Paul Connaughton Snr (Galway East, Fine Gael)
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Question 29: To ask the Minister for Health and Children if the National Treatment Purchase Fund will fund scoliosis surgeries for children experiencing acute pain and needless suffering; and if she will make a statement on the matter. [26374/09]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Question 53: To ask the Minister for Health and Children the measures she will undertake to address the situation at Crumlin Children's Hospital, Dublin; and if she will make a statement on the matter. [26286/09]

Michael D Higgins (Galway West, Labour)
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Question 71: To ask the Minister for Health and Children if it is proposed to provide a new funding stream for the extra work on specific conditions such as sickle cell disease which has been undertaken by Crumlin Children's Hospital, Dublin; if the funding provided for the hospital will take account of the fact that the children who previously had their operations carried out abroad at extra expense to the State, are being treated in Crumlin; and if she will make a statement on the matter. [26318/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 29, 53 and 71 together.

The National Treatment Purchase Fund was established to tackle the issue of excessive waiting times for hospital treatment for public patients. The fund has been successful in fulfilling this remit. It has arranged treatment for more than 145,000 patients to date. Public patients now wait an average of 2.6 months for operations, compared to between two and five years before the establishment of the NTPF. For reasons of patient safety, highly specialised and complex paediatric cases like scoliosis cannot be provided within the private sector. The NTPF has arranged for a limited number of patients with scoliosis to undergo surgery in a public hospital. No additional remuneration accrued to the treating consultant in respect of these exceptional cases, which involved patients whose medical condition was deemed clinically suitable for treatment in another hospital. The NTPF will continue to work with the HSE and the public hospital system to identify and agree cases suitable for treatment through the fund. In doing this, regard will be had to the patients' medical conditions, to suitability and safety issues and to the length of time the patients have spent waiting for treatment.

Each hospital funded by the HSE is required to deliver services within the financial allocation provided to it. Like all hospitals, Our Lady's Children's Hospital in Crumlin must deliver a high quality service to its patients while remaining within budget. The priorities of the HSE and the hospital management at Our Lady's Children's Hospital are to ensure that services at the hospital are maintained at an optimum level and to protect patient care. Following a meeting between the HSE and the three Dublin paediatric hospitals last week, it was agreed that Our Lady's Children's Hospital would revert to the HSE with its proposals to specifically address the needs of scoliosis patients between now and the end of the year. The HSE will consider these proposals within days and form a plan of action with the hospital.

The incidence of sickle cell disease has increased significantly over the past ten years. Earlier this year, a consultant was appointed to a full-time consultant haemophilia post at Our Lady's Children's Hospital, covering inpatient and outpatient haemophilia services for children. Prior to this appointment, another consultant covered inpatient haemophilia services, in addition to covering sickle cell and other red blood cell disorders and other benign disorders. The new appointment has allowed one of the consultants concerned to focus virtually full-time on treating patients with sickle cell and other red blood cell disorders in Crumlin. Patients who had procedures funded by the NTPF at home or abroad, and require ongoing treatment, are treated within the overall annual funding allocated to the hospital.

The most effective way of providing the best possible tertiary care involves the creation of a single national paediatric hospital, alongside a major teaching hospital. The concept of bringing together all three present services is widely accepted. A report commissioned by the HSE, Children's Health First, indicated that the population and the projected demand in this country can support one world-class tertiary paediatric hospital. It recommended that the hospital should be in Dublin and, ideally, should be located with a leading adult academic hospital to optimise outcomes for children. Following detailed consideration, it was decided that the most appropriate location for the new paediatric hospital was adjoining the Mater Hospital. The development of the new hospital is being overseen by the national paediatric hospital development board, which was established in May 2007.

We must move towards a model of care that involves closer integration and co-operation. More than €250 million has been provided for the running of three paediatric hospitals in Dublin in 2009. Significant cost savings can be achieved if services and practices are more closely integrated across the three hospital sites, even before the new 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 achieve savings that can be put back into patient care. The areas of possible increased co-operation that are being examined include paediatric surgery, paediatric critical care services, renal services, genetics and dermatology services.

James Reilly (Dublin North, Fine Gael)
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The Minister has said that great savings can be made by amalgamating the three hospitals, or by providing for greater co-operation between them. It is important to point out that in September 2007, representatives of Our Lady's Children's Hospital in Crumlin asked for a meeting with HSE officials on this matter. The prospect of a meeting being arranged as part of this debate did not re-emerge until recently. On a previous occasion, the Minister argued that €4 million could be saved on blood products. However, Our Lady's Children's Hospital spends an average of just €6 million on blood products each year. It returns all unused blood product to St. James's Hospital, where it is used. Our Lady's Children's Hospital is not reimbursed for that blood. That shows that the Minister's argument is fallacious. The comparisons she previously made with a hospital in Birmingham are equally null and void. How many children are waiting for scoliosis surgery? As the Minister knows, the longer they are left without surgery, the more operations they will need and the more disabilities they will suffer. How many children have had scoliosis treatment under the National Treatment Purchase Fund? How many of them will get such treatment? How many children have had scoliosis surgery under the fund this year? How many more operations are planned before the end of the year? How many children are on the waiting list at Crumlin?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We should all get on with doing what we are supposed to do, rather than trying to fight battles day and night. The saving of €4 million that I mentioned previously did not relate solely to blood products. I agreed with what the Minister of State, Deputy Moloney, had said on "Prime Time", which was that €4 million could be saved if the hospital worked with St. James's Hospital on blood products and with the other two hospitals on the procurement of medical devices and drugs, etc. That is where the figure of €4 million came from. I stand over that. Professor Drumm will address these issues when he attends a committee meeting next week. I stand over all the facts I have mentioned. Somebody said today that there is one physiotherapist in Our Lady's Children's Hospital, Crumlin, even though 17.5 physiotherapy posts are filled there. I do not suggest that more posts are not needed. I am simply saying it was not accurate to say that just one post is filled at present.

James Reilly (Dublin North, Fine Gael)
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I did not hear that contribution. Just one physiotherapy post in rheumatology is filled at present - that is for certain.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Yes. A total of 17.5 physiotherapy posts are filled at the moment. It is a question of the manner in which physiotherapists are allocated. I understand that the person in question will be replaced when she goes on maternity leave. I do not have the figures on scoliosis in my head. I think I had them for an earlier question. I understand that 11 operations were postponed, of which nine were rearranged. It was something in that order. If I cannot find the figures, I will give them to the Deputy after this debate. As I said in my initial reply, the HSE is working with the hospital on the issue of scoliosis, which is a serious condition. As I see it, the money we are allocating to the three hospitals in 2009, for the treatment of children with these serious conditions, should be sufficient to deal with those who most need attention. I acknowledge and welcome the fact that, notwithstanding the current budgetary constraints, the level of activity at Our Lady's Children's Hospital, Crumlin, this year is already ahead of that for last year. If the three hospitals work with the HSE, they will be able to deal with the issues that are concerning them all.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In response to an earlier priority question, the Minister referred to an article in a County Louth newspaper, The Argus. She suggested that a representative of Sinn Féin had expressed a particular view on public-only general practice. I have to say she misrepresented the situation.

Brendan Howlin (Wexford, Labour)
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I would prefer if the Deputy addressed the question we are dealing with.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In line with Sinn Féin policy, my colleague in County Louth has very clearly indicated that a two-tier approach does not work, and that is wholly in line with the position I have articulated here, time and again. I thank the Leas-Cheann Comhairle for allowing me to clarify that point.

Regarding the grouping of questions before the House, the Minister has never given us a breakdown of the alleged €20 million to be generated from the proposed co-operation or amalgamation of the three existing child-related hospitals in the greater Dublin area. Can the Minister give such a breakdown and the facts and figures on the €20 million she alleges is the crock of gold at the end of the rainbow, which, in real terms, represents the end of Crumlin children's hospital as we have known it? It is very important that the debate is informed of the full facts.

While the further cuts at Crumlin were deferred for the summer period, there is, nonetheless, the restraint created as a result of a €9.5 million budget cut already at that hospital. As the national children's hospital, which is supposed to be a centre of excellence, how can the provision of services be allowed to be so restricted, where young people in need of major operative procedures are having access to them denied or deferred, resulting in great pain and potentially life-debilitating consequences?

Mary Harney (Dublin Mid West, Progressive Democrats)
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There are a large number of questions there. That is the article I am referring to, from The Argus newspaper, with the headline, "Private care is curtailed", and-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have it here. It states: "Public only consultant can't admit VHI patients."

Mary Harney (Dublin Mid West, Progressive Democrats)
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-----the Sinn Féin public representative was critical of that. I very much welcome the contribution from The Argus newspaper to this debate because it displays the hypocrisy that exists. We curtail private care and we are all entitled to access to public hospitals, and that is being criticised.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is no hypocrisy. The hypocrisy is on the Minister's side-----

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy cannot have it every way.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----and proves, once again, that co-existence of private and public service provision in the one system does not work.

Brendan Howlin (Wexford, Labour)
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The Minister, without interruption. The Minister, please, without provocation.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy surely does not want us-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It does not work and the Minister has presided over two tiers in the health services all along, without consequence.

Brendan Howlin (Wexford, Labour)
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The Minister, without interruption, please, Deputy Ó Caoláin.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister should stick to the facts.

Brendan Howlin (Wexford, Labour)
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I should not have allowed the Deputy to raise the matter at all. It was in order in the question, but it is not in order now. I call on the Minister to respond to the questions that are in order.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Ó Caoláin can tell his colleague that the public hospital is for all patients.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister can tell him herself-----

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am pretty sure the Deputy will tell him.

I want to clarify what I said regarding the point I was making to Deputy Reilly. The numbers of scoliosis patients' appointments cancelled was 13, not 11, as I said, and I am sorry. Five of those had their appointments immediately rescheduled. I believe Professor Drumm will deal specifically with that issue when he addresses the Oireachtas committee on Tuesday.

James Reilly (Dublin North, Fine Gael)
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How many are waiting overall?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Regarding the €20 million, I am satisfied this is true and in fact a minimum figure when four catering departments are combined as well as four HR departments, four payroll systems, four central sterile units, waste management and all of these things. One does not need to have four CEOs, although two directors of nursing are required, one for children and one for adults. There are very significant savings to be made, I have no doubt, and part of this relates to the €4 million figure I mentioned regarding single procurement, just to make matters clear. I do not want to be accused of double counting.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister circulate the details?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will leave it to the CEO of the HSE to deal with that when he addresses the committee next week. He is a distinguished paediatrician of world renown who worked in Crumlin hospital and knows it well. He will be addressing all the issues.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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He is an excellent paediatrician, but what about his management skills?

Mary Harney (Dublin Mid West, Progressive Democrats)
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He is an excellent CEO as well, a man of substantial vision, who had the guts to take on the job and not merely be a hurler on the ditch.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Guts are not needed to be a CEO, but specific managerial skills.

Brendan Howlin (Wexford, Labour)
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Allow the Minister, please.

Mary Harney (Dublin Mid West, Progressive Democrats)
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One needs to have lots of guts to be a CEO, and vision too. I believe the sum of money allocated within the resource constraints we are living within should be adequate to provide the tertiary services for the sick children from the country and the other services for the children in the Dublin area who require that their secondary care be provided in the three hospitals that exist in the city at present.

Jan O'Sullivan (Limerick East, Labour)
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The Minister, in reply to Deputy Reilly, said that there were five scoliosis surgery patients appointments rescheduled. In the earlier part of her reply she said, basically, that the private hospital system could not do this operation and, therefore, they were all rescheduled in public hospitals. I believe that is what the Minister said, in any event. That puts a hospital such as Crumlin at an unfair funding disadvantage to other types of acute hospitals which can farm out much of their waiting lists to the NTPF. Obviously, Crumlin cannot in these types of situations. Does that not make an argument to the effect that Crumlin should be treated differently in terms of funding, since it does not have the outlet that other hospitals have?

On the question that was grouped with this one, from my colleague, Deputy Michael D. Higgins, specifically about sickle cell disease, again, that is something that Crumlin has taken on as an extra, without any funding stream. Should it have refused to deal with sickle cell cases on the grounds that it did not have the money? What is a hospital such as Crumlin supposed to do in those circumstances?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is not correct that there have been no additional resources. In my response I said that Dr. Beatrice Nolan was appointed as a consultant haematologist to Crumlin in March. She came from the national tertiary centre at St. James's and relieved the doctor who was working with haemophiliacs and sickle cell patients to allow that other consultant to deal exclusively with sickle cell cases, because it is a big issue. We know the cause of sickle cell in a large percentage of births relates to people coming here from African countries. A large percentage, some 20%, of births in national maternity hospitals relate to people from that continent and there is no doubt it will be a growing problem. However, the resources of the hospital have increased significantly. We would love to have more money for everybody. The reality is we are living in an environment where resources are very constrained and, therefore, we have to do our best with what is available, in the way we organise services and how we prioritise things within the hospitals.

Regarding the private system, Cappagh is not a State hospital but a voluntary not-for-profit facility and is in a position to do scoliosis cases. However, there is no question of the treating consultant being paid a fee to perform the surgery there. The NTPF has procured surgery there, I understand, for a number of patients, and two are scheduled to happen at Cappagh within the next couple of weeks. Clearly, we have to use whatever resources we have, whether from the NTPF or the direct allocation to the hospitals, to treat the patients who require medical attention most.

James Reilly (Dublin North, Fine Gael)
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I would like to point out to the Minister that 75% of the increased funding went on wage increases approved by her Government, through benchmarking and social partnership. I asked the Minister how many patients would be and have been operated on through the NTPF and I have not been told. The waiting list for scoliosis surgery is much longer than the Minister has indicated. She is just talking about the cancelled cases. It is not good enough for the Minister to say she has a gut feeling about catering and four of this and four of that, etc. We were told that with the HSE when ten health boards were amalgamated and the shared services unit. All we got was a mess. Has a cost-benefit analysis been done to justify the Minister's figure of €20 million?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Contrary to the Deputy's impression, there has been an significant reduction in the number of people working in management and administration since the HSE was established, and I can give him the data on that.

Crumlin hospital has had an increase of 18% in medical and dental staff and 29% in nursing staff. Extra people provide extra services, so when the Deputy says it goes on pay, that is true of 80% of the health budget. It goes on recruiting extra people or to pay increases to existing staff. There has been a substantial increase. The day before the decision was made that the location for the new children's hospital should be the Mater, it was clear that the three choices were the Mater, Beaumont or St. James's. There was no choice as regards a site on the Naas Road.

I recall talking to the current chairman of the medical board at Crumlin, and he was very excited. In fact, he was very complimentary to me, and then it all fell apart once the site was chosen. It is bigger than a site. It is about a service. I had a very good meeting recently with the chairman of the medical board and one of his colleagues at Crumlin with Professor Drumm and I very much welcome the fact that serious engagement is taking place. I salute that and welcome it. Long after all of us have gone - clinicians, Ministers or politicians - there will hopefully be a state-of-the-art facility for sick children.

James Reilly (Dublin North, Fine Gael)
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The question was on a cost-benefit analysis.

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

James Reilly (Dublin North, Fine Gael)
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Can the Minister make it available to us?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am hearing all about care models and the cost-benefit analysis. Does anybody think the facilities at Temple Street and Crumlin are adequate to the needs of our children and that we should build two new hospitals?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister has been asked twice to share the information.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am inviting the Deputies to deal with these issues at the committee next week.