Dáil Éireann debate -
Tuesday, 12 Nov 1991

Vol. 412 No. 5

Adjournment Debate. - Environment and Health Matters.

Mr. R. Bruton

The issue I want to raise is accessibility for people with a disability to the taxi service.

The pitiful degree to which public facilities are accessible to people with a disability is a matter of shame. People with a disability are literally left on the side of the road. They cannot get into many of our public buildings. They cannot board any of our bus fleet and can rarely get a taxi that can accommodate them.

Perhaps the most telling testimony of all is that this House itself is not accessible to people with a disability because of the various obstacles in the way. Equally, most of our polling stations are inaccessible. That is a testimony to the lack of attention given to the needs of people with a disability when framing policy.

Even their needs as voters and as possible Members of the House are not considered. We are systematically closing off opportunities for persons with a disability to take part in community life in a proper fashion.

In the past few weeks the Government once again decided that the needs of those with a disability must wait still longer. They have issued an order under which an extra 100 taxi plates will be made available in Dublin but they are not making it a requirement that any single one of them be wheelchair accessible or accessible to people with severe disability. This is a downright disgrace and shame on us as able-bodied politicians. It is not too late to change the decision as none of the plates has yet been issued. I suggest that 25 of the new plates be set aside for persons who are willing to provide wheelchair accessibile vehicles to be used by those with severe disability. I accept that this would pose problems for some taxi owners but in relation to this quota the Government should agree to waive a substantial part of the proposed £3,000 licence fee for adapted vehicles. I would ask the Minister of State to consider this suggestion sympathetically.

Minister of State at the Department of the Environment (Mr. Connolly)

Meeting the needs of people with disabilities was always seen as an important part of the review of the law relating to the operation of small public service vehicles. The question of wheelchair accessible taxis has been considered by the interdepartmental committee set up to study the law in this area but it was not found possible to provide for the introduction of suitable vehicles in the interim measures announced on 25 October 1991.

Those measures, particularly the decision to authorise the granting of 100 new licences, were designed to secure an immediate improvement in the level of service provided by taxis in the extended Dublin taxi-meter area. There is a very limited range of vehicles available which would be suitable for use by wheelchairs even with adaptations. It is not a simple matter of adapting standard saloon cars which make up the taxi fleet in this country.

The problem of fixing a specification for a wheelchair accessible taxi is currently being addressed and recommendations in relation to the provision of such vehicles are expected to be included in the final report of the interdepartmental committee. That report is expected in March 1992. I can assure the Deputy that I will bear his remarks in mind.

Mr. R. Bruton

There are thousands of them in London.

Mr. Connolly

The interdepartmental committee will examine that matter and we will wait and see what proposals they have to make in that regard.

Mr. Allen

If it was a State car it would be done.

Mr. Nealon

The north Sligo water supply augmentation scheme was submitted to the Department of the Environment by Sligo County Council in 1986. Since then the water supply for the area has continued to deteriorate but there has been no action on the part of the Department and nothing has been done about it.

The original north Sligo water scheme, dating from 1960, was designed to bring a water supply to the village of Grange. Since then it has been greatly extended, mainly through group schemes. It now supplies areas such as Cliffoney, Mullaghmore, Maugherow, Carney, Lissadel and Gortarowey. The water supply is totally inadequate to meet the demand. The capacity was designed for 220,000 gallons a day but the need is for roughly twice that amount. Those simple figures are the easiest way to demonstrate the water crisis that exists. Many of the houses and the areas are without water for long periods on a regular basis.

Unlike most other parts of the country, the population of north Sligo is, fortunately, growing. Many planning permissions for houses have to be turned down simply because no new connections to the water supply can be granted. This is an extremely popular tourist area with greatly increased demands on the water supply during the tourism season. Development in this industry is also greatly curtailed because of the water supply limitations. The same goes for farming.

The cost of the augmentation scheme is not excessive. It will cost something in the region of £1.2 million. An excellent new source of water supply is available. All documentation is with the Minister and the scheme is the number one priority of Sligo County Council. All that is needed is approval and funding from the Minister. I hope he will quickly notify Sligo County Council of both. I also hope that tomorrow the excellent service given by the Minister of State, Deputy Connolly, at the Department of the Environment will be rewarded with him being given a top job. If so, I hope he will give immediate attention to the north Sligo water supply augmentation scheme.

Mr. R. Bruton

Flattery will get you everywhere.

Mr. Connolly

I thank Deputy Nealon for his kind remarks and I am pleased he has brought this matter to our attention. In 1990 a grant under the small water and sewerage schemes programme was allocated to upgrade the treatment plant and improve water quality at the north Sligo regional water supply augmentation scheme. I am aware there are still some difficulties with the current supply in the north Sligo area and that further works are desirable. However, having regard to the level of commitments and the number of high priority schemes competing for the limited capital funds available it is not possible to say when the scheme will be approved to go to tender and construction stage. In the light of what the Deputy has said I will keep the matter in mind and see what I will be able to do to help when funds become available.

Mr. R. Bruton

I am very concerned about what is happening in our hospitals right across the country. The health boards and hospitals are closing wards for the rest of the year in an effort to stay within their budgets with the result there will be substantial reductions in admissions for scheduled operations. I am aware that in some cases such admissions have come to a virtual standstill. Let me take the Mid-Western Health Board as an example to illustrate this point and I have no doubt my colleagues from the west and north-west could cite many others.

They plan to cut our 10,500 in-patient days during the second half of this year with the result that waiting lists in one of the smallest health board areas will be increased by at least 2,000 people. Recently the Minister had to come into the House to announce that the average waiting time for admission to a public hospital for a routine hip replacement operation in this health board area was two years to two and a half years. The same is true in the case of every other health board. As the Minister is aware, the new accident and emergency rota has led to Dublin hospitals being plunged into chaos. As a recent report to the Minister points out, hospitals in Dublin are providing a full-time emergency service. Many departments are now reporting that admissions for scheduled operations are at a standstill while the waiting lists for Dublin hospitals, which stood at 15,000 at the end of the summer, are now substantially higher. The real tragedy is that this foolish measure will not lead to a red cent being saved, rather it may cost the Department money.

Since the Dáil resumed I have been persistently asking how many people are on the waiting lists and how long people will have to wait but the Minister has consistently been either unwilling or unable to answer my questions in the Dáil. That is disgraceful and is an indication of the way in which the Department of Health is being run. The Department are being run with blinkers and a blindfold on. The Minister has spent the whole year burying his head in the sand and has refused to face reality. Instead of providing care for those waiting on public lists he has extended entitlement to those who have never asked for it and, when the budget went completely off the rails earlier this summer, he introduced ill-thought out cuts. The consequences will be felt in the run-up to Christmas when patients will get an inferior service. As you are aware, a Cheann Comhairle, the south east will not be exempt.

Minister of State at the Department of Health (Mr. Flood)

The question relates to elective admissions to hospitals, particularly in the Dublin area where, Deputy Bruton states, the new accident and emergency rota has aggravated the problem. I intend therefore, to confine my remarks to this issue rather than deal with other health board areas at this time. I would like first to explain that the revised rota for hospital accident and emergency services is confined to Dublin. There is no rota arrangement for hospitals elsewhere in the country.

The Minister for Health recently received a report on the operation of the Dublin accident and emergency service since the introduction of the revised rota on 2 September 1991. This shows that, in the first six weeks following the introduction of the new arrangements, the overall level of elective admissions to the major Dublin hospitals has not changed significantly. In fact, it has risen somewhat, from a pre-September average of 576 admissions per week to a new weekly average of 611 after the introduction of the new arrangements.

Mr. R. Bruton

The summer period is always the quietest.

An Ceann Comhairle

Let us hear the Minister without interruption.

Mr. Flood

To take the Mater Hospital as an example, elective admissions for the six weeks subsequent to 2 September 1991 averaged 141 per week, as compared with an average of 101 per week prior to the changeover and a figure of 129 for the best week in the first eight months of the year. Increased use of day surgery at the Mater Hospital since mid-August has contributed to a more effective use of beds. Hospitals may find it necessary from time to time to cancel elective admissions in cases where beds have been allocated to emergency admissions. However, as I have indicated, the overall level of elective admissions has been maintained.

The operation of the accident and emergency service is closely monitored by a steering group, comprising the accident and emergency consultants from the six hospitals concerned, together with their hospital managers/chief executives and chaired by the acting programme manager, general hospital care, Eastern Health Board. My Department receive regular reports from this group on the operation of the service and hope the Minister for Health will meet the Dublin hospitals involved shortly to discuss the operation of the new rota arrangements.

An Ceann Comhairle

I now call on Deputy Allen to make his two minute statement.

Mr. Allen

I wish to raise the inability of the Southern Health Board to pay their creditors on time and the disclosure that the health board can owe up to £7 million at any given time to their suppliers. This problem is bringing about the possibility of company failures and job losses in the suppliers' companies. The Southern Health Board so far this year have a deficit of £2.9 million and they have been warned by the Minister that they must not overrun their budget this year; otherwise they will suffer the consequences next year.

To keep their deficit to £2.9 million this year the health board have had to embark on laying off the equivalent of 150 persons. There will be that many job losses in the Southern Health Board during the remainder of this year and 130 beds are closing in the Cork Regional Hospital for a prolonged period over Christmas. The sum owed to suppliers can vary from £4.5 million to £7 million. I know that the Minister will say that, according to the time of the month, the sum can be less than the figure I quoted.

As I said, the Minister warned the health board not to over-spend. What will they do? They have already closed wards. Must they close more wards? Must they stop operating altogether to achieve the targets of the Minister? The Minister has lost control of the health services and, with tomorrow's events in mind, he should take the opportunity to throw in the towel because he has lost control and the people are suffering. He has devastated the services. Another dangerous trend is that he has sent six chief executive officers of the health boards in the last couple of days to look at the privatisation process in Guy's Hospital. Is that the Minister's solution to the crisis in our health services at present? The Minister, in his brief response, should tell the Southern Health Board how they can meet the demands of the people they are supposed to serve and the requirements of many companies giving so much employment. I refer to the companies supplying the health board with equipment.

Minister of State at the Department of Health (Mr. Flood)

I cannot agree with Deputy Allen's comments regarding my colleague, the Minister for Health, Deputy O'Hanlon. I most certainly could not agree with his comments that there is something wrong in sending officials from the Department of Health — or indeed from the health boards — to visit other areas to look at the finer points of their health systems, to bring them back and to incorporate them in our health system.

Mr. Allen

It is the privatisation process.

Mr. Flood

We should do this if it will be to the benefit of the patient and the service provider.

The Southern Health Board receive cash from my Department on a weekly basis and in line with the cash profile established at the beginning of the year. This cash profile is directly linked with the level of approved expenditure for 1991. Adjustments are made to the level of approved expenditure from time to time during the year, with a consequent increase in the level of cash. Such increases to the approved expenditure level result from approved pay increases, cash allowances and other service-related items.

Officials of my Department are in touch with the Southern Health Board, and with health boards generally, on a weekly basis to determine cash requirements, including the need to meet a board's special requirements, within the level of the overall cash profile agreed. Indeed, my Department give every possible assistance to each agency on this matter, having regard to the approved expenditure limits.

However, on the basis of this arrangement it is the responsibility of each health board to manage their cash and credit in line with their operational needs and approved expenditure levels. The timing of payments to suppliers of goods and services is entirely a matter for the board management to decide.

The Deputy will appreciate that where a board incurs expenditure in excess of the approved level it is inevitable their credit strategy will come under pressure, as approved bank overdraft limits cannot be exceeded. In this regard, I must emphasise that the cash which is transferred to health boards is tailored, together with the approved level of bank overdraft, to match the approved level of non-capital expenditure. This level of expenditure is geared to enable boards, including the Southern Health Board, to deliver the approved 1990 service levels in 1991.

The Minister for Health recently met the chief executive officers of health boards to emphasise the vital importance of achieving agreed service targets within the budgetary limits. Any expenditure excess arising in 1991 will be a charge against the 1992 allocation.

An Ceann Comhairle

The House will now hear a two minute statement from Deputy Jim Higgins.

Mr. J. Higgins

The boarding out allowance scheme is a very efficient, cheap and caring form of accommodation for the elderly. It is a substitute in the majority of cases, for keeping people in welfare homes or hospitals for geriatrics. It started in the Western Health Board area and operates very well. The principle is that elderly people are integrated with families.

I visited many of the houses in question and can testify to the level of service being provided. Unfortunately, it is being provided literally on a shoestring; for £25 per week, just over £3 per day from the health board, plus half the pensioner's pension — in other words £53 in total. These ladies provide excellent, humane and top quality service. I brought the matter to the attention of the House on 11 June and the Minister of State at the Department of the Environment, Deputy Connolly, assured the House that an increase of £3 was envisged in relation to the recipient of a social welfare pension. I also got the impression that there was a further increase implied.

The ladies in question are literally at the end of their tether and, unless they get a reasonably substantial acknowledgment of the work they put in, are threatening to pull out of the scheme. They have banded together in a very efficient unit and are determined that they will bring home very forcefully to all and sundry the merits of their case. I urge the Minister to retain this service and not to have it scuppered for the sake of a hap'orth of tar. For a few pounds these ladies could continue their good work; not alone could we retain the existing service, we could enhance and expand it. I urge the Minister to be munificent and give the necessary money to the health boards to enable the service to be retained.

Mr. Flood

At present, regulations are being drafted to cover boarding out arrangements, under section 10 (2) of the Health (Nursing Home) Act, 1990. The regulations will govern the standards of accommodation, care and welfare of people being boarded out; the amount of the contribution to the costs involved by the health board; provide for inspections and interviews with the persons being boarded out; and provide for the numbers to be accommodated in any household. These regulations will harmonise the approach by the various health boards to the option of boarding out.

The regulations will also provide that the grant payable by a health board in respect of each person being boarded out shall be increased to a sum not exceeding half the maximum single rate of non-contributory old age pension. At new 1991 rates this would amount to £27.50 per week. Further increases will occur in line with increases in the social welfare rates. As stated previously, this grant is in addition to the agreed sum paid by the elderly person to the householder which is generally also set at half the rate of old age pension. This means that there has already been an increase this year. In effect there will be an increased income to the householder every time there is a revision in the rates of old age pension. This matter was dealt with in an Adjournment debate on 11 June last and it was made clear that an increase would ensue when the new regulations were introduced. Discussions on these with interested parties are at an advanced stage and the regulations should be ready for signature early in the new year.

I agree with Deputy Higgins that this is an excellent scheme and, obviously, we are all anxious that it should continue to prosper. I hope the new regulations, which will be coming into force at the earliest opportunity in the new year, will add to the strenghtening of this excellent service.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Wednesday, 13 November 1991.