Dáil Éireann debate -
Wednesday, 27 Nov 1991

Vol. 413 No. 6

Adjournment Debate. - Health and Environment Matters.

Mr. R. Bruton

Tonight I wish to raise my concern about recent developments in orthodontic services. As the House will know, enormous numbers of children are waiting for orthodontic services. In the Eastern Health Board area alone there are more than 9,000 on the waiting list and the outlook is probably a wait of five years for those at the bottom of the list, that is if they are ever reached at all and, unfortunately, many will not be reached. Nationally, there are about 25,000 waiting for this treatment.

As the Minister will know, for years it has proved impossible to fill consultant positions. They were advertised on numerous occasions but were not filled. The positions require a high degree of skill, it takes nine years to obtain the necessary training. I think that everyone recognises that any alternative, such as farming out the work to private orthodontists, would prove extraordinarily costly and would not provide the kind of public service needed for the children who are waiting.

The hopes of most people were quite high with the beginning recently of recruitment to orthodontic consultant positions. There was a feeling that we were at least taking the first step towards dealing with the problem. The most recent appointment was made to the Eastern Health Board. However, it came as a major shock to me to find that in the case of the most recent appointment, the appointee has resigned after less than five months. There also seems to be a problem in other areas where consultant orthodontists have been appointed. The problem seems to relate to their precise role in the service.

The very welcome development of a corps of public orthodontists providing care for public patients is now in jeopardy. At the heart of the problem seems to be an issue as to whether these consultant orthodontists should operate from a hospital base where the patients would be referred and the consultant would have available a wide range of back-up services.

I earnestly ask the Minister to intervene in what appears to be a growing problem of the position of these orthodontists that may jeopardise their key role in developing a service.

Minister for Health (Mrs. O'Rourke)

I welcome the opportunity to reply. I can tell the Deputy that I have already intervened in that matter since I came into the Department and, following improvements, I am now relatively satisfied as to the pay and conditions attached to the post of consultant orthodontist. Following the Local Appointments Commission competition, offers of employment — as Deputy Bruton knows — were made in the Eastern, South-Eastern, North-Western and Southern Health Boards. As the Deputy himself said, there are still difficulties to be ironed out in relation to the role and conditions of the consultants. However, I am glad to tell the Deputy and the House tonight that these matters are in the process of being sorted out. I am confident that the filling of the posts now will bring about a significant improvement in the orthodontic service, which is regarded as a priority service by the Department and by all of us here in the House.

In relation to the Deputy's particular reference to a person who had taken up a post and resigned after five months, there were several underlying difficulties in that case. I am satisfied, as I said, now that both of the two issues identified, the terms and the role, have been satisfactorily addressed, we will have appointments early in the new year and, following on that, a much greater rate of progress of admission and treatment under the orthodontic services.

Mr. Hogan

First I wish to congratulate the Minister for Health on her new appointment.

Mrs. O'Rourke

Thank you very much.

Mr. Hogan

St. Luke's Hospital, Kilkenny, was originally opened in 1942 to cater for a population of 47,000 people. With the amalgamation of Kilkenny and Carlow that catchment area doubled in 1971 to 100,000 people, with no extra bed space provided. In 1987 St. Luke's Hospital was rated as the seventh busiest surgical unit in the country, with still only one operating theatre. That shows the commitment of the staff, who are working under appalling pressure. I might add that the hospital has one of the highest patient throughputs of any hospital in the country at the moment.

Extra beds are urgently required in the female medical unit. That unit has only 19 beds, yet the Department's norm for a 100,000 catchment area would be 40 beds.

When the hospital was built it had one theatre for the use of one surgeon. Today four surgeons operate, using the same space, with no room for orthopaedic trauma at all.

The hospital has no paediatrician, no facilities for parents to stay overnight and no play area.

Since 1973 beds have had to be put in the corridors of all of the hospital's departments. The daily average for January 1990 in that respect was 27 beds, and that is a situation that could constitute a fire hazard.

A large, modern labour ward is required at the hospital. At present the labour ward is too small, there is no space for spouses and one room has to be used as an admission area-cum-bathroom. In summary, female patients are bearing the greatest proportion of the inadequate facilities at St. Luke's Hospital.

I was glad that when the Taoiseach intervened in relation to this matter in March 1991 he gave an undertaking to Deputy Liam Aylward that work would commence in September 1991 on the much-needed extension of the hospital. September 1991 has come and gone but I hope that with the Minister's new appointment there will be imminent progress on this urgent matter.

Mrs. O'Rourke

I thank the Deputy for his kind comments. I am glad to answer his question and to share with him, with Deputy Aylward and with Deputy Pattison the consistent approach that they have all adopted in their constituency towards the furtherance of this project.

As is known, tenders have been sought and received in the Department. They have been worked through and any technical difficulties have been sorted out. All of the Deputies for the area realise that it is now just a matter of the go-ahead for the project being given.

I am ten days exactly into the Department but I am not new to the problem of St. Luke's Hospital, Kilkenny. I realise that conditions have been far from satisfactory there. I also realise that the staff, the management and the patients have put up with a great deal in order to keep their very fine facility and that work has been carried out under great pressure.

I hope to have some definite views to convey on the matter quite shortly to all of the Deputies in the area. I am glad that the question has been raised here tonight.

Mr. Enright

I join with my colleagues in wishing the Minister every success in the Department of Health.

I speak tonight about Edenderry. There has been a promise from as far back as 1985 that a 40-bed unit would be provided at Edenderry District Hospital. This was to be in the context of an overall scheme for the county involving the development of hospital bed units in Tullamore and Birr as well as Edenderry.

Tonight I reflect the very serious concern of the people of the Edenderry area about the failure to date to provide a 40-bed unit at the Edenderry District Hospital for the elderly people of that area. That is an issue of top priority to the people residing right across the Edenderry area of County Offaly. As far back as March last the Chief Executive Officer of the Midland Health Board, Mr. Doherty said——

Minister for Health (Mrs. O'Rourke)

I know Mr. Doherty well.

Mr. Enright

——that the Edenderry proposal was at the most advanced stage of the three proposed units in Offaly, the others being located at Tullamore and Birr. He went on to say it would be helpful if the Midland Health Board pressed the Minister for sanction for construction.

The position is that at present this proposal is awaiting approval by the Department of Health to go to tender. Many people who have sick relatives or people wishing to enter hospital at present are being sent to different hospitals quite a distance away, in Mountmellick, Athlone and different surrounding areas. As the Minister will be aware, there is grave difficulty experienced in gaining admittance even to those hospitals. In fact some people at present hospitalised there are asked to go home to make beds available.

I have received a number of representations from people requesting me to have this project pushed forward. I am sure the Minister will share my concern and use her good offices to have this proposal sanctioned at the earliest possible opportunity when she will be highly thought of right across the county.

Mrs. O'Rourke

I thank Deputy Enright for raising this problem of which I am aware. Though not in my constituency it is within the Midland Health Board area and has been highlighted over a period of time.

It is a matter of finance. Tenders are in and all is ready, but it is a matter for each health board to establish their priorities and determine where capital moneys can be spent. I know that Deputy Enright and the Minister of State at the Department of the Environment present spoke to me in my previous portfolio about this project for which there is great need in Edenderry.

With the finite budgets available to me for allocation to the various health boards they, within their finite budgets, must establish their priorities. However, I will undertake to have the matter examined as requested. I will take a close look at the budget to be announced for the Midland Health Board to ascertain whether it affords any leeway for the commencement of this project, when I will be in touch with the Deputy and the Minister of State present about the matter. I thank the Deputy for having raised the issue.

Mr. McGinley

Gabhaim buíochas leat, a Cheann Comhairle, as ucht deis a thabhairt dom an t-ábhar seo a phlé anois.

Gweedore has the reputation of being the most densely populated rural area in Ireland if not in Europe, accommodating an industrial estate with a workforce in the region of 1,000 people, five primary schools and a community school, at least seven hotels and various other businesses. It has a severe housing crisis. For a parish of its size and population it is unique in Donegal, in that it has not got one single local authority housing scheme, many of its senior citizens living in demountable dwellings and sub-standard accommodation. Many young couples and their families live in caravans, mobile homes or in overcrowded conditions. It is impossible and prohibitively expensive to obtain rented accommodation in the parish.

In spite of significant industrial development the local authority have failed completely to provide for the housing needs of the parish. Sites in the centre of the parish are almost unobtainable. In the past year there has built up a tradition of building one's own home in Gweedore, when substantial Gaeltacht grants were availed of and the people proudly built their own homes. With the escalation in building costs and the inadequacy of grants that practice has almost ceased. The lack of housing in the parish is contributing to social problems and even emigration. Plans for a 24-house scheme were submitted by Donegal County Council to the Department of the Environment in 1984. I understand approval of the scheme was issued by the Department in March 1985, but, unfortunately, little or no progress has been made since.

I am requesting the Minister of State present, and the Minister himself — who is no stranger to Gweedore and knows the position obtaining there — to have this matter investigated immediately and provide the requisite resources so that the scheme, approved since 1985, can proceed without further delay.

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

Donegal County Council received an allocation of £2.583 million for their 1991 programme, allowing them to start or acquire 100 houses throughout the county. I should say it is a matter for the local authority themselves to determine how this allocation is distributed having regard to the needs of each area of the county. My Department have approved the cost plan, lay-out and house types for a 24-house scheme at Gweedore, subject to some technical considerations. I must stress that it is a matter for the local authority to determine, within the limits of their annual allocation and the authorised number of new starts when to nominate this scheme as part of their housing programme. I might add that we have now changed our method of allocation and do not any longer name schemes. Therefore, it is a matter for the relevant local authority to decide on their priorities. In turn, it is a matter for Donegal County Council to decide, when they receive their allocation, what housing schemes they should proceed with.

Mrs. Owen

I want to appeal to the Minister of State present to make available a special road grant to Dublin County Council to allow for the commencement of work on the Upper Carrickhill Road in Portmarnock, County Dublin. This is a county road which carries the equivalent traffic volume of many national primary roads and indeed more traffic than many national secondary roads, approximately 5,000 vehicles daily, while roads such as those in the Minister's constituency from Tullamore to Birr would not carry anything like that amount of traffic but can receive full grants from his Department.

Of more significance is the presence on this road of a 1,000-pupil community school, putting these pupils' lives at great risk daily as they enter and leave school on to a 24-foot road without any footpaths and on a bad bend.

Dublin County Council prepared plans a number of years ago and lands were acquired under compulsory purchase orders and paid for. But on account of severe cutbacks in rate support grants to Dublin County Council over the past four years, they have not been able to find the requisite £500,000 to undertake this full improvement scheme.

I am appealing to the Minister to pay out, not the full £500,000 required but £100,000 needed to implement an interim improvement scheme, that is to straighten one bend, provide a footpath on the school side of the road and undertake the drainage and accommodation work on the project. Such interim scheme would greatly enhance the safety of these pupils and other road users. If there is a child killed on that road I predict the requisite money will be found. Let us not wait for this type of tragedy to occur. I appeal to the Minister to act immediately to rectify a problem which would not exist if Departments of State, such as Education and others, were subjected to the normal planning process required of a private developer when this school would not have received planning permission without the road in the vicinity having been made good.

I would ask the Minister not to reply to me that his Department do not give special grants because there were plenty available a few years ago to upgrade roads for the EC dinner held in Malahide Castle. Let us see some more of those special grants being given for the improvement of this road.

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

I thank Deputy Owen for having raised this matter. I should say that Carrickhill is not a national road and is the responsibility of Dublin County Council. First, Dublin County Council can undertake such work out of their own resources and, second, by way of a discretionary grant.

I should point out that the discretionary grant to Dublin County Council from my Department in 1986 amounted to £972,000 which was increased this year to £1,395,000. However, determination of priorities in the expenditure of such grant is a matter for the local authority themselves. The Deputy knows full well that it is a matter for Dublin County Council — or any other local authority nationwide — to decide on their priorities.

Regrettably I have no funds at my disposal for the improvement of this road. I must reiterate that it is a matter for the Deputy's local authority, that is Dublin County Council, and their elected members to decide on their priorities, just as it would be for any other local authority with a road of the same nature.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 28 November 1991.