James Bannon (Longford-Westmeath, Fine Gael)
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Question 8: To ask the Minister for Health and Children the reason the Health Service Executive Arthritis and Allied Conditions Report completed early in 2008, has not been published; and if she will make a statement on the matter. [20561/09]

James Reilly (Dublin North, Fine Gael)
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Question 94: To ask the Minister for Health and Children the reason the Health Service Executive Arthritis and Allied Conditions Report completed early in 2008 has not been published; and if she will make a statement on the matter. [20552/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 8 and 94 together.

The working group on arthritis and related conditions was established by the HSE in 2006. The group's report is expected to be completed shortly and will be then considered by the HSE senior management team. It is intended that the work of the group will inform the future planning and delivery of services for people suffering from arthritis and related conditions.

There have been significant developments in this area as a result of the 2005 report of Comhairle na nOspidéal, which recommended the recruitment of a number of additional consultant rheumatologists. The number of consultant posts overall increased from 16 in 2002 to 25.7 currently, including a post for children and young people at Our Lady's Children's Hospital, Crumlin. The recruitment of a second consultant rheumatologist in the north west is underway. In addition, in the period 2005 to 2008, more than 2,700 people were facilitated with rheumatology appointments by the National Treatment Purchase Fund.

James Reilly (Dublin North, Fine Gael)
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Arthritis is the greatest cause of disability in Ireland today, affecting one in every six people or 714,000 people, yet the Minister referred to the NTPF facilitating more than 2,500 patients, which puts this issue in perspective. The World Health Organisation recommends that Ireland should have one rheumatologist per 80,000 people but the reality is we have one per 400,000 people, which means patients must wait up to five years to see a rheumatologist.

In May 2006 the Minister established a working group on rheumatology. It was announced that the group would conduct a review of the provision of services for people with arthritis and publish a report outlining a comprehensive framework for the development of rheumatology services in Ireland. It was completed in 2008 but the report remains unpublished. When will it be published? What plans has the Minister to address this major shortfall in rheumatology services? How many new posts are planned? When will they be advertised? When will they be filled?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I agree there is a major deficit in rheumatology services. Among the reasons for that is that while we have a large number of doctors, there is an overemphasis on junior doctors with too few consultant posts. If we could get the ratio right, the amount we are spending would cover the cost of consultant appointments. As a result of the new consultants' contract, we are in the process of recruiting more consultants across a range of specialists areas, including rheumatology, and this will be financed by shrinking junior doctor posts on a two for one basis. This has been recommended for many years and it is acceptable to the clinical community and to the HSE. Since 2005 I have increased the number of rheumatologists from 16 to 25.7 and we are currently recruiting for a post in the north west.

The publication of the report is a matter for Professor Drumm and the HSE management team. I understand among the issues they are considering is the designation of up to ten specialists centres around the country for rheumatology and linking rheumatology and orthopaedics and so on in a number of centres. Implementation work is delaying the publication of the report.

Jan O'Sullivan (Limerick East, Labour)
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Will the Minister take cognisance of geographical areas if ten centres are designated? If she repeats what she did under the cancer strategy and leaves a vast swathe of the country without a service, that would not be acceptable, particularly in regard to rheumatology services, which many people need.

We have a lost a great deal of time in the appointment of consultants because of the time it took to renegotiate the consultants' contract. Will that be taken into account in the context of the number of consultants appointed this year and next year? If the negotiations had not taken so long, presumably many of the additional consultants would have been in place at this stage.

James Reilly (Dublin North, Fine Gael)
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The Minister stated she will shrink the number of junior hospital doctors and the 2:1 ratio will result in more doctors at consultant level. The average working week of a consultant is between 33 and 38 hours while the average working week of a junior hospital doctor is almost 100 hours. If she takes them out of the system, how will she replace the hours? That does not stack up.

It is three years since the working group began its work but its report has not been published. When will it be published? She is the Minister and she must take responsibility. She cannot continually point to the HSE. How many posts will be filled? When will they be advertised? When will they be filled? Her non-answer that the recruitment process is ongoing is the same as saying Christmas is coming but which year?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I take responsibility for reports I commission but not for those commissioned by others. Under the Deputy's grand plan, responsibility will be handed over to insurance companies and taken out of ministerial control and, therefore, I will not take a lecture on that.

James Reilly (Dublin North, Fine Gael)
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They will be directly answerable to the Minister through the regulator. Answer the question.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy referred to the average working time of consultants. The majority of consultants in the public hospital system work considerably longer hours that he says. They work way beyond their contractual commitment, which is 37 hours. The new team approach with a clinical director will ensure hospitals are appropriately covered. Safe care cannot be delivered through the manner in which we organise doctor services in our hospitals and that is one of the issues driving the reconfiguration. What has happened in the mid-west with the 12 surgeons in the region working as a team will deliver much safer, better and more care for patients there.

A large number of consultants have been recruited in recent years. We have almost doubled the number of consultants in the system over the past 15 years and we need to go further. Between 3,000 and 4,000 are probably needed. I encourage all Members to read the new HealthStat information and perhaps the Joint Committee on Health and Children can examine it. It highlights a significant variation in activity across, and within, different specialties. That information could, hopefully, alleviate many of the pressure points relating to access to consultants. One neurologist in Dublin can see 95 new patients a month while another can see between 12 and 20 a month. In addition to increasing the number of consultants, it needs to be ensured that activity levels are appropriate when we make these key appointments.

James Reilly (Dublin North, Fine Gael)
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How many posts will be advertised? When will they be filled?

Mary Harney (Dublin Mid West, Progressive Democrats)
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A number will be filled this year. I cannot say whether that will happen in July, August, September or October. I am not in a position to give the Deputy that information.

James Reilly (Dublin North, Fine Gael)
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Will the Minister provide it by way of written reply?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes.