Michael McGrath (Cork South Central, Fianna Fail)
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Thank you, a Cheann Comhairle, for choosing this Topical Issue debate. It is an important issue not only for Cork but for the Munster area. As Minister of State at the Department of Health and as a Cork-based Deputy, Deputy Jim Daly will be quite familiar, I imagine, with this issue and will have an interest in it. I imagine the Government does not want issues around a children's hospital to be raised any further but this is an important issue for the people that we represent.

As the Minister of State is aware, the national model of care for paediatric services has identified Cork University Hospital, CUH, for development as the biggest regional unit for the care of children outside of the national children's hospital. However, this development is predicated on the centralisation of children's acute hospital care in Cork University Hospital. The infrastructure required is not currently in place. In fact, no upgrade of the inpatient facilities has occurred since the original Cork Regional Hospital, as it then was, was opened in 1978, over 40 years ago. A planned new inpatient unit has been stalled at the planning stage since 2015. Some believe it is now threatened by the significant overrun in the national children's hospital. That is the first reassurance I am seeking from the Minister. I want to know that this project will not be affected in any way by that.

This project has been known as the Munster children's hospital. The funding envelope for this project at Cork University Hospital is between €34 million and €38 million. The project includes two below-ground floors to accommodate four theatres and associated facilities.

CUH already delivers tertiary care across several specialties that other regional centres have to refer to Dublin. It is delivering specialist care as close to home as possible for paediatric neurology, respiratory, cystic fibrosis, endocrinology and diabetes, allergy and cardiology services. Children within Cork and Kerry have the lowest number of cases occupying secondary and tertiary beds in Crumlin and Temple Street hospitals. Over 90% of our children are cared for their entire treatment locally in Cork University Hospital. The national children's hospital cannot afford for this caseload to change due to a lack of local infrastructure. In fact, it has not been designed with such capacity in mind.

CUH has already had €9 million invested in its modern paediatric outpatient and day-case suite - I wish to acknowledge that. Other charity moneys raised by the staff of the unit are being used to keep phases 2, 3, and 4 of the project moving towards a planning application. It is hoped this will proceed later this year.

The ongoing erosion of surgical and anaesthetic skills is a genuine existential threat to the delivery of all paediatric medical care in Cork. This is what clinicians are telling me. It is not some politician making these claims - they come from clinicians. If these skills are lost, the hospital would have to be immediately closed to all acute admissions and the CUH emergency department would have to be closed to all paediatric cases.

Where would they go in that scenario? It is a red line from their perspective. No airway support means no acute medical care for critically ill children in Cork. Cork hospitals perform more than 5,000 operations on children under general anaesthetic per annum. Crumlin performs approximately 22,000. There is a significant differential in the complexity of the cases. The national children's hospital has been funded for 22 or 24 theatres to do that number. It could not absorb the numbers currently being provided for in Cork. I am looking for clarity about where this project stands. I have been trying to pursue it through parliamentary questions and with the HSE. I am not really getting much reassurance that this project will advance and I hope that the Minister of State can provide that.

Jim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to update the House on the paediatric development at Cork University Hospital. A national model of care for paediatric healthcare services in Ireland has been developed by the HSE and sets out the vision for high-quality, integrated, accessible healthcare services for children from birth to adulthood with an emphasis on early detection and prompt treatment. The model aims to ensure that all children should be able to access high-quality services in an appropriate location, within an appropriate timeframe, irrespective of their geographical location or social background. The model of care explicitly supports the development of the new children’s hospital and an integrated national network for paediatrics, with strengthened and interconnected roles for local and regional paediatric units, including the regional unit in Cork University Hospital.

There are a number of distinct phases within the proposed paediatric development at Cork University Hospital. The HSE is responsible for the delivery of healthcare services, including infrastructure projects, and has advised that the phase 2 development, which includes 74 inpatient beds, is currently at the design stage and is funded up to the detailed design and planning stage in 2019. I understand that a capital submission for phase 3 of the development is currently being prepared in order to enable the "shelled" construction of this project during the construction of phase 2. The submission will have to be considered by the HSE's capital steering committee before it can be approved.

I am happy to confirm that the paediatric development at Cork University Hospital has been included in the Project Ireland 2040 policy initiative announced last year. This provides €10.9 billion for health capital developments across the country, including both national programmes and individual projects, across acute, primary and social care. The delivery of these projects and programmes, including developments in Cork, will result in healthcare facilities that allow for implementation of new models of care and for delivery of services in high quality modern facilities.

My Department and the HSE are currently engaged in a process to finalise the HSE capital plan for 2019. In developing its capital plan for 2019 and future years, the HSE must consider a range of issues including the expenditure that is contractually committed, the HSE's annual requirement with regard to meeting risks associated with clinical equipment, ambulances and healthcare infrastructure. The HSE capital plan will propose the projects that can progress in 2019 and beyond, having regard to the available capital funding, the number of large national capital projects currently under way, the cashflow requirements of each project and the relevant priority. Projects which are currently in construction and which are contractually committed will not be affected. Once the HSE has finalised its capital plan for 2019, it will then be submitted to the Minister for consideration.

Michael McGrath (Cork South Central, Fianna Fail)
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The Minister of State has not given any additional reassurance that the project will be funded to phase 3 and beyond. He says it is included in the Project Ireland 2040 initiative. That is little comfort to those who are waiting for this investment. I assume the Minister of State is referring to the national development plan, which still has many years to run. Without this investment, paediatric care in Cork will continue to be delivered inefficiently across two sites, Cork University Hospital and the Mercy University Hospital, and surgical services for children will continue to be provided in a scattered away across three sites, including those two hospitals and the South Infirmary Victoria University Hospital. Children's surgeries are performed in the middle of adult lists, with no guarantee of having anaesthetic, surgical or theatre staff trained in the care of children.

This project must advance. I acknowledge that it is funded up to phase 2 but we need a capital commitment from the HSE and the Government to ensure that this project can move through detailed design, tender and construction and that the specialist care can be provided locally. The consequences otherwise are that more of the cases currently dealt with in Cork will end up having to travel to Dublin. That is not just an inconvenience but the national children's hospital, expensive though it is, is not designed to absorb additional capacity that is currently being met regionally in places such as Cork University Hospital. It is not often that clinicians come to us to explain the urgency of a project. For the children of Cork, Kerry and the wider area, the development of this paediatric unit is urgent and I hope that the Minister will lend his full support to get this over the line and make sure that it does not end up at the back of a long queue of projects.

Jim Daly (Cork South West, Fine Gael)
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I appreciate the attention that the Deputy is bringing to this. He has eloquently outlined the importance of this project to the future of not just Cork but to the entire Munster area. I assure the Deputy that I and many other Deputies in the Cork area are very anxious to see this progress, in line with a number of other capital projects that are committed to for healthcare in County Cork, both at a community and an acute level, for a different range of necessary services. We are all watching the capital plan as it progresses. The Deputy will appreciate that I cannot give any further commitment other than what I already have given. Detailed design and planning for 2019 are funded. We have to let the HSE work with the Department to finalise a capital plan for 2019. I cannot go outside that and confirm individual projects until it is complete. I assure the Deputy that I appreciate the chance that he has given to air the necessity and importance of this project. I will support him wholeheartedly to ensure that we have delivery for the people of Munster in the years ahead.