Dáil Éireann debate -
Wednesday, 7 Apr 1993

Vol. 429 No. 4

Adjournment Debate Matters. - Health and Education Matters.

Mr. Deenihan

A week before the November general election the then Minister for Health, Dr. John O'Connell, informed the Kerry branch of the Irish Kidney Association by letter, that £140,000 would be allocated to finance the installation of a kidney dialysis unit at Tralee General Hospital. However, the present Minister, Deputy Howlin, has stated there is no such record in the Department's files. In a recent reply the Minister stated that no specific funds have been provided in the 1993 Estimates in respect of these developments. This totally contradicts the commitment made by the then Minister, Dr. John O'Connell, apparently at the behest of the Taoiseach, Deputy Reynolds, who made a strong commitment that he would ensure that the Minister for Health would give the matter priority during his pre-election tour of Kerry.

Seven Kerry patients are forced to travel to Cork for kidney dialysis, sometimes three or four times a week. Three of these patients are what are described as CAPDs and they require treatment on occasions four times a day. Last week a child had to be rushed to Cork and was lucky to survive.

We want a satellite unit in Tralee. The Kerry Association have now collected £115,000 on their own initiative. With an allocation of £140,000, this would almost put the unit in place. I appeal to the Minister to clear up the contradiction between himself and his former colleague and to give a clear commitment on the funding of the dialysis unit this year. At last week's conference, the Minister said that he was looking for money in every place. Did the Minister find it anywhere?

Minister for Health (Mr. Howlin)

I am not aware of any undertaking made by my predecessor before the last general election regarding the provision of kidney dialysis services at Tralee General Hospital. No such record exists in my Department, and I have looked. The then Minister stated that the development of a dialysis service at Tralee General Hospital was included among the developments for consideration for funding for 1993. I found the letter written to Deputies at that time in that regard.

With regard to the Deputy's wish that I should find money, I already spend 20 per cent of all the revenue spent by the Government and I intend to ensure that the very considerable increase in expenditure on the health services this year continues to the best advantage of the patients and the people depending on the health services.

While no specific funding was provided in 1993 in the Estimates in respect of a dialysis unit for Tralee, my Department is currently discussing this with the Southern Health Board in the context of the board's 1993 development service plans.

I assure the Deputy of my direct interest in this matter and of the interest of the Tánaiste who has made repeated representations to me. I am aware of the urgency of this service and I have had discussions with the Kidney Association in that regard. As soon as resources allow, I hope the service will be made available.

Mr. Allen

The Cork Examiner of Monday 6 April last stated:

An investigation into alleged "back-handers" at Tralee General Hospital has found that there was some substance in claims made by patients and their relatives, it was reliably learned last night. The basis of the claims was that money was accepted on behalf of medical card holders who believed that they would receive better treatment if they made payments.

The article goes on to say that payments may have been small and that they were unsolicited. Such payments should not have been accepted anyway. These are very serious allegations striking at the heart of our public health system and affecting the reputation of a number of people. If they are not independently investigated the findings will always be questioned. Since this affair has become public, in the interest of fair play for everybody concerned, both the accusers and the accused, I would ask the Minister to carry out a ministerial inquiry for the sake of everybody involved.

Minister for Health (Mr. Howlin)

I am glad to avail of this opportunity to inform the House of the position concerning the serious matters raised by the Deputy.

In September last a number of allegations were brought to the attention of my predecessor, Dr. O'Connell, by a member of Tralee Urban District Council. On receipt of these allegations my predecessor instructed a senior officer of the Department to meet with the councillor. On consideration of the subsequent report prepared by the officer of the Department my predecessor instructed that the matter be investigated as a matter of urgency by the Southern Health Board.

The Deputy will appreciate that, under the contract of employment for consultant medical staff, the investigation of complaints is a matter in the first instance for the chief executive officer of the Southern Health Board. I understand that the chief executive officer of the health board has almost finalised his report and that he expects to be in a position to submit this to me within the next week. Pending receipt of this report from the chief executive officer, and in fairness to all parties concerned, it would be inappropriate to comment further at this stage.

Mr. Durkan

This is a story that will strike a chord with the parents of children who have been seeking orthodontic service over the past number of years. It relates to a ten-year-old in Dublin south west who in October 1989 was advised by a private orthodontist of the urgent need for treatment. She was examined by the EHB on 1 December 1989 and was not X-rayed. She was again examined on 4 April 1991, appraised by the EHB and put back on a waiting list without X-ray. On 16 May 1991 the girl was again appraised, X-rayed by the EHB and put back to wait further. On 21 May 1991 she was examined once again but not X-rayed, and in April 1992 the X-rays were mislaid. On 16 June 1992 she was further examined by the orthodontic service and found not to be in need of urgent treatment, but on 16 March 1993 when the child began to complain of serious pain she was examined by an eminent orthodontist who deemed that she was in urgent need of immediate treatment. She was referred again to the EHB orthondontic service and was reassessed on 5 April 1993 and has now been categorised as "priority 2". This means she is not deemed in need of immediate treatment and that she might not get treatment for two or three years, or perhaps never, because the child will have grown into a woman by then.

Much has been said and written about orthodontics since I became a Member of this House and in no area has less been achieved. Will the Minister, as a matter of urgency, take action on this case and let it be a watershed?

Mr. Howlin

Children seen by the Eastern Health Board's school dental service are referred for screening for orthodontic treatment in accordance with guidelines issued by my Department. Because of the high cost of secondary care orthodontic treatment, the Eastern Health Board operate the guidelines issued by my Department to ensure that the resources are used to the best advantage for those most in need of treatment.

Cases requiring attention are categorised according to the severity of their condition. The most urgent cases, or category 1, for example, cleft palate, are treated immediately. Other categories are dealt with in order of severity and in the order in which they are placed on the priority list. Category 2 cases can have a severe functional handicap such as a marked overbite or overjet relationship of the teeth and jaws, while category 3 cases are non-handicapped and have a lesser need for treatment.

I understand from the Eastern Health Board that the person referred to by the Deputy has been reassessed recently and placed on the board's waiting list in category 2. Because of the number of children on the waiting list I am not in a position to inform the House tonight at what stage the child will receive the treatment required.

There have been significant improvements in orthodontic care in recent times. I would draw the attention of the Deputy to the fact that a professor of clinical orthodontics has been appointed jointly between the EHB and the Dublin Dental Hospital and School. A number of other service provisions have been put into place and I was happy to provide an additional £2 million this year to improve services. I will take on board the Deputy's suggestions and I will look at the case.

Mr. J. Higgins

I was horrified but not surprised when I saw the front page heading on yesterday's Evening Herald—“Irish in London forced to work as strippers — Students In Sex Trap”. Channel 4 next Tuesday, to our shame, will tell the lot. The sad reality is that the system of higher education grants which the Minister inherited and is now happy to administer has driven thousands of youngsters from our shores in search of higher education elsewhere. In essence no son or daughter of a teacher, a civil servant, a health board official, a garda or a middle income PAYE worker can now qualify. The grant qualifying thresholds are ridiculously low. Qualification is based on gross rather than net income, even though the Labour Party clearly promised in their election manifesto that Labour would change the system and give grants on net income. No cognisance is taken of tax, mortgage repayments, health or sickness costs, let alone the cost of keeping body and soul together.

All our universities and colleges are bursting at the seams. University College Dublin has the "house full" sign up. Students are standing in the corridors of the regional technical colleges and the Dublin Institute of Technology, and things will be chaotic next year because a record 52,000 have applied for entry to an already overchoked system.

The points system and restricted entry to the so-called elitist faculties mean that our students have to go overseas if they want to become doctors, pharmacists or study ophthalmic optics. Our students are to be found in every university campus from Edinburgh to Oxford. The British university and education systems have been good to our students. They have opened their doors and the British Government is paying the fees. These Irish students are, therefore, responsible only for their maintenance and herein lies the problem as outlined in the Channel 4 programme and confirmed by the National Union of Students in Britain. It costs a minimum of £60 per week in the average British city to live and maintain oneself; in London it can cost up to £100 per week. The recession in Britain means that the traditional avenues of part-time employment have long since dried up. In desperation, therefore, Irish students, whom we have failed to accommodate here, are now a world focus and the subject of case histories in next Tuesday's Channel 4 programme. What a price to pay for education. Britain is paying our children's fees. The least we might do is pay the other half and spare them the indignity they must now undertake to educate themselves. What a price for education.

Mr. Aylward

I am glad to have the opportunity to respond to Deputy Higgins on this matter. The Government's commitment to widening access to third-level education, including continued improvements in the higher education grants scheme, is evidenced by the rapid expansion which has occurred in student numbers and the significant increased provision in student support.

Numbers in third-level education have expanded from 21,000 in 1965 to 75,000 in 1991-92, increasing with an intake of nearly 27,000 in 1992-93 to a total of about 80,000. A further increase in student places is planned during the next three to four years which will bring the participation rate up to about 45 per cent of the age group.

Third-level education now accounts for about 22 per cent of the education budget compared to 8 per cent in 1986. In the current year the total student support for fees and maintenance provided by the State is approximately £84 million compared with £75 million in 1992, an increase of 12 per cent.

As regards the issue of where higher education grants are tenable, the scheme provides that grants are tenable at institutions of higher education in Ireland in respect of attendance at degree or other approved courses. The purpose of this requirement in the scheme is to give financial assistance to students ordinarily resident in Ireland who reach a minimum standard in the leaving certificate examination and who because of family circumstances might not be in a position to proceed to third level education in Ireland.

The payment of a grant may be continued for one year in respect of attendance abroad where the period in question is laid down as an integral part of the student's course in line with the terms of the Erasmus scheme, the purpose of which is to promote third level student mobility between EC member states.

I am aware that requests are made from time to time for grants to be made tenable in the United Kingdom and elsewhere in the EC. Except in the circumstances I have just outlined, all such requests have had to be refused on the grounds of cost. The Deputy will be aware of the range of significant improvements introduced in the grants scheme in 1992, including special provisions for mature students. Currently, that scheme is under review and all relevant matters, including the issue raised by the Deputy, will be examined.

Mr. O'Leary

I thank the Minister of State at the Department of Education, Deputy Aylward, for coming into the House tonight in connection with the proposed new national school at Faha, outside Killarney. I am obliged to raise this matter now, due to the seriousness and urgency of the situation. Faha national school was built in 1880. It consists of four small classrooms and two prefabricated rooms. The two prefabs were erected in 1968 — 25 years ago — and are now showing real signs of the effects of the weather. The main building is very damp, the slates are held with pieces of lead and the nails are worn out. The main chimney is leaking and the western gable is extremely damp. There are outside toilets, which are unacceptable in 1993.

The site was purchased ten years ago and the local contribution was collected. I understand that the detailed plans were prepared in 1992 and that the proposed project was ready to proceed to tender at that time. Any reasonable person would agree that Faha must surely be on the top of the priority list for new starts in County Kerry in 1993.

I am, therefore, asking the Minister of State to ensure that this project goes to tender as soon as possible and to commence work on its construction as a matter of urgency this year. The parents and teachers are very concerned at the delay in advancing the proposed new school in Faha to construction stage. The public in the entire catchment area are equally concerned.

Mr. Aylward

I thank Deputy O'Leary for raising this matter and giving me the opportunity to give the up-to-date position regarding Faha national school, County Kerry. In fact, I met a deputation when I was last in Kerry, brought to me by Deputy O'Leary, who pointed out the seriousness of the situation in this case.

The present accommodation consists of four classrooms which were built in 1876 and two prefabricated classroom dating from 1967 and 1969. The school has 146 pupils and five teachers. The request for additional accommodation dates from 1969 when two other schools amalgamated into Faha national school.

An initial proposal to extend the school had to be abandoned owing to title difficulties. These difficulties were resolved in 1987. A plan for a new six classroom school estimated at £300,000 was abandoned owing to financial constraints. A further plan to build a new school in two phases while continuing the use of the existing school was also abandoned owing to financial constraints.

The matter was reviewed in 1989, when the case was removed from the private architect's ambit who had dealt with it up to then, and the Department's architect was asked to report on the feasibility and economics of extending the existing school as opposed to building a new school. The architect advised that a new school would be a cheaper and better option. Plans were prepared for a new five classroom school and the case is ready for the invitation of tenders. However, the proposed extension is one of over 150 projects which were at pre-contract stage in the latter part of 1992. Only a certain number of projects, which were selected on grounds of priority, could be listed to go to contract in 1993. Unfortunately, it was not possible, on the basis of the total capital funding available and the relative priority of other projects, to allow the Faha national school project to be included in the list for 1993.

However, I wish to assure Deputy O'Leary that my Department accepts fully that the conditions are such at this school that the project merits the highest possible priority rating in the context of the projects which will be selected to proceed as part of the capital programme in 1994 and which will be decided on in the next few months.

The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 8 April 1993.