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Dáil Éireann debate -
Thursday, 16 Feb 2006

Vol. 614 No. 6

Adjournment Debate.

Health Services.

I thank the Office of the Ceann Comhairle for allowing me to raise this important matter which concerns the provision of dialysis facilities in the south-eastern region.

The need for someone to receive renal dialysis places a difficult imposition and burden on their lives. It involves people attending a renal dialysis unit between two and three times a week and spending between three and four hours hooked up to a renal dialysis machine in order to stay alive. I understand the average age of people requiring renal dialysis is 69 and that more and more people are presenting each year requiring dialysis, primarily due to changes in lifestyle and habits.

Few of us in the House would relish the prospect of spending three hours up to three times a week immobile and linked to a dialysis machine for the purpose of giving us essential and urgent medical treatment. However, there is a crisis in the provision of dialysis facilities in the south east, where many people, particularly in the Kilkenny and Carlow areas, are being forced to travel for dialysis services to Dublin. Some of these dialysis patients have advised that this can involve a round trip of up to ten hours, three times a week. This is an incredible and unjust imposition on people and their families. I have heard that a large number of patients are being treated at the renal dialysis unit at Waterford Regional Hospital and that because of pressure on the hospital facilities there, the dialysis services have had to be provided through the night.

It is bad enough that any person should have to undertake dialysis two to three times a week, but it is even worse that he or she should be forced to travel long distances, or have the dialysis carried out during gravely anti-social hours. We are not just talking about the disruption on the person involved, we are also talking about the difficulties that are presented for their families and friends.

The reason I raise this issue is that I understand from local patients that a privately funded renal dialysis unit has been commissioned and is open in Kilkenny. It has the capacity to treat all necessary patients from Carlow and Kilkenny who are travelling long distances or undergoing anti-social treatment. I have visited the renal dialysis centre in Kilkenny, which operates as a Wellstone clinic, which is an impressive and commendable initiative. I understand it has also been visited by many HSE representatives, the consultant nephrologist and representatives of the Irish Kidney Association. However, there is the farcical situation where patients in need of dialysis must pass by the door of the clinic in Kilkenny, either on their way to dialysis facilities in Dublin or in the middle of the night on their way to dialysis in Waterford. According to local patients, while the clinic can take patients for dialysis facilities, the HSE is not prepared to pay for the treatment and claims that there is some outstanding procurement process under way.

I am not an expert in procurement law, but it strikes me that where there is a will there is a way. As a matter of policy, surely it must be open to the HSE and the Department of Health and Children to facilitate treatment of patients in circumstances where there is an urgent need in a manner that is most humane and accommodating to them, without raising unnecessary barriers.

I am convinced by many of the local representations I have received that giving people access to the Wellstone clinic would make a considerable improvement in the quality of their life. It would enable people to spend more time with their families rather than on unnecessary and uncomfortable travel to Dublin for treatment that is not optional. As a matter of policy, I urge the Department to ensure that the HSE, while fully adhering to appropriate procurement processes, does not apply those processes in a way that unnecessarily hinders people with urgent medical needs who can be accommodated locally.

I know the Tánaiste and Minister for Health and Children has put patients at the heart of her reforms to the health service and that she is anxious for the private sector to play a complementary role to the public health service. In Kilkenny we have a prime example of a privately developed and funded initiative that can make a substantial difference to the lives of patients throughout Carlow, Kilkenny and other parts of the south east. It must be a salutary lesson to any private sector investor contemplating involvement in the health sector to see that the Health Service Executive seems unwilling to be innovative and patient-focused in the application of public procurement rules in circumstances where, according to the Irish Kidney Association, such rules would not prevent the conclusion of an interim contract between the HSE and the operations of the clinic pending any formal procurement process.

I suspect the events we have witnessed in Kilkenny will be replicated in other areas throughout the State. As a matter of policy, the Department of Health and Children should encourage the commissioning of private sector companies to ensure, in conjunction with the public sector, that patients have the facilities they require as near as possible to their places of residence. I would be grateful to know when the Department will be able to ensure that the HSE sanction and commission the renal dialysis unit at the Wellstone Clinic in Kilkenny to allow the patients of Carlow and Kilkenny avail of this important service locally.

I am addressing this matter on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney.

As the Deputy is aware, the management and delivery of health and personal social services are the responsibility of the Health Service Executive. This includes responsibility for the provision of haemodialysis services for people who live in County Kilkenny. As the Deputy pointed out, the clinic to which he referred is a private clinic offering a private haemodialysis service.

The Health Service Executive is undertaking a national review of haemodialysis. It is expected that the review will be completed later this year. The executive has informed the Department that, pending the completion of the national review, it is recognised that there is a need to source additional haemodialysis capacity for patients.

Given that Deputy Hogan belongs to a party that has made a strong case for value for money, I am sure he is a strong proponent of proper procurement procedures. Under procurement law, the executive must enter into a tendering process for haemodialysis services from the private sector. I understand the executive has begun a national procurement exercise to source additional haemodialysis services throughout the country. The executive has informed the Department that the procurement exercise should be completed within two months.

It is open to any private clinic providing haemodialysis to express an interest to the executive under this procurement process. The executive will seek to source additional haemodialysis services in locations that best meet the needs of patients with a view to minimising the requirement for patients to travel excessively to avail of haemodialysis treatments.

It is envisaged that the executive will form a list of suitable providers who will be invited to tender to provide haemodialysis services when and where an identified need exists. Quality of care, value for money, location and the timeframe for service delivery will be key considerations and detailed award criteria will be set out in the tender documentation.

Rail Network.

I welcome the Minister of State at the Department of Transport who is to reply to my query on the western rail link. With the increase in congestion on our roads, trucks clogging up traffic on single-lane carriageways and the ongoing problems the Government is experiencing regarding the port tunnel, the Government's blind spot in terms of rail freight and the general issue of subsidising rail travel is becoming all the more obvious.

The recent Transport 21 plan, announced with much fanfare, was shockingly short on detail considering its ambitions. Its costings could have been put together on the back of an envelope such was the scarcity of detail revealed in the figures. One figure, that of €34 billion, was pulled out of the hat by the Minister for Transport, Deputy Cullen, who likes dealing in millions and billions. However, few took the figure at face value and it quickly became obvious that €10 billion of the €34 billion had already been accounted for under the National Roads Authority's road building programme, that 90% of the roads mentioned in Transport 21 had already been announced, and that the new inter-urban roads were already agreed under the NRA's 2004 road building project and the national development plan.

If one were not a sceptic, and especially if one were a railway enthusiast, one might have disregarded this creative accounting and looked to the proposed investment in rail services, particularly to the much anticipated re-opening of the western rail corridor. However, the failure to attach an investment figure to this project immediately set alarm bells ringing. How much is being proposed? The Minister says he will not release what he calls commercially sensitive information until the public procurement process for the re-opening of the Ennis-Claremorris line is complete. Road builders appear to be taking advantage of this. They tender and the final costs of their projects eventually come in up to 100% over budget.

I welcome the Minister's renewed commitment to have the Ennis-Athenry link completed by 2008, although I am concerned that he calls this an indicative timescale. Does this represent a climbdown from the original commitment that the link would be open within three years of the date of the announcement and the Taoiseach's commitment that the ten-year transport plan would be completed on time and on budget?

The other fear with the western rail corridor is that the price mooted of between €300 million and €400 million, representing approximately 1% of the €34 billion swag, will be soaked up in capital outlays and that the operations of Iarnród Éireann between Ennis and Galway and on subsequent routes on the western rail corridor will not be subsidised in the same way as other routes on the rail network. This is why I raise this matter on the Adjournment. Will the rail line be subsidised similarly to other routes and will there be added incentives initially to encourage commuters to use the line? When will the commuter service from Athenry to Galway be operational? When can the people of Clare look forward to taking the train to Galway, which is a mere 40 miles from them? Likewise, when can the people of Galway go to Clare by rail?

The Minister should note the outstanding success of the Ennis-Limerick commuter line which was long fought for and once disregarded as being unworkable and commercially unviable. I use the service from time to time when travelling on to Dublin. It allows one to escape the madness, chaos and unpredictability of travelling by road to Dublin. The service has been expanded since it was first announced, with the result that there is considerable pressure to expand the parking facilities at Ennis railway station.

The Ennis-Athenry-Galway line will also be an outstanding success and I hope the work thereon will be completed in the timescale proposed by the Minister. It would link up two very important cities, Galway and Limerick, and would allow for an option to travel to Dublin. I urge the Minister to do as I propose, remove some of the traffic from our roads as soon as possible and, if necessary, make available the subsidies from which every other rail passenger benefits.

I thank Deputy Pat Breen for raising this important issue. Transport 21 provides for the reopening of the western rail corridor between Ennis and Claremorris on a phased basis and the preservation of an alignment as far as Collooney. It also provides for the upgrade of the Athenry-Galway line in respect of commuter services.

The western rail corridor, when completed, will provide a rail link between the cities of Limerick and Galway and an onward connection to Claremorris. The new line will also facilitate the provision of intra-regional services within the Border, midland and west region. The line between Ennis and Athenry will be the first section to be developed and I await specific proposals from Iarnród Éireann in this regard. Subject to progress in planning, the indicative date for the completion of this first section is 2008. The indicative date for the completion of the Athenry-Tuam section is 2011 and that for the Tuam-Claremorris section is 2014. I understand the necessary steps to preserve the section of line between Claremorris and Collooney will be taken this year.

The phased approach to reopening the western rail corridor, in addition to being consistent with the McCann recommendations, addresses the management of the construction programme in the context of Iarnród Éireann's overall resource requirements under Transport 21. It is important to bear in mind that the rail corridor in question has the potential to attract significant new development along the route. The greater the critical mass of population and economic activity, the stronger the case for this investment. I have already made it clear to the relevant local authorities that it is a matter for them to develop and implement land use strategies that support the case for rail investment.

National Car Test.

I thank the Minister of State for attending and congratulate him on his change of portfolio. I wish him well in his new posting. I thank the Ceann Comhairle for facilitating this opportunity on the Adjournment.

I understand the contract for the carrying out of the vehicle testing function will expire in 2009 and will be advertised for tender prior to that date. A mid-term review was scheduled for January 2006. Will the Minister of State clarify the position and advise when the details of that review will be made known and whether they will be placed in the public arena? Will the Minister of State outline the changes he intends to make to the existing terms of reference and guidelines, if any exist, by which future providers of the NCT service will have to abide? Can changes be introduced now on foot of the mid-term review? What is the view of the Minister of State and the Department of Transport on the service that has been offered by the current holders of the contract? Is the Minister of State aware that the existing operators of the NCT centres have imposed a target fail rate of 50% or more of the cars which are presented for the test? The target is even higher for older cars. Does the Minister of State consider that the operators' approach to their business is fair and acceptable? Should each vehicle that is presented for the test not be considered equally and fairly? Should a decision on whether to present an NCT certificate not be based on a car's overall roadworthiness? Is it not the case that car testers are under pressure to meet the target fail rates which are set by the company that employs them? Is it not likely that some cars which might otherwise pass the test are failed so that the imposed targets are met?

The Department of Transport indicated to a Sunday newspaper in July 2005 that it intended to investigate the case of a car that had been passed by an NCT centre before being failed by another centre. An independent test on the car in question, which was carried out by a Dublin dealership garage, found that the car was "in a highly dangerous condition." What does the Minister of State know about that high profile case? Is the Minister of State aware of the highly questionable dismissal by National Car Testing Service Limited of three people who were employed at a testing centre in Monaghan? Is he aware that a tester in Monaghan had deemed the car I have mentioned to be unroadworthy? Is he aware that the three people in question are viewed by everyone in their community as scrupulously honest? I understand that the fail percentage of the employee who failed the car in question was in the low 40s.

Is the Minister of State aware that the three men, two of whom have worked with the company for more than four years, were dismissed on the basis of a spurious claim of gross misconduct? It is alleged that one employee was signed off early one evening by another of the three men, who was the team leader. The employee who left early, who had a legitimate reason for doing so, performed a specific task on behalf of the company on the evening in question — he took a bank lodgment to the bank. Does the Minister of State share my concerns about these matters? Is he prepared to make appropriate inquiries? Will he undertake to return to me on these matters when he is in a position to do so?

I appreciate that the Minister of State's prepared response may not reflect on many of the points I have raised this evening, but I appeal to him to recognise the seriousness of these matters and to investigate the relevant issues accordingly. I thank him for his attention and look forward to receiving a fuller reply from him when he has had an opportunity to examine these matters in the coming weeks.

I thank Deputy Ó Caoláin for raising this matter. It is not correct that the contract for the operation of the national car testing service will expire soon. The ten-year contract that was awarded to National Car Testing Service Limited will run for a further four years until the end of 2009, as the Deputy said. I will deal with the mid-term review that was also mentioned by the Deputy. He may mistakenly assume that the recently completed review of the operation of the car-testing contract is the forerunner to the making of totally new arrangements for the car testing function. The contract with NCTS provides for a mid-term review by the Minister after the mid-point of the contract. Contrary to some public expectations, the question of whether to renew or extend the contract until the end of 2009 did not arise as an issue in the mid-term review.

The purpose of the review was to examine in detail the performance of NCTS and to assess a range of strategic issues such as the quality of the service provided for car owners, the content of the test, the location and number of test centres and the responses to a public consultation process on the review. The review, which began in April 2005, was carried out by the Department of Transport in conjunction with the supervision services contractor for the car testing contract.

The supervision services contractor, which is a consortium consisting of PricewaterhouseCoopers and AA Ireland, provides supervisory support to the Department in monitoring and supervising NCTS to ensure it meets its contractual obligations on an ongoing basis. The contract requires NCTS to meet a range of performance standards for the service, which the company has consistently met over the duration of the contract to date.

The report on the mid-term review, which was received by the Department from PricewaterhouseCoopers at the end of October 2005, contains a wide range of recommendations covering areas such as test content, test integrity, technical standards, customer service and data management. Any changes in the national car test or the way it is carried out or administered have to be agreed with NCTS in accordance with the change control procedures which govern any changes to the contract between the Minister and the company. I understand that agreement in principle has recently been achieved in the negotiations between the Department and NCTS on the implementation of the recommendations contained in the mid-term report. I expect to be in a position to make an early announcement about the implementation of the changes to the national car test and to publish the full report of the review at the same time.

Deputy Ó Caoláin chose to raise, in the context of this more general Adjournment debate, the specific case of a number of people in Monaghan who have been dismissed from their employment. I will make inquiries about the matter and communicate my findings directly to the Deputy

Office of Director of Public Prosecutions.

I welcome the Minister of State, Deputy Gallagher, and congratulate him on his appointment to a new position. I am seeking a review of the Prosecution of Offences Act 1974, which established the Office of the Director of Public Prosecutions and set out its functions. There is a need for matters of general public concern arising from the performance of the DPP's functions to be clarified in the public domain. I am raising this matter on foot of the public controversy and confusion that followed the trial that arose from the tragic death of Robert Holohan. The Office of the Director of Public Prosecutions did not issue any response at that time — all we got was silence. It seems that some issues need to be clarified in this respect.

Over 30 years have passed since the establishment of the Office of the Director of Public Prosecutions. I am satisfied that there is a need for the office because it is important that matters of criminal prosecution should be determined by an independent prosecutor's office. The Office of the Director of Public Prosecutions is, first and foremost, an independent forum. Such matters used to be decided on by the Office of the Attorney General, but they are now the responsibility of the Office of the Director of Public Prosecutions.

I remind the House that the predecessor of the current Director of Public Prosecutions established a precedent when he decided he would not make any public statements on his procedures. He did not comment on the manner in which he acted when bringing prosecutions, such as why he decided to introduce certain information but not other information. Nothing in the 1974 Act prevents the Director of Public Prosecutions from putting a statement into the public domain to clarify any matter or explain why he acted in a certain fashion.

The current Director of Public Prosecutions has issued public statements of explanation in the cases of Nora Wall, the former nun who was convicted of rape in strange circumstances, only for the conviction to be overthrown subsequently, and Brian Rossiter, who died while in Garda custody. While the Director of Public Prosecutions is under no obligation to make a statement, he is allowed to issue a statement if he wishes. The problem is that the current arrangements for making a statement are unclear. The Director of Public Prosecutions in the United Kingdom is also the Attorney General there. He is a Minister in the UK Cabinet and is subject to questioning by parliamentarians. There is a direct avenue to determining cause for prosecution in Britain and in Northern Ireland.

That is not the situation here. The Director of Public Prosecution jealously guards his independence, but there should be no conflict between independence and accountability. It is important because every prosecution is taken on behalf of the State and of every citizen through the channel of the DPP. Unless citizens are involved and unless they are considered in a caring fashion, the criminal justice system will not function. It is important to ensure that there is a level of accountability.

Given the length of time the Act has been in operation, does the Minister consider that it is in need of a fresh examination? There is a need for some mechanism to ensure that matters that cause public controversy and confusion can be clarified. There is provision in the Act whereby the DPP shall consult the Attorney General. To my knowledge, this has never happened and it is the Attorney General that consults the DPP. It would be valuable if that took place.

We have an Inspector of Prisons and Places of Detention who makes an annual report to the Minister. In the new legislation for the Garda Síochána, there will be a new Garda inspector who will make an annual report to the Minister. Could we have an inspectorate for the aspect of the criminal justice system where prosecutions on behalf of the citizen are led by the State? An alternative possibility would be a review oversight committee that made an annual report and would keep an eye on the manner in which prosecutions are processed.

I am not saying that the DPP must give us a running commentary on every case before him, but there is a need for a happy medium. Citizens who are involved in the traumatic circumstances of serious criminal cases should not be left high and dry when major questions on how certain prosecutions took place remain unanswered. There should be some mechanism of clarification in the interests of democracy and accountability.

I thank the Deputy for raising this matter. I am deputising for the Minister for Justice, Equality and Law Reform who is out of the country.

The Minister does not have responsibility for the Office of the Director of Public Prosecutions. That office was established under the Prosecution of Offences Act 1974. The principle which underpins the Act is that prosecutorial decisions should be and should be seen to be free of undue or inappropriate pressures being brought to bear in particular cases. It is this principle, which is a very important part of the legal system, which requires that the Director of Public Prosecutions be independent in the performance of his functions, in accordance with section 2(5) of the Act. That independence would not be maintained under a system where the DPP's decisions were subject to review or justification. While the director is independent in the performance of his functions, he is not independent from the rule of law. Like every other person and authority in the State, the DPP is subject to the Constitution and the law and is obliged to act in accordance with it.

Section 2(6) of the Prosecutions of Offences Act 1974 provides that the Attorney General and the director shall consult each other from time to time on matters pertaining to the functions of the director. Arising from this provision I understand that the Director of Public Prosecutions has from time to time consulted the Attorney General. Such consultation has related to general issues which had arisen rather than specific cases. The consultation provided for by section 2(6) of the Prosecutions of Offences Act 1974 works in a way which does not compromise the independence of the Director of Public Prosecutions and does not leave the Government open to accusations of attempting to interfere in prosecutorial decisions. In addition to the provisions contained in the Prosecution of Offences Act 1974, the Accounting Officer for the office must appear before the Committee of Public Accounts to answer questions on the expenditure, general administration and effectiveness of the office.

The Committees of the Houses of the Oireachtas (Compellability, Privileges and Immunity of Witnesses) Act 1997 also provides for the appearance of the DPP before the Committee of Public Accounts on matters of general administration and certain other matters. That committee can also seek evidence or documents from the director or his officers concerning statistics relevant to a matter referred to in a report of and published by the director regarding the general activities of the office.

The director's practice is not to disclose the existence of material after a trial has taken place which was not put before the court of trial because it was inadmissible or not probative of the case. If the director were to do this, it could involve disclosing prejudicial material and leaving persons affected by the disclosure with no effective means to combat any damage to their reputation.

The policy of not giving reasons in public for decisions not to prosecute predates the Prosecution of Offences Act 1974 and the establishment of the Office of the Director of Public Prosecutions. A number of principles underpin this policy. The first is that if reasons were given in some cases, it would be difficult not to give them in all. Otherwise, wrong conclusions would inevitably be drawn in those cases where the reasons were refused. On the other hand, if reasons were given in all cases and those reasons were more than bland generalities, unjust consequences would be difficult or impossible to avoid. Disclosure of reasons could prejudice a future re-trial following a successful appeal.

While acknowledging the long-established principle of not giving reasons in public, I am aware that the Director of Public Prosecutions is examining whether there may be scope for giving more information about prosecutorial decisions to victims of crime. An obvious difficulty is that where reasons are given privately to victims, they may subsequently be disclosed in public. It is the practice of the director's office to give the Garda Síochána a full account of the reasons for prosecutorial decisions. Furthermore, the DPP has published on his website a statement of general guidelines for prosecutors which sets out in general terms the principles which guide the initiation and conduct of prosecutions in Ireland. These guidelines are intended to give general guidance to prosecutors so that a fair, reasoned and consistent policy underlines the prosecution process. These guidelines are at present the subject of review in the DPP's office. An updated version of the guidelines should be available soon.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 21 February 2006.
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