Adjournment Debate.

State Property.

Mr. McHugh

I thank the Ceann Comhairle for allowing me to raise this very important matter this evening. My purpose in doing so is to establish the situation regarding lands in the ownership of the HSE in Tuam, Portumna and Ballinasloe, County Galway. The lands in Tuam were purchased more than three years ago by the old Western Health Board at the behest of the then Minister for Health and Children, Deputy Martin, for the construction of a 60-bed community hospital with x-ray facilities, a primary care unit, an ambulance base and other ancillary medical facilities. Although a planning brief was submitted to the Minister in 2002, nothing has happened on the project since then, despite a firm undertaking given in 2002 by no less a person than the Taoiseach. This commitment was given on his own behalf and on behalf of the then Minister, Deputy Martin, the local Fianna Fáil public representatives and the local Fianna Fáil organisation.

It now appears that the lands which were purchased for the construction of a community hospital are being assessed to establish how many housing units could be built there under the Sustaining Progress affordable housing initiative. What is the status of this latest madcap idea for the site? Is the proposal to build houses here serious? If so, the community hospital for Tuam is dead. What are the Government's plans for those lands? Is the Government about to sell the lands?

A specific project is proposed for the HSE lands in Portumna, which requires the full amount of those lands in order to be viable. South East Galway Integrated Rural Development Limited, in association with South East Galway Housing Association working in conjunction with Galway County Council, the Heritage Council, Galway Rural Development, Galway County Association for the Mentally Handicapped, east Galway mental health services and others, have formulated a €24 million project for those lands which involves the restoration of old workhouse buildings and the construction of social and private housing. Plans for the project were greatly advanced even to the extent of agreement having been reached to transfer ownership from the HSE to South East Galway IRD and South East Galway Housing Association. It appears that consideration is being given to utilising two acres of those lands under the Sustaining Progress affordable housing initiative.

If the sale of those lands proceeds it will render this community project unviable and will leave the old buildings as a blot on the Portumna landscape for the foreseeable future. What are the plans for the Portumna HSE lands? Will part of the lands be sold or will the lands in their entirety be transferred to the South East Galway IRD and South East Galway Housing Association so that they can proceed with the valuable work in which they are engaged.

The issue regarding the lands in Ballinasloe may not be as critical as with the lands in Tuam and Portumna as no specific project is planned for those lands requiring the use of all the lands under the control of the HSE. However, the western region of the HSE has a requirement for land in Ballinasloe. That requirement needs to be comprehensively established before further consideration is given to the sale of any of the Ballinasloe lands. If after a full appraisal of the needs it is found that some of the Ballinasloe lands are surplus to requirements, consideration should be given to selling part of the land, provided the proceeds are reinvested in Ballinasloe. What is going on with regard to the lands in Tuam, Portumna and Ballinasloe? Is it the case that one arm of the State does not know what the other is planning or is the Tuam health campus project being abandoned, the Portumna community project being torpedoed and the future of health projects in Ballinasloe being put in jeopardy? Is it the case that the Galway lands are being used to fund inner city Dublin social housing?

Minister of State at the Department of Health and Children (Mr. S. Power)

I am taking the Adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this matter as it provides me with an opportunity to provide the House with an update on the situation.

While considerable progress has been made in recent years in increasing overall housing supply, the demand for housing remains high, particularly in major urban areas. Against this background, the parties to the pay agreement, Sustaining Progress, proposed a new initiative aimed at further enhancing the supply of affordable housing, with the objective of significantly increasing the supply of such houses.

The Government is therefore strongly committed to the ambition of delivering the affordable housing initiative and other arrangements under the Planning and Development Acts. It is envisaged that housing provided under the initiative will be aimed at those who in the past would have expected to purchase a house from their own resources but who find that they are unable to do so in the current housing market.

With regard to the specific issues raised by the Deputy, the Health Service Executive western area has been advised of the Government decision to release State lands in the health sector for affordable housing under Sustaining Progress. The executive has identified a number of sites for consideration for inclusion in this initiative. It is engaged in a process of reviewing the implications of the initiative on these sites for planned health services development. This review will be completed shortly.

I understand that the executive will communicate its views shortly to the parties concerned, including the Department of Health and Children and the Department of the Environment, Heritage and Local Government. It is not intended that the affordable housing initiative would have a negative impact on planned developments in the health sector. The Health Service Executive will strive at all times to strike a balance with regard to individual proposals to satisfy in the most realistic way possible both its own objectives and those of the initiative.

Health Services.

Ms B. Moynihan-Cronin

I thank the Ceann Comhairle for the opportunity to raise this important issue. I welcome the Minister of State, Deputy Seán Power, and hope he will have a favourable reply for me.

Will the Minister of State explain to me and the people of County Kerry the reason the number of home help hours in County Kerry has been reduced by more than 100,000 in the space of just two years? Figures the Labour Party recently obtained from the Department of Health and Children show that in 2002 there were 789,011 hours of home help provided to people in County Kerry. In 2004, that figure dropped to just 683,296, a drop of 105,715 hours in two years. Does the Minister of State realise the enormous value of 105,000 hours of home help to people in County Kerry? Home help is probably the most valuable social health service available to an elderly, infirm or housebound person who wants to remain at home with dignity but needs a little care and assistance, usually daily.

We have heard much from the Minister for Health and Children about her desire to see the elderly and the incapacitated cared for at home and kept out of long-stay institutions where possible. The Minister and the Government have emphasised the need for greater investment in home care to enable people to live at home with dignity and to free up long-stay institution places and hospital beds.

I have often spoken in this House about the lack of funding for the Cúram home care grant for people in County Kerry. Successful applicants are being denied the grant because funding has expired. The cases and figures I am putting on the record of the House give the lie to the Government commitment of investment in home-based care. How can the Government say it is investing in home care when it has cut by more than 100,000 the number of hours of home help provided in County Kerry over the past two years?

Let me explain to the Minister of State the reality locally of these kinds of cutbacks. I spoke to a constituent of mine recently whose home help told her that she could not stay and chat any more as she had only so many hours to do her chores for the woman concerned. She had to get in and out of the house as quickly as possible because of her set quota of home help hours. This elderly woman was also told by her home help that she would wash her clothes, but not those of her husband because he was not the person in receipt of home help. The home help sorted the man's from the woman's clothes. What kind of society is it where this happens? Is the Government willing to stand over that kind of a system?

One of the most important roles of the home help service is to provide a level of social interaction to the client who may often not see another human being from one end of the week to the other. Now it seems that thanks to the cutbacks, home helps are only in a position to do the basic household chores and are gone out the door shortly after they arrive. I have heard the Minister for Health and Children persistently deny that the Government is cutting back on home help and insist it is investing more money. It is true there may be more investment but it goes mainly towards increased wages for home helps, and rightly so. However, thousands of people are losing out on the hours of home help they receive because of cutbacks in the Department.

I appeal to the Minister to stop cutting back on what is arguably the best and most valuable social health service available to people who are living at home but not in a position to do some of their household chores. I ask her to give a commitment to the House that the hours lost, particularly in County Kerry, will be restored.

Mr. S. Power

As the Deputy will be aware, the policy of the Department of Health and Children on the development and delivery of services for older people is to maintain them in dignity and independence at home for as long as possible in accordance with their wishes, as expressed in many research studies. It aims to restore to independence at home those older people who become ill or dependent and to encourage and support the care of older people in their community by family, neighbours and voluntary bodies. The role of the home help service is vital to the implementation of this policy.

Following the publication in 1998 of the report entitled The Future Organisation of the Home Help Service in Ireland by the National Council on Ageing and Older People, I am pleased to say that there has been a major step forward in the implementation of the home help scheme from 1999 onwards with the service being provided to an increasing number of older people.

The aim of the home help service is to enable people to remain at home, where appropriate, who would otherwise need to be cared for in residential care. It is recognised that the service is an essential support to family and informal carers. The HSE southern area has advised that the total number of home help hours provided in Kerry in recent years is as follows. In 2002 some 789,011 hours were provided. In 2003, the hours provided came to 701,216. In 2004, some 683,296 hours were provided and the projected hours for 2005 come to 720,000 hours.

Ms B. Moynihan-Cronin

The hours have been cut back. This is now November 2005.

An Ceann Comhairle

Allow the Minister of State to proceed.

Mr. S. Power

It is understood that the home help hours figure for 2001 was similar to that of 2003. However, the total number of home help hours provided in 2002 included once-off hours, arising from the national home help agreement 2000, for annual leave and training and other elements of the service relating to the agreement. Therefore, the 2002 figures reflect both the core service hours for that year and the additional once-off arrears relating to previous years. There have been significant increases in the investment in the home help service since 2002. Some €95.7 million was spent on the service in that year and it is estimated that €120 million will be spent this year. That represents an increase of 25%. As the home help service is a flexible service that responds to clients' needs, the level of service required in individual cases fluctuates from time to time. The service is targeted at high and medium dependency clients, in accordance with their assessed needs, to ensure that an effective prioritisation of the service assessments is undertaken at local level and carried out in all cases by the HSE's public health nursing services.

I am aware that Deputy Moynihan-Cronin has taken a particular interest in this matter. I agree that the home help service has been a wonderful success and has brought great benefits to those who are targeted by it. Those involved in the service appreciate what is being done. The jobs that are done might be quite small in some cases, but small things make a great difference to the quality of life of the people who receive them. As I have explained, the Government has increased its investment in the home help service. All the studies show that people are much happier in their own homes. The home help service allows many men and women to stay in their own homes for as long as possible. It becomes impossible for them to stay in their homes in some cases, unfortunately, and they have to move on to long-term care. Our experience has taught us that the home help service works.

The Government will continue to support and expand the scheme, which offers exceptionally good value for money. Not only does the service benefit older people and carers, but it also solves a number of problems in our hospitals, for example by freeing up beds. The Government appreciates the participation of so many people in the scheme, which is working well. It intends to continue to develop the scheme by investing more money in it.

Medical Aids and Appliances.

Mr. Timmins

I thank the Chair for giving me an opportunity to raise this important issue. Cardiac Self-Help Wicklow is a voluntary group that was established in the autumn of 2003 with a view to making defibrillators available in the wider community. Several thousand people die in Ireland from sudden cardiac arrest each year. The many causes of sudden cardiac arrest include genetic propensity, illness, heart attack, environmental conditions and physical contact. A hard blow to the chest can knock a person, even a fit young athlete, into cardiac arrest. Dehydration or heat exertion can also bring on sudden cardiac arrest. A person of any age can be a victim of sudden cardiac arrest.

As a result of the ambulance service's work with voluntary groups in County Wicklow, the first responders scheme is in operation in 14 parts of the county. Under the scheme, trained local volunteers assist the ambulance service when a person in the locality suffers or is threatened with cardiac arrest. A further eight communities are in the process of getting involved in the scheme. Cardiac Self-Help Wicklow intends to extend the first responders scheme to all parts of the county, with the co-operation of local communities. Under the targeted defibrillation programme, local groups can privately purchase a defibrillator and make it available in their immediate areas. Shopping centres, airports, schools and sporting clubs have defibrillators on site and have trained people to use them. Local community groups have been called into service more than 40 times since the scheme became operational in County Wicklow in the spring of this year. The scheme, which is extremely successful, provides assistance and assurance, particularly in isolated areas. The success of the first responders scheme in County Wicklow is due in no small part to the progressive involvement of the ambulance service in the HSE region that succeeded the former ERHA area. Other HSE areas are reluctant to get involved, however.

I am aware that a Government task force, chaired by Dr. Brian Maurer, will report soon on the issue of sudden cardiac death. I am confident that he will strongly recommend the national roll-out of a first responders scheme like that in operation in County Wicklow. While the resources needed to establish and maintain such a scheme are minimal for the return, human resources need to be specifically allocated to the project. The Garda, fire service and other statutory bodies can also play a role. Planning guidelines need to be amended to provide for the inclusion of defibrillators in commercial developments. The Department of Education and Science has a role to play in including cardiopulmonary resuscitation in the school curriculum. Legislation is necessary to deal with the concerns of volunteers who have a fear of litigation and to assist with the concept of targeted defibrillation. Fine Gael has placed such legislation, the Good Samaritan Bill 2005, on the Dáil Order Paper. The Minister for Health and Children has repeatedly called for ideas from this side of the House. I have been pushing this idea, the implementation of which would greatly improve the health service at a nominal cost, for over two years.

I know there is resistance to the first responders scheme among general practitioners and others involved in the medical profession, who have concerns about handing a piece of medical equipment to people in the community who might not be well trained in its use. The scheme, which has been very successful in County Wicklow to date, has worked beyond our wildest dreams because local people have given a tremendous level of commitment to it. My colleague, Deputy Lowry, raised on the Adjournment some time ago the issue of targeted defibrillations. I am aware that the editor of the Irish Medical Times has written a very condescending and ill-informed article on the issue. I invite him and anyone else involved in the medical profession who has doubts about the matter to travel to County Wicklow to see how the scheme is operated there by volunteers who have been trained by the ambulance service.

The scheme is validated every 90 days by the ambulance service. If a person in the parts of County Wicklow in which the scheme is in operation dials 999, or whatever the relevant number is, not only will an ambulance come from Naas, Wicklow or Baltinglass, but the local scheme volunteer will also be contacted by mobile telephone so that he or she can get to the scene of the difficulty. It is a very successful scheme. When Dr. Maurer's report has been published, I hope the Minister for Health and Children will initiate a proactive and progressive campaign to bring the scheme into operation throughout the country.

Mr. S. Power

I thank Deputy Timmins for raising this matter and giving me an opportunity to outline to the House some details of the work being done to improve how cardiac emergencies are dealt with. As the Deputy said, Deputy Lowry raised a similar matter in the House some months ago. I would like to update the House on the developments since then. The Health Act 2004 provided for the establishment of the Health Service Executive on 1 January last. Under the Act, the HSE is responsible for managing and delivering, or arranging to be delivered on its behalf, health and personal social services. As part of the reform of the health service, a national ambulance office has been established, under the auspices of the national hospitals office within the HSE, with responsibility for the provision of pre-hospital emergency care, including the development of the first responder service where required. The 2001 report of the strategic review of the ambulance service has largely formed the basis for the development of pre-hospital emergency medical services in recent years. The report recommended that all ambulance services should consider establishing first responder programmes to support the ambulance service. In line with that recommendation, the eastern region of the HSE trained more than 1,000 people last year in cardiopulmonary resuscitation in the community. The Department of Health and Children has been advised that a number of community first responder schemes are in operation throughout the country. The HSE has advised that the further roll-out of such schemes will take place subject to the pre-hospital care needs of particular regions.

Deputy Timmins is aware that a national task force on sudden cardiac death was established in September 2004 to address the problem of sudden cardiac death. The task force, which is chaired by Dr. Brian Maurer, has almost completed its work. It will make recommendations on the prevention of sudden cardiac death and the detection of those at high risk. The task force will advise on equipment and training programmes, to improve the outcomes in the cases of those suffering from sudden cardiac collapse, and on the establishment of appropriate surveillance systems. In particular, the task force will advise on maximising access to basic life support and automatic external defibrillators, appropriate levels of training in basic life support and the use of automatic external defibrillators and the maintenance of that training. It will also consider who should be deemed to be priority individuals and priority groups for such training.

The task force will make decisions on the geographic areas and functional locations of greatest need, the best practice models of first responder schemes and public access defibrillation and the integration of such training services. I understand that the task force has been involved in widespread consultation with individuals and organisations and that a report will be published shortly. I thank Deputy Timmins for his contribution. It was heartening to hear his report on the success of the first responder scheme in County Wicklow. The task force's recommendations will inform future policy in this area. Funding will be provided through the HSE to support the implementation of the recommendations.

Third Level Fees.

Cecilia Keaveney

I thank the Ceann Comhairle for giving me an opportunity to raise this issue which is of importance to the students of Donegal and all the Border counties, in particular, as well as the rest of the country. Third level fees were introduced in the North of Ireland a few years ago and a change to the fee structure is being planned for September 2006 whereby top-up fees will be charged to students. It would appear that while in the past the tab for students from the Republic was collected by education boards, this will no longer be the case and, therefore, fees will be applicable to Irish students attending Northern universities.

I declare an interest in that I attended university in Jordanstown just outside Belfast for seven years. I know how important and useful it is to be able to access many different universities when filling in UCCA forms and other third level college application forms at leaving certificate stage. In the context of the Good Friday Agreement we are supposed to be advocating all-Ireland policies and the integration of the Thirty-two Counties in terms of access to education, health, retail therapy and so on. It is important that the Minister for Education and Science would intervene in this matter.

I was annoyed on looking through the manifestoes and policy papers of Northern Ireland parties because, as a member of the British-Irish Inter-Parliamentary Body, the issue of top-up fees and access to Northern colleges would probably not arise if the Northern Executive were up and running. One of the parties stated that fees exacerbate inequalities in access and that the decline in the number of students from low income, rural, isolated and marginal communities was unacceptable.

Another party, coming from a different background, stated that fees act as a deterrent to potential university students from disadvantaged backgrounds and that Queen's University and the University of Ulster had worked hard to be open to all. One party referred to the intention of Queen's University and the University of Ulster to apply a maximum of £3,000 per year from 2006 and that this would lead to severe hardship for students. However, another party stated that the amount of £3,000 per year would only be an introductory amount that would inevitably rise.

A further argument propounded by one party was that top-up fees would damage the health service because people from working class backgrounds would not be attracted to the health professions because of the cost. A party from a completely different background stated that students could opt for cheaper courses regardless of the value they add to their education because subjects like science, engineering and professions such as law and medicine would be more expensive and thus people would not apply for them.

Coming from Donegal, I would like to think that the people with all these views on education would make their own decisions. I would love to see the Executive up and running so that these decisions could be made. Unfortunately, as the Executive is not up and running, students from the Republic could face fees that did not exist previously. This will be to the detriment of students wishing to attend the University of Ulster at Jordanstown, Coleraine or Magee or Queen's University. We have enough anomalies in the system with the recognition of courses and NVQs.

We are supposed to encourage people into education to give them foundations. We keep on using the mantra that a better educated population is a better equipped one in terms of society and the big, bad world, yet we appear to be in a negative free-fall since the Good Friday Agreement in that, in the past, people like me from the Republic were free to go to Northern universities and their fees were dealt with but students in future will be charged. The argument in the North is that everybody is getting charged so everybody is being treated equally, but I am getting representations from people who want to avail of Northern universities and from families that have more than one child who wishes to access university. The prospect of such fees is bad enough for one child but would be extremely difficult for families with a number of children wishing to go to university.

Given that the Executive is not in operation, it is important that the Minister of State, Deputy Seán Power, would pass on my request to the Minister for Education and Science, Deputy Hanafin, to raise this issue as a matter of urgency with her counterpart in Northern Ireland rather than wait for people to complain this time next year about fees or that nobody went to the Northern universities.

Mr. S. Power

I thank Deputy Keaveney for raising this matter on the Adjournment. I will reply on behalf of the Minister for Education and Science, Deputy Hanafin, who is unavoidably absent owing to a prior commitment. The free fees initiative scheme operated by the Department of Education and Science provides free tuition to eligible students who attend approved third level courses. The main eligibility conditions of the initiative are that students must be first-time undergraduates, hold EU nationality or official refugee status and have been ordinarily resident in an EU member state for at least three of the five years preceding their entry to an approved third level course. The courses approved for free tuition are full-time undergraduate courses of not less than two years' duration which are followed in approved third level institutions in the State. At present, in the region of 40 institutions deliver courses approved for free tuition.

There are no plans by the Department of Education and Science to extend the eligibility conditions of the free fees initiative to cover students attending third level institutions in Northern Ireland. Under the terms of the Department's maintenance grants schemes, grant assistance is available to eligible students attending approved third level courses in approved institutions. An approved course for the purpose of the schemes means a full-time undergraduate course of not less than two years' duration and a full-time postgraduate course of not less than one year's duration pursued in an approved institution. To qualify for grant assistance, a candidate must satisfy the prescribed conditions of the schemes, including those relating to residence, means, nationality and previous academic attainment.

Students from this State who attend undergraduate courses in Northern Ireland can apply for maintenance grants in respect of approved courses which are pursued in colleges approved for the purpose of the Department's higher education grant scheme and vocational education committees' scholarship scheme. Both these schemes provide that where a candidate is not eligible for free tuition under the free fees initiative and is pursuing an approved course at undergraduate level in an institution listed in the State, the local authority or vocational education committee may award a full or part grant in respect of the candidate's lecture fee, subject to the terms of this scheme.

There are no plans to extend the payment of tuition fees under the student support schemes to undergraduate students attending approved courses outside the State. It is understood, however, that students attending higher education institutions in Northern Ireland and who are ordinarily resident in a member state of the European Union will be eligible for a fee loan from the Northern Ireland authorities up to the amount charged by the higher education institution. Further clarification is available from the Department of Employment and Learningin Northern Ireland. Its e-mail address is studentfinance@delni.gov.uk.

Section 473A of the Taxes Consolidation Act 1997 also provides for tax relief on tuition fees, at the standard rate of tax in respect of approved courses at approved colleges of higher education, including certain approved undergraduate and postgraduate courses in EU and non-EU member states. I thank Deputy Keaveney for raising this matter in the House.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 10 November 2005.

Dáil Éireann debate - Wednesday, 9 Nov 2005