Dáil Éireann debate -
Tuesday, 9 Nov 2004

Vol. 592 No. 1

Adjournment Debate.

Health Board Property.

Mr. Kirk

I thank the Ceann Comhairle for the opportunity to raise this important matter. We have concluded tonight's debate on the health service in the north-east region and I am looking forward to contributing on that debate tomorrow night.

The matter I am raising on the Adjournment relates to health board land at St. Bridget's psychiatric hospital in Ardee. The land at Currabeg was sold to an industrial prospector for a pharmaceutical plant. There was a long protracted negotiation on planning permission, which was eventually granted by An Bord Pleanála, but, unfortunately, the specific project did not proceed. I understand that the North Eastern Health Board is making arrangements to have the land returned to its ownership, as per the original agreement when the land was sold to the pharmaceutical company.

There is considerable concern in the Ardee and mid-Louth area about what will happen the land when it returns to health board ownership. There is existing planning permission for a pharmaceutical facility on it, which clearly enhances its value and leaves it in a prime position for the location of a pharmaceutical plant if a suitable one were to turn up. Can we have an assurance from the Department that the land will continue to be available for industrial development purposes in the town of Ardee in west Louth? It has not been easy to attract industry to Ardee. The advantage of a ready-made suitable site, not alone for a pharmaceutical facility but for other industries that might come to the area, would benefit the general promotional efforts to attract much needed industry to the town and this part of County Louth.

I also refer to the land to which the Tánaiste referred in her contribution on the Private Members' debate, the land purchased recently which adjoins the Louth County Hospital in Dundalk. We were told recently that land assets are to be brought back into the ownership of health boards and, in certain circumstances, to be sold on. The land at the Louth County Hospital was bought with the clear intention of expanding facilities at the hospital for the future. County Louth has two of the largest provincial towns in the country, Drogheda and Dundalk, where because of the demographic position, health services are under considerable pressure. We hope that the land purchased at Louth County Hospital will be retained for future expansion of the facilities at the hospital.

I am glad the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, will respond on the Adjournment. I look forward to his reply.

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

I thank Deputy Kirk for raising this matter on the Adjournment. The Department of Health and Children is not aware of speculation concerning the lands in question. I have made inquiries from the North Eastern Health Board about the issues raised.

With regard to the lands at Currabeg, Ardee, I am advised that the North Eastern Health Board intends to re-acquire the lands from a third party at the original purchase price paid to it, in accordance with the terms of the sale of the lands. I understand it had been a condition of the sale that an industrial development would be created on the site by the purchaser. While some planning difficulties which had occurred over the years are now resolved, I am informed that the board currently feels that it is uncertain that the planned development for the site will occur. Because of the increased value of the site, the North Eastern Health Board has decided to exercise the condition of the sale on the option to buy back the land at Currabeg.

The position on the land at Louth County Hospital is that the Department gave approval to the board in December 2003 to purchase a site adjacent to the hospital. This site was recognised as being of strategic value for the potential future development of health facilities in the area. The site has been included in the development control plan for Louth County Hospital which I understand is at an advanced stage of preparation by the board. I hope this response is satisfactory.

Hospital Services.

Mr. Ferris

I welcome the opportunity to raise this matter on the Adjournment. Kerry's general hospital was built in the late 1970s and when fully operational has 377 hospital beds. In recent years two wards have been closed down each summer. Each year the number of babies born has increased and the number has rocketed in the past two years. This is an indication of the confidence the people of Kerry, north Cork and west Limerick have in the service provided in Tralee General Hospital. Only two weeks ago I had the beautiful experience of my granddaughter being born there. I compliment the staff on the tremendous work they do, despite the difficulties encountered.

Despite an increase of 40% in the number of babies born in Tralee, staffing levels have remained static. Approximately 1,460 children were born there last year and the figure for this year is running at 150 a month. Despite this growth there is a shortage of midwives. When applications were sought for the position of midwife last month, not one person applied. Six midwives have left the hospital this year. The question must be asked as to the reason for this.

The situation is so serious that the eminent gynaecologist, Dr. Mary McCaffrey, went public yesterday out of frustration and desperation. She is a fantastic person who does tremendous work, but is at her wit's end. She has called for the provision of a new maternity unit and the immediate approval of funds for more doctors and staff. I urge the Minister to address this matter.

The Irish Nurses Organisation has sought an urgent meeting with senior Southern Health Board officials to discuss the chaos in Kerry's general hospital. People are particularly exasperated on account of the fact that the advertisement for three midwives got no response. We must ask why. The reason is evident, according to one of the local newspapers, which states that it is because of poor conditions and wages. Matters are so desperate that some midwives have had to work in the wards changing beds and helping ordinary staff.

All the elected representatives in the area are aware of the situation and they and I have raised the matter here on several occasions. Something needs to be done about the accident and emergency unit, bed closures and the maternity section. The problems must be addressed now. Matters must be serious when we see a conservative newspaper like The Kingdom state:

It can only be a matter of time before the ordinary people of Kerry follow the example of disgruntled patients and their families in Dublin and take to the streets in protest. If they do, The Kingdom will be right there beside them and we will shout loudest and longest.

This is the situation that is developing, according to the local widely read newspaper. These are not the sentiments of somebody like me in the business of opposition, these are the feelings of people on the ground who have visited the hospital, seen the waiting lists, the accident and emergency unit where people are lying on trolleys and the continued deterioration in the maternity section.

The Minister must listen to the staff who are crying out for help. The numbers born in the maternity section have been turned around and there are now more children born in Kerry's general hospital than at any time since 1979, especially in the past few years. Previously mothers went to Cork University Hospital to have their children but that trend has been reversed due to the tremendous service provided in Tralee despite the lack of funds. There is a chance for the Minister to turn the situation around, but she needs to address the matter urgently.

Mr. T. O’Malley

I thank Deputy Ferris for raising this matter on the Adjournment. I congratulate him on the recent birth of his grandchild in Tralee hospital.

The Deputy will be aware that responsibility for the provision of services at Kerry's general hospital in Tralee rests with the Southern Health Board. A capital projects development team for Kerry General Hospital, Tralee was established in September 2000 to prepare a strategy plan for the current and future needs of the hospital. The development plan included the construction of a purpose-built maternity unit.

On 11 February this year, the Southern Health Board sent a statement of need to the Department of Health and Children for a women's health unit at Kerry General Hospital, Tralee. This statement of need sets out the current position on the delivery of maternity services at the hospital, which are under pressure to cater for the current demands for the service. The growth in demand for obstetric services is evident from the number of births at the hospital, which increased from 1,163 in 1999 to 1,452 in 2003. Establishment of a project team to progress proposals for a new maternity unit at Kerry General Hospital falls to be considered in the context of overall funding resources available under the Capital Investment Framework 2004-2008.

The Department of Health and Children understands that the Southern Health Board is in the process of updating the statement of need to take account of the most recent needs identified for the service. In June 2004, the Department approved the filling of a third permanent consultant obstetrician-gynaecologist post at Kerry General Hospital. I understand that the board has now advertised this post.

The Department and the Southern Health Board will continue to work together to identify a means of progressing this project.

Health Board Services.

Dr. Upton

I welcome the opportunity to raise this matter on the Adjournment.

My constituents, an elderly couple whose only income is their invalidity pension, find themselves caught in a health care trap between the cost and availability of private care and the famine of available health care for public patients. This couple has no savings and very limited borrowing capacity. Any borrowing they can access via their credit union places a very severe financial burden on them to repay a loan.

The wife had a number of medical procedures carried out at St. James's Hospital, which were unsuccessful. She had ongoing visits to doctors and stays in the hospital, was constantly in pain and found herself on ever-extending waiting lists for treatment. Finally, the consultant advised that he could do no more for her. A number of emergencies occurred in the midst of all of this.

Her husband decided, having carefully considered the cost, that consulting a private consultant and going as a private patient was worthy of investigation and he undertook to speak to a consultant in St. Vincent's Hospital. The consultant decided that treatment was a possibility and that he would undertake to carry out the appropriate procedure.

At this point the husband discussed the possible cost with the hospital. He was told that the daily cost would be of the order of €225. He decided to borrow this from the credit union and worked out carefully how he would make the repayments. The couple decided together that this was worthwhile and that the consequent improvement in her health would be worth the financial strain of the repayments.

However, they were genuinely unaware that the cost outlined to them referred only to the hospital bed, that it did not include the cost of any specialist tests, the anaesthetist, laboratory reports and so on. All of these additional costs had not been referred to when they made their inquiries. A number of complications arose and she required not one but three weeks in hospital. They now find themselves with an outstanding bill of €7,500. This has been going on since 1999. They are in no position to pay this bill. However, they defrayed the costs of the consultant, the anaesthetist and so on to the extent of €2,500.

This couple acted entirely in good faith. They planned carefully for the hospital as far as they were aware. They were unaware of the complexities of private hospital treatment for the simple reason that they had never had the opportunity to avail of it previously. To add insult to injury in St. James's Hospital on a previous occasion, the patient needed a CAT scan. When her husband telephoned the hospital to make an appointment as a public patient — and his consultant advised him that it was urgent — he was told that there was a waiting list of approximately 18 months. Again, he decided he would save up the cost of a private consultation. He telephoned the same hospital to make an appointment as a private patient and was asked what time the following day he would like to have the appointment.

In a general way, this points up the gross inequality of the private and public facilities and waiting times. It is totally unacceptable and is placed in sharp focus by the dilemma in which this couple find themselves. It is particularly unacceptable when an elderly couple must worry and fret over the cost of health care when illness is already a major burden for them. They now find themselves with an enormous bill that they cannot hope to pay.

They have received a number of reminders from St. Vincent's Hospital as well as reminders more recently from a firm of solicitors acting on behalf of the hospital, and they are now under constant stress because of this bill hanging over their heads. Any consultant they met did not suggest to them that they might have been eligible for the national treatment purchase fund. They would have been more than happy to avail of this if they had been informed of it.

I ask the Minister to review this case sympathetically and to arrange to waive the outstanding amount that this couple has been billed for. They are unable to pay it now or in the future because of the constant strain on their already very meagre resources through ongoing ill health.

Mr. T. O’Malley

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

I understand the person to which the Deputy referred received treatment in a private hospital and is seeking assistance to cover the cost involved.

I should like, first of all, to point out to the Deputy that responsibility for the provision of health services to residents of counties Dublin, Kildare and Wicklow rests with the Eastern Regional Health Authority.

Under arrangements for public hospital services introduced in June 1991, everyone, regardless of income is entitled to public hospital and public consultant services subject only to modest statutory charges, from which medical card holders are exempt. At present these charges are set at €45 per night, subject to a maximum of €450 in any twelve consecutive months, in respect of inpatient public hospital services.

Alternatively, one can opt to be the private patient of both the consultant and the hospital. Any patient, whether a medical card holder or not, who opts for treatment in a private hospital or as a private patient in a public hospital is liable for the costs relating to such treatment. The 1989 Commission on Health Funding recommended on the grounds of equity that patients make an explicit choice between public and private health care.

Under the Health Act, 1970, the determination of eligibility for health services is the responsibility of the chief executive officer of the appropriate health board. I would add that health boards have discretion, in cases of exceptional need, to provide assistance to individuals where undue hardship would otherwise be caused. In this regard my Department has forwarded the case referred to by the Deputy to the Regional Chief Executive of the Eastern Regional Health Authority for consideration.

I will raise the matter with the CEO because I understand the hardship involved for an elderly couple caught in this situation, having come across such cases previously.

Special Educational Needs.

Mr. McGuinness

I welcome the appointment of Deputy Hanafin to the Department of Education and Science. I know from the response from the public and from schools in my constituency that that appointment is welcome. People involved in education are looking forward to her term in office.

The case I must make this evening relates to the School of the Holy Spirit in Kilkenny. No words of mine can describe the anger and frustration of parents who are waiting to have their children placed in this school.

The issue regarding the school as been going on since the school first occupied that building almost 12 years ago. It is a prefabricated building not built for the purpose of education. It certainly does not meet the modern day needs of a school of this type. It has been in existence for the past 12 years. There are currently 31 children and 20 staff housed in a very small building and various temporary structures outside of that building. There is a complete lack of facilities at the school and it does not lend itself to the proper education of the children who attend there and who are availing of the type of education being provided.

Furthermore, it is frustrating that the temporary accommodation that was promised has now been stalled for some reason. The argument has dragged on and on. The parents have been encouraged, with the supporters of the school, to write to every Dáil Deputy in the constituency to highlight the problem. I now highlight the problem on their behalf.

There is a need to provide a special purpose-built school on the site which has been made available at Seville Lodge, Callan Road, Kilkenny. This project has been dragging on and there seems to be some problem in implementing the next stage. Parents of the children who attend the school are anxious that they be given a clear commitment from the Department with regard to the completion of the next stage and its funding. In the interim, I ask that any obstacles in the way of the provision of the temporary accommodation be removed immediately and that the school be provided with the proper accommodation for its pupils. The hardship that is created relates to the fact that many of the children attending the school, some of them autistic, are unable to access the home support which would keep them up to speed in the context of the attention they would normally receive in the school. Action must be taken in this matter.

There is also a problem with regard to those parents who are trying to look after their children at home in that they are not receiving the support that is required. Some children are getting 20 hours home tuition while others are getting far less. Various decisions are being made with regard to home tuition relative to the number of hours given. It is not good enough that the education of these special children is put on the long finger. That they are not receiving sufficient tuition at home adds further to the burden of the parents.

I highlight the Goresbridge situation, where more than €250,000 in funding was announced by the Department for the refurbishment of an old school building for the education of children with autism. I joined the associated group when it lobbied departmental officials and a very clear indication was given that €253,000 would be allocated to the project. We are anxious to see this money spent on refurbishment. The project was sponsored by Saplings and Mr. Marc de Salvo, and we are anxious that they should be involved in the provision of education at the newly-refurbished building.

There is some uncertainty as to the method which will be used in the context of the delivery of education at Goresbridge. Saplings should be central to this but I understand the Department has stated that only aspects of applied behavioural analysis, ABA, will be used. This is not what we entered into in the beginning. When this issue was discussed with departmental officials, a clear plan was set out for the school. This included a provision of €250,000 for refurbishment and the central involvement of Saplings and Mr. Marc de Salvo in the running of the school. The experience gathered by the Saplings group would be of great benefit to those who attend the school.

A High Court case is pending with regard to one family which has spent more than €80,000 in the care of a child while awaiting the opening of the facility in Goresbridge. I urge the Minister to consider these families, those availing of the Holy Spirit special school and the facility in Goresbridge, and the family caught up in a High Court case with her Department. I ask her to bring them some relief in the context of the provision of special education of this kind in County Kilkenny. A great effort has been made by the local community and I indicate my support for the project. It is difficult to find the words to describe the community's anger and frustration, which I hope the Minister will relieve with some announcement.

Minister for Education and Science (Ms Hanafin)

I thank Deputy McGuinness for raising his obvious concern regarding the Holy Spirit special school in Kilkenny and the proposed new autism facility in Goresbridge. My Department is aware of the increased demand for dedicated educational provision for children with autism. Only yesterday, I enjoyed a special evening with seven parents of eight autistic children. These parents shared with me their needs, hopes and aspirations for their children into the future. My officials have been examining the matter of long-term service provision for children with autism, particularly in the context of Deputy McGuinness's question regarding the Holy Spirit special school in Kilkenny city and the new facility to be located in a refurbished former school building in Goresbridge in County Kilkenny.

As Deputy McGuinness observed, the Holy Spirit special school caters for pupils with special educational needs, including pupils with autism. It has an enrolment of 37 pupils and a staffing of seven class teachers and 13 classroom assistants. The building project for the school has been assigned a band one rating by my Department, which is the highest priority rating that can be assigned. A site at Seville Lodge has been purchased for the provision of the new permanent accommodation and architectural planning is proceeding.

As an interim measure, my Department recently approved the rental of temporary accommodation comprising two classrooms and one sensory integration room for the school to alleviate the current accommodation shortfall. I am unsure from what Deputy McGuinness said whether this temporary accommodation is working out well. The Department is finalising its deliberations on the current and future enrolment levels for the school with a view to determining the accommodation brief. The Department will be in touch with the school authorities as it works through this process. As with all special schools, Holy Spirit special school provides an invaluable service in catering for the needs of pupils with special needs in the area and it is a priority to ensure that the scheme is progressed and that departmental deliberations are concluded as soon as possible.

All building projects in the schools building programme are considered in the context of the budgetary and Estimates process. Applications for special needs accommodation command a high priority rating in line with the agreed criteria for prioritising large scale projects. The ranking applied to all special schools in the building programme will heavily and positively influence the timescale for delivery of special needs projects.

Deputy McGuinness referred to the project to develop a facility for the education of autistic children in Goresbridge. This centre will be based on the existing education facility in County Kildare which uses the Saplings model. As Deputy McGuinness observed, the Saplings approach is one component of ABA. From speaking to parents of autistic children, I know that many place great store on this approach and feel it helps their children to develop educationally. The contract was placed on 10 September 2004 in the amount of €253,105, including VAT, to carry out refurbishment works at the school. Departmental officials are of the view that this work will be completed before Christmas. This is not the situation Deputy McGuinness presented so further examination may be required. A pre-Christmas completion was, however, the hope and intention of the Department in placing this contract.

Discussions regarding annual funding and staffing levels based on one-to-one staffing support for the facility are ongoing. This will be done in conjunction with the providers of the service. All costs and issues relating to staffing levels required for the project will be finalised prior to the completion of the current refurbishment works. My Department recognises the crucial nature of an early intervention programme for autistic children and is conscious to ensure that the children who are to avail of this facility should not lose out while they are waiting. In this regard, funding is provided for a system of home tuition for children on the waiting list. If families are experiencing difficulties such as those outlined by Deputy McGuinness, the special needs section in the Department will be happy to work with those parents to ensure their children's needs are met on an interim basis pending the opening of the school.

I thank Deputy McGuinness for raising this important and sensitive issue.

The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 10 November 2004.