asked the Minister for Health if he is aware that the Midland Health Board will be short £1.9 million in their allocation for 1985; and if he will make a statement on the cutbacks he proposes to introduce in the Midland Health Board area.

The Midland Health Board have adopted a package of proposals which provides for the rationalisation of services in their area. The package takes account of the approved allocation level for 1985 and the likely level of available resources in subsequent years.

Has the chief executive officer of the Midland Health Board informed the Minister and the board that he will be able to provide the same level of service as last year and that there will be no cutback in any of the services in the board area this year as a result of the shortfall of £1.9 million?

I assure the Deputy that, on the basis of the implementation of the rationalisation proposals for the area, the health board have assured me that they will remain within the approved level of expenditure for 1985, 1986 and 1987.

There are no rationalisation proposals at this time. What I am asking is if the health board will be able to keep the level of services in their area at the same level as last year? That is what I want to know. The answer is a simple "yes" or "no". Will the Minister guarantee that there will be no closure of any day care centre, clinic or otherwise which we had in the board area last year? It is a simple question.

There is no simplicity in the health services. The health board put forward a package in relation to the hospital services and other services in their area. It is a comprehensive package which is very detailed. As far as I am aware, the Deputy knows about that, but if he does not I can make the package available to him.

That refers to Question No. 3 and and Question No. 2.

On the basis of the package being approved — I have approved it in principle — the health board assure me that they will be able to maintain a full level of service for the population of the Midland Health Board area.

The Minister stated that he approves of the entire package in principle. Does that allow for his statement in the House two weeks ago on an Adjournment debate when he said that he would have a further review of the proposals? He said that in front of his Labour Party colleagues in the Gallery.

The only outstanding issue in relation to the package is one of further consultations between my Department and the CEO of the health board to ensure that accident coverage in the Athlone area in relation to ambulance services is effective. That has been the subject of review. In consultation with the health board I hope to make an improvement in that aspect of the health board's services. That apart, the totality of the package proposed by the health board has been accepted by me and will be implemented.

Athlone is to get an improved ambulance service and nothing else out of the Minister's review of the rationalisation proposals?

The review has taken place. As I indicated when I spoke in Mullingar on 18 February, the entire package put forward by an overwhelming majority of the members has been accepted by me and is now being implemented.

Athlone is to get nothing.

In regard to the allocation to the Midland Health Board area, my information is that in this financial year they will not be able to maintain the same level of service as last year. Is that right or wrong?

It is wrong. The non-capital allocation for the health board this year is £55.2 million as compared with £52.485 million last year. The health board are confident that, on the basis of implementing that package in 1985, they will remain within the overall approved level of allocation and, if anything, the service will improve considerably.

How does the Minister propose that the Midland Health Board will eliminate their deficit?

By implementing the package relating to the various hospitals and to the rationalisation of services, the Midland Health Board assured me that the savings will be very substantial.

There will be no deficit?

Furthermore, the concentration of the maternity and paediatric services in Portlaoise and Mullingar saves a considerable amount of money and is entirely rational and beneficial in terms of the provision of services in the midlands. I am the first Minister for Health in the history of this State who has sanctioned two paediatric consultant posts in the midlands, which was a disgrace up to now.

I asked about the deficit.

For the first time in the history of the midlands children when born will have the services available and we will not have a fractionalisation and a multiplicity of services in Portlaoise, Tullamore and Mullingar.

Athlone does not love the Minister.

This will be of enormous benefit. I am very pleased that I got great support from the members of the health board on this question.

And the chief executive officer.

He is one of the best in the country.

He answered the minute the Minister called.

Ceist 3.

3.

asked the Minister for Health if he has received a document on the institutional services review for the Midland Health Board as passed at a meeting of the Midland Health Board in December 1984; and if he will make a comprehensive statement on his position regarding this very important matter which results in the closure of Tullamore maternity unit, and taking into consideration the fact that on 20 June 1984 in reply to a Dáil question, he gave a commitment to appoint a paediatrician to Tullamore Hospital.

I have received a rationalisation plan for hospital services from the Midland Health Board and given my approval in principle to it. In particular I have approved the establishment of a regional orthopaedic unit in Tullamore, the concentration of maternity services for Laois-Offaly in Portlaoise, the establishment of an associated paediatric unit in Portlaoise, and the provision of a new geriatric unit in Edenderry.

I am satisfied that the plan proposed by the Midland Health Board provides the best solution from both the medical and organisational points of view for the provision of hospital services in this area and discussions are taking place between officers of my Department and officials from the board on the measures which have to be taken to implement the plan.

I have been concerned for some time at the lack of paediatric and orthopaedic services in this area and my previous statement on the appointment of a paediatrician to Tullamore was designed to remedy the situation in relation to paediatrics. However, since that time considerable efforts have been made to find a viable solution to the broader issues and these have resulted in the preparation of the plan which I have now approved and which means that in-patient paediatric services for the area are now to be provided in Portlaoise with associated outpatient clinics in Tullamore.

I would be grateful if the Minister would tell me whether he has given the necessary permission to the Midland Health Board to advertise for the orthopaedic consultants and the ENT consultants. Have the board or the officials in the Department costed this proposal?

The immediate issue was the concern of the health board to get the paediatric service under way and approval from Comhairle na nOspidéal for the appointment of the paediatric consultants. I gave that approval as a first step. I am extremely anxious that it should be dealt with as a matter of urgency. The development of the orthopaedic unit in Tullamore is under discussion currently between the Department and the health board. I have not got sufficient information on that. I will write to the Deputy. There is no question of any delay.

With all due respect to the Minister, there seems to be a difference of opinion on this proposal because the Minister for Defence, Deputy Cooney, gave an undertaking to the people of Longford-Westmeath that the orthopaedic unit would be in Athlone. I believe the Taoiseach gave the same undertaking before Christmas.

That is information. The Deputy must ask a question.

What is the position? With all due respect to the Minister, is this the proposal he approved in principle? Does the total package stand?

I like the Deputy's gentle mischievousness. The package does stand.

Therefore the commitment given by the Minister's Cabinet colleague is of no consequence. Is that correct?

That is argument.

It is not argument. It is a fact. He gave a further commitment since then that this decision would be reversed.

In view of the demand for orthopaedic consultants in the midlands, when will the Minister be in a position to give the go ahead? We like to see things moving on the ground.

The go ahead was given on 18 February and there will be absolutely no delay.