Dáil Éireann debate -
Thursday, 7 Oct 2004

Vol. 589 No. 5

Adjournment Debate.

Hospital Services.

Mr. Morgan

The lack of maternity services at Louth County Hospital is a major ongoing concern to the 80,000 residents in the greater Dundalk area. However, when, as happened this week, a baby was born by the side of the road, people's minds are focused in a powerful way. Is it reasonable or fair that a young mother and her baby should be subjected to this type of experience in 2004? Of course it is not. If the Minister of State agrees that this experience is unacceptable, they why is the Government doing nothing to avert it? After more than seven years in office and almost 50 reports on our health service, citizens expect and, indeed, demand more from their political rulers.

Last weekend, another hospital in the North Eastern Health Board area, Our Lady of Lourdes, was forced to cancel elective surgery, as if waiting lists are not long enough already. Those individual members of the public who were already forced to endure lengthy waiting periods must suffer further hardship by waiting longer as a consequence of these cancellations. Indeed, the hospital was on the verge of going off call. That prospect would have resulted in patients, some requiring urgent treatment, being forced to travel to Dublin, where hospitals regularly go off call.

This is not a proper health care service. It is not the health care service that our citizens both deserve and demand. Neither is it fair nor reasonable for an Administration to neglect the will of the people in the way that this Government is doing.

Let us consider some of the details relating to a roadside birth. A member of Angela Hughes's family telephoned for an ambulance at 3 a.m. yesterday, five minutes after her waters broke. At 3.20 a.m. an ambulance from Dundalk arrived but instructed Angela that they must await a ambulance from Drogheda. At 3.50 a.m. the Drogheda ambulance arrived, collected the expectant mother and set off for Our Lady of Lourdes Hospital in Drogheda, passing the Louth County Hospital on the way. Approximately five minutes after doing so, the ambulance was forced to stop at the roadside to deliver the baby. Luck was in on this occasion. Both baby and mother were fine. However, we know that any one of a multitude of complications could have arisen. Does the Minister of State really believe that in this day an age women should have to give birth in circumstances of this kind? Has he any idea of the increase in anxiety and stress that the lack of maternity services at Louth County Hospital is causing for expectant mothers? Women in Third World countries can expect better conditions than expectant mothers in the Dundalk area. It is nothing short of a disgrace that the State cannot deliver modern accessible maternity care for all expectant mothers.

The sheer stupidity of forcing women who are going into labour to travel to Drogheda from the north Louth area is evident from the timeframe of the Drogheda ambulance journey. It takes 50 minutes to travel from Drogheda and if there had been no stop for small issues such as births on the return journey, it would have taken a further 50 minutes to get back. The round trip is, therefore, over one and a half hours. Where was the "golden hour" rule in this instance? Are people who reside in the greater Dundalk area exempt from this essential medical rule?

When the maternity ward at Louth County Hospital was closed in 2001, we were informed that it was a temporary measure. We were then informed that it was being replaced with a midwife-led unit. Three years on, there is absolutely no sign of this new unit, limited as it would be.

The Minister should avoid playing the numbers game on this occasion. I know about the 800 births per annum requirement. When the maternity unit was closed there were more than 600 births annually and that was with only one gynaecologist on site. Any cases with complications were referred to Drogheda for that reason. On average 2,500 births take place in the county. Had the unit been properly staffed we know that with the continuing growth of Dundalk we could have reached the required number.

What is happening in this case? Does the Minister of State have answers to any of these questions? The Minister of State must accept that patient safety is not the primary issue in respect of north Louth. Why are citizens from this area not entitled to the same reasonable level of care as other citizens?

It would be remiss of me to address the health care issue and not acknowledge the commitment and contribution of staff in our hospitals and ambulance service. I do not know how they do it. They are wonderful and courageous people. They generally work in understaffed conditions and are, like members of the public, carrying the can for the lack of proper health care services. Health care services represent the most important issue in the State. Why is the Government unable to deal with it? Why are we not getting the most essential care for our people, particularly in light of the democratic reminder the Government got last June?

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

I am making this reply on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney. I take this opportunity to clarify the background and present position on the provision of in-patient obstetric services at Louth County Hospital, Dundalk.

I do not accept the characterisation made by the Deputy of our health service as having a Third World character. Neither the volume of investment made, the quality of staff engaged nor the facilities provided in the health service justifies the epithet used by the Deputy that ours is a Third World health service. As far as democratic reminders are concerned, given the Deputy's general lack of awareness of the issues involved in maternity provision in the State, I would be very depressed if his party had any say in a future Government deciding how such services should be provided.

Mr. Morgan

The Minister's attitude is depressing me.

Mr. B. Lenihan

The Deputy should begin by examining the views of the Institute of Obstetricians and Gynaecologists. It advised all health boards in 2000 on the levels of consultant staffing required to provide an appropriate level of care in the maternity and gynaecological service and on the consultant supervision of trainee specialists. The institute is the professional body representing the specialty of obstetrics and gynaecology in Ireland and is the advisory body in Ireland for education, training and administration in the specialty. Neither the Deputy nor I are experts in this area; members of that body are. They considered that a viable unit requires in the region of 1,000 births per annum to enable consultants to maintain their expertise and trainees to develop their skills. The figure is 2,000 births per annum in the other jurisdiction in Ireland, where the Deputy's party has exercised responsibility in government.

The North Eastern Health Board established a review group on maternity services, which issued its report in November 2000. The report, having examined the level of obstetric activity at Louth County Hospital, which in 1999 and 2000 recorded only 406 and 553 births respectively, advised that consultant-led maternity services at Dundalk should be discontinued as the provision of such services was not in line with the recommendations of the institute. These are the facts.

The North Eastern Health Board was informed at that time by Irish Public Bodies Mutual Insurances Limited that insurance cover was being withdrawn for maternity services at Louth County Hospital. As a result, in-patient maternity services at the hospital were discontinued. The board established a further review group to investigate fully all the options regarding maternity services in the board's functional area. This group reported in October 2001.

The group engaged in widespread consultation with medical, nursing and other professionals, as well as with users of the service. The report recommended that midwife-led units should become operational as soon as possible at Our Lady of Lourdes Hospital, Drogheda, and Cavan General Hospital prior to the phased opening of a similar unit at Louth County Hospital, Dundalk. The board adopted the report and established a task force in early 2002 to implement the various recommendations.

The pilot midwifery-led services at Our Lady of Lourdes Hospital, Drogheda, and Cavan General Hospital commenced in July last and are providing antenatal care for eligible women. I understand that in-patient services will commence in these units by the end of this year. The board has also commissioned the School of Nursing and Midwifery Studies at Trinity College Dublin to evaluate the performance of the units. Following evaluation of the efficacy of these services, decisions will be taken on the provision of such a unit at Louth County Hospital, which I am sure is a matter of legitimate concern to the Deputy.

Mr. Morgan

The Government has not even considered it.

Mr. B. Lenihan

With regard to the specific incident referred to by the Deputy, the Department of Health and Children has been informed by the North Eastern Health Board that the ambulance personnel involved in the treatment of the patient followed procedures as per the national pre-hospital care standard operating procedures for ambulance services. Mother and baby are both well.

Mr. Morgan

No thanks to the Department of Health and Children.

Departmental Programmes.

Mr. M. Moynihan

I am glad to have the opportunity to speak on the Adjournment about incentives which the Government should introduce to further enhance the attractiveness of the CLÁR region as a centre of enterprise development by offering greater incentives for setting up businesses there.

About three years ago the Government designated areas in rural Ireland known as CLÁR regions. These areas had suffered 50% or greater population decline between the census of 1926 and the census of 1996. By and large this initiative has been welcomed throughout rural Ireland and has made great strides in upgrading the infrastructure. Many enterprises and businesses have benefited as a result of the CLÁR initiative, for example through the connection of the three-phase electricity which has allowed small and medium-sized enterprises to grow their business through community enterprises.

In the past 12 months local authorities have introduced or increased considerably their development charges. On the one hand the Government has designated these areas in rural Ireland as areas of disadvantage and population decline while the local authorities have applied blanket development charges, which reduce the likelihood of enterprise development in these areas. To follow the Government policy on such areas of disadvantage, local authorities should have applied tiered development charges. I ask the Minister to have development charges applied by the local authorities reduced or eliminated altogether in areas of greater disadvantage.

In recent years the Government and its predecessor have done a considerable amount to enhance rural Ireland. The prosperity of the Celtic tiger has seen improvement in areas that were not developing economically. It is hugely impractical to have the same development charges applied in my area of western Duhallow in north County Cork as are applied within a mile of the airport or Ringaskiddy. While all other set-up costs are equal we must ensure that in CLÁR regions and some smaller towns incentives exist for entrepreneurs wishing to establish indigenous industries. As business people they will try to get the best value for every euro spent on such development.

As these areas have CLÁR regions and areas of decline and disadvantage, they should have reduced development charges. If the Minister were to ask local authorities to review their charges, I am sure they would reduce them. I am grateful for the opportunity to raise this issue and I look forward to the Minister's reply.

Mr. B. Lenihan

I have noted the comments made by Deputy Michael Moynihan about the CLÁR programme, which were addressed to the Minister for Community, Rural and Gaeltacht Affairs. I undertake to ensure that the matter is examined. Financial provision is made in various Government schemes for certain areas which are designated as CLÁR areas. Deputy Moynihan has argued, however, that inadequate provision is made to recognise the fact that the full rigour of development levies apply to such areas, which are found in the functional areas of local authorities, just as they do to areas which are not designated under CLÁR. I appreciate that the failure to make such provision has caused particular difficulties for those who are trying to stimulate much-needed development in CLÁR areas. On behalf of the Minister, Deputy Ó Cuív, I undertake to raise the issue with local authorities.

Health Reform Programme.

An Leas-Cheann Comhairle

Deputies Perry and Costello were absent from the House when they were due to speak on their Adjournment matters. As the Deputies are now present, I propose that we allow them to speak on their matters, if there are no objections. I appeal to Deputies and Ministers to be present when they are due to speak. If they are not present when they are called, their matters will fall.

Mr. Perry

I thank the Leas-Cheann Comhairle for allowing me to discuss the local implications of health service reform. In particular, I wish to debate the decision of the former Minister for Health and Children, Deputy Martin, to locate the western regional centre of the Health Service Executive in Galway. It is important that we build on the successes achieved by the North Western Health Board in areas such as acute services, primary care services, child care and family support, services for older persons, services for persons with disabilities, mental health services and hospice care.

I would not like the innovation in health services in the north west to be lost. Emphasis should be placed on keeping people at home, for example, by supporting them and their carers to do so. We need to provide a wide range of flexible services, such as home care packages, respite care, personal assistants, carer support and subvention payments. Such issues need to be addressed by the new Minister. The North Western Health Board uses its limited funding effectively to provide the best service possible, but that is not always good enough. It is important to achieve a high level of self-sufficiency in acute services so that more people can receive treatment in the north-west region without having to go elsewhere, as cancer patients regrettably have to do at present.

The health board has been effective in linking closely with statutory authorities. We need to form partnerships with voluntary organisations, such as disability groups, mental health associations, care of the aged committees, community groups and religious orders to provide facilities and services. The community nursing home in Ballymote and Nazareth House are examples of such bodies. Services such as orthodontics have been contracted out of the region, unfortunately.

It is regrettable that the peripheral nature and disadvantage of the north-west region were not taken into account in the new structural arrangements. Although the location of the regional office has already been announced, I appeal to the Minister to consider the factors I have mentioned when locating other health service structures. I refer, for example, to the primary, community and continuing care directorate, the national shared services centre, the centre of management of the national acute hospitals sector and other regional centres. There was great disappointment when Deputy Martin announced on his last day as Minister for Health and Children that Galway would be the new regional centre. As I have said, the peripheral nature and disadvantage of our region was not taken into account. I hope the north west does not become the poor relation within the expanded region.

We hear each day that the Government is committed to balanced regional development, but it could have affirmed its commitment by locating the regional office in Manorhamilton. It did not take its first opportunity to encourage such development. Manorhamilton, which has served a large geographical area very well, is geographically central in the expanded region. Carndonagh is as far from Manorhamilton as Galway. The head office of the North Western Health Boardis important to north Leitrim. It is astonishing that there are no other major agency offices in the north-west region. Every regional office seems to be located in Galway. I cannot see the logic of that.

We should use the health service as a means of increasing the opportunities for cross-Border co-operation. The North Western Health Board has more than ten years' experience of successful cross-Border collaboration under the co-operation and working together initiative. It has secured significant investment for major project work within cross-Border communities. There is a need for a significant regional office in the Border region and Manorhamilton is ideally placed for that purpose.

I call on the Minister of State, Deputy Brian Lenihan, and the Tánaiste and Minister for Health and Children, Deputy Harney, to rescind the decision to locate the regional centre in Galway from January 2005. If that is not possible, I demand that Manorhamilton, a town in the Border region which is in critical need of investment and opportunities, be considered when decisions are being taken about the three other structures which have yet to be located. There was huge disappointment in the town, which has some of the finest facilities in the country, when last week's decision was announced. The regional office in Manorhamilton serves the area extraordinarily well and has the capacity to continue to serve as a regional office. The Government missed an opportunity when it failed to announce last week that the office in Manorhamilton will be retained.

I reiterate my call on the Minister of State to establish clearly what will be done for the north-west region. I ask him to indicate in his reply, in the interests of balanced regional development, that Manorhamilton will not be omitted again when further announcements are being made about the Health Service Executive

Mr. B. Lenihan

I am replying to Deputy Perry on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney.

The Government's June 2003 decision on the health service reform programme was based on the Prospectus and Brennan reports. I am sure the Deputy is aware that the health services reform programme will consolidate the multiplicity of different structures within a single agency, the Health Service Executive. The board of the interim Health Service Executive was set up last November. Under its establishment order, the interim executive has responsibility, subject to the Minister's approval, to plan the establishment of a national unified structure for the delivery of health services. This includes responsibility for the integration of the management, administrative and service delivery structures of the health boards. The Government's decision provided that the primary, continuing and community care directorate to be established within the HSE would be supported by a network of four regional health offices and the maintenance of the existing community care area structures, in the form of the 32 local health offices.

On foot of proposals from the interim Health Service Executive, the former Minister for Health and Children, Deputy Martin, and the executive chairman of the interim HSE, Mr. Kevin Kelly, jointly announced the four regional areas of the HSE and the location of the regional offices. The western regional area will be located in Galway city, the southern regional area will be located in Cork city, the Dublin and north-east regional area will be located in Kells, County Meath, and the Dublin and mid-Leinster regional area will be located in Tullamore, County Offaly. The 32 local health offices are to remain in place.

The western region, which will extend from County Donegal to County Limerick, will cover a population of approximately 950,000 people. In making its proposals, the interim HSE has taken cognisance of a variety of issues, including the Government's policies on issues such as the national spatial strategy, and has ensured a minimum disruption of the existing system and the integration of services. Mr. Kevin Kelly has emphasised that the local health office will be the primary service delivery unit in each community. The regional health offices will not take over regional responsibility for the services managed and delivered by the health boards. Instead, they will co-ordinate services where they span more than one local area and will be responsible for performance management, translating national policies through the local areas and gathering and relaying information on a regional basis. Interaction with local communities and their elected representatives will also be part of the functions of the regional offices. It is envisaged that each regional office will employ approximately 25 to 35 staff.

Mr. Kelly has said that while it is not yet possible to be precise about the services and functions which will be delivered from specific locations, significant health employment within the Health Service Executive will continue to be located at the current locations of health board headquarters. Future changes will be made in consultation with staff and unions and with the objective of resulting in minimum staff disruption. The role of Manorhamilton and the existing headquarters of the North Western Health Board is being planned by the interim HSE in that context.

Crime Levels.

Mr. Costello

Today I raise the burglaries that have taken place in inordinate numbers in a very middle-class area of my constituency, something that had not happened there before. The residents felt compelled to hold a meeting in the Tivoli Centre regarding the spate of burglaries. It was attended on 28 September by 200 to 300 residents. The gardaí came along, as did officials from the local authority and local public representatives. They indicated that they had received reports of nine break-ins for September. The residents stated that the figure was more than double that, but that some of them might not have been reported. Perhaps some people felt that it was not worth their while doing so, since they did not expect much of a response. The discussion went on, and it was a microcosm of what is happening throughout the constituency and the city of Dublin. There has been an increase in crimes against property and burglaries affecting people's homes, apparently without any adequate response. There is a great deal of concern about the absence of gardaí on the beat and the fact that 2,000 gardaí have not been recruited. Promises were made and not kept. Some were reiterated, seemingly without anything being produced. I assure the Minister that the Government got quite a roasting on the matter.

The other aspect to the issue is the slow progress on community policing, which was promised and incorporated into the Criminal Justice Bill, which is now a year old and has not yet seen the light of day in this House. We would like to see the Minister for Justice, Equality and Law Reform getting his priorities right and showing a certain sense of urgency in dealing with policing issues in urban and rural areas. We need both greater numbers of gardaí and a new type of policing that engages the community, is participate, and commands the respect of those whom it serves. In that context, I thought it better to concentrate on a single area. I could go through other parts of the city where the problems are the same. I do not want to mention Stoneybatter, where there are currently major problems with policing. The same is true of East Wall and North Strand. The inner city itself has massive problems with drugs and their policing.

There is difficulty getting in contact with the gardaí. If one dials 999, that is one query, and one does not know where it goes. It disappears into a black hole, and there is no guarantee of when there will be a response. Gardaí have no individual telephone numbers, so no one is really responsible when a complaint is made and no one knows whom to get back to. It also transpires that gardaí do not have e-mail; one cannot e-mail a member. In this day and age, every garda in Store Street, Fitzgibbon Street or any other Garda station should be available via e-mail if one wishes to contact them with an issue. They could e-mail back so that one established some connection or communication to pursue one's complaint.

We have serious problems regarding burglaries and crimes against property, and difficulties with gardaí on the beat and with the Minister for Justice, Equality and Law Reform getting his promised legislation up and running and delivering on the numbers of gardaí promised.

Mr. B. Lenihan

I thank the Deputy for raising this matter, and I am aware of the interest in this subject. I am speaking on behalf of the Minister for Justice, Equality and Law Reform, Deputy McDowell, who is unfortunately unable to be present. I assure the Deputy that the Minister and I share his concern and that of the residents in the Clonliffe area on this matter.

Before commenting on the particular issue identified by the Deputy, it is helpful to put the issue of crime and crime statistics into perspective. In July the provisional quarterly figures for headline crime for the State were released by the Minister for Justice, Equality and Law Reform. I am sure all Deputies will agree it was encouraging to see that headline crime had fallen by 10% for the second quarter of the year when compared with the second quarter in 2003.

Mr. Costello

That is because there were no gardaí on the beat to apprehend the perpetrators.

Mr. B. Lenihan

Burglaries as an individual category of headline crime decreased by 10%. Headline crime for the first half of 2004 was 7% less than that for the first half of 2003. Furthermore, headline crime for 2003 was 2% less than that for 2002.

At the time those statistics were released, the Minister cautioned, as he had done before when discussing statistics, that one should be careful when interpreting trends over short periods. However, the timely release of statistics is a valuable source of information for both elected representatives and the public whom they represent. Statistics allow us to identify problem areas and target particular types of crime in addition to facilitating informed debate on crime. The Garda PULSE system provides a range of operational reports based on a variety of criteria which permit local Garda management to identify trends and take action to address difficulties as they arise in particular areas.

However, it is important to realise that the Garda Síochána is not an island of law enforcement. They rely on the ongoing and active support of the public to enable them to be at their most effective in their duties, whether that support is given through the provision of information to the gardaí by members of the public or through more general co-operation by members of the public with the gardaí. As members of society we all have an active part to play in the fight against crime, and a duty to do so.

I will now address the question raised by the Deputy with particular reference to the area he identified. I understand from the Garda authorities that the difficulties being experienced in this area were discussed with approximately 200 residents of the area at a recent meeting held at the Tivoli Centre. I am informed by the Garda authorities that the Clonliffe area is actively policed by gardaí from Fitzgibbon Street Garda station, where the personnel strength currently stands at 119, covering all ranks.

The Clonliffe area is covered regularly by both mobile and foot patrols and by plain clothes and uniformed gardaí. In addition, the divisional mobile units also pay regular attention to the area. There are currently two sergeants and 13 gardaí assigned to community policing in Fitzgibbon Street, with three vacancies to be filled in the near future. As the Minister previously informed the House, local Garda management assured residents at their recent meeting that Garda resources and a higher Garda visibility would immediately be directed to the area concerned. A further meeting with the residents is planned for next week. I have no doubt that the ongoing efforts of the gardaí to tackle the problems encountered by residents will bear fruit in the near future.

Current policing plans in the area are predicated on the prevention of crimes, including crimes of violence against persons and crimes against property, and the maintenance of an environment conducive to improving the quality of life of the residents. This strategy is, and will continue to be, central to the delivery of an effective policing service to the areas in question.

In addition, there is one Garda youth diversion project, which caters for residents of the area in question. Those projects are a community-based, multi-agency crime prevention initiative which seeks to divert young persons from becoming involved, or further involved, in anti-social or criminal behaviour by providing suitable activities to facilitate personal development, promote civic responsibility and improve long-term employability prospects. By doing so, the projects also contribute to improving the quality of life within communities and enhancing Garda-community relations.

The Garda juvenile diversion programme, which deals with juveniles who have committed an offence and have admitted their guilt, constitutes a significant means of dealing with young offenders. As I mentioned earlier, the statistics for the second quarter of 2004 show an overall reduction of 10% in the number of burglaries against the same quarter in 2003, although I realise this will be of only some comfort to the recent victims. However, it is important to stress that these decreases, which are to be welcomed, can only be continued and built upon by the assistance and support afforded to the Garda Síochána by the public at large.

Community-based schemes such as community alert and neighbourhood watch are extremely tangible and practical aspects of crime prevention. If we are to develop a strategy to prevent and reduce crime — not just to detect crime after it has been perpetrated — it is critical that the broad local community be actively involved through, for example, giving it the opportunity to identify those crimes which are the most prevalent and the most damaging to the community and local voluntary groups.

The recent burglaries which have been carried out in the Clonliffe area are under active investigation by the gardaí at Fitzgibbon Street Garda station. The Garda Síochána is confident that it is making progress in solving the recent spate of burglaries and that it will be in a position to bring those responsible to account in the near future.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 12 October 2004.