James Reilly (Dublin North, Fine Gael)
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Question 1: To ask the Minister for Health and Children her view on the impact the planned ward closures at Our Lady's Children's Hospital, Crumlin, Dublin, will have on patient care and treatment; if she will call on the HSE to meet the board of management of Crumlin hospital with a view to securing savings without affecting front-line services; and if she will make a statement on the matter. [20912/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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In common with all hospitals, Our Lady's Children's Hospital, Crumlin, is addressing the challenge of delivering a high quality service to its patients while remaining within budget. The hospital is committed to providing the full level of services that it promised in its 2009 service plan. The top priority will be to protect patient care.

So far this year, Crumlin hospital has delivered more treatments to patients than in the same period last year. In the first three months of 2009, there were 2,745 treatments for children as inpatients and 3,841 as day cases, an increase of 244 over 2008. Crumlin also had 21,252 attendances at the outpatient department, an increase of 1,041 from the first quarter of last year.

The 2009 allocation to Crumlin is €139.6 million, an increase of some 39% over the past five years. This includes a reduction of 3% this year over 2008 in line with the budgetary constraints facing the entire public sector and the wider economy. A particular challenge for the hospital is that it is operating at some 100 posts above its employment ceiling. It employed 1,650 people at the end of March compared with an approved 1,550. This contributes to its current financial difficulties.

The HSE is working closely with Crumlin hospital to achieve an agreed programme of savings totalling €6.5 million this year. The focus of these savings will be on non-pay areas of expenditure and on protecting front-line services. On this basis, the HSE believes the hospital will achieve a break-even position this year.

We need to consider more strategically the way in which we provide paediatric services in Dublin. In 2009, the Government will provide more than €250 million for the running of three paediatric hospitals in the Dublin area. We can achieve significant cost savings if services and practices are more closely integrated across the three hospital sites, even before the new national paediatric hospital has been completed. With this in mind, the HSE is pursuing ways in which services across the three hospitals can best be co-ordinated to avoid unnecessary duplication and to achieve savings that can be put into patient care.

James Reilly (Dublin North, Fine Gael)
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The Minister has had a long time to consider how to make the hospitals more efficient. The issue before the House is of serious concern to people across the country, no more so than the Deputy on my right, Catherine Byrne, whose constituency contains the hospital in question.

Crumlin hospital looks after 80% of children's tertiary needs. The Minister was right to point out that it has increased its activity and efficiency, but this was necessary in light of the increasing population. The Minister acknowledged this fact by increasing the allocation to the maternity hospitals.

The Minister does not seem to have taken into account some of the newer technologies that are available, such as extracorporeal membrane oxygenation, which has reduced the cardiac surgery death rate by nearly half. The hospital was given no extra money in this regard. There is a growing number of cardiac conditions that, unlike previously, are now treatable, such as hyperplastic left heart syndrome. The incidence of sickle cell disease has increased significantly, resulting in Crumlin hospital having the largest outpatient clinics for that illness in Europe.

Why is the Government spending €5 million per year on a virtual new hospital, which no one believes will proceed in the current economic climate, when it is enforcing cutbacks at the very hospital delivering care today? Since all Cork orthopaedic operations are to be brought to Crumlin, any delay in scoliosis operations will result in children having two operations, leading to tremendous suffering. How much-----

Brendan Howlin (Wexford, Labour)
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I will call the Deputy again.

James Reilly (Dublin North, Fine Gael)
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What are the Minister's plans to address this problem and why is the Government spending €5 million per year on the new hospital?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Regarding the last point, we need a new hospital badly. If there is no single new hospital, major work will need to be done at the Temple Street Children's Hospital, which is not fit for purpose, and at Crumlin hospital. The decision was made two years ago, the project is proceeding, money will be provided and there is a great deal of interest in making provision for the hospital.

As I recently stated in the House, the HSE has shown that a minimum of €25 million per year can be saved in duplication costs by combining the three hospitals. Much work has been undertaken to bring them closer together. There will be a joint department of surgery and seven surgeons. There are five currently, one of whom is retiring, so the increase will be two. The surgeons will work in at least two of the hospitals. There will be a single paediatric critical care service between Temple Street and Crumlin hospitals, the implementation of which will be overseen by Dr. Des Bohn of the Hospital for Sick Children in Toronto. Much work is under way.

As I have stated in the House previously, three accident and emergency departments will be open in this city between midnight and 8 a.m. tonight, with theatres and staff on call. On average, they see approximately 29 patients between them. I had a good meeting recently with Professor Brendan Drumm and some of Crumlin hospital's medical team, led by Dr. Pat Doherty, the chairman of the hospital's medical board, Dr. Michael McDermott and others to discuss how to better integrate services and paediatric services generally in the Dublin area.

Next week, a new clinical affairs director, a doctor, will start at the HSE. Bringing clinicians further into the management of services such as paediatrics will greatly help to get better value for money and more services for patients.

Brendan Howlin (Wexford, Labour)
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I want to allow Deputy Reilly back in for a brief supplementary question.

James Reilly (Dublin North, Fine Gael)
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Many of the Minister's comments on clinical directorships, etc. are sensible. However, they fail to answer the questions of why we are cutting front-line services to children, why the money cannot be found elsewhere and why we are spending money on a virtual hospital when the existing hospital is being put under such strain. New PR people are to be appointed to the virtual hospital's team. Yet again, the Government seems to be more interested in spending money on spin than on service.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Since 2005, we have increased the budget to Crumlin hospital by 39%, which is considerable. We are not engaged in spin. A significant amount of work is under way by the development board to put in place the new children's hospital.

I compliment the chairman of Crumlin hospital, Archbishop Diarmuid Martin, on his tremendous work in trying to advance the project. It does not meet with universal approval, but everyone knows that, were we to establish a paediatric service for the city and country, we would not start from our current position. We must improve on the situation with a modern, state-of-the-art facility co-located with an adult teaching hospital. This aim is being pursued and will be achieved.

James Reilly (Dublin North, Fine Gael)
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He is not spending a fortune on PR gurus.