Mary Upton (Dublin South Central, Labour)
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I welcome the opportunity to speak on the closure of wards at Our Lady's Hospital for Sick Children, Crumlin. The decision to close the wards is totally misguided. The only outcome of the decision will be unnecessary pain and suffering for children, who will be put on the waiting list, and incredible stress for their parents. I am sure the Minister, like all other Members, has received the e-mails on this issue. If these e-mails are anything by which to judge, there is a huge level of anger and frustration. In my experience it is matched only by the reaction to the removal of the medical card from people over 70. There is huge annoyance at this decision on the part of parents not just in Dublin - as Our Lady's Hospital for Sick Children is in my constituency I have a particular interest in it - but throughout the country, as the e-mails have made clear.

Closing the wards and reducing front line services make no sense. Over the past few years significant amounts of money have been invested in the hospital and various aspects of its service have been upgraded. What sense or logic is there in closing wards after recently investing substantially in the hospital? The consequence of closing the wards is that the sick children will either be forced into overcrowded wards or put on an extended waiting list, each of which is extremely unsatisfactory and most unfair.

The decision is yet another example of the right hand of the HSE not knowing what the left hand is doing. The HSE will probably argue that critically ill children will get the service and treatment they require. That is most welcome and one would hope nothing other than that would happen. However, it is not good enough for the small children and patients who suffer from illnesses such as scoliosis. I am sure all Members will have received e-mails on that issue as well. It is heart-rending to hear of the impact on and consequences for children if treatment is not put in place in a timely manner. Saying that critically ill children will get the treatment they need is another way of saying that many children who are ill will not get the treatment they require.

Everybody accepts that the HSE is facing serious budgetary problems but it is most inappropriate that the front line services being challenged are the ones that affect children. This should really be the last resort and not the first option, as it appears to be. The revelation today that the HSE spent almost €17 million on spin doctors and management consultants last year indicates that maintaining front line services falls well down on the list of priorities when allocating resources. The spend on public relations is totally unacceptable, particularly in the current climate and against a background of the closure of wards for the provision of services for sick children.

The details supplied by parents about the effects of the closure on their children are graphic and, in many cases, are clearly causing them huge distress. The fear factor alone is enough to prompt them to contact every Dáil Deputy to have the decision reversed. The loss of the service to the children is clearly the priority but there is also concern in my constituency about the secondary effect of job losses. This is also important, and people are very concerned about that risk. I urge the Minister for Health and Children to engage with Professor Drumm and the management of Our Lady's Hospital for Sick Children, Crumlin, to reverse the decision. I will not list the possible areas where savings could be made, as there are many and it is not important now that these are identified. What is important is that the decision to close the wards is reversed straight away. The hospital must be given the go-ahead to reopen these wards and to provide for the sick children of this country.

Áine Brady (Kildare North, Fianna Fail)
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I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. Hospital care for children is provided in Dublin at three hospitals: Our Lady's Hospital for Sick Children, Crumlin; Temple Street Children's University Hospital and the National Children's Hospital, Tallaght. Between the three, funding of over €250 million is provided for a national service for sick children.

The way to provide the best possible tertiary care most cost effectively involves the creation of one single national paediatric hospital, alongside a major teaching hospital, bringing together all the medical and nursing expertise for complex conditions. The concept of bringing together all three existing services is widely accepted. It is, therefore, entirely appropriate that we should now move towards that model of care in terms of closer integration and co-operation in the medical areas and in the most cost-effective use of resources. The Minister understands that significant cost savings are achievable if services and practices are more closely integrated, even before the building of a new paediatric hospital has been completed. For these reasons, to focus on each of these three hospitals providing paediatric services one by one, in isolation from the other two, will miss the full picture of paediatric services and the full potential for the level of services that could be provided within the resources being made available by taxpayers.

The facts relating to the budget for Our Lady's Hospital for Sick Children are as follows. The 2009 allocation to the hospital is €139.6 million. The allocation has increased by over €38 million or 39% since 2004. In line with budgetary constraints across the system, the 2009 allocation is 3% below the 2008 allocation of €143.8 million. The employment ceiling at the hospital is 1,550. At the end of March the HSE reports that the hospital employed 1,650 whole time equivalents, wtes, which is 100 above its employment ceiling, and therefore contributing to the current financial difficulties.

In terms of activity, in the first three months of this year there were 2,745 treatments for children as inpatients and 3,841 treatments as day cases at the hospital. This represents an increase of 244 over the same period in 2008. There were also 21,252 attendances in the outpatients' department, an increase of 1,041 over the same period last year. The HSE has advised that, based on the financial performance for the first quarter of 2009, the hospital should achieve a break even position at year end. This assessment takes account of cost saving measures totalling €6.5 million which have been agreed with the hospital and which are to be implemented over the remainder of the year. Much of the focus of the discussions between hospital management and the HSE has been on ensuring that all areas of non-pay expenditure are critically examined and that costs are reduced where possible.

It has proven necessary for Our Lady's Hospital for Sick Children, Crumlin, to take measures to stay within budget, including the closure of a theatre and a ward from this month. However, the hospital has confirmed that it is committed to delivering on the full level of its service plan commitments for 2009.

The funding and provision of the best standard of complex hospital care for children will continue to be a priority for the Government. Hospitals can work more effectively together, and hospitals will deliver a sustainable and constantly improving service for children by managing costs so that they stay within budget. Our strategic plan to integrate services at one new hospital is most important to achieve best outcomes for children.