Jerry Buttimer (Fine Gael)
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I welcome the Minister of State, Deputy Moloney. There is a need for a clear and precise statement on current and future rehabilitation services in Cork. The HSE has announced plans to close the orthopaedic hospital in Cork and transfer its operations elsewhere. That means there will be changes in the health care system with regard to the provision of prosthetic and orthotic services in the Cork area. It is important we look at what the HSE calls the reconfiguration of services or, in the case of rehabilitation services, provision and revision of services. This must be looked at in the light of best practice and global trends.

Many of those in the prosthetic and orthotic service area are concerned that the HSE is about to embark on a journey which will centralise all referrals to the National Rehabilitation Hospital in Dún Laoghaire. There are discussions taking place with various stakeholders. I do not want to mention names in the House. We must assure the provision of a rehabilitation service in Cork and rehabilitation of better quality. The model we pursue must have the patient and his or her family at its heart. In St. Mary's Orthopaedic Hospital in Cork a consultant orthopaedic and plastic surgeon leads the rehabilitation process. We do not have a dedicated rehabilitation centre in the south such as that in Dún Laoghaire. If I am incorrect, the Minister of State may correct me. The rehabilitation of an amputee begins long before his or her operation takes place. I pay tribute to Mr. Bob Burns in Cork who has been a visionary campaigner for the provision of rehabilitation services and amputees in the south.

In the holistic approach to rehabilitation does it make sense to ask or force patients to travel to Dún Laoghaire? Why can we not provide a local service in Cork such that the requirement to travel would be reduced? There would be less competition for physiotherapy, prosthetic and orthotic services. I refer to a service that would not be in competition with the National Rehabilitation Hospital in Dún Laoghaire but which would complement it. To be fair to it, the hospital in Dún Laoghaire does trojan work and I pay tribute to its staff. However, we need to have prosthetists and orthotists at the core of patient care in Cork. If we are to centralise services, I am concerned that the provision of rehabilitation services in Cork will be put on the long finger and that we will move away from the WHO model that regards community-based care as the best. It is important to keep patients from Cork in that region, where they will be near their families and they will have a support structure. I fear we are moving from a patient-centred rehabilitation model to one that is more economically driven.

I hope the Minister of State will have positive news on rehabilitation service provision in Cork and that the HSE will provide patients with the best possible service in the best possible place.

John Moloney (Laois-Offaly, Fianna Fail)
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I am pleased to take the opportunity to outline the position on the matter raised by the Senator.

I have been advised by the HSE that the requirement to provide access to comprehensive and integrated rehabilitation services for the population of HSE south has been acknowledged for some time. Development proposals were drawn up by both the former Southern Health Board and the South Eastern Health Board in line with the needs of the area.

In the former Southern Health Board area development proposals for an acute unit on the site of St. Mary's Orthopaedic Hospital were developed in 2000. Following on from this, a strategy document was drawn up which was submitted to the Department of Health and Children in 2003. The document entitled, Development of Rehabilitation Services in Cork & Kerry - Our Vision for the Future, addressed the totality of need across hospitals and communities. In the former South Eastern Health Board during the same period a document entitled, Pathways to Independence, was developed which mapped out the future direction of services for the south east. Both documents were submitted to the Department in the context of the development by it and the HSE of an overall policy and strategy for the development of neuro-rehabilitation services.

The HSE and the Department have established a national working group to draw up the policy and strategy for neuro-rehabilitation services. Rehabilitation in this context includes neurological and physical rehabilitation, including for trauma and acquired brain injury. It will also include rehabilitation for older people, including stroke services. The working group is chaired by Mr. James O'Grady, the disability adviser in the office for disability andmental health in the Department, and comprises representatives of the key stakeholders, including the HSE. It has concluded its assignment and is engaging with the HSE on an implementation plan. The report will be submitted to the Secretary General of the Department and the chief executive officer of the HSE in the coming weeks for their determination.

The HSE has been requested to nominate a lead clinician and a lead senior service manager with a view to implementing the action plan for neuro-rehabilitation services. It is in the process of nominating these individuals.

The HSE south is well positioned to engage with this process, having regard to the development plans and needs analysis previously prepared. Discussions have been taking place at hospital network level and across the local health offices to ensure the needs and development proposals under discussion can inform the deliberations of the working group.

Jerry Buttimer (Fine Gael)
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I note from the Minister of State's reply that there is no timetable for or commitment to the provision of capital funding for rehabilitation services in Cork. I hope he will prioritise meeting the needs of rehabilitation services provided in Cork.

John Moloney (Laois-Offaly, Fianna Fail)
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By virtue of the fact that the HSE is in the process of nominating staff, it is expected the capital programme will be in line with that process.