Michael Kitt (Galway East, Fianna Fail)
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Deputies Eric Byrne, McConalogue, Kelleher and Wallace have two minutes each.

Eric Byrne (Dublin South Central, Labour)
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It is a bit rich to be required to say in two minutes what politicians have been speaking about for 16 years. I want to recall a debate in which I was intimately involved as a member of the board of Crumlin Children's Hospital. I recall vividly a debate about the national tertiary paediatric hospital. I am acutely aware that the board threw its weight behind the concept of moving to a single site. The refusal by An Bord Pleanála to grant permission for the proposed new hospital will have horrendous ramifications. My heart goes out to the parents and children who have been desperately waiting for a national paediatric hospital for many years. I appeal to the Minister not to panic in the face of what has happened. If we rush into a new decision to build a hospital on a lesser scale, we could end up with an incorrect development.

I remember the debate in Crumlin when we bought into the McKinsey report. The nine key criteria points were of crucial importance. I am acutely aware that the consultants and specialists in Crumlin - given that Crumlin is essentially this country's national tertiary paediatric hospital, they are the foremost specialists in the country - threw their bodies and souls behind the complex negotiations and took part in the internal planning processes that resulted in the scale of the hospital that eventually emerged. I ask the Minister to cautiously recognise that in the past, the input of the Crumlin authorities has been instrumental in facilitating this development. If my senses are right, I believe they would have severe reservations about any downscaling of the project to which they contributed in recent years.

I am calling on the Minister to carefully consider co-locating an acute general hospital, as set out in the initial criteria, with a paediatric hospital and the Coombe hospital. A potential site for such a hospital exists as a result of the failure to develop the Bailey Gibson site, the Player Wills site and the St. Teresa's Gardens area. It is exciting that we could have the tri-location of an acute adult hospital, a paediatric hospital and a maternity hospital at this site. I appeal to the Minister to consider that. Perhaps he will engage with the boards of management of St. James's Hospital and Crumlin Children's Hospital, as well as the Dublin City Council planners, on the possibility of redeveloping the Coombe site.

Charlie McConalogue (Donegal North East, Fianna Fail)
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This is a two-pronged issue. We need to discuss the delays in the development of a national children's hospital and the reduction in bed capacity at the children's hospitals that are currently operating as a result of the cutbacks introduced by the Government.

A total of 25 beds in Crumlin and ten beds in Temple Street are closed due to budget cuts, forcing children to wait longer to be admitted to a ward and forcing them to stay longer than they should in emergency departments. Overall, 60% of children on inpatient waiting lists are there for more than three months, 50% of children on day case waiting lists are there for more than three months, while 2,500 children are on the waiting list for elective or day treatments. That is the situation at our children's hospitals. They are not operating to capacity because the Minister is restricting their budgets.

One year into the Minister's tenure, we are further behind than ever in respect of the national children's hospital. Today he moves on to his second review of that hospital. Only last week, in response to An Bord Pleanála's decision, I heard him talk about more grandiose elements of the children's hospital. He has been in his job for a year. If he felt that some elements of the children's hospital were grandiose, why did he not address them after he came to office? If it is the case, following the first review, that the Minister said that the Mater Hospital is the right site for the hospital, why has he said in the newspapers this week that he is not sure where he wants to place it? If it was the right site this time last year when he entered office, why is he not looking to amend the Planning and Development (Strategic Infrastructure) Act in order that he can proceed with it and ensure we do not wait any longer than we have done for a hospital that befits the health needs of our children?

Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to speak on this issue. The provision of a national paediatric hospital is the most sensitive issue facing us. We have been talking about this since 1998. We have had the McKinsey report and last year the international expert group reported to the Minister, recommending co-location on the Mater site. We now find that An Bord Pleanála has rejected that on aesthetic grounds and on the grounds of overdevelopment on the Mater site itself.

I would like to ask one or two questions in the context of the terms of reference for the group that has been established which state that it is to inform itself about planning considerations and processes affecting this project. Can the group enter discussions with An Bord Pleanála? Can the group possibly look at amending legislation to allow for the Houses for the Oireachtas to look at this particular project in the context of the Mater Hospital site? This is due in part to the McKinsey report, but more importantly due to the international expert group which stated last year that the Mater was the most suitable site.

There is much concern. Other hospitals and other interest groups will come on board again to say that one site is more suitable than the other, and we will have this debate over and over again. The Minister states that it will 56 days before the group, under the chairmanship of Mr. Frank Dolphin, reports back to him. How quickly thereafter does the Minister expect to be in a position to make a decision on this critical infrastructure in order that we can have it completed for 2016? Everyone would like to adhere to that target in order that we can pass a national children's hospital onto the next generation 100 years after the Easter Rising.

Mick Wallace (Wexford, Independent)
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In the last 24 hours, I have spoken to Professor Michael O'Keeffe in Temple Street and Dr. Orla Franklin in Crumlin. Both are pretty horrified at the situation they are facing. Professor O'Keeffe was at pains to point out that he feels the hospital is being penalised for being too efficient and too effective, and that it had too many operations last year. He states that it will be forced to have 1,500 fewer operations this year, yet if a child is waiting 20 weeks for an operation, the hospital is liable to be fined €25,000. He is really frustrated with the bureaucracy. He states that there are too many officers and not enough soldiers, and that we need more people to roll their sleeves up and see patients.

Dr. Orla Franklin is presiding over a hospital in Crumlin that she claims is falling down. It got a brilliant intensive care unit a couple of years ago, but cardiac and cancer care are causing great problems and the hospital does not have the necessary facilities. There is no doubt that a new children's hospital will be great, but Dr. Franklin makes the point that it is for children who are not even born yet. It will be great when it is built, but what about children who are alive today? There are huge problems in Crumlin with infection. The hospital does not have an infection-free environment due to the amount of room sharing that must occur with children, along with parents sleeping on the floors. She stated that bad things are happening to Irish children due to sub-standard facilities. Surely we can do better than this.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputies opposite for their intentions in raising this. There is no doubt that this is a key facility for the well-being of our children and that it is absolutely necessary. I thank Deputy Eric Byrne for his comments and would like to reassure him that there is absolutely no panic, nor is there a need for panic, but there is a need for expediency and a sense of urgency. That certainly is the case.

I am committed to providing the best possible health service for our children and their families. I want this to be delivered through a new national children's hospital, where tertiary and acute services can be provided from one site. Immediately following the decision of An Bord Pleanála to refuse planning permission for the national children's hospital, I announced my intention to establish a group to review the implications of the decision.

The Government today agreed the terms of reference for the review group. These are to inform itself about the planning considerations and processes affecting this project; to consider the different options which now exist for progressing the construction of a national children's hospital having regard to Government policy on the delivery of health services, including accessibility and paediatric services in particular and best clinical practice considerations, the cost and value for money considerations of the different options, the likely timelines associated with the different options, and the implementation risks associated with the different options; to advise me, in the light of these considerations, on the appropriate next steps to take with a view to ensuring a national paediatric hospital can be constructed with minimal delay; and to report to me within 56 days of the first meeting of the group.

Currently the three Dublin children's hospitals work together as a unified network under the clinical leadership of Dr. Colm Costigan to ensure optimisation of resources and facilities. The hospitals are fully aware of the challenges facing their young patients and of the need to support families. Our Lady's Children's Hospital, Crumlin has been experiencing a surge in attendances to its emergency department and a corresponding increase in admissions through that department. The clinical director, Dr. Colm Costigan, is a joint appointment across all three hospitals. When individual hospitals are under pressure, he clinically reviews patients and, where necessary, redeploys patients across the hospitals to minimise impacts on elective surgery.

The regional director of operations in the HSE has met the clinical director and Ronan O'Sullivan, professor of paediatric emergency medicine. They have organised hospital site visits and are formulating an agreed approach to deal with the seasonal peak in paediatric emergency medicine. The HSE has taken steps to provide as high a level of protection as possible for the funding of the children's hospitals. The budget adjustment to both Our Lady's Children's Hospital, Crumlin and the Children's University Hospital, Temple Street was significantly less than the average in the HSE Dublin mid-Leinster service plan for 2012. The HSE management are in discussions with the Children's University Hospital, Temple Street towards agreeing a cost containment plan and will meet representatives of that hospital next week to discuss the plan further.

The HSE service plan for 2012 has set a target for children's hospitals requiring that no child should be waiting for treatment for more than 20 weeks by the end 2012. The Children's University Hospital, Temple Street is actively engaged with the HSE, the special delivery unit and the National Treatment Purchase Fund to ensure that this target is met. Discussions with the hospital have been positive and are ongoing.

I have emphasised the need to ensure that the impact of any changes to patients is minimised, and that all changes are fully communicated. All measures will be reviewed regularly by the hospital management team to ensure the least impact on patients and service users. Patient safety remains our first priority.

I reaffirm the Government's ongoing commitment to the construction of a new children's hospital. I am committed to the principle of co-location with an adult hospital, but I know that others may have a different view. I will await the completion of the work of the review group. One thing is clear: I am determined to deliver a national children's hospital for the children of this country.

Michael Kitt (Galway East, Fianna Fail)
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There is only one minute for supplementary questions. I ask Deputies to be brief.

Eric Byrne (Dublin South Central, Labour)
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I welcome the Minister's response, but I would like to ask him some personal and pertinent questions. Would he wish to express a view on the concept of a tri-located hospital?

We were always mystified in Crumlin because we had a great relationship with the Coombe Women's Hospital in keeping premature babies alive who required very intricate surgery very early on in their lives that a maternity hospital was not the preferred option in terms of co-location. Will the assessment criteria proposed in the McKinsey report, Children's Health First, in 2006 be used in reviewing An Bord Pleanála tragic rejection of the current site?

Charlie McConalogue (Donegal North East, Fianna Fail)
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It is unacceptable that we have been waiting this long for a national children's hospital. We should have seen its construction before now. It is also unacceptable that the Minister is a year later launching his second review. He must take responsibility in that regard. If he had conducted such a review a year ago, perhaps we might be further ahead. The reality is that he made a decision to proceed with the hospital on the Mater Hospital site. If in his view it was the correct location this time last year, why is he not willing to proceed with it now on it?

The Minister has not answered my questions about - to use his own language - the more "grandiose" aspects of the project. What exactly were the grandiose aspects of it? If he Minister considered they were an unnecessary luxury, why did he not intervene before now?

Unfortunately, we are a year into the Minister's tenure and there is even more overcrowding in the children's hospital and, unfortunately, we are further behind in the delivery of a national children's hospital. I ask the Minister to address these questions.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the context of the Minister's commitment to adhere to best international medical and clinical advice that there be co-location with an adult teaching hospital, the terms of reference of the review group under the chairmanship of Dr. Frank Dolphin in assessing various sites do not refer to this as being sacrosanct. Clearly, if best international practice, based on the McKinsey report and the report that the Minister himself commissioned last year, is that there be co-location with an adult teaching hospital to secure the best clinical outcomes, should this not have been included in the terms of reference to ensure the review group can only look at sites where co-location is an the option, as opposed to greenfield sites? Are we limiting the potential to provide a world-class co-located facility by not even mentioning this in the group's terms of reference in the context of seeking the best clinical outcomes in the provision of paediatric care?

Mick Wallace (Wexford, Independent)
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No matter what the Minister does, there is little doubt but that the new hospital is further down the road. Even if he was to reduce the height, the steel and concrete drawings would have to be redone. There is much work to be done to reach a stage where one can start work on the hospital. The children of today deserve a better deal in Crumlin and Temple Street. We need to spend money on these hospitals because provision of the new hospital is a while away.

James Reilly (Dublin North, Fine Gael)
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To deal with Deputy Eric Byrne's concerns about a tri-located hospital, of course, this would be the ideal and many would agree with him. Having a maternity hospital co-located with an adult and a paediatric hospital would make sense and the Mater Hospital site allowed have allowed for this to happen. However, I want to make it clear that everything is on the table.

I am a little bemused by Deputy Charlie McConalogue complaining that one year on we have not delivered when the Governments led by his party had 14 years to deliver and left the country in a mess.

Charlie McConalogue (Donegal North East, Fianna Fail)
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What has the Minister done so far?

James Reilly (Dublin North, Fine Gael)
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On why the project is not going ahead at the Mater Hospital site-----

Charlie McConalogue (Donegal North East, Fianna Fail)
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What has the Minister achieved in seeking a result?

James Reilly (Dublin North, Fine Gael)
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Did the Deputy not listen to the news last week in respect of the refusal of planning permission? I would have thought it was a major concern.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister was lobbying to have it located in Balbriggan.

James Reilly (Dublin North, Fine Gael)
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The gentlemen opposite should listen.

Michael Kitt (Galway East, Fianna Fail)
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Order, please.

James Reilly (Dublin North, Fine Gael)
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It is all very well for them to sit on the other side of the House and act as if they had nothing to do with what happened in the past 14 years-----

Charlie McConalogue (Donegal North East, Fianna Fail)
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The Minister has not had much of an impact in the past year.

James Reilly (Dublin North, Fine Gael)
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-----but the reason the country is in such a mess and we must take €2.5 billion from the health budget which, of course, will impact across the heath service and which we seek to mitigate as much as possible-----

Billy Kelleher (Cork North Central, Fianna Fail)
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We will locate it in Balbriggan.

James Reilly (Dublin North, Fine Gael)
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The Deputy sits there and acts as if it is all a mystery to him, that he knew nothing about it and that he had nothing to do with it.

Charlie McConalogue (Donegal North East, Fianna Fail)
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What has the Minister been doing for the past year?

James Reilly (Dublin North, Fine Gael)
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I am sorry, but that will not wash with me or the public.

We were advised by the expert group, the recommendation of which at the time was that it be located on the Mater Hospital site. The planners have decided otherwise. We have put together a group to report within 56 days of its first meeting on the best route forward. The main concern must be building a new facility for children in order that they can receive the best treatment in the best environment.

Deputy Mick Wallace mentioned several persons. I put it to him that even Professor Michael O'Keeffe has spoken about the fact that he gets more work done in one day in a private setting than he does in a week in the public sector. There are significant efficiencies capable of being achieved within the public sector in how we use theatres - the productive theatre initiative - and much progress has been made. I compliment Professor O'Keeffe on having one of the shortest waiting lists and doing Trojan work, but I cannot agree that children will go blind or die from brain tumours because operations will not be carried out in time. Urgent adult and children cancer cases are treated first as a matter of priority, which is the way it should be.

The Government is fully committed to developing a national paediatric hospital in order that children can receive the best care in the best environment. We will look at all the options put to us by the review group. I look forward to receiving its report within 56 days of its first meeting.