Dáil Éireann debate -
Tuesday, 12 Dec 2017

Vol. 963 No. 1

Topical Issue Debate

Traveller Community

Deputy Éamon Ó Cuív

Tá áthas orm go bhfuil an tAire Stáit féin tar éis teacht isteach leis an gceist a thógáil. I thank the Minister of State for taking this matter. I am aware of his concern regarding the Traveller community and his commitment to trying to progress issues.

There was a big occasion in the House earlier this year when Travellers were declared an ethnically distinct group in our society. The real question is whether this will translate into a change in their status and well-being. The Traveller community survey that was carried out is extremely informative. It shows the serious challenges faced by the Traveller community. I compliment the Traveller organisations and the Community Foundation for Ireland for commissioning this analysis. It follows many other analyses. I recall a study carried out, as part of a far bigger analysis of social attitudes, by an tAthair Micheál MacGréil in which he tracked this issue over many decades. The standing of many groups changes but, as he said at the time, the standing of Travellers is the great apartheid in Irish society.

The highlights from the survey are quite scary. Some 62% said that accommodation issues are worse than they were five years ago and 72% said that mental health issues are worse than they were five years ago. Unemployment, at 50%, is worse than five years ago. The survey states that 60% are not working but when one adds to that the number who are on schemes or in Traveller community work, we find that it is over 90%. This means only 10% are in commercial employment. More seriously, 0% of Travellers are in State employment. This is an issue I tried to deal with when I served as a Minister. We looked at ways of ensuring that people from the Traveller community would be brought into the public service. Another pertinent factor is the fact that only 30% of Travellers who get training end up in employment. That is a very low progression rate.

Some 36% of Travellers state that they have very poor health, which is way above the national average. We are aware of the suicide rate and, in particular, there is a high rate of mental health issues among men, as well as low self-esteem. Unfortunately, 48% say that they have experienced discrimination at the hands of the Garda and 25% say they have experienced it with housing authorities. Unlike their counterparts in the settled community, a very high percentage of Travellers must interact with housing authorities for public housing. A much higher percentage of the rest of the community provides its own housing and would not have day-to-day contact with housing authorities. The figure in respect of pub staff, shop staff and so forth is approximately 30%. A figure that those of us who work consistently with Travellers can testify to is the 90% who say that they have been the subject of discrimination by the public at large at some time in their lives. It is interesting that, in this survey and the one last year, the figure for Connacht-Ulster is 10% to 20% lower, which shows there is more social acceptance in that province.

Minister of State at the Department of Justice and Equality (Deputy David Stanton)

I thank Deputy Ó Cuív for raising this important matter. We both acknowledge that the Traveller Community National Survey is a timely and valuable resource. I have read it a number of times. It covers a range of important issues affecting the Traveller community.

As the Deputy will be aware, last June I launched the national Traveller and Roma inclusion strategy for the period from 2017 to 2021. I am sure the Deputy has a copy of it. If he does not, I will arrange for a copy to be sent to him. The steering group, which I chair, was established to oversee the development and implementation of the strategy. This group is made up of officials representing relevant Departments and agencies, as well as representatives from the national Traveller non-governmental organisations, NGOs. The strategy contains ten themes. Grouped under these, 149 actions were identified as necessary to help to advance the betterment of the lives of Travellers and Roma in Ireland. To date, work has begun on approximately 100 of the actions. Accommodation is highlighted as a priority for Travellers in both the strategy and the survey. The 2018 capital provision for Traveller-specific accommodation is €12 million, an increase of €3 million on 2017. Further funding may be considered throughout the year, also on a case-by-case basis, in light of progress across the programme generally.

Regarding education, the national strategy contains 14 key education-related actions. While improvements on education outcomes for Travellers as opposed to five years ago are reflected in the 2017 national survey, I am well aware that much more needs to be done, and is being done, in this regard. In fact, a sub-committee of the national strategy steering group has been established to deal with the issue of retention of Traveller and Roma children in education. At its most recent meeting, a proposal was jointly agreed by my Department, the Department of Education and Skills and Tusla to implement a pilot project on this issue in four locations with high Traveller and-or Roma populations. Tusla's education welfare service, comprising the statutory Education Welfare Service, the school completion programme and the home-school community liaison scheme, are key supports for Traveller children.

Earlier this year, the Department of Education and Skills published the DEIS Plan 2017. The plan includes specific actions relating to Traveller and Roma education to promote improvements in school attendance and completion. It should be noted that the Department of Education and Skills continues to provide a number of specific additional resources to support Traveller and Roma children in the school system, including: 141 alleviation resource teacher posts for schools with significant numbers of Travellers and Roma at a cost of €8.46 million; and additional pupil capitation for Travellers and Roma, at a rate of €70 per pupil for primary level and €201 per pupil for post-primary level, at a cost of €1.11 million.

The outcome of the first strand of the programme for access to higher education, PATH, funding was announced by the Minister for Education and Skills in April 2017 and €2.7 million will be allocated through PATH 1 over the next three years to support initiatives by centres of teaching excellence to increase diversity in the teaching profession. Through the PATH 2 1916 bursaries fund, €6 million will be invested in bursaries for students from target groups, including Travellers, over the next three years. Each bursary will be worth €5,000 per year and may be held in addition to a Student Universal Support Ireland, SUSI, grant. The PATH 3 higher education access fund is intended to support regional clusters of higher education institutions to attract 2,000 additional students, full-time or part-time, from groups currently under-represented in higher education, including Travellers. A total of €7.5 million will be allocated over the next three years through the PATH 3 fund.

Turning to access to employment, the Department of Employment Affairs and Social Protection operates a wide range of employment supports. While, in general, the Department's measures are available to Travellers on the same basis as the rest of the population, community employment has special provision for members of the Traveller community.

Traveller health is also a priority area under the national strategy. Examples of targeted support programmes include funding of a range of Traveller agencies and groups to implement priority programmes and actions via service level agreements, such as primary health care projects, counselling services, family support programmes, men's health projects and so forth. In addition to funding to agencies for the delivery of Traveller health programmes, the HSE employs a number of public health nurses and related staff to address priority health needs of members of the Traveller community. In addition, the National Office for Suicide Prevention funds Exchange House Ireland to address the mental health promotion and suicide prevention needs of the Traveller community. Nine mental health service co-ordinators are currently being recruited by the mental health division of the HSE with the aim of driving, managing and supporting implementation of agreed Traveller programmes and actions in respect of Traveller mental health.

The Department of Agriculture, Food and the Marine has allocated approximately €500,000 to support several projects specific to Travellers nationwide on the basis of proposals received from local authorities regarding developing facilities for the urban Traveller horse population.

A great deal more is being done, and it needs to be done.

Deputy Éamon Ó Cuív

I thank the Minister for his comprehensive reply. In the limited time available, I wish to focus on two important issues. The first is that we provide money for Traveller-specific accommodation.

The problem is that under our current system, we can bring the horse to water but we cannot make it drink. The reality is that in many local authority areas, including one very close to me, the local authority is not drawing the money down despite it being available and is not making the hard decisions because there is local opposition. It is very hard to get a Part 8 and where it involves voluntary housing, they stop it because they will not sell the land.

One thing that could be done in 2018 is to change the law if necessary to take responsibility for making decisions about Traveller-specific housing away from local authority members and give it to An Bord Pleanála, where most issues wind up anyway. The Minister of State knows that when it involves the local authority, the reality is that members must vote and that just does not happen in some local authorities. It is non-functional.

The other issue is employment. It is interesting when we look at education because it is one place where significant improvement was made between 2000 and 2017. The percentage of those with the junior certificate has gone from 9% to 39% while the percentage with the leaving certificate has gone from virtually 0% to 16%. The percentage at third level is 5% between postgraduate, undergraduate degree, diploma and other third level. That is a great improvement from nothing. It is small but it is an improvement. However, we are not translating that into the workplace. The State should ensure that quotas are put aside to ensure that Travellers are incorporated in the public service and Civil Service. The social change that would bring about would be immense because the more we integrate people into the mainframe of society, the more the pace of change will accelerate, everybody will have a better life and the community will feel more included in Irish society.

Deputy David Stanton

I acknowledge the Deputy's point that the recognition last March by the Government and indeed by all parties here of Travellers as an ethnic minority represented a crucial step forward in the relationship between the Government, the Traveller community and the settled community. It is my aim that the national Traveller and Roma inclusion strategy will build on this landmark decision and we will work to bring about concrete improvements in the lives of Travellers across the country. The national strategy is a work in progress. I ask everybody to support and become aware of it to ensure it works.

Again, I note the Deputy's understandable concerns about the issues affecting the Traveller community, which have been covered by this survey. My Department and I are ensuring that progress continues to be made regarding tackling each of the areas of concern raised in the national Traveller community survey. Implementing the national Traveller and Roma inclusion strategy is a key objective of mine in co-operation with other key stakeholders. Again, I ask councillors around the country to row in behind this strategy and support it. They have a responsibility as councillors to do that.

In line with the objectives of the national strategy, the programme that is of real benefit to Travellers is the social inclusion and community activation programme, SICAP, which has the aim of reducing poverty and promoting social inclusion and equality through local, regional and national engagement and collaboration. The SICAP funding allocation for front-line delivery for 2017 is €37.5 million, which includes an allocation of €3 million under the European Social Fund's programme for employability, inclusion and learning programme 2014-20. It is a key priority of Government and as a key intervention for the hard to reach in society, the Deputy will be pleased to know that the programme's target groups include Travellers in particular. From 1 January to 21 March 2017, SICAP supported 22,105 individuals, of which 385 self-identified as Irish Travellers with 147 local community groups supported under SICAP where Travellers are a named target group.

I note the Deputy's desire for more Travellers to be included and employed by the State, including Government Departments. Again, this is also part of the strategy. The strategy is very new, having been launched in June. I look forward to everybody supporting it and working through it. Everybody agrees that the challenges are enormous. There is a lot to be done.

Respite Care Services

Deputy Fergus O'Dowd

I thank the Ceann Comhairle and other Members of the House for facilitating this debate. It is hugely important that carers are recognised and supported. It is a fact that there has been a crisis in respite services in County Louth. I welcome the interest shown by all my colleagues in Leinster House both in the Dáil and Seanad in resolving this issue. I acknowledge the intent and commitment of the Minister of State, Deputy Finian McGrath, in respect of dealing with this issue not just in County Louth, but around the country.

It is shameful that families have been left in this appalling situation for too long. When one sees how people like Jacinta and May in Dundalk and others - I am just using first names - look after their families and care for them and their total commitment, one sees how all their lives are devoted to their family members. They look after them at home but when they need urgent care and respite, it is not available in County Louth. I know a recent edition of "Prime Time" identified what we need to do. I welcome the Minister of State's commitment to solving this problem and that he came to Drumcar to see an issue there in a school for children with disabilities.

It is very important that, as our economy improves, the funding, services and support are put in behind those who care most and who have the least amount of help. I know that in CHO8, in which the HSE operates in our area, over 100 people are waiting for respite care, which is a huge number. It is unacceptable. We have gone through a very difficult period economically. Now that our economy is restored, the funding must be found and I hope the Minister of State has good news for us today. I will hand over to my good friend and colleague, Deputy Breathnach.

Deputy Declan Breathnach

Yet again, we are here highlighting the plight of the families in Louth looking for respite care for their loved ones. When I came into this House, I gave a commitment that I would champion the cause of people with disabilities collaboratively with my colleagues in the Dáil and Seanad. We have continued to highlight that issue to the Minister of State. Like Deputy O'Dowd, I thank the Minister of State for his interest in trying to solve the problem not just in Louth, but across the country. In respect of Louth, it took the "Prime Time" programme entitled "Carers in Crisis" for many of us to realise the difficulty faced by these families due to the lack of respite care, which is clearly not just a crisis in Louth, but across the country. These families have been left alone to cope.

Despite all the parliamentary questions we have put and all the opportunities to raise the matter under the Order of Business or Questions on Promised Legislation, this is the second, if not the third, Topical Issue on this matter. A resolution can be found. We have put a series of proposals to the Minister of State over a period of time and I am sure Department officials have looked at them. Praxis Care has recently purchased a property in Dundalk and the Talbot Group has an ideal property in Balbriggan. I am sure that with the Minister of State's help and encouragement, a resolution can, it is to be hoped, be found in my constituency. The figures in County Louth have always been skewed because of the St. John of God operation in Drumcar and the funding it receives, which covers a lot of people across the country. I would welcome a statement from the Minister of State that these facilities, which are badly needed in Louth, will be provided urgently.

Minister of State at the Department of Health (Deputy Finian McGrath)

I thank Deputies Breathnach and O'Dowd for lobbying me for many months on this important issue. I also thank the Deputies for giving me the opportunity to outline the position regarding the provision of respite services in County Louth. Let me make it clear at the outset that the Government's ongoing priority is the safeguarding of vulnerable people in the care of the health service.

We are committed to providing services and supports for people with disabilities that will empower them to live independent lives. In recent months, I have spoken to many people with disabilities and their families and carers. The same point has been raised again and again on the absolutely urgent need for increased respite care throughout the country. I accept it as a valid argument and that is why I appeared on "Prime Time" last week to face the music and deal with the issue. I have made it very clear to my colleagues in government and after much discussion, my colleague, the Minister, Deputy Simon Harris, and I have secured an additional €10 million for the HSE, specifically to enhance respite care in the disability sector. We agreed that extra €10 million at Cabinet.

Many people with disabilities are being cared for by very elderly parents who are finding it very hard to cope. Other carers simply do not have the hours in the day to look after other members of their families and, just as importantly, their own health and well-being. The full details of the services to be provided with the additional €10 million will be contained in the HSE’s detailed operational plan. I have made it clear that this money must be ring-fenced for respite services within the disability sector and that it must be targeted at those who are most in need. I am pleased to inform the House that €8 million will be provided for nine new dedicated houses for respite in each community health area, plus an additional three houses in the greater Dublin area to respond to the very high demand for respite in this area. These additional 12 respite houses will provide approximately 19,000 respite nights yearly to the people living in those areas. In addition, a further €2 million extra funding will be used for innovative respite solutions, such as home sharing and extended day services, to provide assistance where people need it most. I will be keeping a very close eye on how this additional funding is put to work and I will be requiring the HSE to give the utmost priority to putting these new facilities and services in place without delay.

I accept that the provision of respite services has come under additional pressure in the past number of years. More children and adults are now seeking access to respite and the changing needs of people with a disability are also having an impact, as they, along with the rest of the population, live longer lives. A Programme for a Partnership Government recognises the need for respite services to be developed further and I am fully committed to ensuring this happens.

In the context of respite services in County Louth, discussions are ongoing at CHO area 8 level regarding the emerging need for additional respite services and the options to be developed to meet these needs. The HSE continues to work with agencies to explore various ways of responding to this need in line with the budget available. The additional funding I have announced today will include the development of respite services in CHO area 8, including County Louth. The officials in CHO area 8 are familiar with the TaIbot Bower House proposal for respite services. Scoping out the most efficient way of commissioning respite services with this new money will be an immediate priority for the HSE to ensure services are brought on stream without delay. The Deputies will appreciate that any proposals can only be considered within the funding available to the HSE and must adhere to a rigorous procurement process.

I warmly welcome the extra €10 million for respite services because it is urgently required.

Deputy Declan Breathnach

I welcome the Minister of State's announcement. It will be music to the ears of the many families and disability groups who have encouraged us to harass and harry the Minister of State over the past number of months. I had no doubt of the Minister of State's concern to have this matter resolved. I welcome his commitment to the allocation of €10 million and his commitment to make sure one of these facilities will be based in Louth. Further to that, it is most important that with the age profile of families and the growing numbers who will need these services that we continue to enhance them in the years to come. With that in mind, the issue of the funding of the St. John of God in Drumcar, which came to almost €32 million, needs to be examined in terms of whether we are getting value for money in delivering those services. I will speak on that matter later. I thank and commend the Minister of State for bringing some respite to a very difficult situation in Louth.

Deputy Fergus O'Dowd

I agree absolutely with the Minister of State and my colleague opposite that this is really good news for everybody who needs respite care. It is a start but it is not the final answer. It is a way of finding a reasonable solution. There is nothing reasonable about people who are on their own who cannot cope. There is nothing reasonable about a person bringing a family member to a house in the middle of the night, only to be refused entry and having to go to an acute hospital instead to take up an acute bed with a security person outside the door and all sorts of other issues. It is an unacceptable situation. This will definitely help to resolve it. There is no doubt about that and I welcome it. I welcome the commitment to ongoing discussions and the Talbot Bower House proposal, which I visited. It is a very fine place.

This is an issue on which all political parties stood together. Fianna Fáil, Fine Gael, Sinn Féin and the Labour Party stood together to push for something and we got it. It is a positive result for a community that needs 100% support.

Deputy Finian McGrath

I thank Deputies Declan Breathnach and Fergus O'Dowd for repeatedly raising this issue. I am very much aware of the importance of access to planned respite which ensures that people with disabilities receive opportunities to socialise separately. It facilitates families having a break from caring because it is very difficult. Respite services may vary according to the excess needs of the individuals and their carer. The model of respite is changing and although some require overnight respite, others prefer to benefit from day respite. The number of overnight respite places has been reducing as persons with disabilities seek alternative models such as day respite or extended day care. We will also look at those areas. For example, 42,552 day respite services were provided in 2017. Personally, and throughout my political career, I have always advocated for the rights of people with disabilities. I understand and acknowledge the value and importance of respite care for people with disabilities and their families. I hope this funding will enable people to get a well-deserved break and to maintain their own health and well-being.

As I said earlier, I will keep a very close eye on how the additional funding is put to work. I will require the HSE to give the utmost priority to putting these new facilities and services in place without delay because it is a very important part of our disability services. We put €1.763 billion into the social care plan in 2017 and we have to ensure it goes to people with disabilities and their families and carers. That is where our priority should be. The 2017 plan deals with 5,720 people with a disability who avail of day-based respite services. We have another 2,500 who avail of respite services, such as holiday respite or occasional respite and we also have other respite services. We have 128 new emergency residential places, which is a priority issue for me.

I thank my colleagues for their support. We will fight on and develop the services but above all the services will operate in the interests of the person with the disability.

HSE Staff Recruitment

Deputy James Browne

I want to address the lack of psychologists in our health service. Often when I or other Deputies highlight service gaps in mental health services provision or the fact that CAMHS staffing levels are barely more than half that recommended in A Vision for Change, the response by the Government is to cite difficulties in recruitment as a key cause of the difficulties.

However, some of these difficulties could well be self-inflicted. I am speaking in particular to the recruitment of psychologists by the HSE. There has been an issue with this for a number of years especially related to whether they were clinical or counselling psychologists. In 2009 the HSE established a working group of psychology managers to review recruitment procedures for psychologists. Criteria were developed that clearly favoured clinical psychologists for employment in the HSE. Counselling psychologists were deemed eligible to work with only one care group despite already working in the areas from which they were suddenly deemed ineligible.

As a consequence of this, counselling psychologists were excluded entirely from child and adolescent mental health, CAMH, services between 2009 and June 2016. A review process was conducted resulting in some progress being made with regard to the opening up in principle of HSE posts to psychologists other than clinical psychologists. Ultimately it made some helpful and some unhelpful recommendations. The major concern is the stipulation that psychologists who have completed training programmes that do not map neatly to specific criteria around placements were deemed as ineligible for particular care areas in 2016 and 2017 recruitment campaigns and could potentially never be able to work in the HSE after October 2019.

The effect of the recommendations in the period since the issuing of the report has been that trainee psychologists other than trainee clinical psychologists do not know whether they will be eligible to work in the HSE after they graduate. They may be faced with an effective lifetime ban on working in the HSE if the October 2019 stipulation stands.

After the issuing of the review report in June 2016, the HSE convened an implementation group to look at the issue emerging from the report but it seems its terms of reference were extremely narrow. The report of that group was, as I understand it, issued in June 2017 but remained with the national director and was not released until 22 November 2017 despite repeated requests from multiple interested stakeholders. Trinity College Dublin has sought and is still seeking a response from the HSE about the problems that are being caused for the current doctorate in counselling psychology programme. IMPACT and the Psychological Society of Ireland have made attempts to engage with the HSE but the executive has still not responded.

The exclusionary recruitment practices used by the HSE for psychologists do not exist in other countries, including the United Kingdom. Its practices are also in direct contravention of the recruitment policy of the Psychological Society of Ireland. As long as the HSE continues to make inadequate use of high-quality psychologists because of its demonstrated preference for clinical psychologists only, will we not continue to face what the HSE terms recruitment challenges?

Deputy Finian McGrath

I thank the Deputy for raising this very important matter. The Minister, Deputy Harris, sends his apologies. I have a particular interest in the area of psychology and I keep a close eye on it in my role as Minister of State with responsibility for disabilities.

I thank the Acting Chairman for allowing me the opportunity to set out the current criteria and practices for recruiting HSE psychologists. Over the years, there have been ongoing issues with the eligibility criteria for recruitment to HSE psychologist positions. In particular, a change to the eligibility criteria in 2009 made it more difficult for counselling and educational psychologists to obtain employment in the HSE. This change led to the development of eight care groups. Clinical psychologists were eligible for employment in all eight care groups. Counselling and educational psychologists were eligible for employment in one of these care groups.

In order to address these issues, a review commenced in 2015 to examine the eligibility criteria and to make recommendations. The purpose for the review was to ensure the availability of a good supply of candidates with the appropriate skills and experience to meet the needs of service users. The 2016 report of the review group made a number of recommendations, which were accepted. It recommended revised eligibility for entry into competitions for psychology posts, both at basic and senior level. The review group also recommended that the number of care group areas be reduced from eight care groups to four.

It also recommended changes in eligibility. These changes mean that counselling psychologists are now eligible to apply for psychologist positions in all four care group areas. Educational psychologists are eligible for two. The HSE advises that the new care group criteria have been implemented since 1 March 2016 and applied to basic grade and senior psychology competitions held throughout 2016 and 2017. In addition, the review group also looked at the qualification requirements. It has recommended a broadening of these requirements. Instead of named psychology qualifications only, eligibility will be made up of a combination of qualifications and placement or supervised work experience.

An implementation group, chaired by an independent chairperson, has been established to map out the practical steps necessary to implement the revised eligibility requirements. On conclusion of its work, I am advised that the implementation group submitted its report and recommendations to the HSE leadership team for consideration. After its consideration, the HSE accepted all the recommendations in full. I understand that the implementation date has been deferred, for operational reasons, until October 2019. This means that the current criteria for placements remain in effect until then.

I understand that four of the other recommendations made by the implementation group can be implemented without delay. One of these is the formation of a group composed of recruitment managers and principal psychology managers. This group will consider any new definitions to be used in advance of recruitment competitions. It will also deal with unforeseen or difficult decisions that may arise during competitions. This will ensure that fairness and consistency can be protected.

Another important recommendation approved by the leadership team is the creation of a national psychology placement office. In order to prepare for this, a project team will be established to advance this recommendation.

I am confident that the implementation of the recommendations as outlined will significantly improve the role of the psychology services in supporting vulnerable service users and their families.

Deputy James Browne

The Minister of State mentioned the placement criteria several times. The concern is that the HSE may be trying to compel a large number of existing employees to complete very extensive in-service training in order to maintain eligibility for their own jobs for promotion or transfer. This would severely affect service capacity and the opportunity for service development, as well as the career opportunities available to those employees. It is likely that this will not apply to clinical psychologist employees but only to counselling and educational psychologists. There is no clear rationale for the requirement other than an attempt to implement criteria which have already been shown to lead to multiple problems.

IMPACT has notified the HSE of this numerous times but it has failed to account for it. There are no such requirements, for example, for counselling psychologists employed in the NHS in the UK. The bottom line is that although the recent report is positive in tone, the threat of placements not being recognised and thus graduates being ineligible still stands as the new definitions of appropriate placement are potentially as ambiguous as in the past and could be used to exclude some graduates on an ad hoc basis, as has occurred in the past. As written, they seem to exclude HSE adult primary care services. We still urgently need somebody in the HSE with authority to pre-approve a placement as eligible and help to secure such a placement. There are enough senior psychologists in the system to cater for it.

Although there are enough high-quality psychologists who are appropriately qualified, as would be recognised in the UK, HSE placement requirements, in particular undefined and ad hoc requirements, are excluding those highly qualified psychologists. This is the concern that has been raised by Trinity College, the Psychological Society of Ireland and IMPACT. The issue needs to be addressed as a matter of urgency.

We are constantly being told we have a severe shortage of psychologists, but the bodies that know their stuff maintain that the psychologists are there but the HSE is blocking them for ad hoc reasons.

Deputy Finian McGrath

I again thank the Deputy for raising this very important matter. I will bring his comments and views back to the Minister, Deputy Harris.

As of October 2017, there are 954 psychologists employed in the HSE, of whom 925 are clinical psychologists. That is the up-to-date situation. We must not create unnecessary delays in attracting the right health-care professionals to the right positions.

It is clear that there is a vital role for all psychologists, clinical, counselling and educational, in our health service. That is the reason we must all do what we can to employ those individuals to ensure that our health service is as good as it can be.

I am confident that the new framework, as recommended by the review and which is fully under way, will be more than fit for purpose. I am pleased that the Health Service Executive, HSE, is putting in place the necessary supports to enable that. For example, the national psychology placement office will ensure that psychology students of all disciplines have equal access to the placements they need to pursue their chosen careers.

This will go a long way towards protecting our most vulnerable patients by ensuring that services are in place where they are needed the most. On the other issues, I will relay the Deputy's views to the Minister, Deputy Harris.

Acting Chairman (Deputy Eugene Murphy)

I thank the Minister of State. I also thank Deputy Browne for his co-operation. The final Topical Issue is in the name of Deputy Tóibín.

Hospital Services

Deputy Peadar Tóibín

I want to protest at the outset, and no harm to the Minister of State, Deputy Finian McGrath, about the fact that the Minister, Deputy Harris, has not come into the House to take this Topical Issue. Members do not get many opportunities to make a case on significant issues of health in their own counties and when they do, they like to ask questions and tease out issues. The Minister of State, Deputy McGrath, however, will only be able to read a script on this issue. That is not good enough.

Eighteen thousand patients visited the emergency department in Navan hospital in the past year, with 5,500 of those staying overnight in the medical unit in the hospital. Those figures are increasing. Our hospital is a great hospital and we have great staff in Meath. It has proven to be successful in reducing the length of time patients have to stay in the hospital and it has also been successful in reducing the level of readmissions to our hospital. It is one of the best hospitals in the country for dealing with people who have had heart attacks and strokes. It has also taken on a massive amount of new elective surgery from the Mater Hospital.

The hospital serves the whole of the county of Meath, which has a population that is growing radically. When I was a child, approximately 100,000 people lived in County Meath. There are now 200,000 of us and quarter of a million people will be living in the county within the next 20 years, making it one of the most populous counties in the country by far.

Not all the news is good, however. Last September, we saw the near collapse of the accident and emergency department in County Meath due to unofficial industrial action by agency doctors. Navan is more exposed than any other hospital to agency doctors and to this type of strike action because all of the doctors in the accident and emergency department are agency doctors. That means that the HSE does not want to give a full, decent contract to doctors working in the accident and emergency department in Navan because it does not expect there to be an accident and emergency department in Navan for long. Also, I have asked the Minister, Deputy Harris, a number of times by way of parliamentary questions the number of agency doctors and other agency staff working within the health service and I have been told by his Department that it does not know, which is a shocking indictment in terms of the way that service is being currently managed.

Navan used to have a great record with regard to trolley counts. It used to have one of the lowest trolley counts in the country. From January to the beginning of November this year, more than 2,200 people have been on trolleys in Navan. The numbers on trolleys have quadrupled in the space of one year. Why has that happened? Why is it the case that there are four times more people on trolleys so far this year than in the entirety of last year? What does the Minister of State intend to do about that? If a situation arises where there are delayed diagnoses there will be delayed treatment and if there is delayed treatment, there will be sub-optimum outcomes for patients, which is not good enough. I imagine one of the reasons for that is the fact that on a given day this year there were 20 people in Navan hospital who were clinically discharged, that is, 20 people for whom the doctors could do no more but who had nowhere else to go within the health service. Their pathway to further treatment was blocked. There are two State nursing homes in Meath and both of them have equally as many people waiting to get into them as are residents. It means that many people are in hospital beds in Navan because they have nowhere else to go. That is reducing the opportunity for people to access decent accident and emergency health services in County Meath.

Acting Chairman (Deputy Eugene Murphy)

I thank the Deputy for his co-operation.

Deputy Finian McGrath

I first apologise on behalf of the Minister, Deputy Harris. I will deal with this issue.

I thank Deputy Tóibín for raising this important issue because for many years he has been a strong advocate for developing our health services and putting forward sensible suggestions. I strongly take his views on board. I am grateful to Deputy Tóibín for giving me the opportunity to update the House on accident and emergency services in County Meath. Tackling the challenges in emergency departments generally is a key commitment of the Government and I am delighted that €40 million in additional funding has been made available in 2017 as part of the 2018 budget to address winter pressures and waiting lists. That funding will be aimed at reducing overcrowding in our hospitals in this period through the provision of extra capacity and additional supports.

Our Lady’s Hospital, Navan provides a general acute hospital service to the catchment area of Meath and currently provides accident and emergency services in County Meath. Since 2013, the hospital has been part of the Ireland East Hospital Group. Every hospital in that group, large or small, has a vital role to play, with the smaller hospitals such as Navan managing routine, urgent or planned care locally, while more complex care is managed in the larger hospitals and with better linkages with primary, continuing and social care. As a smaller hospital, the challenge is to make sure that Navan provides more of the right type of services for the people of Meath, which can be safely be delivered in order that we maximise the benefit to all patients.

To ensure that the hospital continues to play a significant role in the Ireland East Hospital Group in providing sustainable, safe and effective care at the appropriate level of complexity, a number of developments already have been funded at Navan hospital in recent years. In addition to the refurbishment of the emergency department, there has been an upgrade of general theatres, an upgrade of the sterile services unit, the addition of new end-of-life care family rooms and a garden within the hospital, as well as an allocation of capital funding of €755,000 for the replacement of various equipment. There has also been an increase in day surgical activity, with surgeons from the Mater Hospital carrying out day surgery in Navan. Further developments regarding surgery and other clinical services at Navan are being considered by Ireland East Hospital Group.

The HSE has advised that there are no immediate plans to change the current emergency service configuration of services at Navan. The Ireland East Hospital Group is engaged in a programme of redesign work to further integrate and enhance the role of Navan hospital as a constituent hospital within the hospital group. The hospital group is continuing to engage closely with all interested parties to ensure that the needs of patients, staff and the local and wider community are addressed. Any changes to the emergency department services in Meath would only occur following consultation with key stakeholders, including health professionals at the hospital and other hospitals in the hospital groups, the National Ambulance Service, and community and public representatives.

Deputy Peadar Tóibín

The Minister talks about creating extra resources within the health service but the small hospital framework document states that Our Lady's Hospital will lose accident and emergency, intensive care and coronary care services, as well as 24-hour anaesthesia. How is that increasing the resources within the hospital? I love this; this is rule by euphemism. We have a situation where redesign effectively means the downgrading of a level 3 hospital to a level 2 hospital. That is at a time when 94,764 people spent time on hospital trolleys last year in this State. Such is the pressure in Navan it is forced to open escalation wards that the Minister of State's Government will not even fund currently.

The Minister of State might be able to answer this question. I understand that the Minister, Deputy Harris, met the Ireland East Hospital Group very shortly after the budget. That group asked him if they could close the accident and emergency department in Navan. The Minister stated that it could close the accident and emergency department in Navan if it convinced the people of Meath that it was a good idea. I understand the Ireland East Hospital Group is working to try to convince local doctors that it is a good idea but how can it be a good idea? We only have to look at what happened in Cavan and Drogheda hospitals when Monaghan and Dundalk hospitals were closed.

Both of those hospitals were hammered with some of the highest waiting lists the country has ever seen. The contradiction in all of this is that, in 2015, the then Minister for Health visited Navan to open up the shiny new accident and emergency department. That Minister for Health was our current Taoiseach, Deputy Varadkar. There has been no change in the ability of Navan hospital to provide decent health care services. If it was good enough for Deputy Varadkar in 2015, should it not be good enough for the Minister of State at the Department of Health, Deputy Finian McGrath, and the current Minister of Health, Deputy Harris, that this service remains open and safe into the future?

Deputy Finian McGrath

I will bring the issues raised back to the Minister and will raise the Deputy's points very effectively. The Government has put additional funding into the emergency services this year. The emergency department at Navan hospital has been refurbished and €750,000 was provided for the replacement of various equipment. There has been an increase in day surgical activity. I am informed that, "The HSE has advised that there are no immediate plans to change the current emergency service configuration of services at Navan". That is what I have been told, but I will bring Deputy Tóibín's concerns back to the Minister and also the specific questions he asked about meetings. I am not aware of the meetings he mentioned.