Private Members’ Business - Children’s Hospital Funding: Motion (Resumed).

Wednesday, 24 June 2009

Dáil Eireann Debate
Vol. 685 No. 4

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The following motion was moved by Deputy James Reilly on Tuesday, 23 June 2009:

[880]Debate resumed on amendment No. 1:

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  I am grateful for the opportunity to contribute to the debate on the Government imposed cutbacks to services for sick children in Our Lady’s Hospital for Sick Children, Crumlin. Recently the House debated the horrific abuse of children at the hands of the religious and the State. It was resolved on all sides of the House that no such thing would ever be allowed to happen again. While that debate was taking place, the Minister for Health and Children was withdrawing money from the children’s hospital, which had the effect of forcing the administrators to close wards and a life saving operating theatre. If this action is not reversed, it will cause severe suffering, prolonged pain and misery to innocent, sick children.

[881]The closure of a life saving operating theatre is most likely to be the cause of children dying unnecessarily. The mothers of these children will never forgive the Minister for the actions she took that led to this sorry pass. She put a system in place that empowers an unaccountable quango to use taxpayers’ money as its sees fit. It is not only a shame or a disgrace, it is a crime to allow little children to suffer unnecessary pain and misery and even avoidable death. The Minister and her Fianna Fáil backers who keep her in office are responsible and I would not like to have the consequences of her actions on my conscience.

I refer to two children in my own constituency, who are typical of those needing services at in Our Lady’s children’s hospital. The first is little Jack McNiffe who has spent most of his four years in the hospital. He has been wonderfully cared for and he has had a number of procedures successfully carried out there and in Great Ormond Street hospital. His mother, Aisling, is stressed and worried that the cutbacks in resources at Crumlin hospital will mean vital procedures being dangerously delayed. This boy and his mother have suffered enough without this added unnecessary hassle.

The second child is Devinn Behan. I welcome him and his parents to the Visitors Gallery. Devinn is a bright 12-year old boy who has a condition which has led the twisting of his spine, which, in turn, is damaging his hearts and lungs. He urgently needs an operation to correct this condition. On 26 May, the Irish Independent reported on his case and spoke to his mother, Veronica:

[882]

Both families have the fullest praise for the nurses and staff in Crumlin hospital and they are fearful that the Minister’s resources limitation will cause even more suffering for their special children. These children and others have suffered enough and, on their behalf, I plead with her to find the money for the banks and builders somewhere other than in the budget for Our Lady’s hospital. If she has an ounce of human kindness, she will surely do so. If she is not mindful to heed my plea, perhaps she will heed the pleas of the mothers of the children.

Deputy Mary Upton: Information on Mary Upton  Zoom on Mary Upton  I welcome the opportunity to contribute to the debate.

It seems clear that the real agenda behind the closing of wards in Our Lady’s Hospital for Sick Children in Crumlin is ideological and it is not only monetary. It is skewed logic to believe that the case for the centralisation of paediatric care in Dublin will be strengthened by running down the quality of service offered in Crumlin hospital. If money alone is the issue, there are plenty of ways the Government and the HSE could make up the €9.1 million shortfall. The HSE spent €17 million on spin doctors and management consultants in 2008. This money could pay for the reopening of the wards in Crumlin hospital and the cervical cancer vaccine for 12-year old girls. A 17% reduction in the HSE’s €60 million taxi spend would meet the budgetary shortfall of the hospital for 2009 while a 20% reduction in the €50 million spent on renting prefabs for schools would ensure children could access a full suite of services in Our Lady’s hospital.

However, this is not only about money. The HSE and Government remain hell-bent on following the plans of a Minister whose own party and its ideology regarding health care is defunct. Across the world the health strategies espoused by the Progressive Democrats, which are closer to Boston than Berlin, are being rejected even in the bastion of capitalism, the United States. This ideology extends from co-location of private hospitals on public lands to running down paediatric hospitals to promote the case for the centralisation of services on a patently unsuitable site. I have no quarrel with the concept of centralisation of medical services if the decision is based on sound medical care and services but I have an issue when it is railroaded through at the cost of a vital service to certain sectors of the community for reasons that have little to do with the provision of good health services.

I refer to the issue of fund-raising and the burden placed on families and friends to raise money for basic health care services for children. Even in good times we faced a scenario whereby the children’s hospital had to spend valuable time and resources on fund-raising and to depend on the goodwill of many generous people. The need to make funds available is more acute than ever but it is also more difficult than ever to raise funds from people who are penalised through heavy taxation measures and who are also fund-raising for their local school playground, sports club and every other facility that should be provided by the State.

Without these very generous donors, our public health service for the children who attend Our Lady’s Hospital would be in much worse condition. Even with the about-turn by the HSE yesterday, one ward will still remain closed. Aside from that, it is a disgrace that public and [883]political pressure forces the Government and the HSE to capitulate, not the fact that children’s health will be significantly affected.

The Government constantly accuses the Opposition of histrionics whenever we highlight the scale of indebtedness it plans to lump upon taxpayers, such as with the blanket bank guarantee and now with NAMA. These decisions are saddling every household in the State with enormous debts, while those who ran up those debts in banks and development companies remain in situ. If we think it appropriate to saddle the next generations with the debts of a greedy and favoured few, then we can afford at least to give people proper health services. While the favoured few are being bailed out, operations are cancelled or postponed, children are added to waiting lists and stressed-out parents are left to worry about their sick children.

I have no doubt but that the staff of Our Lady’s Hospital will do what they have always done, namely, go that extra mile for the children in their care. However, there is only so much anybody can do without resources and funding. Our Lady’s Hospital is located in my constituency and I am acutely aware of the service it provides for children throughout the country and, more specifically, the medical care it provides for many local people who have brought their children there in emergencies. I am one of those people who has personal knowledge of the exceptional medical care offered by Our Lady’s, having once over-nighted there with a favourite nephew.

In the last analysis, it is down to the Minister to decide how the resources are to be allocated. Our Lady’s Hospital and the children in its care should not be the fall guys for the mismanagement of the finances of this country.

Deputy Mary Alexandra White: Information on Mary Alexandra White  Zoom on Mary Alexandra White  I wish to share my time with Deputies Dooley, Collins, Flynn, O’Connor and the Minister of State, Deputy Áine Brady.

Acting Chairman (Deputy Jan O’Sullivan): Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Is that agreed? Agreed.

Deputy Mary Alexandra White: Information on Mary Alexandra White  Zoom on Mary Alexandra White  I wish to thank Fine Gael for initiating this debate. We may and will disagree about matters, but there is no greater priority for the Government than to protect and provide for our children. Our children are our flesh and blood. They are our future. When a child is ill, this is devastating and affects family and friends. For those of us elected to represent thousands of families, we have a duty to highlight concerns such as health provision and care.

I have spent the past two weeks highlighting the issue of scoliosis patients, in particular the plight of Jamie Murphy from Graiguenamanagh, County Kilkenny. I am delighted that a private benefactor has come forward to speed up Jamie’s operation, what I want to see is certainty that no child will suffer a delay in treatment for scoliosis or any other ailment because of restraints in the system. I do not like the word “restraints”. Let us call a spade a spade; we are talking about cutbacks. Over the past two weeks I have learnt a lot about scoliosis and how it affects growing children and how important it is to obtain surgery before curvature of the spine causes intense pain, harm to vital organs and terrible disfigurement.

I could not stand over delays in treatment because of closures, delays in life enhancing surgery or more cutbacks that would extend the waiting time for scoliosis patients to be seen. Some very good things have happened recently. The planned closure of a ward and theatre mentioned in the motion moved by the Opposition will not now happen. The postponement of outpatient appointments by 15%, which would have affected approximately 8,843 patients, will not happen and neither will there be 1,100 fewer admissions. As of yesterday, in discussions between the HSE and the three Dublin paediatric hospitals, it was agreed that Crumlin Children’s hospital would revert, as a matter of urgency, to the HSE with its proposals to [884]address the needs of scoliosis patients between now and the end of the year. It is my understanding that the HSE will get active on these proposals within days. The waiting list for scoliosis treatment has fallen and will fall further and there are now dedicated theatre sessions put in place for the paediatric consultant performing this surgery in Crumlin. I welcome that.

I want to ensure that not only those on emergency lists, but those awaiting life-saving surgery will be treated speedily in Crumlin hospital. I want to ensure that we work to reverse the closure of the 25-bed ward and a hospital theatre. I believe that will be done. I personally want to thank the Minister for Health, Deputy Mary Harney, for her work on this issue in recent days. The provision of quality services and non-emergency services is an issue in which I have a deep interest, as has the Green Party. Recession or no recession, cutbacks cannot be allowed to cause pain for children. That is a given. As the Minister said last night, “No child should ever be in pain as they await necessary treatment”.

I would also like to know what the €30 million in fundraising is doing sitting on deposit on behalf of a hospital foundation. If money is being spent on improvements to the hospitals emergency department, why can it not be spent on other essential items? I know hundreds of people who have fund-raised, run marathons, mini marathons or shaken buckets all over the country to help the hospital. Why is that money not being spent?

On the question of budgets, it should be noted that the Fine Gael Party’s budget proposals for 2009 included a cut in all current budgets of 3%, from the 2008 level. Fine Gael cut the funding of the Green Party last night by refusing to give us a pair so that we could take part in a fund raiser to raise funds for Crumlin Children’s Hospital. That was an own goal.

We are all aware of the challenges facing our health system as budgets get tighter. More demands are placed on the system due to increased population. Hospitals will have to work hard to find savings, be resourceful with their facilities and do all they can to centralise services such as the measures outlined in last night’s debate. Despite the budgetary pressures facing all concerned and the work within the service to increase efficiency and resourcefulness, our children must not be caught in the middle waiting for care or surgery.

On the question of savings, nothing must be spared in protecting front line services. Care for our children is a sine qua non. We will do whatever it takes ensure the best hospital care for them. That is the hallmark of a civilised society and that is what I am working for.

Deputy Timmy Dooley: Information on Tim Dooley  Zoom on Tim Dooley  I welcome the opportunity to address this motion. While the specifics of the motion are particular to a section within the health service, the sentiment behind it and the approach taken in the House by the Opposition follow what has come to be a common pattern in recent weeks and months. The Opposition identifies a service facing budgetary pressure — what public delivered service funded by the State does not face such pressure? — succeeds in whipping up a frenzy, selects a number of individual cases and seeks to evoke a sense of shock and awe at these and then proceeds as if these are the fault of the Government.

The Opposition fails to identify the exceptional work done on behalf of so many patients on a daily basis. By isolating a small number of cases in individual and particular circumstances, the Opposition seeks to portray these as the way in which the health service is delivered. This does a disservice to the phenomenal work done by the health service and the people who work on the front line. It is wrong to present these cases as the norm. The Opposition offers its solution, but its solution, which it comes up with on a weekly basis for all these areas it identifies, is not to tax but to spend more money to resolve the problem. It ignores its own so-called budgetary strategy, that great alternative strategy it is prepared to put forward.

[885]Whatever the issue is — tonight it is Crumlin hospital but it will be something else next week — the same solution emerges, put up and spend more money. The Opposition will not agree with any of the taxation measures the Government has brought forward nor with any of the methods of raising funds to take account of the losses in Revenue. The Minister has made the situation clear and we are all well aware of the cost of the provision of the health service, over €15 billion a year. We are raising taxes this year of between €33 billion and €34 billion and will borrow €20 billion. We cannot ignore that.

Budgetary strategy talks about cost containment and reducing costs through efficiency. The solution to the problem in Crumlin hospital is to find efficiencies through closer co-operation between the three hospitals in the network, Tallaght, Temple Street and Crumlin. The front-line staff in these hospitals work extremely hard. I believe there is a management issue. Everyone talks about plugging the black hole within the health budget. That means change and closer co-operation. It means smarter and more efficient ways of working to deliver that service.

Phenomenal advances have taken place in medical technology and in the way in which doctors go about their business during operations. Patients spend much less time in hospitals. Notwithstanding that, the cost of delivering this level of service has increased considerably, but there are much better outcomes.

We have to look at ways to manage delivery more efficiently, through closer co-operation of services and bringing them under one umbrella. In resolving a problem like this it is not unusual that one would find some resistance to change. The technology, medical practice and better outcomes are available and now the service delivery component has to change to ensure the most efficient use can be achieved from the money that is available.

I am somewhat taken aback by Deputy Stagg’s statement tonight, when he referred to the Government bailing out the banks and the builders, and that the money involved in that could be better used to resolve the problems in Crumlin Hospital. It is an outrageous concept to put forward. It shows no regard for the basic understanding of how this has come about.

The boom years were created, perhaps wrongly, by the builders and bankers, but by creating the boom, which generated more wealth for the economy and increased the amount of money that came into the coffers of the State——

Deputy Mary Upton: Information on Mary Upton  Zoom on Mary Upton  The bankers and builders were prioritised.

Deputy Timmy Dooley: Information on Tim Dooley  Zoom on Tim Dooley  Deputy Upton should allow me to finish. The funding coming into the State allowed the Government to increase spending in Crumlin by 39% in 2004. The Deputy should work through that logic. Deputy Stagg is blaming the builders, the bankers and the boom. The reality is that as a result of the boom spending has increased in the period 2004 to date by 39%. We are discussing here a reduction of 3%. We need to have some perspective on this.

First and foremost, we have to get away from the notion that it is somebody else’s fault and that the financial difficulties we face are somebody else’s fault and that the service delivery is being affected by it.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  We know whose fault it is.

Deputy Timmy Dooley: Information on Tim Dooley  Zoom on Tim Dooley  It is not being affected by that. It is still important that we get the best efficiency, based on the advances that have taken place in medical practice.

Deputy Mary Upton: Information on Mary Upton  Zoom on Mary Upton  The Deputy was in Government all the time while they were happening.

[886]Deputy Timmy Dooley: Information on Tim Dooley  Zoom on Tim Dooley  It is unreal to suggest that if the budget has increased by 39% we cannot have a capacity to work more efficiently at a time when the money is not available.

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  The budget was cut by €9 million. The Government is responsible for it. The Deputy voted for it here. He should not be a hypocrite.

Deputy Timmy Dooley: Information on Tim Dooley  Zoom on Tim Dooley  The Deputy should tell me his solution.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  I told him the solution 100 times. He sat with the fat cat builders and got us into the mess we are in.

Deputy Niall Collins: Information on Niall Collins  Zoom on Niall Collins  I am grateful for the opportunity to contribute to this debate because it is a very important issue for Crumlin and the wider Health Service Executive, and the interested public can derive a degree of confidence in the operation of Crumlin and the HSE arising from it. I acknowledge the very fine work that takes place, the level of patient care and the application of medicine in Crumlin hospital. All Deputies know of people who have experienced the hospital and the benefits that have arisen from it. I welcome the decision announced yesterday not to proceed with the closures during the summer months.

Crumlin hospital or the wider HSE should not be dragged into disrepute. The comparisons that are being made between running the HSE and bailing out bakers and builders is idiotic. We have to start getting real about the banking scenario and the running of the HSE and stop mixing apples and oranges. The bank guarantee scheme and the capitalisation of the banks are necessary for reasons which are well documented in this House. If we had a scenario where people went to their bank and found their deposits were not there, we would have a completely different scenario on our hands. Comparing that, and the effort going into the running of Crumlin hospital and the wider hospital service, is not on.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  It is a knock-on from the mess you made.

Deputy Niall Collins: Information on Niall Collins  Zoom on Niall Collins  It brings the whole debate into disrepute. That is my opinion on it and I am entitled to it.

Regarding Ireland and the three children’s hospital locations, we have a population of 4 million people and the three hospitals have a combined budget of some €250 million. To bring them into one location will bring efficiencies and economies of scale. It is correct to compare Birmingham Hospital to Crumlin. Birmingham has a budget of some €212 million in comparison to Crumlin’s budget of €144 million, a difference of 45%. Birmingham provided 32,000 inpatient treatments in 2008 and Crumlin provided approximately 10,000. Birmingham can provide about three times the number of inpatient cases because it operates in one location with a budget that is 40% higher than that of Crumlin. It is a comparable situation and we have to compare like with like.

Regarding health services in general, I have noticed a trend in all the debates here. There is never an acknowledgement given that during the 1950s, 1960s, 1970s and 1980s all political parties in the House contributed to the demise and deficit of capital and human resources in the health service, and that a catch-up had to happen over the last number of years and must also take place into the future. Every political party in the Chamber is responsible for that and that is the process in which we are now involved.

Having an agency like the HSE, which is detached from direct interference and input and from people in the Executive and in this House is the correct way to proceed. We have Members in the House who have a medical background and can contribute to the formulation [887]of policy, and this is advantageous. Nobody in this House should have direct input or interference into the running of hospitals. We have people who are paid——

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  The Deputy should say that to the board.

Deputy Niall Collins: Information on Niall Collins  Zoom on Niall Collins  I am giving my opinion. People are paid to do a job and are given a budget to do it. We cannot have a midsummer rush every year, particularly with the economic crisis in which we find ourselves. We cannot have a midsummer hiatus every year, where hospitals state they are running short. All organisations, whether hospitals or whatever, have to operate within budgets. That is the situation in which we find ourselves.

We had a debate in the House recently on the reconfiguration of health services in the mid-west region in which we all took part. Not one person has contacted me since the reconfiguration was announced to make a complaint or to say the level of care they received was diminished in any way. That is significant. Perhaps other people have other stories to tell, but I am giving my experience and I am just one person.

Deputy Beverley Flynn: Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  I also welcome the opportunity to speak on this debate. I thank the board of Crumlin Hospital, particularly the deputy chair and all those who attended for the presentation and tour of the hospital they gave to members of the Oireachtas health committee. As someone who has availed of the services of Crumlin Hospital for my daughter — many of my constituents have also availed of them — I am very conscious of the excellent work carried out there and I complement it on being a wonderful centre of excellence for paediatric care.

The concerns of the health committee, and my own concerns, and the reasons we were motivated to visit the hospital are that front line service for children be maintained, and all sides of the House agree with this. I recognise that because Crumlin is a national hospital providing many services exclusive to it, unlike an adult who may need a particular treatment or procedure and can avail of it in another hospital, often the only option for a child is Crumlin Hospital.

We recognise that the current economic climate is very difficult, and this has also been acknowledged by all sides in this House. In the past, when money was more plentiful, it was argued that value for money across all sectors in society was not achieved, and the medical sector is no exception to this.

I have examined the budget for Crumlin Hospital over the past five years and significant increases were provided. There has been a 38% increase in funding and the budget for this year stands at €139.6 million. It represents a 3% reduction on the money that was available in 2008, which was €143.63 million. I come from a town with a hospital and recognise that it is always very difficult for any hospital to operate within its budget, but it is also important that savings are made and greater efficiencies are achieved, where possible.

I was very impressed with the board of Crumlin when we met it yesterday with how it achieved efficiency between 2007 and 2008. They pointed out to us at the meeting yesterday that in 2007 the hospital had a budget deficit at the end of the year. Going into 2008, it requested an increase of €14 million from the HSE but was denied this and was given €7 million. In 2008, it still managed to break even without any reduction in service, ward closures or theatre closures. I am simply making the point that very successfully, through its own management efficiency, it managed to achieve excellent results and greater efficiencies in 2008, which is a credit to it.

The cost measure that causes me particular concern is the closure of St. Joseph’s ward with 25 beds. This ward deals with orthopaedic and neurology patients, but the board pointed out yesterday that these patients are now being accommodated in other wards in the hospital. All [888]of this information and the figures have been presented by the board and I am not dealing with any other information. My colleague mentioned Birmingham hospital and I point out that the board would disagree with some of the figures and the comparisons between those two hospitals. I acknowledge this and it is an issue we will have to take up with Professor Brendan Drumm when he comes before the committee next week.

I point out that there are 248 beds in Crumlin, 223 of which are open, which is 81,395 bed nights in a given year. In 2008, with all wards open in the hospital, 72,280 bed nights were used. The major growth in activity for Crumlin Hospital, again pointed out by the board, is in day cases involving those who do not stay overnight in hospital, in which there has been a significant increase of 30% in the past four years.

Another area of major concern for me is the closure of the theatre because theatre procedures increased by 34% in that four-year period, and I addressed that specific question to the board when I was at the hospital yesterday. However, I am heartened by the fact the hospital has clearly stated that no child has been denied access to emergency life-saving surgery due to the hospital’s financial break-even programme for 2009 — it is important to recognise this point. I asked the board why it was necessary to close the ward and the theatre and they informed me that between 2008 and 2009 there were 25 fewer nurses in the hospital, which was necessitated by a €600,000 reduction in the amount spent on agency staff. Again, it is an issue I will take up with Professor Drumm next week.

On the positive side for the hospital, its management and administration is very competitive at 13.6% of staff, which compares very favourably with many other hospitals that have 16% to 20% of the staff taken up in this area. I would ask the Minister to address the issue which was brought forward, namely, that the staff complement at the hospital and the budget for the hospital has not been scientifically arrived at but has been inherited from the old health board days. I welcome the fact there will be a new national children’s hospital. I believe this will be to everyone’s benefit and we must ensure it is completed by 2014.

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  I welcome the opportunity to make a brief contribution to this important debate and I compliment our colleague, Deputy James Reilly, on giving us that opportunity. One would need to have a heart of stone when one sees children needing urgent hospital treatment. Those of us who are parents or, as in my case, a grandparent, can empathise with the parents of those children. One could not but be concerned and upset about the current situation. Deputy Mary White made reference to the case of the Kilkenny girl, Jamie Murphy, and I know much credit is due to the benefactor who helped in that regard.

I received calls on that subject this morning following the publication of The Irish Times pointing out that a foundation which raises funds for the Crumlin children’s hospital had almost €30 million available to it at the end of 2007, to which reference was made in the Dáil this morning. The report states, “...the Children’s Medical and Research Foundation insisted yesterday that its resources could not be used for the purpose of plugging the gap left by shortfalls”. Other colleagues receiving calls might also wonder about this matter, which is an item for debate. The report states that funds are being used for children’s parties, refurbishments and to upgrade equipment. While I bow to no one in my admiration for the Crumlin hospital and the marvellous work it does, it is a fair point to make and there is a question to be asked.

Like other colleagues, I visited the Crumlin hospital yesterday. It is not the first time I have been there. I am a child of Crumlin and I remember the hospital being opened in 1956. I wonder how many of my colleagues can claim, as I can, that they were treated in that hospital and, although it was a long time ago, I remember it well. All three of my children were patients [889]there, as was my little granddaughter. I have huge admiration for what happens at the hospital. While it is not in my constituency, many people from Tallaght and Dublin South-West, like those from other parts of the country, go there.

Yesterday’s visit was very important. The Joint Committee on Health and Children, under the chairmanship of Deputy Seán Ó Fearghaíl, was very clear as to why members wanted to visit the hospital. I know journalists have questioned our motives but it was part of a process. Deputy Reilly made the point that it was important that we went and saw the situation for ourselves, met the management team and the board, and had the opportunity to visit the facilities, including the operating theatres, and meet patients and their parents. Tomorrow, we will take that information into the committee room — I know the committee Vice Chairman will also be present — and talk to senior officials of the HSE in regard to this issue. The process will then be completed on 7 July, when the joint committee meets Professor Drumm. A clear message we will give to the officials and Professor Drumm, bearing in mind the way all of us feel about the services, is that frontline services must be preserved. There is all-party agreement and a determination by the committee to achieve this, and it is important we would try to get this message across to Professor Drumm and his officials.

During this debate, there has been much reference to the future development of children’s services in the country, particularly in the Dublin region. I am a Dublin-born and based Deputy and I feel strongly about the fact we need what was described as a super-hospital. Without playing politics, I have always made the point that the Mater hospital site was a mistake. This is not just to make a case for Tallaght and many of us would agree——

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  Bertie is gone now.

Deputy Charlie O’Connor: Information on Charlie O'Connor  Zoom on Charlie O'Connor  ——although perhaps the Fine Gael spokesperson will not, certainly not publicly. There are issues regarding the Mater site, which it is important we understand, but we must also understand the need for a proper children’s hospital.

In that context, I wonder should the example of cancer services be adopted, given that the model of Professor Tom Keane has clearly driven forward those services and made a difference. Is it time the Government and the Minister, in particular, would consider the need to provide for a children’s hospital czar, such as Professor Keane, to drive forward this project and ensure children’s services are provided in a proper way?

Minister of State at the Department of the Health and Children (Deputy Áine Brady): Information on Aine Brady  Zoom on Aine Brady  I welcome the opportunity to respond to the Fine Gael motion. Along with my colleagues, I would like to categorically refute the allegation that critically ill children have had essential treatment withdrawn. Our Lady’s Children’s Hospital is recognised internationally as a centre of excellence in paediatric care. Crumlin always has been, and continues to be, totally committed to the ongoing care of all children.

I also welcome the announcement by the hospital that further ward and theatre closures, which had been proposed for July and August, will no longer be necessary. I understand from the HSE that this decision was based on the financial performance for the first five months of 2009, which has strongly indicated that the hospital should achieve a break-even position at year end.

Deputy Reilly raised a specific issue in last night’s debate regarding surgery of children with scoliosis. I would like to respond to this matter. The debate about current services for children with scoliosis must not be reduced to over-simplified discussions about angles of spinal curvature. As the health spokespeople know, the decision on whether to operate on a child must take into account many factors and is a complex weighing up of the benefit of the treatment [890]against the risks inherent in surgery of this kind. The decision to operate on a child will depend on many other factors, such as whether the family and surgeon wish to wait until the growth phase has ended to assess severity at that stage. It will also be influenced by the possibility that anaesthetic risk may increase with age, such as with muscular dystrophy, and this will lead to much earlier intervention with curvature of possibly only 20%.

I understand the HSE met yesterday with the three paediatric hospitals, including Temple Street, which also has extensive experience in this area, with a view to making inroads into the waiting times for scoliosis patients. Crumlin has been asked to revert as a matter of urgency to the HSE with proposals to address the needs of scoliosis patients between now and year end. The Health Service Executive, HSE, will consider these proposals as soon as they are finalised.

The real challenge in paediatrics is to maximise the efficient use of all health care capacity in Dublin and throughout the country. Paediatric services in Crumlin, Temple Street and Tallaght hospitals must increasingly work in a co-ordinated, shared and efficient fashion to prepare for the eventual coming together of the three institutions into one national paediatric hospital. With this in mind, the HSE is actively pursuing ways in which services in the three hospitals can be best co-ordinated, to avoid unnecessary duplication and to achieve savings that can be put back into patient care. For example, the three children’s hospitals in Dublin have agreed and developed a model for the development of a joint department of paediatric surgery. The clinical network in the three hospitals will make the best use of the resources available and will ensure a single system of care. A recruitment process is underway to recruit three replacement surgeons that will then give the joint department a complement of seven surgeons. Currently five are in place with another is due to retire shortly.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  There are six such surgeons in Northern Ireland.

Deputy Áine Brady: Information on Aine Brady  Zoom on Aine Brady  It is anticipated these posts will be filled by year end. The HSE commissioned a review in 2008 of paediatric critical care facilities and services with a view to addressing any identified deficits in advance of the opening of the new national paediatric hospital. The resulting report recommended that paediatric critical care services should operate as a single, joint clinical department for the Temple Street and Crumlin sites with a lead clinician, initially as part of a combined department of anaesthesia and critical care. The hospital in Tallaght does not have an ICU, intensive care unit. An Irish paediatric critical care network has been established as the advisory body to lead the development of a co-ordinated system for the delivery of paediatric critical care services and to develop advice, standards and recommendations regarding the optimum delivery of paediatric critical care services in the country.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  The Minister of State is suggesting nothing is wrong.

Deputy Áine Brady: Information on Aine Brady  Zoom on Aine Brady  An independent chair has been appointed, namely, Dr. Des Bohan, an internationally respected expert, to facilitate and guide the development of the joint department of paediatric critical care. Other areas currently being examined to increase co-operation include renal services, genetics, endocrinology and dermatology services, among others.

Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  That script should be returned to whoever wrote it.

Deputy Áine Brady: Information on Aine Brady  Zoom on Aine Brady  In the area of paediatric orthopaedics, it is important that services outside Dublin continue in such a way that unnecessary trips for children to Dublin are avoided. Therefore, the news that the HSE is to re-advertise for the paediatric consultant position is welcome and I trust the service in Cork can resume as soon as possible.

[891]Deputy Emmet Stagg: Information on Emmet Stagg  Zoom on Emmet Stagg  That is nothing more than a self-serving script from the Department.

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  I intend to share time with Deputies Terence Flanagan, Deasy, Clune, Connaughton and D’Arcy.

I welcome the opportunity to speak on this motion and I commend Deputy Reilly on tabling it. It has raised the profile of this very serious issue. I was with the delegation from the Joint Oireachtas Committee on Health and Children which visited the Crumlin hospital yesterday. I compliment the board and management on the time they spent with us, the openness of the information provided and on their deep concern for the hospital and its patients. I found the approach of those I met very humane and they expressed a great concern that the service they provide will be affected by the proposed changes.

A Government Deputy welcomed the fact that the planned closure did not take place. However, the reason it did not take place was the HSE approach, that is, to seek volunteers to absent themselves. It sought people to leave voluntarily but could not achieve the appropriate mix. In other words, the response was either all from nurses with no doctors or vice versa. The resulting mix was not right and it was not feasible to implement the planned closure. Those I met made this point very clearly. The intended cutbacks must now take place elsewhere, which, they have indicated, will affect patient services and the treatment of patients.

The hospital management made the point that the hospital, built in 1956, is a voluntary hospital and its operation and that of all voluntary hospitals is derived from public funding. It goes against the whole approach to suggest private funding should be involved. Any voluntary funding is used for research and capital development. These are the reasons such money is collected and why the organisations carry out such fund-raising. To switch such funding for use in the day-to-day running of the hospital is wrong and deceitful.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  Hear, hear.

Deputy Dan Neville: Information on Dan Neville  Zoom on Dan Neville  That is not the reason the money was collected nor is it the intention of the board of management that the money should be spent in that way. It is the duty of the Government to fund voluntary hospitals and to fund Crumlin hospital.

Crumlin serviced 135,000 patients last year, including 80,000 outpatients, 30,000 emergencies and 24,500 in-patients, rather than the figure of 10,000 suggested by the Government side. The issue of Birmingham hospital was raised. It was suggested we were not comparing like with like. However, the figures for Birmingham are based on inpatients and outpatients and the calculation for Crumlin hospital is for inpatients only. When one compares the same figures for both hospitals, the result is the same. The inefficiency suggested by some people in respect of Crumlin hospital is false. It has seven theatres, six of which are open, as previously mentioned. One theatre and some 25 beds have been closed because of the lack of finance.

It was made clear to the visiting delegation that Crumlin hospital provides a national service of interventions, some of which are exclusive to it such as oncology, haematology, cardiac, thoracic surgery, burns and medical genetics. It is also the national centre for cystic fibrosis. It is a key hospital in ensuring these services are provided.

It was pointed out to us on the wards that in any given ward there are people from all parts of Ireland, including the west, the south and the north. The hospital provides a service to the nation. It was also pointed out to us that at 13.6% of the total spend, management and administration costs are the lowest of any hospital in Ireland. Efficiencies exist in the management and administration of the hospital, an area often finger-pointed by people as inefficient. However this is not the case with Crumlin hospital.

[892]I refer to the proposed cuts. The approach of the Government is crude and determined on an historical basis. Much has changed in Crumlin hospital since the ballpark figures suggested by the Government. The board of management of Crumlin hospital seeks a complete analysis of what is required given the changed circumstances. It has no hesitation in welcoming an evaluation of its performance in the delivery of services. Any such evaluation would find areas are under-resourced rather than otherwise. Recent studies show an under-resourcing in intensive care. The Minister of State has made comparisons with 2004 but I remind her that the number of outpatients has increased by 23% since then, the number of theatre procedures has increased by 34% and the number of ICU beds has increased by 21%. The whole areas of service delivery has improved in numbers and because of improved medical developments.

Some 25% of the increase that has occurred in costs is a result of payments to staff on the basis of agreements. Therefore, there is no return for 25% of any increase and it must be paid in any event. The non-pay element is only 3% and the balance of 13% is related to increases in volume and complexity of interventions to save the lives of children, as already outlined. Prior to the time for which the Minister of State has made comparisons, cases of cardiac surgery were sent abroad at a substantial cost. Now, no cases of cardiac surgery are sent abroad and all such procedures are completed in Crumlin. They wish to develop other innovations such as national share-care programmes to keep more children at home. It was explained to us that when children are discharged programmes or personnel such as dietitians are not available to ensure those children have a healthy diet and that it complements the surgical intervention or treatment in Crumlin hospital. This service is not available on a nationwide basis. There are no nurses or nutritionists.

The social consequences are worse for children than for adults because if the surgery is not carried out, children grow with the problem which then causes difficulties. They cannot give an assurance that no emergency case will not be dealt with. They said that emergency cases may not be dealt with, that if the cuts continue we are going to fall further behind international norms for proper of children. They are regarded as some of the leaders in Europe. Much concern was expressed that the international norm of proper treatment for children would be dropped in Crumlin.

Deputy Terence Flanagan: Information on Terence Flanagan  Zoom on Terence Flanagan  I thank Deputy Reilly for bringing forward this Private Members’ motion on this critical subject, the cutbacks at Our Lady’s children’s hospital, Crumlin. Last month, a 25-bed ward was closed at Our Lady’s children’s hospital which has led to much-needed procedures being cut. There will also be reductions in outpatient clinics in August and in future months, which will cause severe disruption to services. This will naturally lead to longer waiting times for children who need urgent surgery. These cutbacks have resulted in the withdrawal of essential treatment for critically ill children and there has been an unacceptable increase in cancelled operations. The hospital is likely to see further ward and theatre closures which will see a reduction of outpatient appointments by 15% or 8,483 attendances and 1,100 admissions in 2009. In addition, the National Treatment Purchase Fund is not funding urgent cases and surgery for children experiencing acute pain and suffering, in spite of assurances given by the Minister for Health and Children on 21 May 2009.

The 3% cutback across the board by the HSE is causing great misery to the various children and families affected and takes no account of the fact of the increased costs to the hospital of new technologies, the transfer of orthopaedic services from Cork to Crumlin, the increase in the birth rate over the past number of years and the fact that savings can be made elsewhere in the HSE budget.

[893]Our Lady’s hospital, Crumlin is operating on a funding shortfall of €9 million. As a result of this shortfall, 25 beds and a theatre were closed last month and this has caused pain and suffering for children. This amount of money is small change in a total health budget of €15 billion.

Fine Gael calls on the Government to put children first and immediately reverse this thoughtless decision of reducing the hospital’s budget by €9.1 million and so alleviate the needless pain and suffering of hundreds of children. I ask all Deputies in the House to support this very reasonable motion from Deputy Reilly. There is no reason the Minister could not issue a directive to that hospital and other hospitals to ensure that the cutbacks do not take place on the frontline but rather in the back office. It is frightening to read that the management of Our Lady’s hospital in Crumlin will be unable to guarantee that urgent surgery and procedures will be treated. This realises the worst fears of parents and children.

I refer to the amount of wastage in the health service including the money wasted on public relations. Professor Brendan Drumm receives a salary of more than €500,000 which is huge money. There must be savings in salaries paid to the top people who are creaming the system. Funding must be directed towards children.

Jamie Murphy is a child who was forced to travel to London for immediate surgery because she could not receive it at Crumlin. She is just one of many children who continue to wait on waiting lists. This is unacceptable. A total of €5 million has been wasted in salaries for officers to work in a new children’s hospital which does not exist. This money would have been better used in Crumlin and such funding should happen as a matter of urgency.

Deputy John Deasy: Information on John Deasy  Zoom on John Deasy  I am very happy that a benefactor has stepped forward and has indicated that he or she is prepared to fund Jamie Murphy’s operation and I wish Jamie all the best. What struck me about the responses I received about Jamie’s case and the recent debate is the use of the word, “emergency” and the definition of emergency. The response I received from the Minister in Jamie’s case stated that no child has been denied access to emergency life-saving surgery due to the hospital’s financial break-even programme. If this is the case, why did this child need an anonymous donor to fund her operation in London? The family made it clear to me that the consultant made it clear to them the grave necessity of an immediate operation and the dire consequences of her not having that operation immediately. This was an emergency and it was delayed.

In the case of another young girl I refer to a letter from a GP to the consultant in Crumlin. The GP writes that he is aware of the situation with regard to the waiting list and the constraints put on the consultant with regard to doing this surgery. He writes that it is very distressing for her parents and for himself to see this girl with this condition having to wait an inordinate length of time to have the operation. He writes that it is a terrible pity that she has to deteriorate to a huge degree before she can have this essential surgery. He writes that he will be sending a copy of the letter to the HSE and to a TD in the hope of highlighting the problem with regard to the long waiting list. He writes that her family are quite adamant that they do not want to take the place of another equally seriously ill child on the waiting list.

In my opinion, “ a huge deterioration” in the case of a teenage girl is an emergency situation.

I refer to another case which came to my attention in the past few weeks. I received a letter from a GP which states:

This lady has asked me to forward details of her situation to your office. She presented in December 2008 with severe scoliosis, spinal curvature. This is progressive and has deteriorated considerably since that date and this is documented by repeated plane X-rays. She has [894]been assessed by the consultant in Crumlin and is on a waiting list for surgery. Prior to surgery if she requires an MRI scan, the earliest this can be done in Crumlin in the public system is early October 2009. Therefore, it will be at least a year before she will have urgent corrective spinal surgery in Crumlin. Her long-term outlook and degree of disfigurement would be greatly improved by the earliest possible surgical intervention. Next year is her leaving certificate so it was hoped originally to have surgery this summer so as not to interrupt her studies. In my opinion, disfigurement for a teenage girl is an emergency.

This morning on TV3 I watched a spokesperson for the HSE make the case that the situation was unacceptable but that it was up to the hospital not the HSE to deal with it. I noted the same attitude and the same approach in the Dáil this morning. This requires leadership. It is unacceptable to pass the buck back to the hospital and to swap responsibility between the Government and the HSE.

Deputy Deirdre Clune: Information on Deirdre Clune  Zoom on Deirdre Clune  Having listened to the debate tonight and last night Members, including those in the Government parties, should know the depth of feeling that surrounds the protection of our children, particularly when their health and well-being is threatened. This feeling is more intense when life saving and life improving procedures have been identified and cannot be implemented because of budgetary measures, or an absence of such measures.

  8 o’clock

We have all heard and read the heart rending stories of children and their parents who have been forced to publicise their cases in an effort to receive vital treatment. I am sure this is not a pleasant situation for many of them. They would prefer to receive the services they need and deserve without such publicity. These stories represent a very small number of the 24,000 day cases, the 30,000 emergency department attendees and the 80,000 out-patients who visit Crumlin hospital annually. Crumlin hospital is our largest children’s hospital, providing up to 80% of tertiary or highly specialised care for children across the State. It touches so many families and communities.

Children who are ill cannot survive without vital intervention. Everyone in this, so called, civilised society should be outraged at the way we treat these vulnerable children. I saw the statement issued by Our Lady’s Children’s Hospital, Crumlin this week. It outlines the background to the situation in which the hospital finds itself this year. In 2007, the hospital funding was €9 million less than its expenditure. That shortfall was resolved as a once off payment. In 2008, funding was €14.4 million less than the hospital’s projected spend. The HSE became involved and the shortfall was halved to €7 million by non-replacement of staff and management and by pay and non-pay issues. In 2009, expenditure is estimated to be almost €138 million. We are talking today of a shortfall of the order of €9 million in that projected budget.

I am glad the Joint Committee on Health and Children visited Crumlin hospital yesterday and saw the situation there. I have personal experience of the hospital as one of my children was treated there. I am sure many Members of the House have been touched by it. Everyone wishes the best for the hospital. It is recognised as the best. The hospital integrates families and provides a child focused recovery. These effective procedures, developed through many years of experience, have been outlined by many speakers today.

The Minister for Health and Children and the Taoiseach spoke of the need for Crumlin hospital to operate within a budget. This restriction cannot apply. More children are being born and procedures which were previously unheard of are now possible. Outcomes, particularly in the area of cardiac care, are much better. Premature babies now survive, many of them with complications which need intervention. All of this points to the fact that inputs into Crumlin [895]and the number of patients attending there have increased. An economic restriction such as this should not apply.

We need the different approach which has been outlined by the Fine Gael spokesperson. In our FairCare approach, the money would follow the patient. It does not make sense to ask a hospital like Crumlin, where numbers are increasing on an annual basis, to live within a budget. It certainly does not make sense to the children who find themselves without life saving services.

Deputy Paul Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  I congratulate my colleague, Deputy James Reilly, on spearheading this motion on behalf of every vulnerable child across the country. This debate on the children’s hospital in Crumlin epitomises everything that is wrong with the Irish health service. The fact that we had to bring this debate into Dáil Éireann shows that the HSE and the Minister have no sense of priority and no compassion for the most vulnerable in our society. The lesson I learn from the Crumlin story is that the HSE and the Minister have no idea what the parents of a sick child go through when they see their child pining away in front of their eyes, while waiting for the miracle surgery that will give their child a fighting chance to live a normal life.

Crumlin children’s hospital is different from most medical institutions. There is hardly a family in any townland, village, town or city in the country which has not been touched by the sheer professionalism, dedication to duty and proven track record of the best medical brains, not in Ireland or Europe but in the world. Crumlin hospital is embedded in the psyche of most Irish people. I have heard people say a thousands times that Crumlin is the place where small miracles are performed on small children every day of the week. They believe that to be the case, and so do I.

Most people outside this House believe it has little relevance to any subject matter. Whatever one says about Dáil Éireann, were it not for Dr. Reilly and the opportunity he has given the House, fewer people would have been seen in Crumlin this summer. It is a shame that even following this debate, one ward will be closed this summer.

I do not wish to be too political, but this is a political arena. The game is up for the Minister for Health and Children and the HSE. No one at a leadership level, either in Government or the HSE, knows the terrible grinding pressure on young parents when they see a child with, for example, a severe heart complaint unable to access the life giving procedures that are part and parcel of Crumlin.

We all know that the news is not always good in Crumlin. However, there is a world of difference between a situation where everything medically possible has been done for a child and one where a child did not get the required help on time. What galls parents is that when such facilities are available their child can be denied access at the crucial moment. That is what is wrong with closing the ward in Crumlin hospital.

When Government backbenchers are down the country they give the impression to parents that they will do everything possible to ensure that Crumlin hospital does what it is so good at. They will have an opportunity in half an hour’s time. We will see how many of them follow like sheep up the steps to the division lobby.

Deputy Michael D’Arcy: Information on Michael D'Arcy  Zoom on Michael D'Arcy  Our Lady’s Hospital for Sick Children is such an evocative name. It is one of the primary hospitals in the country for the treatment and care of sick children. Children from all over the country are sent there for medical treatment of various illnesses and conditions. The hospital has long been synonymous with the provision of quality treatment and care. It has enjoyed an excellent reputation and commands great respect.

[896]In view of the cutbacks children will be turned away. That is the reality. Worried parents will be caused more stress and anxiety for a saving of €9 million. With some applied thinking this money could be saved in many ways. The hospital issued a statement yesterday saying it wanted to reassure children and families that all emergencies will be catered for and the hospital will do everything it can to protect the sickest patients. I have no doubt the staff of Crumlin will work conscientiously to ensure this is the case. However, in the same statement the hospital admits that the measures will mean longer waiting times for some children for clinical assessment and non-emergency surgery. Most parents will tell you the most anxious time is awaiting a diagnosis after their GP has become concerned that something is wrong with their child that requires further investigation. Prolonging the wait for assessment and, subsequently, treatment will add greatly to the burden of stress and anxiety.

It is similar for parents of children requiring non-emergency surgery. The condition might not be life threatening but the surgery is required for good reason and delaying it will certainly affect the child’s quality of life and health. In some cases, delaying such treatment will mean turning non-emergency situations into emergencies. A total of 25 beds and one operating theatre will remain closed at the hospital. This is a very serious reduction of important services in this hospital.

A four year old little girl named Mollie D’Arcy, the daughter of my cousin, was diagnosed with a major heart defect when she was four weeks old. The quality of the service and the standard of professionalism in that hospital for my family were nothing short of magnificent. Mollie’s dad, Nicky, who is my first cousin, spent four months at the hospital. When Mollie was four months old she had a heart transplant. The service was magnificent. To cut it back or change it for money is reprehensible. It should not and cannot happen. I have been fortunate to see the benefit to a member of my family of that good service. To change it is nothing short of appalling.

Minister of State at the Department of Health and Children (Deputy Barry Andrews): Information on Barry Andrews  Zoom on Barry Andrews  I met with the board of Our Lady’s Children’s Hospital, Crumlin, about three weeks ago. We had a very good discussion about the future and the problems the hospital is facing this year. I appealed to the board then, and repeat the appeal now, that it buy into the new pediatric hospital for Dublin. We have been dragging our feet on this issue for too long. The proposal was first made in 2006; three years later we are still waiting for Crumlin hospital to commit to it.

Lest there be any doubt, I acknowledge, like Deputy D’Arcy and other Deputies, the wonderful work that is done in Crumlin children’s hospital. However, we must deal with the real world here. We need a single pediatric hospital in the city, as was established by the McKinsey report in 2006. Since then there have been potential judicial reviews, all sorts of position papers and, in my view, we have been buried in medical politics. The main argument against establishing this hospital on the Mater site has been its location. It is argued that it is a tight site, it is hard to get to and has no parking. However, Temple Street hospital, which is 400 yards down the road, has no parking and is difficult to access. The two main hospitals in London, Guy’s Hospital and Great Ormonde Street Hospital, have no parking but nobody argues about that.

Deputy Michael Creed: Information on Michael Creed  Zoom on Michael Creed  London has the Underground.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  Try to park in the vicinity of Crumlin children’s hospital — it is almost impossible. Three years later these arguments are holding this project back.

It has been made clear on many occasions that if we can achieve this new hospital, there will be considerable savings. This is not just about money. The clinicians will say the same. We [897]must put medical politics to one side, once and for all. This is a huge national issue but we end up having these debates and listening to the stories about sick children. It will happen again and again until we, as politicians, grasp this nettle. We must put vested interests to one side, now more than ever.

Deputy Michael Creed: Information on Michael Creed  Zoom on Michael Creed  The Minister has been in Government for more than ten years.

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  What does this have to do with the motion?

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  It is an appeal to the board of Crumlin children’s hospital.

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  What does this have to do with the motion on the closure of that ward?

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  What Deputy Alan Shatter’s lack of vision——

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  Outrageous nonsense.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  ——prevents him from seeing is that the recommendations of the McKinsey report——

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  The motion has nothing to do with that.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  ——found there would be €20 million in savings through the integration of these services. The Deputy is obsessed with the here and now; we are trying to prepare for the future.

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  The here and now is very important to children in need of medical care.

Acting Chairman (Deputy Jan O’Sullivan): Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Deputy Shatter will have an opportunity to speak.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  In north Dublin, the Mater Hospital is being developed, Broadstone is being redeveloped and, hopefully, Mountjoy will be developed in due course. All of these developments are taking place in the same area. Metro north is also to be delivered to the area, with a stop at the Mater Hospital. I ask the board of Crumlin children’s hospital to look to the future. The hospital absorbed savings last year of €7 million.

Acting Chairman: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  The Minister must conclude.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  I support the Government amendment. The debate has been about a black and white view of politics, where the monsters are the HSE and Government politicians. On the other side is the Opposition, with a monopoly on empathy with sick children. I reject that.

Deputy Paul Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  Do something about it.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  It is a monochromatic view of the world which is incurious. We must consider the real issues and the future of pediatric care in this country.

Deputy Paul Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  Keep the ward and the theatre open.

Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  I wish to share time with Deputy James Reilly.

Acting Chairman: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  Is that agreed? Agreed.

[898]Deputy Alan Shatter: Information on Alan Shatter  Zoom on Alan Shatter  The motion is about the capacity of Crumlin children’s hospital to meet the immediate needs of children who require surgical treatment or clinical assessment. These are issues that the Minister of State with responsibility for children, Deputy Barry Andrews, has managed to avoid addressing. It is what happens during the rest of this year that is of immediate relevance.

The Minister for Health and Children, Deputy Mary Harney’s main focus in her speech last night, like that of Deputy Barry Andrews tonight, was on the construction of the promised new national pediatric hospital to be built in 2014. She also talked about seeking to integrate services between Tallaght, Crumlin and Temple Street. She dealt with the vital issues of services currently available in Crumlin children’s hospital more as debating points than as the Minister in charge of our health service. Much of what she said was largely a red herring with regard to the current funding difficulties confronting the hospital and the anxiety of parents to ensure that children receive vital treatment.

Our Lady’s Children’s Hospital, Crumlin, is an efficiently run hospital of excellence, providing a continuously developing service to an increasing population of children. Dispassionate talk of cutbacks and financial savings by the Minister is merely a euphemism for depriving children of essential medical treatment and surgery. It is phraseology used to conceal the reality, which the hospital has acknowledged, that there will be longer waiting times for children for vital clinical assessment. Nowhere in her speech did the Minister refer to the closure of St. Joseph’s ward — the Minister of State with responsibility for children did not refer to it either — or the closure of a theatre. She did not address the increasing waiting list of children suffering from scoliosis and requiring urgent surgery. Nowhere did she address the impact of €9 million in cutbacks, which will lead to an estimated reduction of outpatient appointments of over 8,000 and 1,100 fewer hospital admissions.

The hospital announced on Monday evening there was a threat of closure of a second ward with 20 beds and a second theatre. The Minister last night welcomed the hospital’s announcement that these closures will not take place in July and August, but neither the Minister nor the hospital has guaranteed the closures will not take place in September, with a consequent further dramatic reduction in admissions and essential surgery and treatment.

The Minister does not present as somebody in charge of the health service. In her speech she came across as a semi-detached commentator on the service. While she acknowledged that nothing concerns parents more than the health of their children, she had nothing meaningful to say to parents who are distraught because essential surgery will be delayed or postponed by the cutbacks for which she is responsible. She had nothing to say about the impact of postponement or delay on a child’s quality of life or, in the case of scoliosis, about the long-term risk posed on attaining adulthood. Ministerial talk of “efficiency savings” which we heard last night is merely Orwellian newspeak for depriving children of access to essential medical care.

The Minister is a capable debater. Ten days ago she spoke eloquently about the State’s failures that were graphically described in the Ryan commission report. This report, she acknowledged, confronts us with an awful truth — the fact that we should be ashamed of our past with regard to our treatment of children. The truth is the Minister should be ashamed of her present with regard to her direct responsibility for depriving children of treatment. She should be ashamed that she is presiding over and defending a health service that has a pediatric hospital of excellence whose staff is being forced to turn children and their parents away from its doors. The motion on the Ryan commission report committed this House to cherishing all of the children of the nation equally. There is terrible hypocrisy and deceit in this Government and the Minister for Health and Children being party to such a motion and within days betraying their obligation to children in need of medical care.

[899]Members of the previous and current Fianna Fáil-led Governments have engaged in political soapbox oratory about children’s rights and their welfare. There has been talk of a constitutional referendum. Most recently, the Minister for the Environment, Heritage and Local Government, Deputy John Gormley, climbed onto the soapbox when speaking on the Ryan commission report and pretended that the Green Party had some commitment to a children’s rights amendment to the Constitution, despite the fact that the only Green Party member of the children’s rights committee, Deputy Paul Gogarty, has attended only approximately four of the approximately 50 meetings of that committee.

The truth is that soapbox oratory is not matched by action. Fianna Fáil, the Green Party and the Minister for Health and Children, Deputy Harney — who, at this stage, has practically re-entered the Fianna Fáil Party — regularly throw shapes but have no commitment of any nature to children’s rights, in this case, the basic right of a child in a civilised democratic society to gain access to medical care.

Yes, we are in the middle of a recession and cutbacks in Government expenditure are essential. In making cutbacks, however, there are values to be protected, principles to be applied and priorities to be recognised. The utter failure of the Government to recognise that providing essential medical treatment to children must remain a continuing priority starkly illustrates the extent to which it is both politically and morally bankrupt. It is bereft of any recognisable principles or values.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I start by reminding the Minister of State, Deputy Andrews, that this debate is not about the Never-Never Land of a paediatric national hospital but about cutbacks of today that are hurting children who are in pain and suffering today. It is about today.

I will not repeat all that I said last night but I must remind people of the efficiency of Crumlin hospital, its increased productivity in day and theatre cases and in outpatients. Some of the statements comparing it to Birmingham have been refuted already. Birmingham’s inpatient and day cases were matched with Crumlin’s inpatient cases on their own. This is disingenuous at best.

I reiterate what I said last night about the needless pain that children will suffer because of delayed surgery. They may need five episodes of surgery, with five episodes of post-surgical pain, where one would have more than sufficed. I think of what Deputy Paul Connaughton said a few minutes ago and I realise the staff in Crumlin are stars — but the children are heroic.

The Minister said last night that our document shows a 3% cut. That is across all Departments, not across all hospitals. If I were Minister for Health and Children, I would look to the hospitals that deliver the sort of efficiencies Crumlin delivers. Under the money-to-follow-the-patient regime of budgeting we wish to bring in, Crumlin hospital would receive more money, not less, be allowed do more operations, not fewer, and would be allowed keep more of this country’s children for treatment, not fewer.

It matters greatly who the Minister for Health and Children is although last night the Minister tried to pretend otherwise. She goes for the easy cut and does not look hard. She is tough on children but not on reform. I shall return to that point. Is she tough on reforming the HSE? There is no sign of it. She goes after the weakest in society instead of going after waste in hospitals and in management.

Concerning the working group idea which has been trotted out yet again, Crumlin hospital asked for this in 2007 but suddenly today it is the panacea for all our ills. Last night there was talk about the National Treatment Purchase Fund and the cost of scoliosis treatment. Under the NTPF, scoliosis treatment would not be as wasteful as certain other treatments because the surgeons in question are public surgeons who will not charge private fees if they do the work [900]elsewhere. Cappagh hospital is a public hospital. There is no problem there. What is stupid and inexcusable, however, is the closing down of a perfectly good theatre in Crumlin with its team in place, and referring the lot over to Cappagh. To what end? It is ludicrous and a waste of money.

I return now to the budget of Crumlin hospital. A speaker mentioned a figure of €144 million, which is incorrect. The figure is €138 million from which the Government wants to take €9.1 million. That sum of €138 million represents less than 1% of the €16 billion that we spend on health in general. I remind the Minister of State that there are 1.25 million children in this country who represent over 30% of our population. He wants to cut €9 million from their budget.

The facts speak for themselves. An elderly lady once said to me “You know, Doctor, the truth isn’t fragile, it won’t break.” I assure the Minister of State that in this case the truth will not break either. I think of the disingenuity of the Minister of State, Deputy Moloney, who suggested that treatment delays might be the patient’s fault. I shall return to that but now offer the point made to me by the doctors in Crumlin, namely, deferred treatment is always more expensive. The money still has to be spent but more than likely there will be complications.

Deputy O’Sullivan mentioned the coldness of the Ministers last night. I wrote that down on my page. The cold dispassionate approach, seeing children as mere statistics, shown by the Minister, Deputy Harney, and the Minister of State, Deputy Moloney, said more about their attitude than I could ever say.

I shall read out some of the statements made by the Minister of State. He said, “Our Lady’s Hospital Crumlin is no different from any of our hospitals”. I guarantee to him that 1.25 million children in this country would believe otherwise. He also said, concerning reasons for operations not taking place, “The patient may be deemed unfit to proceed, the procedure may be cancelled by the patient or the guardian”. How many times has that happened? He went on to say, “There may be normal re-scheduling due to appointment times not being suitable”. That is code for “we cannot take you because of the cutbacks”. The Government has lost touch with the people in a major way.

I wish to raise some other points in the few minutes that remain. Why is there no national czar or leader for paediatrics in this country? We have one for cancer. How many patients with cancer are there in this country? How many children? Talk is cheap but action takes longer. Let us not forget the 1.25 million children. We talk about waste. I asked last night why, when billions of euro are being provided for the bankers there are cutbacks for our children.

I say to the Minister of State to look elsewhere for the savings, to look at the waste within the HSE. I was challenged on this point last night by a claim there were only one or two such areas. The sum of €60 million was paid for taxis. A 10% saving in that area would yield €6 million. Money spent on consultants to deconstruct the HSE amounted to €1 million. Private consultants and spin doctors were paid €17 million. In the HSE bureaucracy there were six Grade 8 personnel when it started. Now there are 700, all earning more than €80,000. Advisors to the Government were paid €6.2 million. There is the national drugs bill for which there was a €50 million shortfall in expected savings and no attempt made to prescribe generic drugs, by which hundreds of millions of euro could be saved.

HSE banking inefficiencies cost €20 million per year. Consultants’ contracts face a spend of €50 million due to a loophole in the contract. The hospitals’ cleaning bill cost €578 million, up 54% since 2005. We need them clean but we should not be cleaned out while we are doing it. How many millions have been wasted on decentralisation of Government? Professor Brendan [901]Drumm said there were 3,000 to 4,000 people in the HSE who did not know what their jobs were. All this waste, but the Minister of State wants to go after the children.

  9 o’clock

Last night Deputy Mary White said she could not attend the hospital because she could not find a pairing. My Whip told me that was not the case. She is delighted about the very welcome news that Jamie Murphy will now have her operation abroad through the goodwill of a benefactor. I, too, welcome the relief this will bring to the Murphy family. However, what of the hundreds of other families and children? The Deputy is silent on this matter. Did she not say in this House two weeks ago that she would cherish all the children equally? It is in her gift, as the deputy leader of the junior partner in Government. Tonight she can bring that same joy and relief to hundreds of other families by voting for our motion to stop these cuts.

Deputy Paul Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  Hear, hear.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  I want Deputy White and her Green Party to look at this issue tonight. I want them and their colleagues in Fianna Fáil to realise what their vote would mean to families, to patients such as Dakota Rudd and Carol Ann Walsh and to Conor Coughlan, who is in the Visitors Gallery tonight. I welcome him and his mum and dad, Con and Mary. I salute his courage. I can look these people in the eye. I hope the Minister of State will be able to do so after tonight. The Taoiseach’s words today gave no consolation to these children and their families.

The reason I entered politics was because of health. Nothing is more political than health and I do not buy the buck that we are politicising health. It is political everywhere one goes. Co-location of our hospitals is political. Having no cancer centre north of a line between Galway and Dublin is political. The failure to address reform in the HSE is political. In fact, it is political cowardice, the worst kind of which is attacking the weakest in society. Removing special classes from learning disabled children and medical cards from the elderly, meanly means testing the terminally ill, making them queue——

Acting Chairman: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  I must put the question.

Deputy James Reilly: Information on Dr James Reilly  Zoom on Dr James Reilly  ——for a place to die and denying young girls a life saving cervical cancer vaccine are political decisions. Now, the Government wants to delay life saving surgery for children. This is the last straw.

The motion aims to prevent cutbacks at Crumlin hospital that would otherwise result in suffering for children caused by us, who vowed to protect them only two weeks ago. It is a test for us. I say to the Minister of State and his colleagues in the Government that actions speak louder than words. They should act now and stop this needless suffering of children or forever hold their heads in shame. I commend the motion to the House.

Deputies:  Hear, hear.

Acting Chairman: Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  As it is 8.30 p.m., I must put the question on amendment No. 1 in the name of the Minister for Health and Children.

Deputy P. J. Sheehan: Information on P. J. Sheehan  Zoom on P. J. Sheehan  She is not present.

Amendment put.

The Dáil divided by electronic means.

[902]Deputy Paul Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  I wish to call a vote under Standing Order 69. I was horrified this evening when I got a call from the Irish Independent stating Deputy Mary White could not get a pair from the Fine Gael Party to go to Crumlin hospital. The Fine Gael Party was never asked for a pair by Deputy White to go to Crumlin hospital.

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  We cannot discuss that now.

Deputy Paul Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  As a result, I am calling a vote under Standing Orders. I ask the Members opposite to look into the eyes of the little children in the Gallery——

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  No, we will not go into that now. We have had a discussion on the motion.

Deputy Paul Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  ——and consider the consequences of turning left or right in the lobbies.

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  The Deputy is out of order.

Deputy Paul Kehoe: Information on Paul Kehoe  Zoom on Paul Kehoe  As a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.

An Ceann Comhairle: Information on John O'Donoghue  Zoom on John O'Donoghue  As Deputy Paul Kehoe is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby. The vote will now proceed.

Amendment again put.

The Dáil divided: Tá, 72; Níl, 67.

Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot. Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael.
Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Chris Andrews  Zoom on Chris Andrews  Andrews, Chris. Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán.
Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Aine Brady  Zoom on Aine Brady  Brady, Áine. Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian.
Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny. Information on John Browne  Zoom on John Browne  Browne, John.
Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas. Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara.
Information on Pat Carey  Zoom on Pat Carey  Carey, Pat. Information on Niall Collins  Zoom on Niall Collins  Collins, Niall.
Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret. Information on Sean Connick  Zoom on Sean Connick  Connick, Seán.
Information on Brian Cowen  Zoom on Brian Cowen  Cowen, Brian. Information on John Cregan  Zoom on John Cregan  Cregan, John.
Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán. Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin.
Information on John Curran  Zoom on John Curran  Curran, John. Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy.
Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley. Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul.
Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel. Information on Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary.
Information on Mary Harney  Zoom on Mary Harney  Harney, Mary. Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán.
Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie. Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy.
Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan. Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael.
Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony. Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus.
Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom. Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian.
Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor. Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas.
Information on Mattie McGrath  Zoom on Mattie McGrath  McGrath, Mattie. Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael.
Information on John McGuinness  Zoom on John McGuinness  McGuinness, John. Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin.
Information on Micheál Martin  Zoom on Micheál Martin  Martin, Micheál. Information on John Moloney  Zoom on John Moloney  Moloney, John.
Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael. Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J.
Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon. Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán.
Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh. Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie.
Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie. Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel.
Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  O’Hanlon, Rory. Information on Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt.
Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary. Information on Christy O'Sullivan  Zoom on Christy O'Sullivan  O’Sullivan, Christy.
Information on Seán Power  Zoom on Seán Power  Power, Seán. Information on Dick Roche  Zoom on Dick Roche  Roche, Dick.
Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon. Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor.
Information on Eamon Scanlon  Zoom on Eamon Scanlon  Scanlon, Eamon. Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan.
Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel. Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary.
Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra. Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.



Níl
Information on James Bannon  Zoom on James Bannon  Bannon, James. Information on Seán Barrett  Zoom on Seán Barrett  Barrett, Seán.
Information on Joe Behan  Zoom on Joe Behan  Behan, Joe. Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P.
Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard. Information on Ulick Burke  Zoom on Ulick Burke  Burke, Ulick.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Catherine Byrne  Zoom on Catherine Byrne  Byrne, Catherine.
Information on Deirdre Clune  Zoom on Deirdre Clune  Clune, Deirdre. Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul.
Information on Noel Coonan  Zoom on Noel Coonan  Coonan, Noel J. Information on Joe Costello  Zoom on Joe Costello  Costello, Joe.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Michael Creed  Zoom on Michael Creed  Creed, Michael.
Information on Lucinda Creighton  Zoom on Lucinda Creighton  Creighton, Lucinda. Information on Michael D'Arcy  Zoom on Michael D'Arcy  D’Arcy, Michael.
Information on John Deasy  Zoom on John Deasy  Deasy, John. Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy.
Information on Andrew Doyle  Zoom on Andrew Doyle  Doyle, Andrew. Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J.
Information on Damien English  Zoom on Damien English  English, Damien. Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn.
Information on Frank Feighan  Zoom on Frank Feighan  Feighan, Frank. Information on Martin Ferris  Zoom on Martin Ferris  Ferris, Martin.
Information on Charles Flanagan  Zoom on Charles Flanagan  Flanagan, Charles. Information on Terence Flanagan  Zoom on Terence Flanagan  Flanagan, Terence.
Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon. Information on Brian Hayes  Zoom on Brian Hayes  Hayes, Brian.
Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom. Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D.
Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Enda Kenny  Zoom on Enda Kenny  Kenny, Enda. Zoom on George Lee  Lee, George.
Information on Ciaran Lynch  Zoom on Ciaran Lynch  Lynch, Ciarán. Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Pádraic.
Information on Shane McEntee  Zoom on Shane McEntee  McEntee, Shane. Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny.
Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian. Information on Joe McHugh  Zoom on Joe McHugh  McHugh, Joe.
Information on Liz McManus  Zoom on Liz McManus  McManus, Liz. Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia.
Information on Dan Neville  Zoom on Dan Neville  Neville, Dan. Information on Michael Noonan  Zoom on Michael Noonan  Noonan, Michael.
Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín. Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus.
Information on Kieran O'Donnell  Zoom on Kieran O'Donnell  O’Donnell, Kieran. Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus.
Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim. Information on John O'Mahony  Zoom on John O'Mahony  O’Mahony, John.
Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian. Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan.
Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie. Information on John Perry  Zoom on John Perry  Perry, John.
Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat. Information on Dr James Reilly  Zoom on Dr James Reilly  Reilly, James.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Alan Shatter  Zoom on Alan Shatter  Shatter, Alan.
Information on P. J. Sheehan  Zoom on P. J. Sheehan  Sheehan, P. J. Information on Sean Sherlock  Zoom on Sean Sherlock  Sherlock, Seán.
Information on Róisín Shortall  Zoom on Róisín Shortall  Shortall, Róisín. Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet.
Information on David Stanton  Zoom on David Stanton  Stanton, David. Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy.
Information on Joanna Tuffy  Zoom on Joanna Tuffy  Tuffy, Joanna. Information on Mary Upton  Zoom on Mary Upton  Upton, Mary.
Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.  

Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.

Amendment declared carried.

Question put: “That the motion, as amended, be agreed to.”

The Dáil divided: Tá, 71; Níl, 62.

Information on Dermot Ahern  Zoom on Dermot Ahern  Ahern, Dermot. Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael.
Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel. Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry.
Information on Chris Andrews  Zoom on Chris Andrews  Andrews, Chris. Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán.
Information on Bobby Aylward  Zoom on Bobby Aylward  Aylward, Bobby. Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall.
Information on Aine Brady  Zoom on Aine Brady  Brady, Áine. Information on Cyprian Brady  Zoom on Cyprian Brady  Brady, Cyprian.
Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny. Information on John Browne  Zoom on John Browne  Browne, John.
Information on Thomas Byrne  Zoom on Thomas Byrne  Byrne, Thomas. Information on Dara Calleary  Zoom on Dara Calleary  Calleary, Dara.
Information on Pat Carey  Zoom on Pat Carey  Carey, Pat. Information on Niall Collins  Zoom on Niall Collins  Collins, Niall.
Information on Margaret Conlon  Zoom on Margaret Conlon  Conlon, Margaret. Information on Sean Connick  Zoom on Sean Connick  Connick, Seán.
Information on Brian Cowen  Zoom on Brian Cowen  Cowen, Brian. Information on John Cregan  Zoom on John Cregan  Cregan, John.
Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin. Information on John Curran  Zoom on John Curran  Curran, John.
Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy. Information on Tim Dooley  Zoom on Tim Dooley  Dooley, Timmy.
Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael. Information on Michael Fitzpatrick  Zoom on Michael Fitzpatrick  Fitzpatrick, Michael.
Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán. Information on Beverley Cooper-Flynn  Zoom on Beverley Cooper-Flynn  Flynn, Beverley.
Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul. Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel.
Information on Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary. Information on Mary Harney  Zoom on Mary Harney  Harney, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Jackie Healy-Rae  Zoom on Jackie Healy-Rae  Healy-Rae, Jackie.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. Information on Brendan Kenneally  Zoom on Brendan Kenneally  Kenneally, Brendan.
Information on Michael Kennedy  Zoom on Michael Kennedy  Kennedy, Michael. Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony.
Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus. Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom.
Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian. Information on Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor.
Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas. Information on Mattie McGrath  Zoom on Mattie McGrath  McGrath, Mattie.
Information on Michael McGrath  Zoom on Michael McGrath  McGrath, Michael. Information on John McGuinness  Zoom on John McGuinness  McGuinness, John.
Information on Dr Martin Mansergh  Zoom on Dr Martin Mansergh  Mansergh, Martin. Information on Micheál Martin  Zoom on Micheál Martin  Martin, Micheál.
Information on John Moloney  Zoom on John Moloney  Moloney, John. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J. Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon.
Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán. Information on Darragh O'Brien  Zoom on Darragh O'Brien  O’Brien, Darragh.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel. Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  O’Hanlon, Rory.
Information on Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt. Information on Mary O'Rourke  Zoom on Mary O'Rourke  O’Rourke, Mary.
Information on Christy O'Sullivan  Zoom on Christy O'Sullivan  O’Sullivan, Christy. Information on Seán Power  Zoom on Seán Power  Power, Seán.
Information on Dick Roche  Zoom on Dick Roche  Roche, Dick. Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon.
Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor. Information on Eamon Scanlon  Zoom on Eamon Scanlon  Scanlon, Eamon.
Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan. Information on Noel Treacy  Zoom on Noel Treacy  Treacy, Noel.
Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary. Information on Mary Alexandra White  Zoom on Mary Alexandra White  White, Mary Alexandra.
Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.  


Níl
Information on James Bannon  Zoom on James Bannon  Bannon, James. Information on Seán Barrett  Zoom on Seán Barrett  Barrett, Seán.
Information on Joe Behan  Zoom on Joe Behan  Behan, Joe. Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard.
Information on Ulick Burke  Zoom on Ulick Burke  Burke, Ulick. Information on Joan Burton  Zoom on Joan Burton  Burton, Joan.
Information on Catherine Byrne  Zoom on Catherine Byrne  Byrne, Catherine. Information on Deirdre Clune  Zoom on Deirdre Clune  Clune, Deirdre.
Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul. Information on Noel Coonan  Zoom on Noel Coonan  Coonan, Noel J.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Michael Creed  Zoom on Michael Creed  Creed, Michael.
Information on Lucinda Creighton  Zoom on Lucinda Creighton  Creighton, Lucinda. Information on Michael D'Arcy  Zoom on Michael D'Arcy  D’Arcy, Michael.
Information on John Deasy  Zoom on John Deasy  Deasy, John. Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy.
Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J. Information on Damien English  Zoom on Damien English  English, Damien.
Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn. Information on Frank Feighan  Zoom on Frank Feighan  Feighan, Frank.
Information on Martin Ferris  Zoom on Martin Ferris  Ferris, Martin. Information on Charles Flanagan  Zoom on Charles Flanagan  Flanagan, Charles.
Information on Terence Flanagan  Zoom on Terence Flanagan  Flanagan, Terence. Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon.
Information on Brian Hayes  Zoom on Brian Hayes  Hayes, Brian. Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom.
Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D. Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil.
Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul. Information on Enda Kenny  Zoom on Enda Kenny  Kenny, Enda.
Zoom on George Lee  Lee, George. Information on Ciaran Lynch  Zoom on Ciaran Lynch  Lynch, Ciarán.
Information on Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Pádraic. Information on Shane McEntee  Zoom on Shane McEntee  McEntee, Shane.
Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny. Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian.
Information on Joe McHugh  Zoom on Joe McHugh  McHugh, Joe. Information on Liz McManus  Zoom on Liz McManus  McManus, Liz.
Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia. Information on Dan Neville  Zoom on Dan Neville  Neville, Dan.
Information on Michael Noonan  Zoom on Michael Noonan  Noonan, Michael. Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín.
Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus. Information on Kieran O'Donnell  Zoom on Kieran O'Donnell  O’Donnell, Kieran.
Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus. Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim.
Information on John O'Mahony  Zoom on John O'Mahony  O’Mahony, John. Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian.
Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan. Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie.
Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat. Information on Dr James Reilly  Zoom on Dr James Reilly  Reilly, James.
Information on Michael Ring  Zoom on Michael Ring  Ring, Michael. Information on Alan Shatter  Zoom on Alan Shatter  Shatter, Alan.
Information on P. J. Sheehan  Zoom on P. J. Sheehan  Sheehan, P. J. Information on Sean Sherlock  Zoom on Sean Sherlock  Sherlock, Seán.
Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet. Information on David Stanton  Zoom on David Stanton  Stanton, David.
Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy. Information on Joanna Tuffy  Zoom on Joanna Tuffy  Tuffy, Joanna.
Information on Mary Upton  Zoom on Mary Upton  Upton, Mary. Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.

Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.

Question declared carried.


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