As the first two items are being taken together, the Deputies will have five minutes each to speak and the Minister of State will have ten minutes to reply.
Adjournment Debate.
Hospital Accommodation.
It is with great disappointment that I rise to speak about the need to provide extra beds at Letterkenny General Hospital. Although the matter was discussed when I was a member of the former North Eastern Health Board, neither side ever made progress for a number of reasons.
I would like to outline why it is sad that I have to raise this issue tonight. Letterkenny General Hospital is one of the best staffed and managed hospitals in the country. There is a great feeling among its staff and its patients receive great care and attention. The hospital's problems are not caused by the type of bed blocking we hear about in other parts of the country. The population of County Donegal is increasing significantly — Letterkenny's population has increased by 42%, for example — and the population of the region is aging.
I would like to discuss two issues which are causing great difficulty, the first of which is the state of Letterkenny General Hospital's accident and emergency department, where a new 12-bay medical assessment unit is needed. The Tánaiste said in January, in response to a question from me, that the unit has been identified as a priority for attention. Since then, she has announced a ten-point action plan, the progress of which will be implemented by the Health Service Executive. The executive told me in February that an application has been made and that it is awaiting approval to proceed to the design stage.
It is important for progress to be made. Accident and emergency patients are being moved into areas where day services should be carried out, as a consequence of the lack of space in the accident and emergency unit. Day services are under pressure — they cannot absorb the number of people currently availing of such services.
It is not right that just six bays are available in an accident and emergency department that is accessed by 30,000 patients each year. There is a need to develop the hospital's accident and emergency service because 8,000 of the 30,000 people who avail of it every year are deemed to be GP referrals. Therefore, 90% of them will be looking for an inpatient bed. The 8,000 patients who are sent to accident and emergency units by their GPs are causing problems for inpatient elective surgery and day services, through no fault of their own.
In recent months, hundreds of people have been prevented from accessing such services as a consequence of the problems I have mentioned, some for the third or fourth time. There were over 100 such cases in a single week recently. In some cases, a patient who has been prepared for his or her operation has been informed that it will not take place. It is an unacceptable set of circumstances for patients, staff and onlookers. The vast majority of people in County Donegal have either used the hospital directly or are related to somebody who has done so. Of the 100 day cases which were deferred over a single week recently, 20 were serious inpatient cases which were scheduled for elective surgery. As a doctor, the Ceann Comhairle knows the difficulties such postponements cause for everybody.
A proposal has been submitted to the Department of Health and Children for the construction of an additional two storeys, providing 70 additional beds, over the new accident and emergency department. That development is as important as the extension of the accident and emergency unit, but it falls under a separate application. It is important that both plans are considered.
There have been difficulties in deciding which of the two options to pursue. Some people who were on one side are now on the other side. It is important, however, that the entire project is advanced. I asked for some information about the first option, which is to transfer the acute psychiatric unit to St. Conal's Hospital and to convert the vacated psychiatric unit to provide a maximum of 30 beds for medical patients. That would cost approximately €10.5 million. The preferred option is to refurbish the acute psychiatric unit, while providing temporary accommodation, and to build the two additional floors over the proposed new accident and emergency unit. That option would cost approximately €16 million.
There is a timeframe of 18 months for the acute psychiatry service and a 36-month lead-in for the medical beds. It seems that no plans have been submitted yet. Therefore, I understand that the Tánaiste might be in a position to say that there are no plans. I would like the problems in Letterkenny General Hospital's accident and emergency department to be relieved immediately.
I am sorry that the Tánaiste is not here tonight to respond to the important issue being raised by Deputy Blaney and me. It affects every family in our constituency. I ask her to meet the Deputies who represent the area and those who are capable of moving this process forward. The HSE, the Department, the hospital and the different partners can blame each other, in one sense. I would like all those involved in progressing the two related but separate applications to come to a single table to thrash out the issues, take a decision and make progress on the basis of that decision. It is simply unacceptable that people who are ready for surgery have been denied it on three of four occasions.
The population of County Donegal is increasing and aging. A high-dependency unit needs to be opened. I appreciate that we are doing the best we can with the resources available to us. I hope a renal dialysis unit will open in October. We need the support and help of the Department of Health and Children and the Health Service Executive. They cannot be separated — they must work together, for example by talking to those involved at the coalface. They must decide that Letterkenny General Hospital is a priority. The hospital has not yet benefited from many services, such as BreastCheck. We are working in co-operation with those on the other side of the Border, such as the authorities at Altnagelvin Hospital. We need more beds and we need them now.
I join my colleague, Deputy Keaveney, in speaking about the concern caused by the serious problems faced by Letterkenny General Hospital, which is unable to handle the current level of patient intake. It would be an understatement to say that the circumstances at the hospital, which I visited on Monday, are chronic. I have never witnessed anything like it. The day-services ward has six beds and can, therefore, accommodate six patients, but on Monday it dealt with 16 seriously ill people who were waiting for elective surgery and other surgical procedures. Those present were male and female and ranged from children to pensioners. No washing or showering facilities of any kind were available. I spoke to a consultant, Dr. Keating, who was tearing her hair out.
I support Deputy Keaveney's comments. I would like to analyse this matter from three perspectives. I will outline the causes and effects and then offer some solutions which, I hope, the Minister for the Environment, Heritage and Local Government, will pass on to the Minister for Health and Children.
It is important to state there are two major interrelated problems facing Letterkenny General Hospital. The emergency medicine department has six bays, as Deputy Keaveney said, and that is not sufficient to assess the 30,000 patients who attend each year. Six bays normally cater for only 10,000 patients. There are not enough beds to facilitate the annual number of admissions, which is just short of 10,000 per year.
As Deputy Keaveney outlined, the attendance level in the emergency department is rising. In 1992, approximately 15,000 people attended whereas now more than 30,000 attend each year. This is caused by changing demographics, urbanisation and growth. As Deputy Keaveney stated, the population of Letterkenny has grown by 42% in recent years.
There have been many consultant appointments in the hospital since 2000, including a haematologist, oncologist, cardiologist, respiratory consultant, nephrologist, geriatrician, breast care surgeon, two radiologists and two anaesthetists. There have been two appointments to the accident and emergency department. Although new consultants are being appointed, we feel we are not getting a fair crack of the whip. As the Ceann Comhairle will know, each consultant needs his or her own bed in turn. Only 17 beds have been added to Letterkenny General Hospital in the past 25 years.
The effects of all these problems include the cancellation of day service procedures, elective inpatient procedures and outpatient appointments. The morale of staff is at an all-time low despite that there are good staff at the hospital. Public confidence in the hospital is also at an all-time low. The effects are also such that patients admitted overnight are put in inappropriate accommodation. Some 340 patients were put in inappropriate accommodation so far this year. Already in 2005, 250 procedures have been postponed owing to the unavailability of beds. Twenty-two of the procedures were cancelled twice. This will increase the number of patients on the day case waiting list for next month by up to 10%. Waiting lists will get even longer if the problem persists.
On the cancellation of elective inpatient procedures, 52 procedures were cancelled during January 2005 owing to the lack of a recovery bed. Cancelled procedures included boil, bladder and breast cancer cases. Some patients' procedures were cancelled two, three or four times. The inpatient waiting list grew by 22% during 2004 and it is growing further as we speak. On the cancellation of outpatient appointments, 315 patients had their appointments cancelled between 5 January 2005 and 12 January 2005.
Deputy Keaveney outlined some solutions. In this regard, I refer to the ten-point plan announced by the Minister for Health and Children and the uniqueness of the problem faced by Letterkenny General Hospital. All the points in the plan that can be implemented in the hospital have already been. The others cannot be implemented until the two issues we have identified are addressed, namely, the need for approximately seventy extra beds and the need for an adequate extension to the emergency medicine department.
We already have a transit lounge to be employed in respect of the second consultant appointed to the emergency medicine department. A joint management consultant group has been in place since 1998 and there are additional nursing staff in the accident and emergency department. The triage service has been introduced and extended and there are additional non-consultant hospital doctors in the emergency department. There is an air tube system for the delivery of samples and a digital X-ray system has been introduced. A bed manager and discharge liaison nurse have been appointed to maximise bed turnover.
Among the medium-term to long-term solutions are additional accommodation to house 70 beds and an extension to the accident and emergency department. These are essential. The 11 oncology and haematology beds also comprise part of the solution and they will need to be fully funded if they are to be commissioned in 2005. I ask the Minister of State at the Department of Health and Children or the Minister, if she is available, to come to Donegal to see at first hand the severe circumstances that prevail at Letterkenny General Hospital and note how the hospital is different from those in Dublin to which the ten-point plan relates. Circumstances are different in Donegal.
I welcome the opportunity to clarify the position on the development of services at Letterkenny General Hospital on behalf of the Minister for Health and Children, Deputy Harney, who, unfortunately, cannot be present tonight. Deputies Keaveney and Blaney will be aware that the Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision and development of services at Letterkenny General Hospital.
The Department of Health and Children is advised by the executive that the increasing capacity pressure at Letterkenny General Hospital has arisen from the recruitment of additional consultants in recent years, as mentioned by Deputy Blaney, and as a consequence of demographic change and advances in modem medicine which have resulted in greater life expectancy. The most recent consultant appointments to the hospital, including a consultant cardiologist, haematologist, oncologist, geriatrician and a consultant in respiratory medicine, have meant that more patients now access more services locally. These developments are to be welcomed but it is acknowledged that they have led to an increase in the local demand for services.
To assist the hospital in addressing the issue of capacity, the Department gave approval in 2003 to what is now the HSE north-western area to proceed with the planning of an extension to the emergency medicine department at the hospital. The HSE north-western area appointed a design team to carry out an option appraisal or feasibility study to determine the preferred location for the facility on the hospital site. The study, which examined eight options, has been completed and is under consideration by the HSE. The proposal also includes the provision of two shelled-out floors over the emergency medicine department for the future provision of up to 70 beds. The Minister for Health and Children has identified the delivery of emergency services as a priority area for attention.
Many of the difficulties and delays experienced in emergency medicine departments reflect system-wide issues. It is therefore necessary to adopt a whole-system approach, involving primary, acute, sub-acute and community care in tackling the problems in such departments. In November 2004, the Minister announced additional funding of €70 million to implement a ten-point action plan to improve the delivery of emergency services. She has met senior management of the HSE, and the Department of Health and Children is working closely with the executive to ensure early implementation of these measures.
I thank Deputies Keaveney and Blaney. I understand their concerns and will certainly draw to the attention of the Minister for Health and Children the very cogent case they made for Letterkenny General Hospital.
Schools Building Projects.
I thank the Ceann Comhairle for affording me the opportunity to raise this issue in the absence of the Minister for Education and Science, who explained to me why she could not be present tonight. I am very pleased her substitute is a Wexford man who is very familiar with the school to which I want to draw attention, the Loreto secondary school, Spawell Road, Wexford.
I have a particular affection for the Loreto secondary school.
That is very good. The Minister will be aware that the school is one of the most successful secondary schools not only in County Wexford but in the country. On the principle that the meek inherit the earth, I am afraid the school accepted a situation in which facilities were allowed to deteriorate over a period of years to an unacceptable level while expecting that the Department of Education and Science would eventually recognise the righteousness of its case and it would get the decent facilities it requires.
The school began negotiations with the Department in 1997. A revised schedule of overall accommodation was issued on 30 May 2001 following protracted negotiations. That was based on a long-term enrolment of 600 students. Officials from the Department met school management and the design team in the school in July 2001 when the schedule was fleshed out in detail. The design team submitted a stage two report to the Department in July 2002, for which the cost of the extension and refurbishment required and agreed was of the order of €6 million to €7 million.
In January 2003 the Department's website showed that the project was not to be progressed that year. The pupils, staff and parents remained quiet and waited till the next year. In January 2004, however, the website indicated that it would not progress in that year. These people are angry that their project did not appear on the website last January. I submitted a parliamentary question to the Minister to which the reply was that this project is in the early stages of architectural planning.
The school has 660 pupils, although the plan subsequent to the refurbishment and investment was to cater for 600. It is expected that total enrolment by September 2006 will be 700 students. The 660 students have no sports hall and access to only two science laboratories. In May 2001, the schedule gave the school entitlement to three laboratories and a demonstration room. The existing laboratories are in chronic need of refurbishment. They have been upgraded since they were built in 1970 but are unsuited to some of the present curriculum demands.
The school is inaccessible to wheelchair pupils or staff. It has no lift. The middle block of the building is so unsuitable for school use that, after a visit by officials of the Department, the design team recommended its demolition and replacement with a purpose-built building as part of the stage two report. Despite numerous letters to the Department from the board of management and the parents' council, and representations from all my colleagues, there has been no progress on this project for the past two and a half years.
I attended a very angry meeting of staff, pupils, parents and Wexford people who feel absolutely neglected. The Minister may have received direct representations because one of the most coherent speeches that night was made by a very eloquent and focused teacher with strong convictions who happens to be a close relative of the Minister present. I am sure she has made direct representations to him.
I put the case to the Minister for the Environment, Heritage and Local Government and to the Department of Education and Science that this is a fine school with a fine reputation but it is at risk for lack of basic facilities. This is unacceptable in a time of plenty when education is a cornerstone of our development.
I thank the Deputy for raising this issue. As he said, it is a school in which I have a particular interest. I endorse all his points about its excellence and superb teaching record. I will outline the response of the Minister for Education and Science to the query about the school.
The design process is under way for a large-scale building and refurbishment project at the school to cater for a long-term projected enrolment of 600 girls, although according to Deputy Howlin that figure has already been overtaken. The planned extension consists of a total area of 1,588 sq. m. and will include specialist rooms such as a PE hall, and general classroom accommodation.
The project is at an early stage of architectural planning and a stage two submission has been received. It has been given a band rating of 2.4 in accordance with the 2005 published criteria for prioritising large-scale projects. This project was not sufficiently advanced in architectural design to be considered for inclusion in the recently announced 122 major school building projects that will progress to tender and construction phase over the next 12-15 months under the €3.4 billion multi-annual funding secured for the years 2005 to 2009.
The Minister for Education and Science is anxious to ensure that a consistent flow of projects to tender and construction can be sustained. The Minister also plans to make several announcements soon on the schools building and modernisation programme, including details of those school projects which will progress through the design process. All projects in architectural planning, including the school in question, will be considered as part of this process.
I will pass on the Deputy's comments and cogent arguments. These were echoed by my sister-in-law when she spoke to me privately on the issue. I thank the Deputy once again for raising the matter and I will draw his concerns and my own to the attention of the Minister.
Radon Gas Levels.
I thank the Ceann Comhairle for allowing me raise this matter on the Adjournment. The Radiological Protection Institute of Ireland found during the course of a national survey, published in 1999, that in parts of County Kerry, particularly the Tralee and Castleisland areas, there were inordinate levels of the potentially dangerous radioactive gas, radon.
In July 2003 a test carried out by the Radiological Protection Institute of Ireland found the highest levels of radon ever identified in Ireland in a house in the Castleisland area. The householder had requested this survey. The house had radon concentrations of approximately 49,000 becquerels. This was almost 250 times higher than the national reference level for radon in homes and one of the highest values ever recorded in Europe.
The householder's wife had died five years earlier from lung cancer and in 2002 the householder was diagnosed with lung cancer. As both people were young, healthy and non-smokers, a medical expert advised them to have their home tested for radon gas. Last November the householder died. He said publicly that radon was the cause of his wife's death, and no doubt it was the cause of his own death.
A radon expert likened exposure to one day's radon in this household to one week's exposure to the radioactive plant in Sellafield. Along a one-mile stretch of road, which includes this household, nine people, many middle-aged and younger, have died from cancer over the past decade. This should surely be enough for the Departments of the Environment, Heritage and Local Government, and Health and Children to take appropriate and urgent action to deal with this problem.
Owing to the discovery in this household, the Radiological Protection Institute of Ireland carried out a survey of 377 homes in the Castleisland area. Of those surveyed, 52 were found to have radon concentration above the recommended level, six had five times the recommended level while one had the highest concentration ever found in Ireland. The fact that of the 2,500 households contacted by the RPII, just 413 requested radon test kits and 377 sent the kit back for analysis, gives rise to serious concern. The possibility is that, based on this sample, up to 400 homes could have radon levels over the recommended level and the people living in them could be exposed to the risk of contracting lung cancer.
In the survey, eight homes in Tralee were found to have radon levels ten times over the recommended level. Last November, the town council advised every householder in the Tralee area to test their house for radon levels. I understand the council will provide the testing equipment free to their own tenants. The reason for the extraordinarily high levels of radon gas in the Castleisland-Tralee-Fenit areas of County Kerry is due to underlying karstic limestone overlain by shale, known to contain high uranium concentration levels. Karstic limestone contains underground caves and streams which facilitate the movement and accumulation of radon gas.
There is a need to carry out tests in all schools in the area. In the 1999 survey, 22% of schools in Kerry were found to have radon levels over the recommended level. In 2001, the RPII initiated a programme to direct employers responsible for above ground workplaces in high radon areas to measure radon concentration levels. The institute issued 1,800 such directions to employers in the Tralee area. The response at the time was poor. Of the 200 employers who carried out radon measurements in their workplaces, 30 had radon concentrations greater than the reference level of 400 becquerels per cubic metre, specified in the Radiological Protection Act 1991 (Ionising Radiation) Order 2000.
It is now time for a comprehensive programme to be put in place in the Castleisland-Tralee-Fenit area to reduce exposure to radon. There is a precedent for this in countries such as Sweden, the UK and the USA where radioactive hotspots are targeted for remediation work. Intervention by the State either with free testing to help identify if there is a risk, and with grant support for remedial works in houses over the recommended levels, appears to be the only way forward.
I thank Deputy Deenihan for raising this serious issue. The statistics he illustrated, and the statistics produced by the RPII, illustrate how important it is for householders to have their premises tested. Testing is a very cheap and convenient process.
I am aware of the high levels of radon found in the house in question in Castleisland, County Kerry. I saw the test results when I visited the RPII recently. As the House is aware, radon is a naturally occurring radioactive gas found in variable amounts in rocks and soil. When it surfaces in the open air, it is quickly diluted. However, where in certain circumstances it enters an enclosed space, such as a house, it can reach unacceptably high concentration levels. This is what has happened in some of these cases. There is evidence to suggest that long-term exposure to high levels of radon can be a contributory factor in increasing the risk of lung cancer and that the incidence is higher among smokers than non-smokers. As Deputy Deenihan said, this is a very dangerous gas which can cause lung cancer in specific circumstances.
In July 2003, a house located close to the town of Castleisland was found to have an extraordinary concentration of radon at 48,000 becquerels per cubic metre. This was 250 times greater than the national reference level of 200 becquerels per cubic metre. The national reference level was established by the Government in the early 1990s and is the level above which the carrying out of radon remediation works should be considered. This exceptionally high radon concentration level was unprecedented in Ireland. As the Deputy said, it was one of the highest levels found in Europe. I understand that subsequent radon remediation works on the house resulted in a significant reduction in the concentration level, that is, below 500 becquerels per cubic metre, illustrating what can be done with remediation works.
Following this discovery, the RPII sent 2,500 letters to all households in the four 10 x 10 km national grid squares adjoining the town of Castleisland, informing them of the high levels found and advising them to have radon measurements carried out. By way of response to the institute's letters, 418 householders requested radon measurements. Results now available for 384 of these indicate that 54 houses, or 14%, exceeded the national reference level of 200 becquerels per cubic metre, including five houses, or 1%, which had concentrations above 1,000 becquerels per cubic metre. The highest concentration level found among the 384 houses was just over 6,100 becquerels per cubic metre, while the average concentration was just below 150 becquerels per cubic metre. In all cases where concentration levels in excess of the national reference level were found, the RPII would have advised the householder to consider undertaking radon remediation work.
A further 90 local authority homes in the four grid squares adjoining Castleisland were measured for radon at the initiative of Kerry County Council, for which it is to be complimented. However, none of these houses was found to have radon concentrations in excess of the national reference level. These follow up radon measurements in houses in the area indicate that the exceptionally high radon concentration levels found in the house in Castleisland has not been replicated generally to date in other houses in the area.
The Government has been concerned about the issue of radon for some time. Through the RPII, it has committed significant resources to assessing the extent of the radon problem throughout the country and to highlighting public awareness of radon. Upgraded building regulations, introduced in June 1997 by my Department, require all new houses which commenced construction on or after 1 July 1998 to incorporate radon protection measures. My Department has recently published an updated edition of the Technical Guidance Document C on Part C of the Building Regulations (Site Preparation and Resistance to Moisture) which incorporates enhanced radon prevention measures for new buildings commenced on or after 1 April 2005. The new guideline document is aimed at ensuring that the 1997 radon protection measures are carried out more effectively. Ireland was among the first European countries to introduce specific building regulations and related detailed technical guidance on radon prevention in new buildings. In February 2002, the Department of the Environment and Local Government published a booklet, Radon in Existing Buildings — Corrective Options, advising designers, builders and homeowners on remediation options for reducing radon in existing houses to, or below, the national reference level.
The RPII published a booklet in November 2004 entitled Understanding Radon — A Householder's Guide. The guide is directed at householders who have been informed that they have radon concentrations above the reference level in their homes. The aim of the guide is to assist such householders in interpreting their radon measurement results and in deciding how to deal with the problem.
The Radiological Protection Institute of Ireland has been promoting public awareness of radon for many years as well as highlighting the risks associated with it. The institute has always encouraged householders, as I also encourage them, particularly those residing in high radon areas, to have their homes tested for radon and, where measurements are found to exceed the national reference level, to carry out appropriate radon remediation works. The cost to a householder of having his or her home tested for radon would be in the order of €45.
This week the institute announced the commencement of a radon awareness campaign. This will involve a series of nationwide public information seminars on radon and it is being targeted at selected high radon areas. The first of these seminars took place in Ballina yesterday. I understand that, as part of the renewed campaign, a similar public awareness initiative will take place in Tralee later this year.
Basically the institute's campaign, announced this week, is aimed at further promoting public awareness of radon and encouraging householders, particularly those in high radon areas, to have their homes tested for radon.
The Government takes the issue of radon very seriously. As I indicated, the Government has taken a number of initiatives down the years to tackle the radon problem and it will continue to publicise and heighten public awareness of the issue.
The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 24 February 2005.