Adjournment Debate.

Hospitals Building Programme.

Mr. McHugh

I thank the Ceann Comhairle for allowing me to raise this issue on the Adjournment. I welcome the Minister of State, Deputy Callely. I have sought this debate in an attempt to move forward the position concerning Tuam Health Campus. The hospital in Tuam was closed almost three years ago, on 6 April 2001. While it functioned as a hospital up to the day it closed, it has not been utilised since then for the delivery of health services to people in the catchment area, which comprises north-east Galway, south Mayo and west Roscommon. That was the area it serviced while it functioned as a hospital and that is the same area that is being deprived of proper health care services because it remains closed.

The saga has been continuing for three years since the Minister for Health and Children made money available to purchase the Grove Hospital in Tuam, which was being disposed of by the Bon Secours Sisters. Unfortunately, that was the end of the action as far as the Government was concerned. Public money amounting to approximately €4 million was expended on the purchase but that asset, purchased with public money, has been allowed to remain idle since then. It has also been allowed to deteriorate, which is a terrible waste of taxpayers' money.

The Western Health Board has identified the need for a community hospital in Tuam and has prepared a planning brief, which identified the need for a community hospital comprising 60 beds, in addition to X-ray facilities, a GP unit, day care hospital, dementia day care, mental health day care, a hospital primary care unit, an ambulance base and a regional child and family care training centre.

That planning brief was submitted to the Department of Health and Children on 8 October 2002 and has been on the Minister's desk since then — that is, for the past 20 months. During that time nothing has happened and the fault clearly lies at the desk of the Minister for Health and Children. The blame also lies at the Government's door because the Taoiseach gave a guarantee that the Government would provide a hospital in Tuam. That guarantee was underpinned by a similar assurance from the Minister for Health and Children to the effect that a hospital would be provided in Tuam. It is now past time for the Taoiseach and the Minister to honour their commitments and give approval to the Tuam health campus project, which encompasses a community hospital.

Since the Western Health Board made its submission to the Minister for Health and Children, the case for a hospital in Tuam has been further supported by the national spatial strategy, which was published in November 2002. That strategy designated Tuam as a hub town, the only town in county Galway to receive such a designation. The spatial strategy further outlined the characteristics of a hub town as including a local or regional hospital. This is an example of a national strategy supporting the case for a hospital in Tuam. Over a year has passed since this strategy was published and it is now time for the Government to give expression to this national policy and its associated aspirations by giving approval to the Tuam hospital project.

In recent days, the West Regional Authority published a document entitled Draft Regional Planning Guidelines for the West Region. This document identifies the need for the provision of health care services in Tuam to service the catchment area of north-east Galway, south Mayo and west Roscommon.

The case for improved health care services in Tuam was further underlined by the Western Health Board when, under a pilot scheme announced by the Minister for Health and Children regarding the delivery of primary health care, it identified two priority areas in Counties Galway, Mayo and Roscommon for the provision of primary care units. Tuam was one of those two priority areas, the other being in Erris, County Mayo. However, the Minister failed to sanction the Tuam application.

In a separate study on the siting of ambulance bases in the Western Health Board region, Tuam was again identified as a priority area for the provision of an ambulance base. This application has also gone separately to the Minister but, regrettably, the proposal has not been approved.

I am not asking that a hospital should be provided overnight in Tuam. What I am seeking is that finance be made available immediately to commence the planning of Tuam hospital and the Tuam Health Campus. Separate finance should be made available for the immediate establishment of the ambulance base and for the construction of the primary care unit. A timescale must be outlined for the completion of the entire health campus project.

Minister of State at the Department of Health and Children (Mr. Callely)

I thank Deputy McHugh for raising this matter on the Adjournment and clarifying a number of related issues. Following the closure by the Bon Secours Order of the Grove Hospital in Tuam, the Western Health Board, which is responsible for the provision of health services in the Tuam area, took a decision to build a new 50-bed community hospital on the grounds and adjoining land. The new hospital will comprise a mix of up to 30 beds for continuing care and the remaining beds will be made up by direct access beds. In line with what is generally provided in the board's district hospitals, the service will have a significant mix of multi-disciplinary staff, as well as complementary therapists.

Coupled with this, the board envisages the Tuam hospital functioning at the hub of a comprehensive outreach service, providing home care programmes and associated programmes, as well as a flexible care package. The specialist care services will be supported by social support services, such as the community welfare and home advisory programmes. The project does not envisage the reopening of the old hospital for nursing care purposes.

The Government has made services for older people a priority and is fully committed to the development of a comprehensive health service, which is capable of responding quickly, fully and effectively to the health service needs of older people. In recent years, health and social services for older people have improved, both in hospitals and in the community. Since taking office, the Government has substantially increased the level of funding, both capital and revenue, in respect of services for older people. For example, the amount of additional revenue funding has increased from £10 million in 1997 to £57 million in 2001, over €87 million in 2002 and €23 million in 2003. A further €10 million was allocated this year. This serves to demonstrate the Government's ongoing commitment to improving services for our older population.

Significant capital funding for the health sector has been provided since the commencement of the national development plan in 2000. Total expenditure for the years 2000-03 was approximately €1.7 billion. Considerable progress has been made in addressing the deficits in health infrastructure and in improving the standards of facilities required for quality modern patient care.

The national development plan is providing considerable capital funding to services for older people. Nationally, this will enable a comprehensive infrastructure of community nursing units and day-care facilities to be put in place, as well as the refurbishment of existing extended care facilities and the replacement of old workhouse-type accommodation. Older people deserve first-class facilities and we intend to provide such facilities in appropriate locations.

My Department is currently examining the health capital programme for 2004 and beyond, to ascertain what new projects can be progressed through planning and construction stages, taking account of existing commitments and the overall funding resources available. In this context my Department will continue to liaise with the Western Health Board regarding the proposed development in Tuam, in light of the board's overall capital funding priorities. As soon as I have definite news about the Tuam project, which I understand may be available in approximately 12 or 14 weeks, I will communicate further with the Deputy. The Department is waiting to hear from the Western Health Board regarding its priorities for its catchment area and we will be guided, accordingly, by the submissions received.

Mental Health Services.

Dr. Upton

I welcome the opportunity to raise this matter. A 19 year old man who suffers from Asperger's syndrome and from a serious eating disorder has been moved from one inappropriate treatment centre to another. He is currently at home and his condition continues to deteriorate rapidly. He weighs approximately six and a half stone. He is seriously under-weight and, despite the best efforts of his parents and family, he is not responding to their care. This young man needs specific and focused treatment. His parents were told by the specialist in St. Vincent's Hospital that no more could be done for him. This commentary issued from a unit that specialises in treatment of eating disorders. The young man stated that the treatment he received in the psychiatric unit of Tallaght hospital was of no benefit whatsoever. He described it as a negative experience.

There is no longer significant health board support for this young man and his family. His parents have become his carers and his therapist. They are not qualified nor do they have the expertise and they are extremely worried about their son. They are seeking support from the South Western Area Health Board to send their son to an appropriate treatment centre in the UK. Other health boards have funded individuals to attend such centres for treatment. The outcome for at least one patent was positive and that young person is in third level and making excellent progress.

The South Western Area Health Board has been dealing with this case for approximately three years. It refuses to fund the young man's treatment at the Huntercombe Manor centre in the UK, even though there is no equivalent facility in the State. His condition is deteriorating rapidly and his father described the situation earlier as "a matter of life or death." This young man, despite his numerous medical problems, has succeeded in completing and passing the leaving certificate. His parents are exhausted from the burden of caring for him in addition to their worry and concern for his future. He is an intelligent young man who has the ability to live independently but he will only be able to do so if he is given the appropriate medical support. No facility is available in the State to meet his needs. I ask the Minister of State to prevail on the health board to provide the resources necessary to give this young man and his family the opportunity to get on with their lives.

Mr. Callely

I thank the Deputy for giving me the opportunity to outline the position concerning this issue. I refer to the general policy of my Department in regard to the development of services for persons with an eating disorder. The policy of my Department is that a broad range of appropriate support services should be developed in consultation with the health boards, other relevant service providers and people with mental illness, eating disorders and their carers, including those with anorexia and bulimia, throughout the State. These services should be person centred, should incorporate best practice norms and take account of internationally recognised advances in treatment or approaches to meeting individual needs.

Individuals are only placed in services outside the State in particular circumstances. Decisions relating to placements abroad are a matter for the relevant health board. With regard to the person referred to by the Deputy, it is not appropriate for me to comment on the individual circumstances. However, there has been significant contact between the family and the South Western Area Health Board with input from senior clinicians and health board management.

The Deputy asked me to prevail on the health board. However, she would not want me to prevail on senior clinicians and other professionals who have been involved in this case, unless she feels inappropriate decisions have been made. If so, I ask her to bring the details to my attention. I would be deeply concerned if that were the position and I give an undertaking to have the matter fully investigated if that is the case. I do not wish to comment on the individual's circumstances but various senior clinicians and health board management have had an input into this case and their decision stands. If there was a change in circumstances, I would be happy to prevail on the health board, as requested.

An expert group on mental health policy to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future, was established in 2003. The expert group will examine, inter alia, models of care and treatment, and the development of psychiatric services for specialised groups such as those with eating disorders. The group requested submissions from interested organisations, individuals and the public in October 2003, and more than 140 submissions were received. Members of the group are considering these submissions.

The outcome of the review will assist in ensuring services are delivered in an appropriate, efficient and cost-effective manner and will identify targeted areas to be addressed in planning for the future. I expect the group to report in 2005. Substantial progress has been made in ensuring those in need of mental health services are receiving the best care and treatment available. However, much remains to be done and, during the period 1999-2004, an additional €80 million was invested in mental health services to develop and expand community services. Approximately €190 million will be provided over the lifetime of the national development plan for further development of mental health services.

While I am pleased with the progress in many services, I accept that much remains to be done in providing a service that will enhance the quality of care for those suffering from mental illness.

Services for People with Disabilities.

Mr. Stanton

I thank the Ceann Comhairle for allowing me to raise the matter and I thank the Minister of State for coming to the House to debate it. The matter centres on a report commissioned by the National Disability Authority, which states that there have been significant failures in the provision of needs assessment, respecting the rights of patients and consulting family members regarding the care of relatives. I refer to the issue of standards of services for people with disabilities. I ask the Minister to publish the report as soon as possible.

The Minister of State will agree it is alarming that only 25% of service providers and health boards surveyed met the required standard. This issue must be addressed as a matter of urgency. What does the Minister of State plan to do about this? Has he obtained a copy of the report? What action does he intend to take?

According to the report, up to €1 billion will be made available for such services but the service providers and health boards are not subject to inspection. The NDA is doing a good job. It produced a draft national standard for disability services last April but, unfortunately, the promised expansion of the social services inspectorate has not taken place. I call on the Minister to expand the role of the social services inspectorate to ensure it can deal with adult as well as child services and report on them.

I have been trying for the last number of months to find out how the €50 million which the Minister made available to the disability sector last July was used. I am still waiting for that information. I ask the Minister of State to use his good offices to ensure that this information becomes available. I was told last November that it would become available as soon as possible and I am still waiting almost three months later. This is not good enough.

There is grave disquiet at the reported shortfall in standards, quality, equity, person-centredness and value for money in the provision of services to people with disabilities. The voluntary organisations are not subject to inspection, despite significant State funding. We must help the voluntary sector to come up to the standards the Minister of State's Department has set for them. The State is responsible for what takes place. The responsibility cannot just lie with the service providers. The State has a duty of care in this area, which it has ignored for many decades.

I remind the Minister of State of the various commissions which have been set up to examine such neglect in the past. We do not want to do the same in the future. There is also a need to avoid duplication. Perhaps the Comptroller and Auditor General should be invited to look at this area and to see how money has been spent. The money has been voted by the Oireachtas and the public rightly expects that it will be spent on appropriate person-centred accessible services for people with disabilities. Many service providers have their own standards but many have none. This is not acceptable. I know the Minister of State is a man of action. I ask him to take action in this most important area, sooner rather than later.

Employees of the disability services and external consultants reported significant differences in the results of the assessments.

The disability Bill needs to be published and debated. It has been delayed since last November. If it were published people would have some recourse to the services they should be receiving. The standards set by the Minister of State's Department are not being met in as many as 75% of the cases surveyed. This is not good enough. Radical and urgent action by the Minister of State is demanded.

Mr. Callely

I thank my good friend and colleague, Deputy Stanton, for raising this matter. Deputy Stanton is ahead of the posse on this very important issue. I am happy to respond positively to him. However, it is important that I clarify some matters relating to this issue.

The standards to which Deputy Stanton refers are, at present, in draft stage and are part of a process in which my Department is engaged, in partnership with the National Disability Authority. The purpose of this process is to identify and develop standards appropriate to health services for people with disabilities, and rightly so.

This collaboration has been further enhanced by the support of the NDA standards advisory committee, people with disabilities, their families, carers, service providers, Government agencies, representative bodies and other stakeholders. The co-operation of all stakeholders demonstrates the significant commitment to improving services for people with disabilities.

The process began in 2002 with the commencement of a national consultation process. More than 500 submissions were received and these form the basis of the first draft standards.

Following these consultations, my Department and the NDA agreed to a pilot project to test and evaluate the application of the assessment process of the draft national standards for disability services, including the use of an audit tool. This evaluation process would include an internal and external assessment of the services. The external assessments were to be undertaken by an independent agency appointed by the NDA through a process of competitive tendering. This contract was awarded to Excellence Ireland.

The pilot project was undertaken in 20 participating organisations in the final quarter of 2003 and was followed by an evaluation by an independent assessor, also appointed by the NDA. The independent assessor was asked to deliver a report to the NDA. This report does the following: collates and analyses the experiences of the pilot participants consulted; identifies the strengths and weaknesses of the national standards for disability services monitoring system and tools in their current form with respect to the validity and reliability of the tools; and makes recommendations for future development.

The purpose of this exercise was not to evaluate the quality of services by any particular service provider but to evaluate the pilot project and the monitoring tool which would inform the ongoing process of developing national standards.

This pilot project looked at only 20 services and cannot be judged to be a true representative of the overall services. Any findings must be viewed with this in mind. This report cannot and did not, at any time, seek to give an evaluation at national level. Central to the evaluation was the pilot project, and it alone.

The report of the consultant has not yet been received by my Department. What we are discussing is a draft. Nonetheless, the present draft throws up, as Deputy Stanton rightly indicated, important data which will inform the process of developing national standards. Therefore, it must also be recognised for its successes. All of the 20 service providers completed the assessment. Data relating to evaluation of the assessment of the impact the draft standards will have on improving service delivery indicated that 96% of respondents considered that the draft standards will definitely impact or may impact on the quality of service. More than 605 of the respondents reported positive features of the standards process, including an identification of areas for improvement, raised awareness among staff and highlighting good practice. However, 36% of the respondents reported areas that needed to be improved, including the time involved and the danger of raising expectations. Three assessors commented that the system was unsuited for the purpose.

Some 34 internal assessors attended focus group meetings and identified a number of positive and negative features. These included: improve the quality of services, 56%; identifies gaps and improvements, 56%; involves all stakeholders, 53%; needs to take into account communication needs of people with an intellectual disability, 50%; emphasises service users rights and staff accountability, 47%; requires time and resources, 35%; and needs to take into account existing approaches and systems, 35%. A majority of interviewees were very happy with the interview process, including the way the interview was conducted, 90%, and the listening skills of the interviewer, 93%.

Once the formal evaluation is received it will provide useful data which is now being reflected as part of the next phase of developing national standards.

As the Deputy quite rightly states, considerable investment has been made in the provision of services for people with disabilities. The development of national standards for health services for people with disabilities is part of that investment.

Crime Levels.

Mr. Broughan

A few weeks ago the Fine Gael leader, Deputy Kenny, inadvertently misled the House when he stated categorically that the Minister for Justice, Equality and Law Reform is no fool. That proposition is debatable. The Minister has shown he is either a fool or recklessly incompetent by the way he has dealt with some of the most serious crime in the State.

This evening I raise the distressing and outrageous issue of car crime and joyriding for, perhaps, the 40th time since the 1997 general election. The communities of the northern fringe of my constituency of Dublin North East are tormented by the plague of joyriding and car-related anti-social activity of the past three months. Night after night the old Belcamp Lane district is a scene of screaming, skidding cars as residents of nearby estates look on in horror at vehicle after vehicle being driven dangerously up and down this cul-de-sac. When a vehicle is wrecked it is set alight, and the road surface of Belcamp Lane is now totally blackened by the nightly fires. Over recent weeks these stolen cars have also been appearing during daylight throughout the north Coolock area and it can only be a matter of time before a child returning from school or a worker coming from work is killed. The long list of tragedies caused by this deplorable crime — some affecting Deputy Callely's constituents — is sad and depressing.

On many occasions in the past 20 months I have asked the Minister for Justice, Equality and Law Reform to take urgent action to end this plague. Gardaí from Coolock, Raheny and Santry stations have bravely tried to enforce the law but I am informed that significant additional resources of members and equipment are necessary. I am informed that in the J and R districts of the Dublin divisional area, up to 200 gardaí with appropriate equipment are required.

A standing invitation to visit the area was extended to the Minister for Justice, Equality and Law Reform more than a year ago, but so far Deputy McDowell has steadfastly refused to go. I have also asked repeatedly that he re-examine the Labour Party Bill making joyriding a specific serious crime, which I introduced twice but on both occasions it was defeated by Deputy Callely's party and the Progressive Democrats. It was part of a wide programme of education and prevention measures.

It was reported in the media that a dedicated car crime unit was set up in the Grosvenor Road district of Belfast with a resulting decline in such crime in the past three months of 40% to 50%. The figures speak for themselves. On 27 January last, the Minister for Justice, Equality and Law Reform gave me a breakdown of the number of vehicles stolen for joyriding crime some of which were recovered in the operational areas of Coolock, Raheny and Santry Garda stations during the years 2000, 2001, 2002 and 2003. During 2000, there were 1,290 incidents of unauthorised taking of vehicles in total and 427 vehicles, many burnt out, were later located in these areas. In 2001, there were 1,271 incidents of unauthorised taking with 976 vehicles, again usually destroyed recovered in this Garda district. In 2002, 1,318 vehicles were taken in the Santry, Raheny and Coolock Garda district with an astonishing 1,436 recovered vehicles, again usually vandalised and burnt. Last year 1,276 vehicles were taken and a similar astonishing 1,170 vehicle remains were recovered in the district. These are totally disgraceful figures. I regret that the Minister for Justice, Equality and Law Reform is not present to hear that more than three cars a day have been taken and driven to the point of destruction during the past four years. The only conclusion that can be drawn is that Deputy McDowell just like his predecessor Deputy "zero tolerance" O'Donoghue is soft on car related crime and does not want to know the appalling problems suffered daily and nightly by my constituents.

The great Fr. Peter McVerry said recently that the horrendous joyriding and car crime culture is the ultimate symbol of youth alienation. That is certainly true and shows the huge efforts that are necessary in socially deprived areas to bring this and related social problems to an end. We need a justice Minister who is actually tough on crime, and not the Minister for Justice, Equality and Law Reform who has time to talk about every problem under the sun, and express his views on the expansion of the European Union, or whatever one cares to mention, but does not have views on stopping very serious crime which occurs nightly in my constituency and also in the constituency of the Minister of State at the Department of Health and Children, Deputy Callely.

If the events I described happened in the constituency of the Minister for Justice, Equality and Law Reform, Deputy McDowell, there would be uproar in the media, consternation and revolution and we would soon have action to end it. We are not seeing such action from the Minister. I urge him to cease being soft on crime and to start taking his duty seriously. I urge him to take action or else allow somebody else do the job.

Mr. Callely

I am deputising this evening for the Minister for Justice, Equality and Law Reform. I thank Deputy Broughan for raising this matter on the Adjournment and acknowledge his longstanding interest in this subject. I assure Deputy Broughan that the Minister for Justice, Equality and Law Reform and I share his concern and that of the public in general regarding serious car crime and associated anti-social behaviour.

It is generally a hard core of youths who engage in this activity, many of whom are known to the Garda Síochána. The Minister has been informed by the Garda authorities that they are continually monitoring trends on car theft with a view to identifying and targeting both persistent offenders and areas prone to such activities, to which the Deputy referred. Persons serving sentences for persistent offences related to so-called joyriding are not granted early temporary release, except in the most exceptional circumstances.

The Garda Síochána continue to operate special foot and mobile patrols, targeting specific areas in response to identified local requirements. All vehicles taken without authorisation are technically examined when recovered, and known offenders are targeted for these offences. In addition, each division has a traffic unit, which targets incidents of joyriding and enforcement outside of peak traffic hours.

I understand special plain clothes Garda patrols which concentrate on identifying cars that could be seized under section 41 of the Road Traffic Act 1994 have shown some success. The Garda air support unit has also been particularly effective in this area. In 2002, the unit assisted in the recovery of 51 stolen vehicles, and the arrest of 172 persons.

The Garda Síochána and local authorities have made good progress in recent years in regard to estate management and are actively reducing the opportunities for so called joyriding. For example, physical changes, such as barriers and speed ramps, are being used to reduce access to areas frequented by youths engaged in anti-social activities. The gardaí are constantly liaising with community groups, and a number of projects are operating which have proved to be very valuable in dealing with offenders.

Deputy Broughan will be aware that in addition to targeted Garda operations in areas that have been identified as potential hot spots for joyriding, the Minister for Justice, Equality and Law Reform has provided funding to the Priorswood task force on joyriding to tackle the causes of so-called joyriding. This strategy involves developing joint initiatives with local agencies and the community to prevent young people from joyriding; engaging with joyriders, including those in custody; developing alternatives in education, training and leisure and developing appropriate models of family support.

In addition, in the past seven years more than €320,000 has been provided from the Department of Justice, Equality and Law Reform for the Woodale Garda youth diversion Project in the Darndale and Priorswood area, which has proved successful in diverting young people from involvement in criminal behaviour such as joyriding. Deputy Broughan has a great feel for the constituency and is very active in it and if these measures are not working as I am led to understand they are, will he take an initial step of meeting the Garda superintendent and the local authority manager——

Mr. Broughan

I met them at Priorswood.

Mr. Callely

——in round table talks and bring this issue to the table to see what additional steps can be taken?

Mr. Broughan

Will the Minister for Justice, Equality and Law Reform come out? He has been invited.

Mr. Callely

I know the Minister for Justice, Equality and Law Reform would be very happy to receive feedback on the proposal I have put if there is not an improvement in the Coolock, Raheny and Santry Garda district.

The Minister is as concerned as Deputy Broughan about serious car crime and associated anti-social activity. He has introduced legislation and has been assured by the Garda authorities that they are satisfied that the provisions of the Road Traffic Acts 1961 to 1993 are adequate to deal with situations where persons use or take possession of mechanically propelled vehicles without the consent of the owner. The legislation pertaining to the investigation of criminal damage, such as burning out cars is defined under section 2 of the Criminal Damage Act 1991.

Section 41 of the Road Traffic Act 1994 provides the Garda Síochána with the powers to stop and seize vehicles it believes to be driven by under age drivers. Any amendments to the existing body of road traffic legislation is a matter for the Minister for Transport, who is responsible for all road traffic legislation.

The Children Act 2001 makes a serious effort to tackle this problem by providing a number of measures. Other provisions include section 133, under which the court can order young offenders to be at a specified residence at any time between 7 p.m. and 6 a.m. the following day.

The Minister is satisfied these measures combined with the tough sanctions in the Intoxicating Liquor Act 2003 and the Criminal Justice (Public Order) Act 2003 are making a real impact.

This is a complex problem which, while requiring significant inputs from the criminal justice system, can only be tackled to lasting effect through a multi-faceted and multi-agency response, involving the community and relevant statutory bodies.

The Dáil adjourned at 10.40 p.m. until 10.30 a.m. on Thursday, 26 February 2004.

Dáil Éireann debate - Wednesday, 25 Feb 2004