Colm Burke (Fine Gael)
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This motion relates to the appointment of a paediatric urologist. My understanding is that for children who have spina bifida and hydrocephalus there is a severe difficulty in accessing vital urology services. My understanding is that the post of paediatric urologist was advertised but not filled and that while one person was interested in the post the position was not taken up, although it was offered. My understanding is that in the long term because it is a specialist area the likelihood of the post being filled is remote. My understanding is that the Great Ormond Street Hospital for Children in London has offered to provide backup support and that there is a need for a more co-ordinated approach between the HSE and Great Ormond Street. I am highlighting the issue because of parents of children in the Cork region. At one stage they believed the problem was going to be resolved and that there would be a centre in Dublin to deal specifically with the matter.

It appears that the necessary backup support that the parents require is not in place and there is a need for a proper structure. The set up is rather disjointed at the moment and they are concerned about this, especially for the long term. Urology is a specialist area and it needs particular attention. If treatment is provided to children at a younger age then the problems that arise can be dealt with far more effectively later on. This is the reason the parents are particularly keen for a more co-ordinated approach between the HSE and Great Ormond Street to deal with the matter for the entire country.

I realise several additional paediatric consultants have been appointed in the past 18 months but none of them has this particular speciality. At a meeting of the Joint Oireachtas Committee on Health and Children I asked whether some of the existing paediatricians could train or acquire the necessary skills. I understand there is a reluctance to proceed in this way. This is a particularly significant problem for the parents concerned. Can we arrange for a more co-ordinated approach?

Brian Hayes (Dublin South West, Fine Gael)
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I thank Senator Burke for raising this matter and for the way in which he has done it. I apologise on behalf of my colleague, the Minister for Health, Deputy Reilly, who is unable to be in the House this evening. As Senator Burke noted, this is an important issue. I understand Ireland has the highest incidence of spina bifida in the western world and therefore it is important that this issue is highlighted in the House. Were the Minister here he would say that this is a complex issue concerning physical disability. Children with spina bifida have multiple problems caused by the condition. The majority of children and adults with spina bifida have hydrocephalus, to which Senator Burke referred.

Best practice recommends that multiple professionals are involved on a spina bifida team. We know that on average 30 children per year are born in Ireland with open spina bifida, the most severe form. I am aware that early intervention by a specialist and local team is essential to optimise the long-term functioning of these children and to prevent medical complications later in their lives. The Children's University Hospital, Temple Street is the national tertiary care centre for spina bifida and hydrocephalus. All infants born in Ireland with spina bifida are transferred to Temple Street after birth for ongoing neonatal management. The model of care being developed by the HSE involves sharing care between the specialist team in Temple Street and the local team. The best care should be provided nearest to the patient's home with guidance and support from the specialist team. However, it is acknowledged that there are many complex issues which are best managed by the specialist team.

A multi-disciplinary spina bifida clinic was established in Temple Street last year in February 2011. However, I am advised that there has been no dedicated urological input to date. A recruitment process was under way in 2009 and 2010 from which the hospital had hoped to recruit a urologist. Unfortunately the recruitment process found no suitable candidate for the post. However, a new recruitment process is in train and it is hoped that the post will be re-advertised before the end of the year. The HSE is hopeful that the new recruitment process will succeed in hiring a suitable candidate.

As an interim arrangement, children requiring urgent urological input are prioritised clinically and seen in the United Kingdom under the treatment abroad scheme. Where a patient is refused access to the treatment abroad scheme the hospital is currently in final negotiations with St. George's Hospital in London with a view to having that hospital treat children pending the appointment of a permanent urologist. Arrangements are currently being made to have a consultant visit from the UK to cover clinical priorities here. In addition to the consultant urologist post, other key staff will also be required to develop the model of care, including, for example, in the areas of occupational health, continence, nurse management and orthopaedic surgery. A business case is currently being developed by the HSE to progress the matter. The Government is acutely aware of the challenges that patients with spina bifida and their families face in managing their condition. I am committed to providing the best possible health service and will continue to work with the HSE to ensure the best possible outcomes for these patients.

Colm Burke (Fine Gael)
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Basically, this is an issue about co-ordination. A parent who contacted me said that in the Cork area there has been a failure to provide regular and comprehensive kidney and bladder assessments to ensure early detection of problems in renal function. This problem needs to be addressed immediately. The failure to address the problem will lead to increased numbers of people with renal failure and they will require dialysis for the rest of their lives at a great cost to the State. The parent concerned has suggested that even the simplest of procedures which should be available is not available in the Cork area at the moment. Will the Minister of State relay this to the Minister for Health? I will write to the Minister myself on the matter. However, there seems to be a falling down in the follow up. The service is not available in Cork and I presume that is because the unit in Dublin is under pressure as well there is a difficulty with trying to co-ordinate with London.

The post of paediatric urologist is a specialist function. I realise the HSE intends to re-advertise the post but with all due respect the likelihood of the post being filled is rather remote. I am being blunt about it but this is the word I am getting from the medical profession. We need to consider the long-term plan for the next three or four years. We should plan now rather than live in a false sense of hope that the position will be filled and I call on the Minister to ensure this.

Brian Hayes (Dublin South West, Fine Gael)
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The Senator has raised two issues. As I said in my remarks on the first issue - this is the view of the Department of Health and the Minister as well - basic testing should be done locally. There is no reason that cannot happen and certainly I will bring to the Minister's attention the comments made by the Senator concerning the difficulties in Cork. It is not acceptable that patients would have to travel extensive distances for what are basic tests such as those necessary in the cases he has highlighted.

The second issue relates to the re-advertising of the paediatric urologist post. I have heard what the Senator has had to say. It is a serious matter if an appointment cannot be made. Although I do not wish to prejudge the matter, we cannot allow a hiatus to develop such as what has occurred in recent years whereby no systems are in place while we are waiting for a permanent post to be filled. The suggestions the Senator has made whereby while the post is being filled a more permanent relationship is developed between the hospital in London and the authorities here in Temple Street will be of great value and I will certainly bring it to the Minister's attention.