not been able to do so because they are not available out-of-hours, including at weekends. That problem must be addressed.

In respect of families who are at risk, sometimes the issues that arise and put families and children at risk arise much later in the evening than 5 p.m. and arise over the weekend period for a variety of reasons, which everybody in the House who has any understanding of this area of life knows full well. There is no service available at those times. That must be addressed urgently.

One need only imagine the consequences if the fire service operated on that basis, that it only operated from 9 a.m. to 5 p.m. and not at night nor at the weekend, of if the Garda Síochána operated on the basis of providing a service from 9 a.m. to 5 p.m., Monday to Friday. We are concerned here with children and their protection and the services which are supposed to be there to provide protection and support for families who are at risk. This service is closed from 5 p.m. on a Friday until 9 a.m. on a Monday. It appears, as much from the blacked out sections of this report as from what is contained in it, that is what happened here.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am very conscious that this is a tragic time for any family involved in such a situation. There is no question of an attempt to cover up anything but rather it is a question of taking legal advice as to what is publishable-----

Pádraic McCormack (Galway West, Fine Gael)
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Black stripes.

Brian Cowen (Laois-Offaly, Fianna Fail)
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-----on the basis of what was produced to the Ministers concerned as a result of the work done by those who did the work. It is as simple as that. On the question of what lessons are to be learned, the whole purpose of publishing the remainder of the report was to this end and relates to the fact that there are lessons to be learned and we need to learn those lessons.

Eamon Gilmore (Dún Laoghaire, Labour)
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If we could read them.

Brian Cowen (Laois-Offaly, Fianna Fail)
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An out-of-hours service will be provided to ensure a place of safety for children who are at extreme risk. This was not available in the past and it will now be provided because it is necessary.

With regard to the point raised by the Deputy on the role of the HSE, it will also have to take whatever steps it can take to learn lessons from this report. The chief executive officer of the HSE has a statutory duty of care in these matters and this is the reason he is in the privileged position of being able to read the report in its entirety. There is no question of covering up anything; it is a question of having to take legal advice with regard to the report-----

Alan Shatter (Dublin South, Fine Gael)
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The advice is wrong.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am sorry, the Attorney General is the person who advises Government in these matters, not the Deputy or anyone else -----

Alan Shatter (Dublin South, Fine Gael)
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Let him explain what happened in the Kelly Fitzgerald report.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Shatter, I asked you-----

Brian Cowen (Laois-Offaly, Fianna Fail)
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There is no point in coming across-----

Alan Shatter (Dublin South, Fine Gael)
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Can the Taoiseach identify any report that was published with recommendations blacked out, seven recommendations?

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am entitled to speak without interruption.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Shatter, I must remind you that you have no local standing during Leaders' Questions.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am entitled to put on the record of the House-----

Alan Shatter (Dublin South, Fine Gael)
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It is about the lives of children. How many more children are going to die due to the incompetence of this Government?

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Shatter, please do not interfere again.

Noel Dempsey (Meath West, Fianna Fail)
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There must be pressure in Dublin South.

James Reilly (Dublin North, Fine Gael)
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It is Government censorship.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Do not interfere, please. This is a democratically elected Parliament and the Taoiseach is entitled to reply and I have to insist that he be allowed reply. The Taoiseach, without interruption.

Pádraic McCormack (Galway West, Fine Gael)
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Whether he makes sense or not.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The reply does make sense in the context that it is consistent with the legal advice available to the Government and with regard to what action the Government needs to take as a result of this report. My reply also confirms to the Deputy that it does not mean that arising out of this report there will not be action taken by the HSE on a range of areas.

Joan Burton (Dublin West, Labour)
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How do we know that?

Brian Cowen (Laois-Offaly, Fianna Fail)
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One of the issues is the need to be in a position to provide out-of-hours service for a place of safety for children at extreme risk. This will now be provided from June in a way that was not available before and when there was a gap in the service.

James Reilly (Dublin North, Fine Gael)
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There is no chance.

Brian Cowen (Laois-Offaly, Fianna Fail)
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As the Deputy says, the idea that there are no other parts of the health service-----

Alan Shatter (Dublin South, Fine Gael)
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This is nonsense. What it is needed is not being provided-----

Brian Cowen (Laois-Offaly, Fianna Fail)
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What is the point of trying to reply?

John O'Donoghue (Kerry South, Ceann Comhairle)
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Please allow the Taoiseach to finish.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The idea that there are no other parts of the health service available on a 24-hour basis is not correct. The mental health services, the acute hospital services, the GP services, all of these services are also available to assist in these matters if problems arise, in addition to what is now being proposed by the Minister of State, Deputy Barry Andrews, as a solution to the question of providing out-of-hours emergency care for children at extreme risk.

Paul Connaughton Snr (Galway East, Fine Gael)
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What did the report cost?