Dáil Éireann debate -
Wednesday, 7 Apr 2004

Vol. 583 No. 4

Adjournment Debate.

Hospital Services.

Mr. Connolly

I am pleased to have an opportunity to raise this matter. I wish to remind the Minister of State that Monaghan General Hospital is still off call. This means if an ambulance is called, it will bring one to any hospital other than Monaghan.

A few days ago, I received an invitation to attend the official opening of a cardiac rehabilitation unit at Monaghan General Hospital. It was a very well attended function, with many staff and members of the public present. We were shown around the different areas. We were shown the cardiac rehabilitation unit, which included some fantastic equipment. There was great enthusiasm among the staff and the nurse was very enthusiastic. She had completed a special course and started the unit in recent weeks. We were then brought upstairs to the cardiac imaging department where a cardiac technician was employed. She showed me the equipment in the unit of which she was very proud. She said it was better than the equipment in most Dublin hospitals where she trained and worked. The equipment was capable of creating three-dimensional images. We were shown around the stress room. It was a fantastic unit which is very well equipped and staffed by very well-trained staff who were very keen to work. The unit is more up-to-date than what is available in most Dublin hospitals.

The availability of the equipment means that an in-patient can be seen in Monaghan General Hospital almost immediately, whereas in Dublin hospitals one could wait six weeks before getting an appointment. Out-patients in Monaghan must wait approximately two to three weeks to get an appointment for cardiac investigations, whereas the waiting time in Dublin is approximately six months. Monaghan General Hospital has the capacity to take pressure off not just hospitals in the north-east region but hospitals in the Dublin area. This small hospital could be a centre of excellence. It is a centre of excellence in its own right if it was allowed to function as such.

I also met the cardiac physicians who are highly qualified. One is the most qualified in the north-east area. They are well respected and willing to work, which are excellent criteria. The whole evening portrayed a great image of Monaghan General Hospital. Many patients who attended the opening were very pleased with what was taking place at the hospital. However, the hospital is still off call. If a patients gets a heart attack at 10 a.m. or 4 p.m. tomorrow at the gates of Monaghan General Hospital, and an ambulance is detailed to pick up the patient, the first thing the crew will do is await instructions to take the patient to any hospital other than Monaghan. They must sit by the side of the road with the patient before determining whether the patient should be taken to Drogheda, Cavan or Dublin. It does not make sense that one of the best units in the country, with highly-trained staff, is off call and the ambulance personnel are not permitted to take the patient 100 yards or 500 yards to the hospital.

There was the well documented case of Christina Knox who lived five miles from Monaghan. She suffered a heart attack and the ambulance was sent to collect her. Her physician was on duty at 9 a.m., yet the ambulance personnel were detailed to take the woman to another hospital. She died 45 minutes into the journey at the gates of the other hospital. She may have died in any case, but the logical thing would have been to take her to her own physician in Monaghan General Hospital where there was a well-equipped unit.

Allowing Monaghan General Hospital to remain off call is not acceptable. I call on the Minister for Health and Children to intervene directly in this case. The chief executive will not do it. There are different reasons given for the hospital not being on call, which I do not accept. Monaghan General Hospital is an excellent facility and, with a little goodwill, can provide a much-needed and excellent service. Patients should be stabilised there, because the sooner they receive clot-bursting medication into the vein, the greater chance there is of preventing a fatal heart attack.

There is no reason people who suffer from an acute asthmatic attack, severe haemorrhaging or appendicitis should not be brought to the hospital and stabilised. I ask the Minister for Health and Children to take a hands-on approach in this instance. There was a recent announcement of €2.7 million for Monaghan, which shows the Minister has an input. He should intervene directly and put Monaghan General Hospital back on the agenda.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank Deputy Connolly for raising this matter on the Adjournment.

Cardiovascular disease is the biggest killer of Irish people. After taking office in 1997, the Government decided that addressing cardiovascular disease should be given a high priority. We established a cardiovascular health strategy group in 1998. The report of this group, Building Healthier Hearts, launched by the Taoiseach in July 1999, set out the blueprint for tackling heart disease in Ireland in the long term.

In the strategy's first four years, the Government has committed €54 million to implement the cardiovascular health strategy report. In practical terms, it has funded the appointment of almost 800 new staff in the first years of implementation. These include 328 hospital-based professionals as well as funding for the appointment of 17 additional consultant cardiologists, resulting in the substantial increase in cardiology diagnostic and treatment services and providing more accessible, equitable and better-quality care for patients with cardiac conditions. Some 109 additional cardiac rehabilitation staff are now in position, therefore, today most acute hospitals treating people with heart disease have developed structured cardiac rehabilitation services. The 81 additional staff employed in the area of information systems, audit and research are improving the quality of and agreeing guidelines for patient care. Work on information systems includes developing clinical databases such as the coronary heart attack Ireland register that will provide essential data on the quality of treatment for patients.

We know that at a population level the health promotion benefits from the strategy's implementation will not be seen until the long term. However, immediate benefits are arising from the wide range of new and higher-quality services already available. These include: stronger intersectoral partnerships in the area of health promotion; reduction in emergency call to treatment times; regional self-sufficiency for non-invasive diagnostic procedures; increased availability of new services such as chest pain clinics and cardiac rehabilitation; almost 200% increase in certain cardiology procedures resulting in a 24% reduction in the waiting list for cardiology procedures; and the 47% increase in the frequency of prescriptions for cardiovascular disease for people covered by the General Medical Services (Payments) Board which reflects the increase in the numbers now being detected and treated with conditions such as chronic heart failure.

The cardiac investigation facilities at Monaghan General Hospital, namely, the echocardiography room, the stress testing room and the cardiac rehabilitation room have recently been refurbished and upgraded in line with recommendations 8.17, 8.18, 8.20, 8.21 and 9.1 of the Building Healthier Hearts cardiovascular health strategy at a cost of €22,636. This initiative will enhance the delivery of services by the newly-recruited cardiac technician and cardiac rehabilitation co-ordinator. This service was previously delivered by a medical consultant or medical teams and hence will allow the consultant more patient contact and also improve the delivery of tests, enhance the assessment of patients' disease process and facilitate evidence-based treatment.

The refurbishment of the cardiac rehabilitation unit will assist the delivery of a comprehensive rehabilitation service to patients who have sustained a cardiac event, for example, myocardial infarction or post-cardiac surgery. The service is both educational and exercise-based.

In addition, I recently issued approval to the board to proceed with its proposals to upgrade the male medical ward and the treatment room at the hospital at an estimated capital cost of €2.75 million. This significant level of capital investment will greatly enhance existing facilities and represents further tangible evidence of the commitment to the continuing development of improved services to the people in the catchment area served by Monaghan General Hospital. Mid-way through the original implementation timeframe, significant progress has been achieved on the majority of the cardiovascular health strategy's 211 recommendations, while substantial progress has been made on approximately 130 of them. Following the success of the cardiovascular health strategy, cardiovascular health is one of the key themes of the current Irish Presidency of the EU.

Mental Health Services.

Mr. Neville

I welcome this opportunity to raise the important issue of psychiatric services for adolescents. Adolescence is a time of rapid developmental change and in addition to physical, intellectual, emotional and social development, adolescents are managing the transition from the world of the child and family to that of the independence of adulthood. Adolescents, because of their developmental stage, are often reluctant to approach adults with their problems. Many simply do not know who to approach or how to approach services for help with psychological and psychiatric problems.

Psychiatric disorders increase in incidence and prevalence during the adolescent years. Deliberate self-harm and attempted suicide increases with age during the adolescent phase. Epidemiological studies show that psychological disturbance of varying intensity exists in up to 20% of adolescents. Only 2% to 5% of the total adolescent population, however, has a moderate to severe disabling condition such as a major psychiatric disorder and the adolescent psychiatry services should deal with that specific target group. Milder psychological problems may be dealt with by a primary care service, such as a community care psychological service, if it is available.

Child psychiatry currently provides services for children up to the age of 16 years. Over the age of 16, services are provided through the adult service. Existing adult services are not resourced to deal with adolescents because of the lack of developmental perspective and the serious lack of appropriate multi-disciplinary input which would be centred on family, school and social interventions. Adult services do not have in-patient facilities that are appropriate for the admission of teenagers for various reasons. These relate to the health and safety issues, in addition to treatment issues. Adult out-patient clinics are generally not adolescent-friendly.

Existing child psychiatry services are not equipped to deal with the older adolescent age group because of the significant increase in major psychiatric illnesses which occur in this age group. Traditionally, existing child psychiatry services provide out-patient services only and have limited medical and nursing back-up with no in-patient beds or day hospitals.

As a result of the changing life profile of problems with age, existing child psychiatry services find that the younger adolescent group, those between 13 and 15 years old, dominate the services because of the high dependency and high rate of emergency presentation with acute illness and suicide attempts. The need for urgent responses to this age group dictates that the service deals largely with adolescents at the expense of working with younger children, thereby preventing useful early intervention which has secondary prevention value. Waiting lists for child psychiatry services are lengthened further by the need to respond urgently to adolescents. Both child and adult psychiatric services are seriously concerned about the lack of dedicated adolescent services.

The age limit of adolescents is variable. The psychological stage of development is the parameter used by the psychiatric service. It may start between 12 and 14 years and continue from 18 to 21 years. Target age groups vary in other countries — some services in Europe target 12 to 17 years and others 16 to 21 years. In Ireland we look at the years between 16 and 18 years of age. Under the Mental Health Act 2001, adolescents under the age of 16 are not deemed capable of giving consent to treatment — consent is implied by the agreement of the parents. Difficulties with out of control children present problems for both child and adolescent psychiatric services. It is recommended that out-patient multi-disciplinary teams should be provided to deal with this.

I draw the Minister of State's attention to the continuing discussion on "Liveline" where parents, friends and siblings talk about instances where children between 14 and 18 years of age have taken their lives and they criticise the lack of psychiatric services for this.

Mr. T. O’Malley

I thank Deputy Neville for raising this matter. In June 2000, a working group on child and adolescent psychiatry was established to make recommendations on how child and adolescent psychiatric services should be developed in the short, medium and long term to meet identified needs.

The second report of the working group, published in June 2003, contains proposals for the development of psychiatric services for 16 to 18 year olds. It recommends that in the further development of the child and adolescent psychiatric services, priority should be given to the recruitment in each health board area of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence. The working group's report further recommends that arrangements should be made with the relevant adult services for the admission to acute psychiatric units of persons aged 16 to 18 under the care of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence, where such a consultant is available. It also recommends that consideration be given to the establishment of specialist adolescent units, particularly in the greater Dublin area.

The report emphasises the importance of co-operation and close liaison between child and adolescent mental health services and adult mental health services and suggests that the current arrangements, whereby the adult services provide a service to the population of their catchment area, including the 16 to 18 age cohort, should continue on an interim basis pending the development of the specialist service referred to earlier.

The first report of the working group on child and adolescent psychiatry considered the development of services for the management and treatment of attention deficit disorder-attention deficit hyperactivity disorder. All aspects of the presentation, diagnosis, treatment and management of children suffering from ADD-ADHD were considered by the working group in the course of its deliberations. In its report, published in March 2001, the different components of treatment required were set out and the importance of adequate linkages with other services, such as education services and community health services, were emphasised.

The group recommended the enhancement and expansion of the overall child and adolescent psychiatric service as the most effective means of providing the required service for children with this condition. The working group found that the internationally acknowledged best practice for the provision of child and adolescent psychiatric services is through the multi-disciplinary team.

The first report also recommended that seven child and adolescent in-patient psychiatric units for children ranging from six to 16 years should be developed throughout the country. Project teams have been established to develop child and adolescent in-patient psychiatric units in Cork, Limerick, Galway and one in the Eastern Regional Health Authority area at St. Vincent's Hospital in Fairview.

The development of child and adolescent psychiatric services has been a priority in recent years. Since 1997, additional funding of almost €19 million has been provided to allow for the appointment of additional consultants in child and adolescent psychiatry, for the enhancement of existing consultant-led multi-disciplinary teams and towards the establishment of further teams. Further development of the service along the lines recommended in the reports of the working group on child and adolescent psychiatry will be considered in the context of the Estimates process for 2005 and subsequent years.

The future direction and delivery of our child and adolescent mental health services will be further considered in the context of the work of the expert group on mental health policy, which is expected to report in 2005.

Airport Development Projects.

Mr. P. Breen

I welcome this opportunity to raise the issue of the uncertain future faced by Shannon Airport. A meeting was recently held in Shannon Airport that was advertised only among airport staff, but 700 people attended it, with local politicians. The Minister of State at the Department of Education and Science, Deputy de Valera, and the Minister of State at the Department of Justice, Equality and Law Reform, Deputy O'Dea, were present at the meeting. The Minister of State, Deputy O'Dea, was not complimentary about the Minister for Transport, Deputy Brennan, in his contribution, especially the way in which the Minister and the Government are giving free rein to Mr. Willie Walsh. We all know that Willie Walsh's main agenda is to consolidate business in Dublin at the expense of Shannon Airport.

The Minister of State, Deputy O'Dea, was not alone in his attacks on Aer Lingus because my Fianna Fáil colleagues in Clare took a similar stand. At the meeting, I proposed that a deputation meet the Taoiseach to discuss the future of Shannon Airport, which was seconded by my Oireachtas colleague, Deputy O'Sullivan. It was then unanimously agreed at the meeting that the Taoiseach and the Minister for Transport should visit Shannon Airport as a matter of priority to discuss with local interest groups and representatives the alarm felt at the threat to the future of Shannon Airport as a result of negotiations on the transatlantic air agreements and the outrageous proposals by Aer Lingus. I was disappointed the Minister of State, Deputy Tim O'Malley, was not at the meeting but I presume he had other commitments on the night.

Aer Lingus workers in Shannon are in a state of bewilderment as to what lies ahead for themselves and their families who rely on the airport for their livelihoods. They have consistently made sacrifices to bring the company to profitability in 1992 and again in 2002. Currently the company is looking for 104 redundancies in ground handling staff. Aer Lingus is also directly neglecting Government policy on decentralisation by forcing cabin crew who live and have families in the region to transfer to Dublin. There is no need to change the current bilateral agreement to facilitate Aer Lingus's expansion into other US states. This could be facilitated under the present agreement. However, the Government needs to put pressure on Aer Lingus to put in place a five year business plan for Shannon Airport which should be guaranteed by the Government as the main stakeholder of the company.

Recent decisions by Continental Airlines to extend the Shannon-Newark route until the end of the year proves that there is a market for transatlantic business in Shannon, yet, at the same time, Aer Lingus is reducing services. US Air may follow the same route for a winter schedule on which the company had a 94% occupancy rate on its flights in 2003. I also welcome the new airline, Duo, and wish it well in Shannon Airport.

The Taoiseach and Minister for Transport need to visit Shannon, which was demanded as a minimum by the people at the meeting. They have no confidence in the Government or the Minister for Transport. They know that actions speak louder than words. They know that the Government is not making the case for Shannon to the US negotiators negotiating an EU open skies policy.

Are the workers in Shannon Airport once again to be the sacrificial lamb? Reports that Aer Lingus could be sold off beg the question of whether these workers will pay the price to make millionaires of people like Willie Walsh. Before the previous general election, the Taoiseach paid a well-heraIded visit to Clare proclaiming his full support and commitment to Shannon Airport. This invitation tonight from Deputy O'Sullivan and I is an opportunity for him and the Minister for Transport to prove and reaffirm their commitment in actions.

Ms O’Sullivan

Deputy Pat Breen and I tabled this joint motion as a result of a meeting we attended in Shannon which was also attended by a huge number of people working in the airport. We tabled tonight's motion to get a commitment from the Taoiseach and the Minister for Transport to come to the Shannon region in the near future to hear at first hand the genuine fears of people in the mid-west and west at the Minister's proposal to dilute the 50:50 gateway status enjoyed between Dublin and Shannon and the actions of Aer Lingus in forcing 29 workers to move to Dublin and seeking 100 further redundancies in Shannon. This is on top of other actions taken by the company.

The Taoiseach's party colleagues were left in no doubt as to the strength of feeling at the packed meeting held at the airport recently to the extent that the Minister of State at the Department of Justice, Equality and Law Reform, Deputy O'Dea, was moved to attack the stand of the Minister for Transport. The Minister of State, Deputy Tim O'Malley, may not have been at the meeting, but he may well have read in the Limerick Chronicle on the following day what exactly the Minister of State, Deputy O’Dea, said. Initially, the Minister of State was not going to speak, although he did in the end, not being able to hold himself back from rightly criticising the Minister.

Unfortunately, my colleagues in the mid-west are not hugely confident in the ability of the Minister of State, Deputy O'Dea, to sway the Cabinet. This is why we need the Taoiseach to come out of Dublin and see for himself how critical are the concerns. Shannon relies on the transatlantic routes for 36% of its business. It has 44% of transatlantic traffic to Ireland. It is a fact that, wherever in Europe airlines have been allowed to ditch airports in the regions on transatlantic routes, they have done so and we were given evidence to this effect at the meeting. It suits airlines to centralise in the capital city for long-distance flights. Aer Lingus is already putting measures in place in anticipation of the dilution of the bilateral agreement and the company's own privatisation for which it is hoping. The Minister is making the noises that he intends to do so.

The job losses in Shannon are evidence of what Aer Lingus is trying to do. Management, staff and pilots have already been transferred to Dublin and the number of cabin crew based in Shannon has been halved. Only the Minister for Transport believes Willie Walsh when he says he is committed to Shannon, the suggestion of which was laughed at during the meeting. It is considered derisory. The meeting also heard from employees of Aer Lingus of ruthless manipulation of US travel agents and Internet bookings to deliberately steer business to Dublin and away from Shannon.

This is probably the only successful measure in terms of regional development which is in place. Why should it be taken away when it is working and when we stand to lose thousands of jobs in the Shannon region? I am concerned that the Progressive Democrats agenda is infecting Fianna Fáil, although I am sure the Minister of State is not concerned. It is essential that the Taoiseach visits Shannon so that he can understand the fears of people in the region.

Mr. T. O’Malley

I thank Deputies Pat Breen and O'Sullivan for tabling this Adjournment matter. Both Deputies have referred to my absence from the meeting in question. In that connection, I received a telephone call at 4.30 p.m. that day to invite me to the meeting and, as Deputy Breen rightly stated, I had a prior engagement that night. I assure Deputies that I would have been at the meeting if I could have been. My party has been involved in the affairs of Shannon Airport for many years and, but for the party being involved in some affairs, certain events may have occurred which would not have been in the best interests of the airport.

The Minister for Transport has spoken in the House about these issues on a number of occasions recently. Unfortunately, he cannot be in the House due to other commitments associated with the Presidency of the European Union, but I am happy to restate the position.

The Government has a clear commitment to the future of Shannon Airport. The Minister has already met interests from the Shannon region regarding the issues facing the airport. On 5 February, the Minister met a trade union delegation and set out the approach he is pursuing which is designed to secure the best possible outcome in respect of the Shannon stopover.

Mr. P. Breen

There is no Shannon stopover.

Mr. T. O’Malley

In regard to the Shannon stopover and the EU-US negotiations on an air transport agreement, I would like to outline the background to this for the House. The European Court of Justice ruled on 5 November 2002 on a case taken by the European Commission against eight member states, not including Ireland, in respect of those states' open skies agreements with the USA. The court ruled that the designation of national airlines in those member states' bilateral air transport agreements is contrary to the right of establishment provided for under the treaties establishing the European Union.

While this finding specifically related to the eight member states against whom the action was taken, it was clear that the principle behind the finding applied equally to all EU member states. This means that member states must allow any European airline established in their countries to enjoy the benefits of that member state's bilateral agreements. This legal principle applies to each member state's bilaterals with every third country, not just the USA.

In response to the court's ruling, the European Commission then reactivated a proposal to give it a mandate to negotiate an open aviation area agreement with the USA. This was a long-standing proposal and it has been understood within the European Union for some time that it was only a matter of time before such a mandate would be given to the Commission. Under the mandate, the EU and US territories would be treated as a single aviation area. The mandate given to the Commission envisages a liberalised regime in which airlines may operate services in both Europe and the USA as well as between them. The intention is that European and US airlines would not be constrained as to the destinations to which they fly, just as they are not so constrained within Europe today.

When deciding what position he should adopt at the Transport Council in June 2003 on behalf of Ireland, the main issues that the Minister took into account were the ruling of the European Court of Justice last November, the impact on Shannon airport and its hinterland, the impact on tourism of increased access to Ireland, the opportunities for Aer Lingus to increase its business on transatlantic routes as well as Ireland's wider relationship with Europe. The Minister also had to consider the fact that an EU-US liberalised market is the inevitable outcome of this process in Europe.

At the Transport Council last June, the Minister stated that he would not oppose the wish of all the other member states to grant this mandate to the Commission to negotiate an EU-US agreement. He also reiterated his concerns about the impact an EU-US agreement might have on Shannon Airport and that he would carefully assess the draft agreement which ultimately emerges from those negotiations.

The Transport Council, on 9 March this year, considered the outcome of the negotiations up to that date. The Council rejected the initial deal then on the table and instructed the European Commission to continue negotiations to get a more balanced deal and to report back to the next Transport Council in June. At the March Council, Ireland reiterated its concerns regarding Shannon and stated that Ireland's acceptance of any EU-US deal would be contingent on our being satisfied that the best possible deal for the future of Shannon Airport had been achieved. Ireland also indicated that, in order to get that best deal for Shannon airport, Ireland would engage in bilateral talks with the US.

The revised understanding regarding Shannon that Ireland reaches with the US can then be accommodated within the EU-US deal, if such a deal is agreed at the June Transport Council. While informal contacts have taken place between Irish and US officials, negotiations have yet to be held. There will be further discussions with the unions and the Shannon Airport Authority designate before the Minister's negotiating position is finalised. The House will appreciate that it would not be appropriate for the Minister to publicise his negotiating position in advance but it will be designed to secure the best possible outcome in relation to the Shannon stopover.

Mr. P. Breen

There is no stopover. The Minister of State knows that.

Child Care Services.

Aengus Ó Snodaigh

The Central Statistics Office figures show that there are 1,464 children under the age of four in the Ballyfermot and Cherry Orchard areas. In two of the electoral wards, Cherry Orchard A and Cherry Orchard C, 44% and 66% of the population, respectively, are under the age of 25. This is higher than the national average. The proportion of lone parent families has risen from 20% to 26%. This is more than double the national average of 11.7%. These figures are expected to continue to rise. High density building planned for the next 18 months will lead to an additional 1,500 homes in the area. While these homes are welcome they will increase the population of Ballyfermot by 20%.

A child care survey carried out by the Ballyfermot Partnership last year found that only 432 children in the Dublin 10 area are accessing child care services while 255 are waiting for places. There are only two full-time child care facilities in Ballyfermot, one private child care service and 25 part-time and play-school facilities. All of these are dependent on community employment and jobs initiative staff. All of the support staff and 72% of the assistant members of staff are on these schemes. We know how the Government has dealt with these schemes. Therefore, all of the existing child care services are currently under threat. Services need to be increased by 55%, just to meet current local demand.

There has been an application to the Department of Justice, Equality and Law Reform's equal opportunities child care programme for funding for four new child care services in Ballyfermot. One of these applications was made in January 2003 and a decision is still awaited. Decisions on these applications have been deferred indefinitely because of the review of the programme. The delay is worsening the situation in the area.

In an era of economic growth it is imperative that training and work opportunities are available and open to all. The provision of child care is an essential component in achieving the goal of equal access to these opportunities. Henceforth, affordable child care must be available to all. Lack of child care affects all of the community, including parents, grandparents, carers and others, whether married or single, young or old. Lack of child care hinders the right of all of these people to access education, training and employment opportunities. It is affecting them now and will do so in the future.

The indices for the Ballyfermot and Cherry Orchard areas show that the area is disadvantaged and has high unemployment levels and a significant problem of drug and alcohol abuse. All of those working in education and health in the community and the gardaí agree that a co-ordinated approach is required to break the cycle. Ballyfermot has double the national figure for those who left education at primary level. Long-term unemployment in the area is double the national average. It has a higher rate of people with disabilities and double the rate of lone parents. One third of the unemployed in the area who are over the age of 35 have had recent contact with the criminal justice system.

A co-ordinated strategy is required but a component part of that is an affordable, accessible and local child care service. This will ensure that the opportunities exist to allow young parents to return to education or training, to get training in the first place or to join the work force

This crisis needs to be addressed immediately. I urge the Minister of State to complete the review and to provide the required funding to allow these services to be developed in the area.

Mr. T. O’Malley

The current review of the capital provisions of the equal opportunities child care programme for 2000-06 is taking place largely because of the programme's success to date in stimulating activity to develop child care throughout Ireland. It is always prudent to step back and take stock from time to time to ensure that best use is obtained from the not inconsiderable sums that have been entrusted to the Minister for Justice, Equality and Law Reform to develop quality child care. The mid-term review of the national development plan afforded such an opportunity.

This is a seven year programme. The original funding provision of €436.7 million has just been increased by an additional €9 million of ESF support following the mid-term evaluation of the national development plan. This additional funding was made available in recognition of the programme's success to date and its capacity to develop and support quality child care to meet the child care needs of parents in employment, education and training.

The EOCP originally set aside more than €140 million capital funding to create new and enhanced child care places. The availability of this ground breaking funding together with the demand for child care places sparked considerable interest in the capital element of the EOCP. Capital investment is an investment for the future as well as for the short term. As a result, the child care directorate of the Department has undertaken the current review to ensure that as much funding as possible will be channelled to support the creation of much needed new child care places. It is reviewing different budget lines within the capital programme to ensure that the most effective use is made of all remaining capital funding in accordance with the objectives of the programme. The review is also looking at all existing financial commitments under the programme to ensure that all capital projects which have already received grant allocations will proceed.

While the review is not quite complete and has to wait for some financial technicalities to be completed at the EU/NDP programme level before it can be fully implemented, it will, when complete, lead to a thorough appraisal of all capital applications to determine those which best address the ends of the programme and, therefore, which will be accorded the highest priority for funding in the short term.

In carrying out the review of the programme's achievements to date, the Department of Justice, Equality and Law Reform found that every county had benefited from considerable support for new child care facilities under the new EOCP. In all, funding to create 28,300 new places has been approved to date. When fully drawn down this will bring an increase of 50% in the number of centre-based child care places throughout Ireland since the start of the programme in the year 2000.

The programme also makes grant assistance available towards the staffing costs of community based/not for profit child care facilities which have a clear focus on disadvantage and which support disadvantaged families who are in work, training or education. Staffing funding which is current expenditure, as distinct from capital expenditure, is helping to support a further 26,000 child care places.

Efforts are being made to achieve a good geographical spread throughout the appraisals and approvals process. Included in the national total figures I mentioned earlier are approvals for the creation of 6,702 new places and the support of 6,756 existing places in Dublin city and county. The Deputy may not be aware that almost €2.8 million has been awarded to a number of projects in the immediate Ballyfermot and Cherry Orchard areas. This funding will create 249 new child care places and will help to support a further 121 existing child care places in the area.

Apart from looking at the funding amounts to be made available for the capital programme, the review has also examined approvals to date in each county in the context of existing services. It has reviewed the type of services which are being supported to ensure that there is a good mix of full-time and essential services serving the full range of age groups, particularly children under two. Value for money is a key consideration, but where child care is concerned, quality is also a key dimension.

I understand that following the current review of the capital programme, at least €30 million in capital grant assistance will be made available to projects which can be brought to fruition by the end of 2007. Given the success of the present programme, I do not doubt that the Government will continue to build on those successes into the future. The equal opportunities child care programme is a complex programme which makes a range of grants available to support and develop the child care sector. It requires regular review to ensure that it best addresses the needs of parents. It is in that context that the present review is being completed.

As I said earlier, all capital proposals, including those in Ballyfermot and Cherry Orchard, to which the Deputy referred, are being collectively reviewed against the detailed programme criteria to identify those which can best address service gaps and which can be brought to fruition within the lifespan of the current equal opportunities child care programme.

The Dáil adjourned at 11.15 p.m. until10.30 a.m. on Thursday, 8 April 2004.