Simon Coveney (Cork South Central, Fine Gael)
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I am disappointed the Minister is not present to take this matter, particularly in view of the fact it has been raised by Deputies from three different parties, one of which is in government. I do not normally comment in detail on health policy or health cases. I usually leave that to my party's spokesperson on health. However, what is happening at Our Lady's Children's Hospital, Crumlin, is such a disgrace that as many people as possible must see to it that the cases of the individuals affected by ward and theatre closures are raised. There is also an obligation on all Members to speak for their constituents when they are directly affected by what is taking place at the hospital.

It is not an exaggeration to say that keeping five and six year old children who have complicated, painful and severe spinal deformities and who require surgery on waiting lists for up to six months, or indefinitely in some instances, is a form of State-imposed child abuse. I do not make that comment lightly and I am particularly aware of the debate that took place in this House in the past seven days.

I wish to focus on the case of Conor Coughlan, a young boy from my constituency, who is seven years of age. Due to the fact that his spine is S-shaped and he is a growing child, Conor had what are referred to as "growing rods" inserted into his back on 17 April 2008. Essentially, these steel rods are inserted into one's back in order to try to straighten one's spine. On 13 November 2008, those rods were extended. Conor had been informed that as he grows, the rods will have to be extended. He was due to have them extended again last month. However, when his parents contacted the hospital they were informed he should return in November, one year after the rods were previously extended. This was despite the fact the rods are supposed to be extended on a six-monthly basis.

The Taoiseach recently stated here that necessary emergency surgeries in Crumlin are not being affected by cutbacks. It may well be the case that there is a need to identify further efficiencies at the hospital and that the staff to patient ratios do not compare well with hospitals in other jurisdictions. If we need to bring about change in this regard, that is fine. However, such change should not be achieved at the expense of five and six year old children who face enough challenges without being asked to wait six months for vital surgery. These children have deformed spines and a series of other complications that could be solved through the carrying out of basic operations provided by highly skilled professionals at Our Lady's Children's Hospital, Crumlin. The latter cannot carry out such operations as a result of ward closures and a lack of availability of theatre time there and at other locations.

I am glad Deputy White is also raising this matter. I appeal to her party, which has significant influence over the major party in government, to be brave and to take a stand on this issue. Children and their families are relying on people such as Deputy White to take a stand.

Mary White (Carlow-Kilkenny, Green Party)
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I am raising the tragic case of Jamie Murphy because I want to obtain the facts. Jamie and her family are constituents of mine in lovely Graiguenamanagh in County Kilkenny. This little girl suffers from spina bifida and scoliosis, and she requires an extremely delicate operation to address the latter. The Murphy family were informed that their daughter would have the necessary operation. A few days later, however, they were informed that, due to cutbacks, ward closures and problems with intensive care units, it would not be performed. Jamie's parents are very clear in their understanding of what was said during their conversation with her consultant.

I wish to be seek information on two matters. First, has this little girl's operation been deferred as a result of severe limitations on the service from a resource point of view? Second, if this is not the case and if Jamie is fit enough for this difficult surgery, when will she have her operation. If Jamie's operation is considered an emergency and has been deferred as a result of resource constraints, then that is a shocking indictment of our society and how it cares for children who are very ill. The hallmark of a civilised society is how it cares for the old, the young and children who are very ill.

It may be the case that conflicting signals are emanating from Our Lady's Children's Hospital, Crumlin. In such circumstances, I want its representatives and Jamie's parents to sit down together in order to chart a way forward for her. Jamie should have her operation as soon as possible. I am well aware that there are many children like Jamie. Recession or no recession, we must care for those in need. Jamie Murphy is a little girl in need.

This case is extremely distressing. I met Jamie's parents and I am aware that they are extremely stressed with regard to her health. I cannot and will not accept the cancellation of Jamie's surgery, particularly if the latter is considered an emergency and also if the decision not to proceed was due to resource constraints.

Jan O'Sullivan (Limerick East, Labour)
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It costs a great deal of money to treat and operate on children who are seriously ill. Many of them spend months, even years, in hospital. The parents of four such children - Jamie Murphy, Dakota Rudd, Jack McNiffe and Sarah Dorney - are so desperate that they allowed them to be photographed by the media this week. As public representatives, we all know their heartbreaking stories and we have heard about many more from families who have contacted us.

How can such children be the victims of the country's financial problems? This is the worst of all cutbacks. No civilised society would delay treatment for children who are seriously ill. Like Deputy Coveney, I am disappointed the Minister for Health and Children, Deputy Harney, is not present. However, I call on her to intervene and to provide the money required by Our Lady's Children's Hospital, Crumlin, which is over-budget because it is responding to the needs of sick children. It is frequently very expensive to cater for such needs.

The priority in this instance must be the children. I accept that belts must be tightened, that budgets must be controlled and that major reforms must be introduced with regard to certain aspects of health spending. However, the question of children's health should not be an area where such considerations apply. This is an issue on which the Minister must be for turning.

Our Lady's Children's Hospital, Crumlin, requires in the region of €9.3 million this year to maintain its services. Management at the hospital made severe cutbacks last year in order to balance the books. Despite this, the hospital still managed to increase its caseload. Management has made cuts where possible but it has now been forced to close at least one ward and an operating theatre and to reduce the number of front-line staff. The direct result of this is obvious - sick children must be placed on longer waiting lists. It is estimated that 3,000 fewer children will be seen this year.

The sum of €9.3 million is a tiny fraction of the €15.957 billion that will be spent on health services this year. Surely 3,000 children are more important than most of the items covered under that budget.

They are more important than outside advisers and spin doctors and layers of management. What is the point in having a Minister for Health and Children if she cannot intervene on an issue such as this? She must use her political authority and insist that the funding required is diverted to Crumlin hospital and that it is spent to address the needs of these children.

I have before me a quotation from a parent of one of those children in Monday's Irish Daily Mail: It states:

How can they do this to children? It is one thing loading taxes on adults - we can complain, children can't. Our Lady's Hospital is the only centre in the country for many of the services provided there - how can you cut the only services available in the country? It's going too far.

John Moloney (Laois-Offaly, Fianna Fail)
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At the outset I must apologise that the Minister for Health and Children, Deputy Mary Harney, cannot be here this evening.

Jan O'Sullivan (Limerick East, Labour)
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She should be here.

John Moloney (Laois-Offaly, Fianna Fail)
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She cannot be here this evening, and I am standing in for her by way of making a response.

Hospital care for children is provided in Dublin at three hospitals, Our Lady's Children's Hospital, Crumlin, Temple Street Children's University Hospital; and the National Children's Hospital, Tallaght. Each hospital funded by the HSE is required to deliver services within the financial allocation provided. The priority of the HSE and hospital management is to ensure that services for children at the hospital are maintained at an optimum level. The HSE is fully aware of the financial challenges being faced by the hospital. It is involved in ongoing discussions with hospital management regarding its 2009 financial allocation and service plan. The priority is to ensure that services are maintained at an optimum level.

In common with all hospitals, Our Lady's Children's Hospital, Crumlin is faced with 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 service plan for 2009. The top priority will be to protect patient care.

Simon Coveney (Cork South Central, Fine Gael)
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That is rubbish. That is what the staff want to do, but they are not being allowed.

John Moloney (Laois-Offaly, Fianna Fail)
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That is the commitment given and I accept and believe it.

It has proven necessary for Our Lady's Children's Hospital, Crumlin to take measures to stay within budget. However, the hospital has confirmed that it is committed to delivering on the full level of its service plan commitments for 2009.

Jan O'Sullivan (Limerick East, Labour)
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How can it?

John Moloney (Laois-Offaly, Fianna Fail)
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The hospital is committed to that. I am not suggesting that the Government is covering up for decisions taken. I am making the point that the hospital has committed and confirmed that it can live up to its service plan for 2009.

So far this year, Crumlin hospital has delivered more treatments to patients than for the same period last year. In the first four months of 2009 there were 3,704 treatments for children as in-patients and 5,095 as day cases - up by 234 over 2008. The allocation to Crumlin for 2009 is €139.6 million, an increase of some 39% over the last 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 has been operating at some 91 posts above its employment ceiling - it employed 1,641 people whole-time equivalents at the end of April compared with its ceiling of 1,550. This is contributing to the current financial difficulties.

Simon Coveney (Cork South Central, Fine Gael)
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While I am aware he did not write his script, does the Minister of State believe that this is an answer with which the parents will be happy?

John Moloney (Laois-Offaly, Fianna Fail)
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I take account of the concerns the Deputies are reflecting on behalf of the families, and I want to respond as honestly as I can. I must come back to the point, however, that the hospital is committed to working within its service plan and I believe it will do so.

Either way, the HSE is working closely with Our Lady's Children's Hospital to achieve an agreed programme of savings, totalling €6.5 million this year. The main focus of these savings will be on non-pay areas of expenditure and on protecting front line services to the maximum possible extent.

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 present 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.

In 2009 the Government will provide over €250 million for the running of three paediatric hospitals in Dublin. 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 back into patient care. For example, the three children's hospitals in Dublin have agreed and developed a model for the development of a joint department of paediatric surgery. The clinical network across the three hospitals will make the best use of the resources that are available and will ensure a single system of care. The early retirement of an orthopaedic consultant in Cork has increased pressures on the scoliosis waiting list at Crumlin. The National Treatment Purchase Fund has identified a number of cases from the waiting list for treatment at Cappagh Hospital. Further cases are being reviewed.

In addition, discussions are ongoing with the three paediatric hospitals with regard to the provision of orthopaedic services generally and in particular the treatment of children suffering from scoliosis. The hospital has reiterated that no child has been denied access to emergency life saving surgery due to its break-even programme.

Simon Coveney (Cork South Central, Fine Gael)
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It has to be life saving.

John Moloney (Laois-Offaly, Fianna Fail)
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I would not belittle that statement, as it is very important to be able to assure parents that talk of cutbacks are not relevant where it is a matter of life that is at stake.

Jan O'Sullivan (Limerick East, Labour)
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These are extremely ill children.

John Moloney (Laois-Offaly, Fianna Fail)
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I accept that, but it is also important to nail down the specific commitment in that regard.

The hospital's medical team continues to prioritise each patient on the basis of clinical need.

Simon Coveney (Cork South Central, Fine Gael)
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I accept that, the consultants are excellent but they do not have the resources.

John Moloney (Laois-Offaly, Fianna Fail)
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I do not want to be adding to the response as prepared but it is fair to emphasise that the hospital has said it can remain within its service plan and deliver on the commitments in that.

The hospital does not discuss - I take the points raised by Deputy White - individual patient cases due to confidentiality agreements with the patient and family. I understand that the family in the case mentioned here today have asked the hospital to respect its privacy and not release information in relation to the case. The funding and provision of the best standard of complex hospital care for children will continue to be a priority for the Government.