Dáil Éireann debate -
Tuesday, 10 May 2005

Vol. 602 No. 1

Adjournment Debate.

Hospital Services.

Ms B. Moynihan-Cronin

I had hoped the Minister for Health and Children would listen to this debate as it concerns a health issue. I am very disappointed she has left. I am pleased the Ceann Comhairle has afforded me the opportunity to raise this issue. Sadly, it is not the first time I have had to highlight the difficulties at Kerry General Hospital, Tralee. I reiterate my disappointment that the Minister has left the House in the past few seconds and would not wait five minutes to hear my point.

The management and staff at Kerry General Hospital are a team of dedicated and committed professionals who provide a wonderful service to the people of Kerry and to our visitors during the summer months. Their commitment and dedication is not matched by the Department of Health and Children and the Government in terms of resources, funding and personnel for the hospital, particularly in accident and emergency which is the focus of this debate.

I had the opportunity to visit Kerry General Hospital with my colleague, the Labour Party spokesperson on health, Deputy McManus. We met management and staff who raised a number of concerns, particularly the delay in progressing the much-needed extension to the accident and emergency unit. The need for such an extension is indisputable. The staff see 20,000 patients per annum and waiting times are short. However, there is a need to extend the unit to enhance the services provided. There are just four cubicles with three beds in the resuscitation ward. These are used as an overflow for emergency cases. The facilities for families and relatives are insufficient and staff often operate in cramped conditions.

There is a pressing need to have the medical assessment unit open on a 24-hour basis. Since 1993 the unit has given priority access to general practitioner patients who may not need admission to the hospital but need urgent medical assessment. This takes pressure off the accident and emergency department. The medical assessment unit is open between 9 a.m. and 5 p.m. from Monday to Friday, but as we are all aware, people get sick not only during these times, they also get sick during the night and at weekends. The medical assessment unit needs to be open 24 hours per day, seven days per week if it is, as the HSE states, "to fulfil its true potential and to alleviate waiting periods in the accident and emergency department".

This needs to be addressed with the necessary funding and personnel to make the unit operational around the clock. The cap on public sector recruitment is having severe consequences in Kerry General Hospital. The accident and emergency consultant told me that the extension of the accident and emergency unit would resolve the space and capacity difficulties in the unit. However, staffing levels would need to be increased, to include three new registrars, to use the new facilities. The cap on recruitment imposed by the Government will make that impossible. Building the new accident and emergency unit will be worthless if the staff are not available to make the extended unit operational.

I ask the Minister, through the Minister of State, to address three specific issues. A clear timeframe needs to be provided for the extension of the accident and emergency unit at Kerry General Hospital. Funding must be provided to allow for the recruitment of staff to open the medical assessment unit on a 24-hour basis. The cap on public sector recruitment needs to be addressed as this will prohibit the functioning of the new accident and emergency unit when it is extended.

We have a very efficient accident and emergency unit at Kerry General Hospital, but significant problems need to be addressed. This is prevented by the failure of the Government to sanction the extension of the accident and emergency unit and to provide the necessary funding and personnel to allow it to operate at full capacity. I ask the Minister of State, in the absence of the Minister, how much longer the people of Kerry will have to wait for the Government to respond to these issues.

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

The Deputy 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 of services at Kerry General Hospital.

The Department of Health and Children has been advised by the Health Service Executive southern area that a project group has been established and is preparing a statement of need for the upgrading and extension of the existing accident and emergency department at Kerry General Hospital. The proposed development includes a resuscitation room, X-ray facilities, extra treatment and observation places, improved waiting areas and special facilities for children.

The detailed capital funding programme for hospitals for 2005 is being finalised in the context of the Capital Investment Framework 2005-2009. This process will be concluded in the near future and the Health Service Executive will then be in a position to make progress on its capital programme, in line with overall funding resources available in 2005 and beyond. A decision on the extension and upgrading of the accident and emergency department at Kerry General Hospital will be made in the context of the agreed capital framework for the executive.

A medical assessment unit was established at Kerry General Hospital in 1993. The main objective identified for the unit was to give priority access to GP patients who may not necessarily need admission to hospital but who need urgent medical assessment. Another objective was to assist the hospital bed management services in managing bed demand.

As the Deputy is aware, the unit is open from Monday to Friday, 9 a.m. to 5 p.m. The HSE recognises that for the unit to fulfil its full potential and to alleviate waiting periods in the accident and emergency department, it would be necessary to extend the opening hours to a full 24 hours per day, seven days per week service.

The additional resources required to operate the unit on a 24-hour basis is a matter for the Health Service Executive to consider in the context of available resources. I am confident that Kerry General Hospital will continue to provide high quality services to the people of Kerry.

Mr. Crawford

I thank the Ceann Comhairle for the opportunity to raise this issue. There is a need for the Taoiseach and the Tánaiste to take a similar interest in the position regarding Monaghan General Hospital as they are prepared to take in regard to Ennis General Hospital. The Taoiseach has pledged to personally intervene in the upgrading of services in that hospital. The provision of an improved casualty unit, a high-care unit with a reasonable level of surgery, is the minimum we want in Monaghan General Hospital. That is what was promised but at this point everything is uncertain and that is extremely worrying. The casualty unit was to open in February but as yet the funding — out of a national fund of more than €11 billion — has not been provided to staff this unit.

There are five consultant surgeons in Cavan General Hospital and one in Monaghan General Hospital. The plan of the Health Service Executive is to place the three new surgeons in the Cavan-Monaghan hospital group. It is clear every effort is being made, even by devious means, to persuade or encourage the one surgeon in Monaghan General Hospital to either move from Monaghan General Hospital or base himself in Cavan General Hospital.

I welcome the information I received today that the junior surgeons will be allowed stay in Monaghan General Hospital for another six months. However, that is no way to run a business not to mention a hospital structure, lurching from month to month with no long-term commitment. Staff times are being changed so that surgery has to close at 5 p.m. Often that means the operating theatre is closed at 4 p.m. to ensure deadlines are adhered to. Valuable theatre and other services are only partially used at a time when the Government is funding, ad lib, the national treatment purchase fund that could easily and safely be used to carry out procedures at Monaghan General Hospital. I remind the Minister of State that only a few years ago patients were brought under contract to that theatre in Monaghan General Hospital from Northern Ireland and now it is half closed.

Lack of services in Monaghan General Hospital is forcing patients into Cavan General Hospital where the accident and emergency department is overflowing. There is a lack of management of resources at both sites. Clearly, there is a need to ensure full and proper use by the Health Service Executive of facilities at theatre and bed level. The information available to me leads me to question who is in charge.

The Tánaiste and Minister for Health and Children cannot wash her hands of this ongoing problem with the Cavan-Monaghan hospital group. Tonight I am dealing with Monaghan General Hospital but one cannot ignore the fact that it is supposed to be a joint group.

On 29 September 2004 the then Minister for Health and Children, Deputy Martin, promised that a 24-hour seven-day large emergency room would be operational from the end of February, ten additional beds would be coming on stream immediately at Monaghan General Hospital, and a CAT scan would be provided at Monaghan General Hospital. We want no more promises. We do not expect what was promised at the election but we need acute emergency services to be retained at Monaghan General Hospital. We must be able to have accident cases stabilised.

We do not want another case such as that highlighted at an inquest in Dundalk this week where the consultant, Dr. Lynch, said that if the patient had been dealt with in Monaghan General Hospital the patient might have had a chance of survival but none at all after the journey. The coroner in Dundalk was angry and said he could not place blame. He could not believe the services were not available in Monaghan General Hospital. Only if worthwhile surgery remains in Monaghan General Hospital can the overall unit be retained as an emergency unit. If it is not retained it raises major questions so far as industry, sport and so on is concerned in that area. In the absence of the Tánaiste, I beg the Minister of State to ensure that when the funding is distributed in the next few days that proper recognition is given to the Border region and that we are no longer ignored.

Mr. T. O’Malley

I welcome the opportunity to respond to Deputy Crawford on this matter and to outline to the House the position with regard to the provision of surgical services across the Cavan-Monaghan hospital group.

Under the Health Act 2004, the Health Service Executive is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Responsibility for the provision of services at Monaghan General Hospital rests with the Health Service Executive.

My Department is advised by the Health Service Executive north eastern area that the position in regard to the reconfiguration of surgical services is as follows. In April 2004 the chief executive officer of the former North Eastern Health Board issued a directive to establish a steering group for the Cavan-Monaghan hospital group, to determine the level of service to be provided at each site. The steering group reported in October 2004.

My Department is advised by the Health Service Executive, north eastern area, that the position in regard to the reconfiguration of surgical services is as follows. The steering group, following consultation with the Royal College of Surgeons in Ireland, has recommended that major emergency and elective surgery be carried out at Cavan General Hospital and that selective elective surgery be performed at Monaghan General Hospital.

In accordance with the recommendations of the steering group, a full surgical team, based in Cavan, will provide services at Monaghan General Hospital, Monday to Friday. There will be a consultant surgeon present at the Monaghan site on each of these days. This joint department of surgery team will provide selective elective surgery, endoscopy and outpatient services and consultation on inpatients as required.

In accordance with the steering group's recommendations, the hospital returned to 24-hour seven day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call. Their role is being developed as part of a joint department of anaesthesia and will include ensuring the safe transfer of patients when required and to assist the consultant anaesthetist in theatre during surgery.

Consistent with the recommendations of the steering group, ten additional day beds are to be commissioned at Monaghan General Hospital to facilitate the development of surgical services across the Cavan-Monaghan hospital group. The executive has advised that gynaecological and obstetric services, including outpatients, ante-natal services and day gynaecological services including colcoscopy, are now provided at Monaghan General Hospital.

Interviews are being held this month for three permanent replacement consultant surgical posts for the Cavan-Monaghan hospital group. It is envisaged by the Health Service Executive that the appointment of these three consultants will see an enhancement of surgical services provided at Monaghan General Hospital and the early implementation of the steering group's recommendations in regard to surgery across the Cavan-Monaghan hospital group.

Social Welfare Benefits.

Mr. Wall

We are all aware that a person in receipt of unemployment assistance or unemployment benefit must at all times be available for work. The issue is this debate is in regard to athletes who are in receipt of sports grants. As such some may be in full-time employment and may be allowed time off by their employers for training camps or for international appearances. Unfortunately, others are not in employment. In those instances the athletes sign for unemployment assistance or unemployment benefit. Given that they are in receipt of a sport grant of approximately €11,000 they are not eligible to apply for unemployment assistance. In many cases they depend on the sports grant to survive. Many of those young athletes are wonderful ambassadors for the country. They appear on the county, national, provincial, and international stages proudly representing their sport. Because of the rules that pertain in regard to unemployment assistance they are solely dependent on the sports grant. If one subtracts the unemployment assistance of €7,436 from the sports grant of €11,000, it shows the sports grant has a value of approximately €4,000 to these athletes. They are required to give consideration to their diet and acquire equipment. It is only the joy of performing and doing well in their sport that keeps them going. A great fuss is made of the sports grant but unemployment assistance is being taken back from those who, unfortunately, need it.

The Department should recognise the sports grant is specifically attached to an athlete's performance in the international, national or county arena. They need that grant to prepare themselves for participation in their sport. It is not a grant designed to cover the daily needs of food and drink but rather to allow them perform better through the equipment, training and back-up services required. Many of the national sporting associations do not have the financial resources to provide for the athletes in training camps or at international competition. The application for unemployment assistance only arises when they are at home and not competing in international competitions but they are not paid for that period of time. We expect these athletes to give the example to young people who are the men and women of tomorrow and to help avoid the development of social disorder. Young people follow their idols in a given sport.

There are not many cases where an athlete needs to apply for unemployment assistance. I ask the Department to reconsider the situation and allow those people to be granted unemployment assistance during that period.

Mr. T. O’Malley

I thank Deputy Wall for raising this matter on the adjournment of the House.

In assessing a person's means for unemployment assistance purposes, account is taken of all income that a person or his or her spouse receives. Income from all sources, unless specifically excluded by legislation, is taken into account in carrying out the means assessment. Money received by way of a sports grant towards a particular sport is normally assessable on a euro for euro basis. There is no provision in legislation to disregard such income.

A self-employed person may qualify for a reduced rate of unemployment assistance if his or her net income is below the relevant threshold. Where income from self-employment is assessed as means for unemployment assistance, the weekly payment is reduced on a euro for euro basis by the weekly means assessed. The weekly amount assessable is based on the person's net income in the previous 12 months.

Where the person is self-employed the method of assessment allows for an investigating officer to estimate the person's income in the coming year. In the absence of information on this, the previous year's income is taken as a guide. If the investigating officer has good reason to believe that the prospects for self-employment will increase or decrease in the coming year, the estimate of the person's means will accordingly be adjusted. All reasonable work-related expenses and outgoings are then deducted from the gross income from self-employment. The remaining amount is then divided by 52 to give a weekly means assessment. It is considered that this method of assessment is fair and equitable.

Qualification for the grants scheme operated by the Irish Sports Council is made available to athletes on a case-by-case basis based on sport-specific criteria. Direct financial support is made available under the scheme for two purposes. These are out of pocket expenses and general living expenses. In the case of out of pocket expenses, a player-athlete must account for all items of such expenditure before the year end by completing an official expenditure report accompanied by receipts, invoices and supporting documentation. Such expenses incurred would not be assessed as means for the purposes of unemployment assistance, subject to the appropriate documentation being made available to the Department. In the case of world class and international class categories only, players and athletes may opt to have up to 50% of the grant available under the grants scheme applied to general living expenses. This portion of the grant is assessable in full for unemployment assistance purposes.

A self-employed person who has his or her means assessed is free to request a reassessment of means if dissatisfied that these means do not correctly reflect his or her situation. He or she is free to outline any considerations which might have an effect on the means assessed. If the applicant is still unhappy after the review, he or she may appeal to the social welfare appeals office for an independent review of his or her means.

The conditions for receipt of unemployment assistance also require that a person must be unemployed, available for full-time employment, genuinely seeking work and satisfy the condition as regards means. Each case is treated on an individual basis.

The introduction of special arrangements exempting athletes from the requirements to fulfil any of the statutory conditions for entitlement to unemployment benefit or assistance would raise equity issues vis-à-vis other claimants to unemployment payments.

State Airports.

Mr. Boyle

I am grateful for the opportunity of raising this matter. The interim management arrangements for the country's international airports are proving every bit as fraught as many of us feared they would be on the proposal to bring an end to Aer Rianta's role as the holding company responsible for the management of Dublin, Cork and Shannon airports. In the interim situation Dublin Airport Authority has assumed the role of Aer Rianta and has become to all intents and purposes the new holding company. While Aer Rianta may have had many faults, at least it fulfilled its role in a relatively impartial manner in terms of the proportionate allocation of resources and passenger numbers between the three main airports. It tended to treat the development plans of each airport in a relatively impartial way.

Currently there is much uncertainty. There is disagreement at Government level regarding the progression of Dublin Airport. The Minister of State may find himself on a particular side of that argument. Those of us who represent constituencies where other international airports are located are sitting on the sidelines, looking askance at the lack of activity regarding the formation of truly independent airport authorities for the airports in our areas. We are very worried that decisions which must be faced are not being taken as a result.

It is of little matter to us in Cork whether Dublin has one, two or three terminals, or who will run those terminals. However, it is of great concern to us that this inter-party squabble within the Government is delaying the establishment of a formal holding company for Irish airports allowing for a decision on how Cork Airport will enter into independent life. The biggest factor will be the decision on how the debt for the new airport development will be treated. A debt of €160 million is very big for any new commercial entity, particularly when the decision was made by a national airport authority and was approved by the Government.

Many in the Cork region fear that as we now have a holding company that is the Dublin Airport Authority, the agenda is being set on behalf of the Dublin Airport Authority and decisions are being made or deferred by that authority including decisions on whether to allocate resources. We seem to have entered into a kind of administrative and commercial limbo in which the Government has no set timetable other than the production of business plans, which ultimately must be approved by the Dublin Airport Authority and submitted to Government under the new arrangements. While the Minister of State might have some concerns about Shannon Airport, my concerns relate to my role as a public representative for Cork South Central and my knowledge of Cork Airport. I suspect some factors assist Shannon Airport that have little to do with civil aviation.

In recent times Cork Airport has embraced its new commercial realities with great gusto by attracting new airlines, increasing passenger numbers and having a degree of certainty in terms of decisions about the provision of necessary new infrastructure. However, a doubt now exists because of uncertainty concerning airline and airport policy for the country. The Minister of State might be in a position to outline where this stands and perhaps he might be able to avert the prepared script he is about to read to the House. However, if this issue is not resolved quickly regardless of how many terminals Dublin has, a price will be paid in Cork and, I suspect, in the international airport that serves the constituency of the Minister of State.

Mr. T. O’Malley

I thank the Deputy for raising this matter on the Adjournment this evening. As he will be aware, the State Airports Act 2004 mandates the board of the Dublin Airport Authority to do everything necessary to give effect to the restructuring of the State airports. The Deputy will also be aware that section 5(2) of that Act specifies that the "appointed days" for Shannon and Cork Airports, that is the days on which airport assets are transferred to the new Shannon and Cork Airport Authorities, cannot be earlier than 30 April 2005. The Shannon Airport Authority and the Cork Airport Authority were incorporated in September last year and in line with the framework provided by the State Airports Act, these two new authorities will, in due course, own and operate their respective airports once sufficient distributable reserves are available to transfer the relevant assets.

Prior to the assets of Shannon Airport and Cork Airport being vested in their respective authorities, their boards are charged with preparing to assume full responsibility for the management and development of their airports. They are also empowered to undertake functions delegated to them, on an agreed basis, by the Dublin Airport Authority. Each of the airport authorities is also required to prepare a comprehensive business plan for its airport. The framework provided under the 2004 Act allows for a phased approach towards the transfer of airport assets, which specifies that Shannon Airport can be vested first, while Cork Airport will be vested once sufficient further distributable reserves have been built up within the Dublin Airport Authority.

Both the Minister for Transport and the Minister for Finance must be satisfied as to the state of operational and financial readiness of the Shannon Airport Authority and the Cork Airport Authority before the assets of the airports are vested in those authorities. The formulation of comprehensive business plans by the new boards will be a key aspect of achieving operational and financial readiness. The three airport authorities are preparing these business plans with the Dublin Airport Authority co-ordinating the process. It is envisaged that the business plans will be submitted by around mid-June for consideration by both Ministers.

In tandem with the ongoing work to give effect to the restructuring, work is proceeding on the major new development programme at Cork Airport, which will effectively deliver a new landside airport and represent the first major upgrading of facilities since the airport was built in the late 1950s. The project comprises a new terminal building and will be approximately 28,000 sq. m. in size. It will accommodate separate arrival and departure levels, space for 30 more check-in desks and new luggage carousels and up to 3,500 sq. m. in retailing and catering facilities. The development also involves the construction of new multi-storey and surface-level car parks, a new fire station, new internal road systems and the upgrading or replacement of all utility services such as water, gas, electricity and communications facilities. When completed, the new Cork Airport will have a passenger capacity of 3 million people with the facility to expand to 5 million when needed.

Similarly, Shannon Airport is a key infrastructural asset which contributes positively to meeting the air transport needs of its region, not just in respect of tourism but to service the ever growing demand from the business community, and to cater for the rapidly increasing air freight sector. Significant investment has been made in developing the airport and passenger facilities at Shannon in recent years to support the growth of Shannon. The new passenger terminal of Shannon Airport, which opened in 2000, has effectively doubled the airport's capacity providing it with the capability to handle 4.5 million passengers per annum. Passenger throughput last year was 2.4 million and the Shannon Airport Authority is planning for substantial growth in traffic over the coming years.

Both Shannon and Cork Airports are well positioned to cater for future growth in air services. The Minister for Transport is confident that the new boards of all three airport authorities will successfully meet the challenges ahead. Through more focused commercial operation, all three airports have and will continue to play a key role in stimulating and supporting regional and national economic activity to the benefit of their customers, both airlines and passengers, and of Irish tourism, trade and industry.

I thank the Deputy for the concern he showed about Shannon Airport.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 11 May 2005.