James Reilly (Dublin North, Fine Gael)
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I move:

"That Dáil Éireann:

noting that Our Lady's Children's Hospital, Crumlin is the largest children's hospital in the State, providing some 80 per cent of tertiary or highly specialised children's care for the country:

is deeply concerned:

— that the postponing of lifesaving surgery in growing children should not be an option as it can cause lifelong disability and may even shorten their lifespan;

— that the Government has applied funding cuts of €9.1 million in 2009 which, to date, has led to the indefinite closure of a ward and theatre;

— that cutbacks have resulted in the withdrawal of essential treatment from critically ill children;

— at the unacceptable increase in cancelled operations;

— by the lengthening of already long waiting lists;

— that the hospital is likely to see further ward and theatre closures which will see a reduction of out-patient appointments by 15% or 8,483 attendances and 1,100 admissions in 2009;

— that the National Treatment Purchase Fund is not funding urgent scoliosis surgeries for children experiencing acute pain and suffering, in spite of assurances given by the Minister for Health and Children on 21st May, 2009; and

— that these cutbacks take no account of:

— the increased costs that Crumlin has experienced due to new technologies such as Extra Corporeal Membrane Oxidation which has reduced the mortality from cardiac surgery by 50%;

— the transfer of orthopaedic services from Cork to Crumlin;

— the increasing number of cardiac conditions which are now treatable;

— the huge increase in sickle cell disease in this country which has resulted in Crumlin now having the biggest sickle cell clinic in Europe;

— the increased birth rate over the past number of years; and

— the fact that savings can be made elsewhere in the HSE budget;

calls on the Government to put children first and immediately reverse this penny wise pound foolish decision of reducing the hospital's budget by €9.1 million so as to alleviate the needless pain and suffering of hundreds of children."

I wish to share my time with Deputies Catherine Byrne, Seymour Crawford, Fergus O'Dowd, Tom Hayes and Andrew Doyle.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

James Reilly (Dublin North, Fine Gael)
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I move this motion on behalf of Fine Gael but, more importantly, on behalf of our children. A fortnight ago, we discussed the Ryan commission report, which outlined dreadful inhumanity and cruelty to past generations of children. All of us, one after another, expressed our shame and horror at what was done to them while nothing was done about it. While the wrongs were committed by the religious orders, the State was complicit in allowing it to happen, and the broader society turned a blind eye.

The cutbacks in Crumlin Hospital will once again inflict needless pain and suffering on children. The big difference is that this time there is something we can do about it. We know what the implications of our decisions will be; they have been outlined very clearly for us by the relevant medical experts.

Let me give a few facts about scoliosis. This is a condition that causes increased curvature of the spine. In the bulk of cases, this is of little concern, but for the small percentage of progressive cases, it affects children severely leaving their backs twisted and deformed. In this country we put people on the operating list when they reach 68o of curvature in their spine, because of our lack of resources. The international standard for intervention is at 48o. Nonetheless, at 68o one operation will correct the situation. By the time children here get to theatre, they will be at 75o of curvature.

The budgetary cutbacks at Crumlin will result in patients being left longer on waiting lists. This could mean up to three, four or even five operations for a patient who otherwise would have needed only one. This is unacceptable. Not alone is it unacceptable because of the need for five general anaesthetics, five admissions and five episodes of post-operative pain where one of each of these would have sufficed, it is unacceptable because these children are then left with, perhaps, their entire spine fused, resulting in reduced ability to rotate or to flex their spine, giving them life long disability where they might have had virtually none. It is needlessly cruel to cause extra pain and suffering where it can be avoided. It is also financially inane, because it costs the State so much more money in terms of repeated surgery time, theatre time, hospital time and then a life of reduced capacity and all that implies for the child when he or she becomes an adult.

In the area of cardiac surgery, the situation is equally serious for children with cardiac anomalies like a hole in the heart, incomplete valves or other rare conditions like hypoplastic heart. These conditions, some of which were not amenable to correction by surgery in the past, are now amenable to correction through advances in surgery and other techniques, particularly extra corporeal membrane oxidisation, ECMO, which has reduced by 50% mortality from cardiac procedures. This has, of course, saved the lives of many young babies, but some of the corrections require repeated procedures as the baby's heart grows.

Even a more simple condition like a hole in the heart is a dynamic situation that changes. Sometimes the hole will close over itself, sometimes it will stay stable and other times it will deteriorate. When doctors realise the defect is getting worse rather than better, they will plan to do surgery in an urgent fashion. This does not constitute an emergency, but it will rapidly become an emergency if not corrected. Therefore, the foolishness of believing that one can delay such procedures, as will be the case due to these cutbacks, is just that, foolish. It is foolish because it endangers the life of the child and because it may well end up costing the State more money. Emergency surgery is never deemed to be an ideal solution, or a substitute for planned surgery. The outcomes are very different. When patients develop complications, this means further suffering for the patient and further worry, anxiety and emotional distress for the family. It also means further costs for the State. Everybody loses.

The list of procedures that have been delayed as a consequence of these cutbacks goes beyond these areas. However, every effort has been made to protect children, particularly those requiring cardiology and oncology services, but in urology there are many children with serious defects, such as hypospadias, which need to be corrected, especially before they go to school where their condition can cause them tremendous psychological problems if left uncorrected. Again we see a penny wise, pound foolish health policy from this Government. While a 3% cut across all hospitals might on the face of it seem sensible, surely it would be more sensible to examine the efficiencies of each hospital, reward the ones that are efficient and penalise those that are inefficient?

Let us consider some of the facts on Crumlin Hospital. In 2004 the budget was €98.6 million and in 2009 it is €134 million, an increase of some €36 million or 37%, but what we have to examine here is what happened to the €36 million. A total of €24.3 million went in pay awards, which were outside the control of the hospital and were awarded by this Government. The balance of some €12.4 million, or 13%, was available to deliver increased volume and complexities.

The increased budget enabled Crumlin to see more patients, to treat more patients and to treat more complex problems, and this it has achieved. It can now perform life-saving operations on heart conditions that were untreatable before and is now treating many more patients. This is not surprising because our population has increase. This is acknowledged by the Department through increased allocations to the maternity hospitals, but the very hospital which has to treat the rare and more serious conditions and the increased number of children requiring treatment has its budget cut.

Today members of the Oireachtas health committee visited Crumlin Hospital. I had already visited it in the previous week and had an in-depth tour. I have statistics which are worth reading into the Dáil record. All hospitals have been asked to be more efficient, to cut down bed days stayed, to do more day cases and fewer inpatient procedures. We have had an increase in our population and our birth rate and this has been acknowledged, but Crumlin Hospital is not being acknowledged in the same way.

With an increasing population, more children will need treatment, but inpatient figures for 2004 and 2008 show no percentage change. Day case surgery, however, has increased by 30%, so Crumlin is following Government policy and there is a greater emphasis on day care. It is right and proper for children to wake up in their own beds in the morning, go to hospital for treatment and go to their own beds at night, where that is possible.

The number of total bed days used has increased by 14% and outpatient activity by 23%. Theatre procedures have increased from 10,000 to 13,000, a 34% increase. ICU bed days increased from 4,600 to 5,600, a 21% increase. At every level of measure for efficiency, increased activity and greater emphasis on day cases, the hospital has done all that it has been asked to do, and did it within the increased budget of €12 million, or some 5%, afforded to it. The figures show a pretty good return. To ask it now to cut back the budget by €9 million will have a detrimental effect. It will delay cardiac surgery. It will turn many urgent cases into emergencies. It will delay orthopaedic surgery, with life-long consequence for children. This is not acceptable. We have been told Crumlin Hospital is overstaffed by comparison to other hospitals. Nothing could be further from the truth. There are 63 whole time equivalent consultants in Crumlin, representing 3.7% of the workforce. Non-consultant hospital doctors account for 6% and nurses 43%. Administration accounts for 13.6%, which compares very favourably with other hospitals - in particular Birmingham Hospital - which generally have a figure of 16%.

It is disingenuous, to say the least, to compare Crumlin Hospital with Birmingham, when the figures for Birmingham included its day case surgery as well as its inpatient surgery, but the figures for Crumlin included only its inpatient surgery. When one compares like with like, one finds Crumlin compares very favourably. International recommendations for oncology cases state that if a hospital sees more than 50 new patients per year, it needs another consultant. The three oncology consultants in Crumlin are seeing 100 new patients a year between them, double the international standard. There are five paediatric surgeons in the country. In the North there are six, serving a population one-third the size of Ireland

We have debunked the thoughts the Government had, namely, that the cutbacks were necessary because of overstaffing and unproductive doctors and nurses in Crumlin. It was a needless insult to the staff at Crumlin. It is bad enough to be understaffed and have one's budget cut, but to have it suggested that it is because one is inefficient, overstaffed or not producing the goods is grossly insulting.

The staff at Crumlin Hospital, however, are not particularly concerned about that hurt, rather, they are concerned about the hurt to their patients, to small babies in their mother's arms who have serious, ongoing cardiac conditions and who are having their treatments delayed causing great anxiety to their parents and extended families. They are concerned about the children who have scoliosis, whose spines are starting to press on vital organs, whose longevity may be shortened and whose lives will have needless additional disability imposed upon them.

The reality of this is that the closure of St. Joseph's Ward resulted in 25 beds being lost. While we welcome the news that there will not be further cuts, one theatre remains closed and 25 beds are lost, representing 4,000 lost bed days. With an average bed stay of approximately five days this could cause up to 800 patients to have their treatments delayed. We know one theatre will be closed. This will delay surgery for many children with very worrying conditions, not just scoliosis and cardiac surgery, but also other urological conditions like hypospadias. All of this is done for what? For the sake of €9.6 million.

It is clear to me there are billions for the bankers but cutbacks for the children. This is real. These are not statistics. These are real children, such as a young girl from Galway who had surgery in Crumlin where rods were inserted into her back, and has had two lengthening procedures since. She was due another lengthening procedure within the next two weeks, but she has been advised it will now take place in September at the earliest. She was nine months on the waiting list to have her surgery. Her sister was diagnosed at the age of 15 with a 66° curvature of her spine in April 2008 and today is still waiting for surgery, despite the fact that when she was reviewed in April 2009 the curvature had increase to 80°. She has been on the list for 15 months. Her breathing is affected and her lung capacity is diminished. She is an Irish citizen.

These are real people, real children and they are our citizens. How can we do this to our own? The many thousands of children now who will wait for an outpatient appointment because of the delays and cutbacks in the outpatients in Crumlin will rightly ask why them, and why they must suffer the delay in diagnosis. Disabilities that could last for life might have been cured.

There has been tremendous spinning and management of the media on this and the latest twist is that there will not be any further closures of theatres over the summer. However, that does not address the serious issue of St. Joseph's Ward being shut, the lost 4,000 bed days and a theatre being shut, while fully trained specialist anaesthetists and spinal surgeons stand idly by, being paid for their services by the State and unable to do the work they have been asked to do, are paid to do and want to do.

The idea that Cappagh can be made available was welcomed by the staff, but only if Crumlin was working at full capacity to allow them to tackle the existing backlog. However, to close Crumlin and open Cappagh is foolish nonsense, will not save a penny and will cost the State money. The children of this nation are our future. Their parents will not be deflected from their responsibility to protect and care for them. I will not be deflected from my responsibility to protect them from cutbacks. The Minister should look elsewhere. She should look at the €16.5 million spent on outside consultants and PR gurus, or the €60 million spent on taxis and transport - a 10% saving through better logistics would yield €6 million there alone. Fine Gael will not stand idly by while this happens. It is our responsibility to cry halt and to use whatever democratic mechanisms are open to us.

In closing, this motion is about preventing cutbacks at Crumlin hospital which will result, make no mistake, in needless suffering for children, whom we vowed to protect only two weeks ago. This is a test for us, and it is a test for the Fianna Fáil-Green Government and the Independents who support them on their commitment to children. I ask the Government not to fail them. I commend the motion to the House.

Catherine Byrne (Dublin South Central, Fine Gael)
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I welcome the announcement, however temporary, that the closure of two more wards and another operating theatre at Crumlin hospital will not go ahead next month. As we know, one 25-bed ward and one theatre have already been closed, leaving longer waiting times for sick children. The long-term consequences after the summer months will only bring increased hardship and anxiety to parents throughout the country when the closure of these wards comes into operation.

Our Lady's Children's Hospital is a very special place. It is more than just a hospital for sick children; it is a place where the family and extended members are placed at its very heart. The hospital prides itself on its relationship with not only the sick child, but also with the families and extended family members, making it unique in modern day health service. There is an urgency for the Minister not only to provide a temporary solution to this ongoing situation, but to deal with this continued uncertainty once and for all.

As a parent of five children, I have on many occasions made the midnight dash to Crumlin hospital when one of the children had become unexpectedly ill. At all times, the hospital and staff went beyond the call of duty to ensure that everything was done both medically and emotionally to reassure both parent and child. In Crumlin, we have a hospital of excellence, a home from home in the heart of a living community where people down the years have given it every support possible through fundraising and particularly through voluntary activities. I do not understand, nor do the people of the area, what is the rationale for this decision to move what is a much-loved hospital to a location which is plainly one of the most unsuitable sites in the city. There is no obvious reason to move the hospital to another location when it has such a track record of excellence and is situated on a 12-acre site in Crumlin within easy reach of the Luas, trains, buses and so on.

When a parent is confronted with the illness of their child, all other life is put on hold. The state of the national economy is way down the priority list. What is important is the medical care, the child-friendly atmosphere and the accessibility of the hospital. All these have been tried and tested in Crumlin. Despite the recent cutbacks and reduction of services in the hospital, the staff continue to provide an excellent service and a proper standard of care for children who are seriously ill and also for those who present for just an hour or two. In the coming months, and in the current climate, the Minister will have the opportunity to reassess the decision to relocate Crumlin hospital to the Mater hospital site. There is a now a real urgency to take decisive action and to channel funding into Crumlin hospital, which is ready, willing and able to meet the current and future needs of all sick children throughout the country.

For many years, I have been very much a part of a choir in my community. I have sung at the regular mass and one of the songs we continue to sing at the children's mass is "Suffer little children". I believe the words of this song relate to Crumlin hospital today. Children do not have to suffer when all the facilities and, in particular, the staff are in place. We have a real opportunity to change many of these lives and to give children who are seriously ill the opportunity to laugh and play again with their friends and again become part of their family home and community.

I welcome this motion put down by Deputy James Reilly and thank him for allowing me some of his time to speak on the matter. This hospital is very much a part of me as I have grown up in the area and lived there all my life, and have on many occasions, voluntary and otherwise, been within its grounds. I urge the Minister to reconsider immediately the decisions that have been made and, first, to keep the wards open continuously and, most of all, to reconsider the location of Crumlin hospital.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank my colleague, Deputy James Reilly, for raising this issue. In no small way, he, with others, had a role to play in making sure that at least some of the worst cutbacks planned for Crumlin hospital have been eased.

The Minister has a major role to play in this regard. On behalf of the Government, she can decide whether the ward is re-opened and the funds are made available. I appreciate more than most that we are in difficult times, but we were in difficult times before. While I do not remember it, I was often told of the time my oldest brother was born prematurely and rushed to Monaghan General Hospital where his life was saved. My late mother would always write to any family that had a bereavement because she realised how precious it was to save a child.

Monaghan General Hospital is another issue which I will not go into here. However, the Minister will have to bear the responsibility in that regard also.

I think of the Clerkin family in my parish who, although they lost their child as a result of serious illness, thought so much of the work that was done for the family in Crumlin hospital that they organised a major fundraiser. I think also of the Quigley-McPhillips family who, thankfully, still have their child. They raised €106,000 in one night jointly for the hospital and the Jack and Jill Children's Foundation, which does a great job in its own right. These are two examples of where the people of a small community in the parish of Aghabog and Killeevan came together and committed themselves to provide funds to help this hospital because they saw the great job that was being done and the great need for it.

I can personally recall the case of a 13-year old girl who had a serious illness, although it was a major task to find out what the illness was. Crumlin hospital did not give up, however, and was eventually able to transfer that child to London where she had her transplant. Subsequently, she has moved on in life and she now has her own children, although she had been at death's door. I understand also that a young couple were glad their baby girl had her operation yesterday at the hospital.

These are some of the real issues for families, yet the Minister has tried to claim, as she did on television recently, that these cutbacks will not affect anybody. I am not totally dependent on Deputy James Reilly or the Minister's colleagues who visited the hospital with him today. Like every other Member of the House, I have received an e-mail from a family that has recent experience of being in that hospital. They made the point that many of the beds in the cardiac wards in St. Brigid's ward are being used for orthopaedic patients since St. Joseph's ward closed last month. This means there is reduced cardiac surgery and children's vital heart operations are being postponed. It is only a matter of time before a family pays the ultimate price for these cutbacks. I do not state as much flippantly, this is what the parents of a child patient told me. They further stated that during their visit there were signs over the ECG, electrocardiogram, room stating, "No staff, limited services". They were informed only three staff were working in an area in which there should be three times that number to cover all the clinics. While they were being admitted to the day ward a young girl with a newborn baby was informed the cardiac procedure for which she presented had been cancelled at the last minute. She had to go home with her tiny baby and wait until the hospital could fit her in another time. How can the Government maintain these cuts will not affect children? How can it continue to hit the most vulnerable sector in society? These are not the words of a politician. This is the case of a real family which saw what is taking place at first hand in the hospital in Crumlin.

Professor Drumm has stated on the record that there are management or senior staff in the HSE and he does not really know what they do. I suggest, with all due respect, that there are other areas within the HSE and Government which should be examined before the treatment of children is compromised. I make no apology for using that word. Children are the dearest thing on the earth to the parents who brought them into the world. They only seek fair play and a service.

We could spend all night discussing the idea of moving this hospital to the Mater Hospital, which would beg the political question for the move. Anyone who has visited the Mater Hospital as often as I have is aware that in the present circumstances there is no parking or anything else available much of the time. However, savings must be made within the Department of Health and Children. In recent years I have sought taxi services for genuine hardship cases but I have been told none was available. However, as a result of a Dáil question, I have discovered that in the past two years some €60 million has been paid out in taxi costs. This is only one relevant example. Before it is too late, the Minister should either find the necessary money or savings from elsewhere or make a decision on what she should do personally.

Fergus O'Dowd (Louth, Fine Gael)
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This is a very important debate which goes to the heart of the purpose of our society and health services. Our services are a measure of how we treat the very young and old in our society, the type of people we are, the type of country we have created and how we manage and run it. In the case of these very young children any necessary help, support and money should be given to the hospital or hospitals which treat them. Whatever services are needed and whatever medical specialties are required must be provided. This is the bottom line for our society.

Let us put down a basic benchmark of a human, just republic which we all seek and which cherishes all our children equally. If we can help young children who have a medical problem or a disability to live a longer, better life then that is the measure.

As in the case of other speakers, I wish to address in a constructive way what should happen in our society. The Minister for Health and Children has failed in her duty of care to provide the moneys for these operations and to consider the necessary processes.

As transport spokesman in my party I examined the transport costs associated with health care. In 2003 the HSE transport costs came to €18 million total. In 2008, the latest year for which the figures are available, the figure is in excess of €29 million, an increase of some €11 million from the 2003 cost of providing transport in the health services area. Our argument and that of Deputy James Reilly, the Fine Gael health spokesman, is that it is surely possible to find savings in the area of transport policy to provide the moneys necessary for this hospital.

Let us examine the facts. I have read the relevant details and acute hospitals throughout the world have an effective transport policy and in many cases a green transport policy. Such policies reduce costs and the carbon footprint but provide essential services to people in an effective way. In the past two years the HSE spent €60 million on transport policy, compared to a figure of €20 million in 2003. There has been a significant overrun in this area. Let us consider the staff taxi costs of last year. In one area, that is, the mid west the transport spend last year was almost €150,000, in the east coast area some €162,000 was spent on staff taxis, in the south west more than €277,000 was spent, but in the north east only €1,340 was spent. Clearly some areas have an effective transport policy for their staff and others do not. The Minister must examine the matter. Some areas work very well and others are not working as well.

Another matter arises in the reduction of costs associated with the transport policy for patients. Appointments are made in such a way that when a patient is notified of an appointment, public transport options are provided, including how to reach the destination and the associated costs. This can be done quite easily. Many people must travel from rural areas to cities and in many cases long distances are involved. Such people require essential and important treatment and are often very ill. However, if one provided transport options upon making the appointment along with the costs of same it would provide alternatives. The cheapest possible option, if public transport is available, would effectively underline the importance of ensuring that moneys available in the health services are used to provide the medical expertise at the point at which it is needed. Other essential costs can and must be reduced. Why is it not possible to save €6 million for Crumlin hospital in our transport policy? It would make a good deal of sense to do so.

I understand many people must travel long distances to attend specialist care. If someone has cancer he or she must go to the appropriate regional centre. If a person suffers from serious kidney disease he or she must go for dialysis elsewhere. I understand in other countries a volunteer programme is in place. A similar programme might operate here which in the case of cancer care could be operated through the hospice movement. A volunteer programme for kidney dialysis treatment could be operated by survivors or people who have had such illnesses. They might offer or be available to drive patients to the treatment centres. If such a voluntary network were built up and supported in association with the hospice movement and strategies were put in place it would make a significant difference to the cost and the quality of concern expressed by the community on behalf of sick people. The community could lend its support and empathise with sick people during an illness. The Minister must think again about the way in which she manages the budget. She must re-examine how to reduce some costs and make it more practical and realistic to get patients to the point of treatment. The bottom line is it is possible to make such savings if they are sought, but the Minister has not done so up to now.

Tom Hayes (Tipperary South, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to speak about the issue of Our Lady's Hospital in Crumlin and I compliment Deputy James Reilly on moving the motion and allowing a real opportunity to discuss and debate a matter on the minds of many people in the weeks since the matter first arose. The number of e-mails we received and the concern expressed by many people surprised me. According to the hospital, the cutbacks announced and still in place will result in longer waiting times for assessment and non-emergency surgery. This issue came up on the doors in recent weeks when I canvassed all across Tipperary South. People know that we are in a terrible time financially. They can feel it in their pockets and in the job losses they see around them or which they may even be experiencing themselves.

However, people on the doorsteps in Tipperary South were sure about one thing - there is a bottom line in politics. That bottom line means that children should get the health care they need. Children are waiting in pain for vital surgery or wait years for assessment while their health and sometimes their education are cruelly put on hold. People have told Fianna Fáil over and over again where is the bottom line in politics. They do not want older people to have their medical cards taken from them, they do not want children to be desperately in need of health care and to go without.

I represent the people of Tipperary South when I point to the burden that families carry when a child is sick. Parents will travel, they will juggle school and child care and jobs and other children. They will do whatever is needed to get that sick child the care he or she needs. We in Dáil Éireann need to honour that commitment to parents and the struggle which young children with serious illness go through every day. I ask the Minister, Deputy Harney, to ensure these children receive the essential surgery, assessment and out-patient care they deserve.

Ward closures and surgery cancellations are not good enough. Patients in Tipperary South are very grateful for the excellent paediatric services provided in the county hospital in Clonmel. However, they need the back-up available in Crumlin. These cutbacks in Crumlin will affect children all over the country as the most seriously ill children will not have the services in Crumlin and will be more dependent on their local service. This will only create more pressure on those services and fewer patients will be cared for.

Every parent in this country fears their child being seriously ill above all else. Every other disaster can be handled, but a seriously sick child is devastating and this has been the case for many parents. Parents in Ireland believe this Government has lost all touch with them. It has created longer waiting lists, cuts in surgery numbers and longer times for assessment. To make matters worse, this Government has done nothing to tackle the waste in the HSE. The waste stems from the number of administrators hired by the HSE and without the permission of the Department of Health and Children. When I spoke to health care professionals in south Tipperary they pointed to the waste in medical supplies, the numbers of products that are over-ordered and cannot be re-used due to the sell-by dates, but the HSE procurement processes does not allow for these orders to be reduced as required. This is a significant issue that needs to be addressed by the Government and the HSE. We need to address the issue of wastage.

I have met health professionals who are very concerned about the procurement process and the way it is being handled. The Government has created a monster. I am asking it to stop the monster and protect the children of Ireland. They need the Minister's support on this issue. Many people all over the country are very concerned. I urge her to take away that fear and to issue a statement after this debate promising that the children of Ireland will be protected so that any care they need can be guaranteed by the Government. We all agree that cutbacks and savings must be made but not at the cost of our children.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and to substitute the following:

"— endorses the Government's view, based on international evidence, that the best way to provide high-quality tertiary paediatric care in a country of Ireland's size is to establish a single national paediatric hospital, functioning alongside a major university teaching hospital, so that the medical and nursing expertise needed for complex care is brought together;

— supports the work being done by the three existing children's hospitals to move towards closer integration and co-operation in preparation for the establishment of the national paediatric hospital;

— welcomes the funding of over €250 million allocated this year by the Government for the three existing children's hospitals at Crumlin, Temple Street and Tallaght;

— supports the work of the Minister for Health and Children, the Health Service Executive and the three children's hospitals to achieve savings by working closely together in a way that will free up further resources for services;

— notes that in the current financial situation, all hospitals throughout the country have been working intensively to achieve necessary savings while still delivering on the level of activity promised in their service plan for 2009;

— welcomes the fact that the HSE has been working very closely with Our Lady's Hospital Crumlin to achieve a break-even position, and that the hospital has received considerable financial support from the HSE for this purpose;

— welcomes the fact that the hospital has indicated it will not now be necessary to proceed with the ward and theatre closures in July and August that it had earlier anticipated;

— supports the plan being developed by the HSE for treating children with scoliosis who require surgery;

— welcomes the contribution made by the National Treatment Purchase Fund to meeting the cost of selected cases and notes that the fund will continue to arrange treatment for cases where this is clinically appropriate;

— notes that, contrary to recent claims, the NTPF negotiates very competitive prices for scoliosis surgery and that no premium is paid for work done through the fund; and

— supports the Minister and Government in their continuing commitment to ensuring that children receive the best possible quality services throughout the health system in a manner that meets their needs efficiently and effectively."

I wish to share my time with the Minister of State, Deputy Moloney, with the permission of the House.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Agreed.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Nothing concerns parents more than the health of their children. Nothing concerns people worthy of election to this House more than the health of our children. One of my main priorities as Minister for Health and Children is to try an put in place a new national paediatric hospital in which we could bring together the three children's hospitals in Dublin on a single site in order to deliver better patient care for our children.

In this debate I wish to refute some of the suggestions made opposite. I have made many visits to Our Lady's Hospital Crumlin. I hold the hospital in the highest esteem. Crumlin hospital is a centre of excellence, delivering outstanding care to the sick children of Ireland. It is the tertiary hospital for the vast majority of children with a serious illness. Its cancer services which were centralised there by Dr. Eoin Smith, are second to none. I have said in this House before and I repeat it now that the outcomes for children's cancer in Ireland are top of the class, world-wide. We are at the top because we have centralised the service, even though, following initial diagnosis and surgery, some of the services are delivered in 16 hospitals around the country. This service was led by Dr. Eoin Smith of Crumlin hospital. What we have learned from the treatment of children's cancer is what we are trying to achieve for adult cancers, with the concentration of the services into eight centres.

I refer to the international peer review of haemophilia services last October. The review group said that Crumlin hospital operated to best international practice. The group recommended the appointment of a new paediatrician-haematologist and Dr. Beatrice Nolan was appointed in March of this year. She came from the national tertiary centre at St. James's Hospital which is an international service.

The standard of care provided in Crumlin, in Tallaght and in Temple Street hospitals is exemplary by any standards but we could do better. I have said and I repeat here that it has been suggested to me that we could save €20 million a year on the operation of those three hospitals by bringing them together on a single site. In reply to Deputy Catherine Byrne, the people who were the biggest persuaders in my decision to move to a single children's hospital were some of the doctors in Crumlin. They were strongly enthusiastic for the establishment of a new children's hospital bringing the three existing hospitals together to be co-located with an adult teaching hospital. Two sites were under consideration, at St. James's Hospital and at the Mater Hospital and the Mater was chosen as the favoured site. It was only at that point that some of the paediatricians did not agree with the decision. However, there was unanimous agreement and the submission made by the hospital was for a single children's hospital. The alternative is to build two new hospitals, one for Crumlin and one for Temple Street.

Crumlin hospital has 170 doctors and 708 nurses. It admits 30 patients a day and 45 day cases a day are carried out. A total of 102 out-patient appointments are seen every day. Temple Street hospital has 110 doctors and 365 nurses with 20 admissions a day, 14 day cases a day and 70 out-patients appointments a day. I do not have the information for Tallaght Hospital to hand. We want to bring these resources together in order to give better services to the patients.

Better services for patients will be achieved by having one payroll department, one human resources department, one waste management department, one department dealing with materials, a central sterile department instead of four, which was one each for the three children's hospitals and one for the Mater. This is where the €20 million saving will be made. There will be one chief executive officer, one director of nursing and so on. In the short term we are seeking to integrate those services. It has now been agreed to have a single department of surgery. Deputy Reilly is correct in that we have five paediatric surgeons between those hospitals. One surgeon is due to retire and three new surgeons will be appointed this year. There will be seven surgeons and instead of them all being on call in three hospitals, a single service will be available across the three hospitals.

Dr. Des Bohan has come here from Canada. He is a very experienced paediatrician with specialist training in critical care and he will organise a joint department of critical care between Temple Street and Crumlin. Tallaght does not have a critical care department. He has made recommendations which we want to implement. In advance of building the new facility in 2014, we are moving to integrate the services. If Crumlin were to work more closely this year with St. James's Hospital in the area of blood products and in the procurement of drugs with the other two hospitals, they could save €4 million.

Furthermore, I understand they are owed €3 million by private insurers. Temple Street Hospital seems to have a better record on making applications to private health insurers. That amounts to €7 million which we could get this year by closer integration on the procurement of products, particularly blood products for haemophiliacs in St. James's Hospital, which is already approximately €900,000 over budget. I make these suggestions to be helpful. No matter who is in my seat, we will not have unlimited resources for health care. No country in the world has such unlimited resources. We must do our best.

There has been a 39% increase in funding for Our Lady's Children's Hospital in Crumlin since 2004. That is considerable. Approximately 74% of the increase goes on pay and 26% on non-pay. Listening to Opposition speakers, one would assume there was no additional staff in Crumlin. Since 2004, there has been an 18% increase in medical staff, a 29% increase in nursing staff, a 19.7% increase in health and social care staff, a 19% increase in management and administration staff and an 11% increase in general support staff. We have put substantial resources into Crumlin hospital, as we have in every other hospital.

Crumlin is being asked for a 3% cut, which is no more than every other hospital. Fine Gael published its pre-budget plan in October. On page 19 of that document, they said we must find 3% saving in every Government Department and every single activity. On page 21, they go on to say that existing levels of service should not be the basis for deciding budgets. This is the case in the health system because we want to try to maintain the previous year's level of service. Fine Gael says we should have a 2% cut and that existing levels of service should not be the basis for deciding budgets. I do not make this point to be partisan. I am surprised to hear such proposals from a spokesman who aspires to be a member of a Government, particularly as Minister for Health and Children, in a time of unprecedented economic challenges. We will spend 40% of the money we will raise this year in income tax on the public health service. I do not know of any other country which spends 40% of all taxation on its public health system. We are spending a considerable amount of the money. In fact, we are borrowing more than €20 billion. Every single penny we are spending is actually borrowed money. We do not have the option of bringing a supplementary budget for hospitals before the House.

People are being asked to make an efficiency saving. All of us can do better, no matter how good we are. My Department is also making savings through voluntary early retirement and other schemes. We must all do better because there is less money. No matter who is Minister for Health and Children, that will be the reality for the next 24 or 36 months. In that context, it is not unreasonable to ask people to make efficiency savings. I find it strange that when we ask hospitals to make efficiency savings, some hospitals decide that the most sensitive area is the one that must be cut first.

Decisions on patient care and clinical care must be made by clinicians. They cannot be made by me or by the Health Service Executive. The HSE has given Crumlin hospital a budget of €139 million. I have already explained how there is €3 million outstanding from private health insurers and how €4 could be saved by greater co-operation with St. James's and other hospitals. Funding must be allocated on the basis of decisions made by clinicians within the hospital.

The Fine Gael alternative suggestions are flawed for a number of reasons. Deputy Reilly referred again to the €16 million spent on advisers. When one is spending such large sums it is not unreasonable to get outside expertise. Even if we are spending too much on advisers, Deputy Reilly seems to use this €16 million for every problem that arises. Two weeks ago, it was to be spent on orthodontics, tonight it is to be spent on children's services, next week it will be something else. One cannot spend the same €16 million on every problem one identifies. Taxi bills are for patients who travel for dialysis and other treatments. Staff taxis are used, in the main, by people who are called out at night and who may not have their own transport. They are used, in the main, by people who are providing front line services and not by administrative staff. If the HSE were to abandon its arrangements with private taxi companies, keep its own fleet providing 24/7 cover and pay for insurance, driver training and vehicle replacement it would be substantially more expensive. That is not to say we should not look at transport costs. Everything is being looked at.

I was criticised recently for centralising the issuing of medical cards in order to free up 300 people. The Opposition demand that we cut the number of administrators but oppose our efforts to provide services more efficiently. They cannot have it every way. Every cost is being examined. Since Professor Tom Keane became director of the national cancer strategy we have provided a volunteer transport service for cancer patients, run by the Irish Cancer Society. An allocation of €500,000 has been given to that service and it is working incredibly well. I would love to see it expanded because I am sure many people would be happy to give their time voluntarily to transport patients for essential care.

How do we organise services so that more money is spent on the care of the children? In the short term, this can be done by integration between the three hospitals. The HSE is headed by a paediatrician who is a former doctor in Crumlin, Professor Brendan Drumm. He has asked the former CEO of St. James's Hospital to head a group to work with the three hospitals and, in particular, to work with Crumlin to come up with a plan for scoliosis patients for the rest of this year. If everyone applies his or her mind, ingenuity and sense of innovation, that issue can be addressed.

Yesterday, the board of Crumlin hospital decided not to close any further wards or theatres during the months of July or August. The board made the decision at a regular meeting. I had no part in the decision and I would be surprised if they were influenced by Deputy Reilly's motion. I welcome that decision and the fact that the board was able to make it in the context of the current financial arrangements.

The way forward is the single children's hospital but we will not have that until 2014. A huge amount of work has gone into that project. The chief executive of the development board has been appointed. He is the former deputy chief executive of St. James's Hospital. The medical director is Dr. Emma Curtis from Tallaght. A huge amount of work is under way. Some people would prefer a different site for the new hospital. However, this is not about a piece of land or a building. It is about bringing expertise together in a single entity with all the benefits which flow from that.

The last thing we need is to politicise the plight of some of the sickest people in the country. I hope we can avoid that. Managers, Ministers, Opposition Deputies, doctors and nurses must look at how we can provide services in a more innovative fashion. I salute the fact that this year's activity level for Crumlin is already ahead of last year's. There are more day cases and we are moving to a situation where 85% of surgery is done on a day case basis. When I had my tonsils out as a child, I was in Jervis Street Hospital for a week. We have come a long way from that. Safe care can be provided on a day case basis, greatly reducing the need for 24-7 staffing. The more rapidly we can move in that direction, the more resources that can be provided to a larger number of people.

The budget for the National Treatment Purchase Fund is 0.5% of what we spend, and those who work on it do a fantastic job. They are maligned constantly. The fund has paid for the treatment of some scoliosis patients and two more will be treated next month in Cappagh National Orthopaedic Hospital. The fund does not pay three times more for the service there. Cappagh National Orthopaedic Hospital is a public hospital; it is as public as Crumlin hospital. The State does not own Crumlin hospital, it funds it. The State does not own Temple Street Childrens University Hospital or the National Children's Hospital, Tallaght. There is a unique situation in the Dublin area whereby the State owns none of the hospitals but funds them. The new children's hospital will be a State-owned hospital, and rightly so. There is huge support for that. Clearly, there are limitations with regard to hospitals the State does not own.

Professor Drumm has appointed one of his main finance personnel to go into Crumlin hospital to work with the staff there and to examine the activities with a view to supporting the hospital. If the hospital moves to an automated system for claiming from private health insurance, for example, it might help to secure that €3 million I mentioned. We must look at the many innovative ways to provide the money for the treatments and less money for administration and so forth. If all of us approach the issue of paediatric services on that basis, there is no doubt that no child would have to wait unduly for the treatment he or she needs and no child should ever be in pain while awaiting necessary treatment.

John Moloney (Laois-Offaly, Fianna Fail)
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Last week I responded to the Private Members' motion and listened with great interest to Deputy Mary White and Deputy Simon Coveney. On that evening I refuted the allegation that critically ill children have had their service withdrawn. I reiterate that this evening.

I support the Minister and her commitment to reforming the health services. We see that again in this particular area. I have in mind what has taken place previously, particularly the initiative she took to reform cancer services. The same arguments were made by Members on the other side of the House, yet we have seen the progress that has been made. I am more than pleased with it. Other developments were the consultants' contract and progress with accident and emergency services. However, that is not the argument before the House.

I do not intend to be drawn into the remarks thrown across the floor that we are more interested in bankers because, clearly, people who are knowledgeable would not say that in the first place. I do not accept it. The strategic view the Minister has taken is the one on which we should focus. I also share her view about throwing out the same old remark about the money for every area coming from the same small pot of money. I cannot buy into that. It is nonsensical to include the issue of taxi fares when it is clear that most of the taxi expenditure goes to provide transport for essential services in the HSE. It is not worth responding to in the context of this debate.

The real issue is the Minister's strategic policy. While Crumlin hospital is central to the debate before the House, the most important issue is the sensible initiative taken to establish one hospital, instead of three, to serve paediatric needs across the city. With regard to the saving of €6.5 million, it must be put on record, because obviously it is a position that is not being taken up, that the issue is to protect front-line services, which is so important. It is also important to delve into the background to this debate and take the longer-term point of view. We are talking about initiatives for the appointment of new clinical directors. This is quite important and should make the public realise that the Minister has total command of the issue of providing essential services.

The issue we are debating is the €6.5 million. The HSE has advised that based on the financial performance for the first five months of 2009, the hospital should achieve a break even position at the end of the year. 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 discussion between the 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. The allocation for Crumlin hospital for 2009 is €139 million, an increase of more than 39% over the past five years. As with all expending facilities, the reduction that is expected is 3% over the 2008 figure. A particular challenge for the hospital is that it has been operating with 91 posts above its ceiling and employs 641 whole-time equivalents.

The point was made during the last Private Members' debate that apparently the issue was purely to deal with life threatening illnesses. It should be pointed out that when the orthopaedic services in Cork were severely disrupted in 2007 by the early retirement of the consultant paediatric surgeon, efforts were made to recruit a replacement without success. At that time arrangements were put in place for Crumlin hospital consultants to provide the outpatient clinic service in Cork, with patients requiring surgery transferring to Crumlin. It should be noted that the HSE pays €0.5 million per annum for the service. It also pays the consultants separately. The HSE intends to advertise again for a paediatric consultant with a special interest in orthopaedics.

I heard the criticism last week of the National Treatment Purchase Fund. The fund has identified a number of cases from the waiting lists for treatment at Cappagh hospital. Two operations have been carried out for scoliosis patients as a result. Further cases are being reviewed. 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 National Treatment Purchase Fund strongly rejects the recent media claim, which I was alarmed to hear on the radio one morning, that scoliosis procedures arranged by the fund cost two to three times more than similar procedures performed in the public hospital system. The claim is entirely incorrect. No evidence has been offered to support the claim which comes, of course, from unnamed sources. The prices the National Treatment Purchase Fund pays for operations are as competitive as the published prices for the public hospital system and no premium is paid for work through the fund. Achieving value for money for the taxpayer throughout the process of arranging faster treatment for the longest waiting public patients is a matter of the highest importance for the fund.

The commitment of the Minister is not just the short-term one of reducing and dealing with the overspend. Hospital care for children is provided across the three hospital sites in the city. Significant progress has been made over the years in developing paediatric services in Crumlin. There has been development of the national paediatric hospital, a priority project for the Government. It is of strategic importance in the development of paediatric services in Dublin and nationally. Work has been ongoing to move towards that model of care in terms of closer integration and co-operation of the existing three hospitals and the most effective use of resources.

It was claimed this evening that the cut was made without any concern. However, the Minister outlined the overall strategic position for providing paediatric services and made the point that the reduction is expected not just of Crumlin hospital but of all hospitals so they can remain within their service plans. I do not wish to make political points and I accept that dealing with health issues in children is important. However, when one considers that 40% of taxes go to the health service it does not make sense to suggest that we can just allow continuous overspends without a service plan being agreed as well. The HSE is fully aware of the financial challenges faced by the hospitals and is involved in ongoing discussions with hospital management regarding its 2009 financial allocation service plan. The priority is to ensure that services are maintained at an optimum level, in agreement with the Department and the HSE.

Our Lady's Hospital Crumlin is no different from any of our hospitals. In common with all other hospitals, Crumlin is faced with the challenge of delivering a high-quality service to its patients while remaining within budget. A top priority will be to protect patient care. It has proved necessary for Our Lady's Hospital to stay within budget. In that regard I agree with the Minister who made the point that Professor Drumm, who has known expertise in the area, clearly supports the notion that all hospitals should live within their service plan.

Having clinical directors is a tremendous initiative. Regarding the integration of the three hospitals, this key initiative is the same as the appointment of Professor Tom Keane in the cancer area and is the specific way forward. The appointment of a new clinical director to operate across the three hospitals is pivotal to the success of the integration of current paediatric services. The appointment of a director in the near future who will have responsibility for all three paediatric hospitals in Dublin in preparation for the advent of the new paediatric hospital shows the surety of the policy proposal. I re-emphasise that this post promises to contribute significantly to the achievement of more efficient and effective services, in Crumlin and the other two hospitals. It will draw the medical professionals together with greater co-operation and integration in respect of the critical service they provide.

The new consultant contract also allows the model of clinical director to operate in a way that is internationally recognised as effective. This was not possible in the old manner, before the new contract was negotiated and went into operation. The new model allows equitable access to care based on medical need, more efficient use of public resources and a requirement to support patient safety initiatives in high-quality acute sector services.

I shall deal with some of the issues regarding the service provided at Crumlin. So far this year, the hospital has delivered more treatments to patients than in the same period last year. In the first four months of 2009, there were 3,704 treatments for children as in-patients, running approximately 6% ahead of the service plan target. There were 5,095 day places. Staffing levels at the hospital have increased by 24% since 2004. This percentage reflects the increase to the approved ceiling of 1,550 but the actual increase is higher, at 31%. Day care activity has increased by 26% since 2005, outpatient attendance by 16% and elective admissions by 12%.

The issue of cancellation of operations has cropped up, creating the notion the hospital is not keeping to its service plan. It is important to establish some of the reasons-----

Cyprian Brady (Dublin Central, Fianna Fail)
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The Minister of State has one minute left.

John Moloney (Laois-Offaly, Fianna Fail)
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I shall finish on this point. To bring clarity to the issue of cancellation of operations, which I heard discussed on a radio programme last week, I point out that operations are cancelled for a variety of reasons. The patient may be deemed unfit to proceed, the procedure may be cancelled by the patient or the guardian, or there may be normal rescheduling due to appointment times not being suitable.

I support the long-term strategy of providing a world-class paediatric service. Arising from her commitments in the past, the Minister will deliver this level of health reform and I support her fully.

Cyprian Brady (Dublin Central, Fianna Fail)
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The next speaker is Deputy Jan O'Sullivan and I understand she is sharing her 20 minutes with Deputies Ó Caoláin and Ó Snodaigh.

Jan O'Sullivan (Limerick East, Labour)
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Are there 20 minutes left in tonight's debate?

Cyprian Brady (Dublin Central, Fianna Fail)
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Exactly 20 minutes remain.

Jan O'Sullivan (Limerick East, Labour)
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With the permission of the House I wish to share tonight's slot with Deputies Ó Caoláin and Ó Snodaigh and tomorrow night with Deputies Emmet Stagg and Mary Upton.

I congratulate the Fine Gael Party, in particular Deputy James Reilly, for tabling the motion on this very important issue. I wish to challenge the Minister, Deputy Harney, and the Minister of State, Deputy Moloney, on some of the points they just made. The Minister constantly insists that, somehow or another, the Opposition is being political and she is not. That is far from the truth. The Minister stated that bringing three hospitals together will make savings and provide a solution to the problem and we are being political by focusing on the problem here and now.

When the HSE was being set up almost five years ago, the Minister used exactly the same arguments. She said that by bringing 11 health boards and a number of other organisations together there would be economies of scale. I went to the launch of a book today, "Irish Apartheid: Healthcare Inequality in Ireland" by Sara Burke. It debunks this absolutely. There is no point in the Minister smiling at me. She has an immense facility to debate, to retain facts and figures in her head and to stand up and repeat them but she tries to deny the right of the Opposition to make political arguments.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not.

Jan O'Sullivan (Limerick East, Labour)
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There are extreme political arguments to be made on this issue and they are about children in the here and now. It is all very well to talk about what will or may happen if three paediatric hospitals in Dublin are brought together with economies of scale. However, I understand there has not even been a cost-benefit analysis on the bringing together of those hospitals. The work has not been done. Nothing has been done at this juncture apart from the planning of the tertiary hospital.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is wrong.

Jan O'Sullivan (Limerick East, Labour)
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They are not together at this point but are operating separately. The Minister spoke about the clinicians having to make the decision, which is a clinical one. The clinicians in Crumlin are in an impossible situation. They have 1,318 children on the waiting list. The figures quoted by Deputy Reilly are factual, namely, that between 2004 and 2008, despite most of the increase in budget having to go on pay-related issues, the hospital increased patient activity by 30% in day cases, 23% in outpatients and 34% in theatre procedures. They had to deal with matters such as the fact that the birth rate in Ireland is increasing. More children are presenting with serious illness and it is not their fault there is no funding stream for sickle cell disease or that much of the money that used to be allocated for treating children outside the country has dried up. Referrals to Crumlin from around the country are increasing. The demand on the hospital is growing.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is a consultant for that.

Jan O'Sullivan (Limerick East, Labour)
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The demand on the hospital is growing and the clinicians have to respond to that demand. They are doing so in a humane way while the Minister is talking about implementing change. However, the change has not been implemented. We simply must respond to the needs-----

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am trying to get them to do it.

Jan O'Sullivan (Limerick East, Labour)
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-----of the children. There is no point in the Minister telling us what will happen in the future. She should tell us what will happen to the sick children now, to the children with scoliosis whose spinal curvature is increasing day by day because they are waiting for treatment. I shall read from an e-mail I received today:

What are these families to do? Watch their child every day to see if he is turning blue, having difficulty with his feeding, not let him out to play because he cannot keep up with other children as he doesn't have the energy to walk at times, don't mind run. They live on their nerves, are shattered, stressed and worried. These are just some of the difficulties that families of heart children have to deal with on a day to day basis.

That comes from parents of a child who had four heart operations in Crumlin hospital. Unfortunately, the child has since passed away but the parents are talking from experience.

I was one of those who tabled an Adjournment motion last week in the Dáil. For part of the motion, two speakers focused on particular children. The speaker on the Government side focused on a child called Jamie Murphy. I read in the newspaper today that a private benefactor has had to come along so that child can have her treatment outside this country. Where is the policy in a situation where a private benefactor must come along in order to pay for the essential treatment of a small child whose condition is constantly deteriorating, day by day? Discussing planning for the future is all very well. While I accept we must plan, we must deal with the current situation, namely, that our sick children are incurring greater costs than heretofore.

We must cut budgets, but to stand back and enact a 3% cut across all health services would be wrong. One must consider individual situations, particularly where children's health care is concerned. I fundamentally disagree with the Minister that the same type of decision making process can be applied to children's medicine as is applied to other aspects of the health service. This is a fundamental difference that we are trying to get across to the Minister, one that many of her backbenchers and members of the Fianna Fáil Party understand. I do not know whether Green Party Members understand it and the Minister no longer has a party, but there are Deputies on all sides of the House who realise one cannot stand back at a distance when it comes to children's health.

The Minister must intervene. Her problems must be overcome. One such problem was her abdication of responsibility for the majority of the health budget, despite her Department's advice. When the HSE was being established, she decided that its CEO would be the Accounting Officer for the sizable health services' budget. For this reason, she can stand back and say something is a matter for Professor Drumm or individual hospitals and that a percentage cut across the board is fine.

Mary Harney (Dublin Mid West, Progressive Democrats)
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No, the Deputy should not say that. I am defending what is occurring. I am not passing the buck to anyone.

Jan O'Sullivan (Limerick East, Labour)
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Exactly.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is only confusing the issue.

Jan O'Sullivan (Limerick East, Labour)
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This situation requires a political decision. We are discussing children and costly but life saving operations. One specialist, Dr. Patrick Kiely, a consultant surgeon, has stated that putting off operations makes no economic sense. However, as the HSE is so focused on balancing books, it is making an across-the-board, swingeing cut to the system to every hospital irrespective of the types of caseload that I have mentioned or the additional procedures implemented by hospitals.

Had we a system of money following patients, which is advocated by every Opposition party, the hospital would be paid appropriately for its workload. One cannot claim that sick children are somehow responsible for being ill. We must respond to their needs. I welcome today's decision by the board of Crumlin hospital. I am not sure how it has managed this within its budget, but it has announced that it will not close the extra beds and theatres as planned. It stated: "Our Lady's Children's Hospital, Crumlin reiterates that this decision has been made in light of the existing pressure on services and the potential impact on children and families of additional closures". This is the hospital's focus. Sadly, it is not the focus of the Government or the HSE. They focus on balancing books.

The Minister of State, Deputy Moloney, does not believe we should contrast this situation with what is occurring in terms of the banks. However, when the banks came back and stated the money given to them was not enough, the response was not to the effect that they would need to make do. Rather, the Government gave them billions of euro more. When a children's hospital comes back and states the money is not enough, it is told that it must make do.

Cyprian Brady (Dublin Central, Fianna Fail)
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The Deputy has one minute remaining.

Jan O'Sullivan (Limerick East, Labour)
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This is a matter of political priority.

James Reilly (Dublin North, Fine Gael)
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Of course it is.

Jan O'Sullivan (Limerick East, Labour)
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The Government prioritises getting the banking system right. This is obviously a priority for an economy. However, must it not also be a Government priority that sick children should not wait for an improvement in the system at some point in the future? Five years down the road, the improvements that were supposed to come about because of the HSE have not been implemented. If this is the type of timescale in question, it is unfortunate that the sick children who need treatment today will not be able to benefit.

I congratulate Fine Gael on tabling this motion, as the debate is important. However, the Government's response has been cold and defensive and it has not addressed in a humane way the problems being experienced by the children's parents.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Were I a Government Deputy, I would hang my head in shame-----

Noel Grealish (Galway West, Progressive Democrats)
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If you did that, it could not go any lower.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----at the Government-created crisis in Our Lady's Children's Hospital in Crumlin. Even as a legislator in the Dáil, which we are all supposed to be, and as a Member of a House to which people look for leadership, responsibility and solutions to problems, I feel ashamed. So should every other Member.

John Moloney (Laois-Offaly, Fianna Fail)
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We felt ashamed over issues that had more to do with the Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is shameful that the Government, in the name of the Oireachtas elected by the people, has been responsible for such a betrayal of children.

Noel Grealish (Galway West, Progressive Democrats)
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What about those children blown up by bombs?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is shameful that parents must shake collection tins to send their children abroad for vital operations that can and should be provided by the excellent staff of our public health services.

I wondered at Deputy Grealish's presence. I see that the Minister has not quite cut the umbilical cord from her child.

When necessary, most parents will sacrifice everything for their children, even life itself. The parents of children requiring treatment in Crumlin can only look aghast at the Government's refusal to provide the essential support required by the hospital. They are rightly incensed that this suffering is being visited on their children because of a cut of €9.1 million.

Noel Grealish (Galway West, Progressive Democrats)
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What of the parents of children blown up in England?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The concept of €1 billion is beyond the imagination of most of us, yet many multiples of this in taxpayers' money is being poured into the corrupt financial institutions that have helped to bring the economy to its knees. Public and political pressure, including the tabling of this motion, which we in Sinn Féin fully support, has apparently resulted in some respite from further cuts. The hospital remains in crisis because of the funding cuts of €9.1 million already imposed in 2009. As a result of these, children are suffering. Operations are being cancelled and postponed, parents and children are being put through anguish and agony and children could be more severely disabled as a result of entirely avoidable delays to the essential surgeries that they desperately need. The lives of some children may even be shortened.

In response to parents' distress, the Minister, Deputy Harney, can only resort again to her mantra about the need for the reorganisation of children's hospital services in Dublin. What is to occur to sick children in the meantime? One 13 year old girl with scoliosis has been on a waiting list for surgery since last August and has had her appointment for July cancelled. The older she gets, the worse the curvature of her spine, the more serious and perilous the surgery that she will face and the poorer her chances of living a near-to-normal life. In a reply to a Dáil question, the Minister claimed that the National Treatment Purchase Fund, NTPF, was seeking to arrange operations in the private system for this patient and others. When the family inquired, they found this was not the case.

The Minister's other stock solution - privatise, privatise, privatise - came unstuck yet again.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Cappagh National Orthopaedic Hospital is not private.

Arthur Morgan (Louth, Sinn Fein)
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It would be had the Minister got her way.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In response last week, the NTPF stated: "Highly specialised and complex paediatric cases like scoliosis cannot usually be provided within the private sector and it is best clinical practice that these patients are treated through the public hospital system".

Mary Harney (Dublin Mid West, Progressive Democrats)
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In Cappagh, there is a public service. Does the Deputy know of the hospital?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I hope the Minister and her colleagues in Cabinet from both Fianna Fáil and the Green Party, all of whom are equally responsible, have noted this statement. "Best clinical practice" are the key words. Is there even one Government backbencher with the courage to come out from the shadows and make a stand on the issue of children's lives? I appeal to him or her to do so.

I will conclude with the words of one of my constituents, Michelle Murray of Cavan town whose son has had several serious surgical operations in Crumlin and who wrote in the Irish Examiner on 18 June:

Our children are our future and we as parents are their voices. Families may face losing a child. They have gone through and fought a big enough fight through their young lives already and due to these cutbacks face a most uncertain future. We as parents should not have to fight to keep them alive or face losing them due to cutbacks.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I welcome the opportunity to speak on this important debate. I welcome the Fine Gael motion, which is timely and, I hope, will bring to bear on the Government backbenchers the need to stand up for once in their lives.

I am not critical of the staff of Our Lady's Children's Hospital, nor of the families, who deserve our praise for the contribution they have made to try to help children in need. I also praise the contribution of the hundreds of thousands of people who make donations to Our Lady's Children's Hospital, because without those charitable donations the situation in the hospital would be much worse than is the case at present.

One of the areas on which I wish to concentrate is that which the Minister of State, Deputy Moloney, tried to defend, namely, the increased spend on private hospital procedures for children in recent years. In a five-year period it increased by 8,400%. I received that information in a reply from the Minister, Deputy Harney. In 2004 the amount of money spent on the National Treatment Purchase Fun and on outsourcing of other private operations was €54,000. Last year the spend had increased to €4.615 million. One can work out the maths. That is more than €4.5 million that did not go to a public children's hospital. That is the privatisation of public health care, in particular, children's health care.

The result is that Our Lady's Children's Hospital cannot operate properly. One operating theatre and one ward have already closed and are not due to re-open. The HSE spin doctors who said today and yesterday that there was a reversal of the decision were talking rubbish. The announcement that further cuts will not take place is a relief but I deplore the fact that children and their parents who are dependent on outpatient facilities will have to wait for their appointments in the future due to closures for a week here and a week there. The result will be the cancellation of 7,000 outpatient appointments in the next few months because the HSE cannot appoint relief staff, invest in the hospital or in the health care of our children.

Our Lady's Children's Hospital, Crumlin, is operating ahead of its care plan in every respect. It treats more inpatients, deals with more day cases and caters for more outpatients than was planned when the hospital drew up this year's care plan. The HSE's reward for the hospital doing its job properly, treating sick children quicker and using the hospital to its full capacity, with in excess of 85% bed occupancy, which is one of the highest in Europe, is that the Government is starving the hospital of funds required to deliver the best possible medical care for our children.

The moves by the Minister, Deputy Harney, the HSE's cuts in funding and refusal to fund will result in a cancellation of more than 2,000 operations. That is the figure also supplied by the HSE. Approximately 2,000 operations are carried out in almost every theatre in the hospital and that will be the effect if one closes one theatre. That will result in delays, injury and pain for children who are dependent on those operations. At the end of the day it is children whom we are talking about. Often they do not understand what is happening to them. They have no alterative, as they are dependent on their parents and us as legislators to try to address the problems they have.

The Minister has an opportunity, not just to fund her friends in Anglo Irish Bank to the tune of €4 billion, she can spend a few bob here-----

Noel Grealish (Galway West, Progressive Democrats)
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Deputy Ó Snodaigh's party-----

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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-----and a few bob there to help children in hospitals.

Cyprian Brady (Dublin Central, Fianna Fail)
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We must adjourn the debate.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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If the pipsqueak from Galway can control the squeaks out of him-----

Noel Grealish (Galway West, Progressive Democrats)
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I am telling the truth. The truth hurts.

Cyprian Brady (Dublin Central, Fianna Fail)
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I ask the Deputy to move the adjournment of the debate.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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-----there might be a better debate in this House.

Noel Grealish (Galway West, Progressive Democrats)
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Deputy Ó Snodaigh should not come in here to lecture us.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It is a pity he is not here to debate on most other occasions-----

Cyprian Brady (Dublin Central, Fianna Fail)
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The Deputy should speak through the Chair.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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-----instead of squealing in here behind somebody who does not even have a party to represent any more.

Cyprian Brady (Dublin Central, Fianna Fail)
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I ask Deputy Ó Snodaigh to move the adjournment of the debate, please.