Dáil Éireann debate -
Tuesday, 7 Mar 2006

Vol. 616 No. 1

Adjournment Debate.

Hospital Services.

Ms Lynch

While I appreciate the presence of a junior Minister from the Department of Health and Children — it is rare that the relevant Minister comes before the House for the Adjournment debate — I would have preferred the Minister to attend.

The health of more than 200 diabetic children is in serious danger because of inadequate treatment and staffing at Cork University Hospital. This was pointed out four weeks ago to all public representatives and Deputies in Cork city during a meeting of parents. The parents in question found it extremely difficult to attend the gathering because they had to leave children who need to be monitored on an hourly basis. While the number of diabetic children attending Cork University Hospital has almost doubled to 207 in the past three years, the number of staff at the hospital has decreased. The hospital used to have one whole-time diabetic nurse specialist but now has only a part-time diabetic nurse specialist.

Diabetic children must wait six months and sometimes longer for a check-up, despite the fact that international diabetic bodies recommend that check-ups take place every three months. I could accept such waiting times if they were the same across the country but parents of children aged as young as 18 months who have been diagnosed with diabetes are now travelling from Cork to Dublin to have them treated. This is a long journey to take every three months but at least if their child's sugar levels fluctuate they are able to obtain advice on a 24-hour basis from a nurse specialist simply by making a telephone call. If a child in Cork is diagnosed with diabetes, parents have access to a half-time nurse, an endocrinologist who is not employed full-time to treat children with diabetes, a social worker and a dietician, neither of whom is employed in a whole-time capacity for this purpose.

Type one diabetes is the most common form of diabetes in children and is automatically assumed to refer to children. Having experienced the trauma of learning that her child has diabetes, one parent informed me that she was given an orange and syringe and told to practise injecting her child. She was then left on her own with no idea of how to deal with a child who experiences fluctuating sugar levels and bouts of lethargy. The terror of the experience virtually overwhelmed her.

Lack of education for parents and children, the absence of proper management of diabetes and a sense of being abandoned with no one to turn to if the treatment prescribed does not provide good blood sugar control are the major problems faced by parents. Those of us who attended the parents' meeting, including Deputy Boyle who is present, were asked to write and telephone Tony McNamara, the general manager of Cork University Hospital, and do all in our power to have the matter rectified. We were told a meeting was about to take place but Mr. McNamara would prefer to discuss matters with the parents, which is fine. Parents informed me that the meeting was unsatisfactory and merely confirmed their views. We have been informed, for example, that an advertisement for a full-time specialist nurse in diabetes care will not be placed as planned and if a recruitment procedure proceeds, it will be for a half-time specialist nurse. The parents, who are desperate, are not the type of people one finds protesting outside Leinster House, although perhaps that is what they need to do. They find it outrageous that this should happen.

The decision to take one's child to Dublin for treatment in hospital is a significant one. Parents know the difficulties involved but are prepared to face them for the sake of their children. Over the past few days, debate has taken place on a new children's hospital. We hear that millions of euro will be spent, yet Cork is a blackspot in terms of care for children with diabetes, who look forward to continued ill-health. I appeal to the Minister to insist that the hospital should employ the required number of staff. It has suggested imaginative ways of paying for nurses, involving sponsorship by drug companies of a health service for our children which the State is obliged to provide.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I thank Deputy Lynch for raising this matter, which I will take on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

As the Deputy will be aware, operational responsibility for the management and delivery of health and personal social services falls within the remit of the Health Service Executive. This includes responsibility for the provision and development of paediatric diabetes services at Cork University Hospital. The hospital currently employs one general paediatric consultant with a special interest in diabetes and endocrinology. A part-time clinical nurse specialist is also employed at the hospital. A full-time clinical nurse specialist post for the paediatric service will be advertised in coming weeks. This post is a development of the service and will address some of the current issues around the education and resources of the service.

The management of the hospital met with patient forum groups in February to discuss the issues surrounding the service. Hospital management has reported that the suggestions made at this meeting are currently being examined. The development of the paediatric diabetes service remains a priority for the executive management board of Cork University Hospital. The Tánaiste is confident that the Health Service Executive will continue to monitor the delivery of this service to ensure that the needs of the service users are prioritised and met.

Mental Health Services.

Mr. Andrews

I am glad of the opportunity to raise this matter. The east coast catchment has the unhappy distinction of being the mental health service area with the lowest funding in the State. The reason is partly historical, in that most counties had their own psychiatric hospitals and, when these were closed and replaced by better community-based facilities, funding was provided to compensate for the loss of county hospitals. However, because Dún Laoghaire never had a county hospital, it had nothing to bring to the bargaining table. As a result, it lies at the bottom of the league table of funding according to figures provided by the HSE. We need to acknowledge that significant problems exist in terms of funding for this area.

The recently published report, A Vision for Change, details a comprehensive model mental health service provision in Ireland. The report describes a framework for building and fostering positive mental health across the entire community and for providing accessible community-based specialist services for those suffering with mental illness.

In Dún Laoghaire, when a national pilot project, DETECT, was established, a mere 10% of the necessary funds was provided by the HSE, with the balance coming from Order of St. John of God. The project, which was rolled out last month, tries to reduce the duration of untreated psychosis because people with an established psychosis are 25 times more likely to commit suicide than the general population. This highlights the importance of early detection. As it is an established fact that psychosis is treatable, the earlier the detection, the better.

This issue particularly affects areas of disadvantage and identifiable social and economic problems. The lack of services within the Dún Laoghaire area affects people on low incomes more than those with private insurance. The need for a multidisciplinary response to diagnoses of psychosis is not always met in such circumstance. Sufferers are seen by psychiatrists but have little or no access to community psychiatric nurses, social welfare officers or occupational therapists.

A false economy is created by balancing the cost of hospitalisation for sufferers of mental illness against the much lower cost of setting up a system of early detection. DETECT has impressed me with the type of service it intends to provide. The people involved in the project made a presentation at Cluain Mhuire last month, in which they demonstrated their knowledge of best international practice and their plans to reduce the incidence and duration of psychosis.

There is a perception among the providers of mental health care that the service is grossly under-resourced, both in financial terms and in the range of staffing and physical resources required to provide a quality service. The serious funding crisis that exists may be illustrated as follows. In 1984, 13% of total health expenditure went towards mental health but this figure decreased to 10% in 1994 and to 7.3% in 2004. While the overall pie has grown larger, the lack of resources for this area is apparent.

In the past, mental health budgets were funded on the basis of historical budgets and existing service pressure. In the future, this funding will follow existing population trends and needs, if the recommendations of the report, A Vision for Change, are implemented. The report draws into focus the uneven distribution of funding and human resources throughout the country. The recommendations have been made and the ideas are there. We need substantial extra funding to finance these policies. An urgent programme of capital and non-capital investment in mental health services adjusted in line with inflation should be introduced in line with the reorganisation of the mental health services.

Mr. B. Lenihan

I thank Deputy Andrews for raising this matter, which I will take on behalf of my colleague, the Tánaiste.

Our mental health services have undergone significant changes over the past two decades. The move away from institutional care to community care has brought the mental health services generally closer to the service user. The move from hospital-based care to individualised care has empowered users to take a more proactive role in their care and treatment. This has been complemented by the care and treatment provided by multidisciplinary teams in partnership with other health care professionals and voluntary agencies.

These changes have been in line with the model of service provision now recommended by the recently published report of the expert group on mental health policy, A Vision for Change. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. The report has been accepted by the Government as the basis for the future development of mental health policy. It recommends that a programme of capital and non-capital investment in mental health services, adjusted in line with inflation, should be implemented in a phased way over the next seven to ten years. The proposed new workforce will comprise more than 11,000 staff throughout the service. Allowing for the assimilation of all existing posts, the expert group has estimated that a total of 1,800 new posts are required across the services, together with a total non-capital investment of €150 million per annum in addition to existing funding. This programme of investment has already begun with an additional €25 million allocated to the HSE in the Estimates for 2006 for the further development of mental health services.

Significant capital investment will be required to implement the proposals in A Vision for Change regarding the provision of new and replacement facilities for the mental health services. This has been estimated by the expert group to be of the order of €800 million and, as outlined in their report, much of it could be realised from the value of existing hospitals and lands.

The proposals in A Vision for Change will allow for further significant expansion in community services and in specialised services for groups such as children, older people and those with particular needs. The implementation of this policy will be a matter for the Health Service Executive in accordance with the provisions of the Health Act 2004. The national mental health directorate within the HSE is in the process of establishing an implementation group to ensure that the recommendations are realised in a co-ordinated manner.

I am aware the adult mental health service in former community care area 1, now known as the local health office in Dún Laoghaire, has a population of 170,000 and a mental health budget of almost €13 million for 2006. There are 4.5 consultant-led mental health teams operating in the area.

In preparation for the implementation of the Mental Health Act 2001, the Health Service Executive reviewed the number of consultants per capita in the new local health office areas. The review indicated that the local health office in Dún Laoghaire has the lowest number of consultant psychiatrists per capita in the country. In order to begin to address the issue, an additional €550,000 revenue funding will be allocated to the Dún Laoghaire service in 2006, and the intention is to provide additional funding in coming years in order to increase the number of consultant-led teams in line with the national norm.

My colleague, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, who has special responsibility for mental health, will be seeking the active support of all involved in the mental health services so that together we can bring about the far-reaching improvements contained in A Vision for Change. He will shortly be appointing a group, as recommended in the report, to monitor the implementation of its recommendations.

I would like to stress that A Vision for Change details a comprehensive model of mental health service provision for Ireland. It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness. On that basis, I assure Deputy Andrews that, in line with this policy, the level of mental health service provision throughout the country will be improved and equalised in the coming years.

General Practitioner Co-operatives.

Mr. Deenihan

The concept of the general practitioner co-operative has been introduced successfully in Ireland over the past five years. Traditionally, out-of-hours service was provided by general practitioners on an on-call basis. This meant that many GPs, particularly those in single-handed rural practices, could be constantly on-call. Other doctors working in group practices or in urban areas with colleagues in practice nearby were able to organise rotas and secure some time off duty. As demands increased on general practice, the level of out-of-hours calls increased and doctors were becoming increasingly tired and stressed. In response to increased demands on GPs, they began to explore the introduction of the co-operative model of providing out-of-hours services in 2000. This model, which had been in operation in the UK, was introduced to Ireland initially on a pilot basis and has expanded throughout the country in recent years.

In the south west of the country SouthDoc, which commenced in 2001, is a co-operative of general practitioners which provides an out-of-hours service for Cork city and county and most of Kerry. The call centre is located at St. Finan's Hospital, Killarney. The co-op has a board of medical directors and employs a general manager to run the centre. There are different types of treatment centres in operation: overnight centres which are staffed throughout the night; treatment centres which are staffed up to midnight only; and lock-up centres, which are used as a base to see patients but are not staffed.

The location of various centres is determined by the demographics of the region. In general, the treatment centres are based in the major centres of population, large towns and villages such as Tralee, Castleisland and Killarney in Kerry, and Bantry and Cork city in County Cork. Centres are located in order to be accessible within a reasonable travelling time to the population they serve.

In the period 2001 to 2005 the co-op has been rolled out in counties Cork and Kerry and now most of these two counties is covered by the service. Although the scheme has been a major success in these counties, north Kerry remains excluded. Some 14 general practitioners in the north Kerry area, from Kerry Head to Tarbert, have waited to be admitted to the GP co-op scheme for four years and were finally given approval in October 2005, or so they thought. Initially the relevant GPs were informed that the scheme would commence in early 2006. However, they have now been informed that the funding which had been promised to them to run the scheme is available but has not been released.

I wish to stress to the Minister that the extension of the GP co-op scheme is essential to north Kerry, which is predominantly a rural area. The GPs in this area still find themselves excluded from the scheme and have to cover a large rural area without any back-up. Many of them have to work day shifts immediately following what are sometimes lengthy call-outs during the night. Professor Drumm and the Minister, Deputy Harney, surely have a duty of care to the GPs as their employers to ensure the personal safety of these doctors and that they are not at risk while carrying out their duty. These GPs sometimes have to drive long distances at night on their own. This can be stressful and scary for female doctors in particular. If they were included in SouthDoc, these GPs would have the services of a nurse and driver and other back-up services. It is not fair to the GPs in north Kerry.

I call on the Minister, through the Minister of State, Deputy Brian Lenihan, to contact the chief executive of the Health Service Executive immediately so that the funding to get the scheme up and running can be released without further delay. The north Kerry area should not remain excluded from this essential primary care out-of-hours service.

Mr. B. Lenihan

I am taking this debate on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney, and I thank Deputy Deenihan for raising this matter on the Adjournment. The Government is committed to the development of GP out-of-hours services as outlined in the national health and primary care strategies. Currently, out-of-hours general practitioner co-operatives are operating in at least part of all counties in the State.

In the Health Service Executive's southern region, out-of-hours general practitioner services are provided in counties Cork and Kerry by the SouthDoc co-operative. Decisions regarding the geographical areas to be covered by general practitioner out-of-hours co-operatives and any expansion of the services are made by the HSE, which has regard to the strategic, financial and other issues involved, including the readiness of general practitioners within an area to become part of a co-operative.

With regard to SouthDoc, this co-operative was established as a limited company for the provision of out-of-hours general practitioner services in 2001. Initially it began in south Kerry and west Cork. By 2003 it expanded to take in Cork city and in August 2005 it further expanded to north and east Cork. There are 365 GPs participating in the SouthDoc co-operative. It has, on average, 2,250 calls per week, and it provides services to a population of 581,000 people. There are 26 treatment centres. In Kerry, these treatment centres are located in Killarney, Cahirciveen, Tralee and Castleisland.

In 2006, approximately €34 million is included in the HSE's baseline funding for GP out-of-hours co-operative services. Of this amount, €2 million is new funding for this year. In the context of this additional funding, the HSE has advised me it is currently considering the expansion of the GP co-operative service to north Kerry along with proposals for expansion to other areas. The HSE southern area continues to work closely with the north Kerry GPs in terms of moving towards their inclusion in SouthDoc. In 2006, the HSE will have over €6 million available in its baseline funding for the SouthDoc co-operative. Between 2000 and 2005 almost €18 million has been provided to fund the out-of-hours services provided by SouthDoc. These amounts do not take into account fees for attendance on patients that participating general practitioners would receive.

Schools Building Projects.

Mr. Boyle

It has been a longer day than usual. I sat through the entire Report Stage of the Finance Bill 2006, but I am grateful for the opportunity to raise the issue of a group of schools building projects in my constituency which is causing ongoing concern and controversy for the school managements and the parents of pupils in each of the schools involved. School building in Cork may have suffered from an expectation created by the term in office of my constituency colleague, Deputy Martin, as Minister for Education and Science from 1997 to 2000. Since the change of Ministers in 2000 school building in Cork has slowed down to a trickle.

Among the schools I have included in my question on the Adjournment are four primary schools, though one may be a putative primary school, and two secondary schools, all of which became political issues as we approached the general election in 2002. I am a member of the Committee of Public Accounts and we put questions to the Secretary General of the Department of Education and Science, who assured us there was no geographic bias in terms of where schools were built. It is strange, however, that the blips in school building programmes seem to follow the appointment of particular Ministers in particular constituencies. Perhaps that is just a gift the Taoiseach has for making these appointments, but the inverse is that where school buildings were built at a quicker than average rate they tended not to be built in subsequent years.

Some of these schools have waited four or five years and there is no sign of progress. The Government must give a clear explanation for the delays. Some schools have experienced difficulty with land acquisition but parents and the boards of management wonder why the Department, or the Office of Public Works acting on behalf of the Department, is not more proactive.

The primary school in Passage West was all set for development in 2000 but the Seveso directive threw it into doubt because it was within a quarter mile of a dangerous industrial facility, the IFI plant in Marino Point. With the closure of IFI, which had serious economic implications, it was thought the road was clear to build the new school. Three years on there is still no development.

Rochestown is an area of high population where the land is being provided but there still seems to be no clear decision from the Department as to when a new school will be provided.

Carrigaline is a Gaelscoil which is very successful in terms of student intake. Most of its pupils, however, continue to sit in prefabricated structures and the parents and board of management are entitled to demand answers from the Department.

The two secondary schools are in my own community, Ashtown and Coláiste Chríost Rí. Both have been waiting for ancillary facilities in the shape of PE halls and modified classrooms and learning centres. As the primary schools, they have been waiting half a decade and more for positive decisions and the start of construction work on their projects.

The questions are very simple. Why are so many projects outstanding and why is it so in this particular community? The process seems out of step with the average waiting time for schools throughout the country and, as the TD for that constituency, I would like to be able to assure my constituents that their expectations will be met at the earliest opportunity. If the Minister can offer any words of comfort in the way of dates or decisions on resources many people in my constituency will be pleased.

Minister of State at the Department of Education and Science (Mr. B. Lenihan)

I am giving the reply to the matter raised by Deputy Boyle on behalf of the Minister for Education and Science, Deputy Hanafin. I welcome the fact that the matter has been raised as it affords the Minister the opportunity to outline to the House the strategy of the Department of Education and Science for capital investment in education projects and to outline the position on the development of both primary and secondary education provision in Cork South-Central.

Modernising facilities in our 3,200 primary and 750 post-primary schools is not an easy task, given the legacy of decades of under-investment as well as the need to respond to emerging needs in areas of rapid population growth. Nonetheless, since taking office, this Government has shown a sincere determination to improve the condition of our school buildings and to ensure that the appropriate facilities are in place to enable the implementation of a broad and balanced curriculum. As evidence of this commitment there will be 1,300 building and modernisation projects active in our primary and post-primary schools during 2006. Over €490 million has been spent on primary and post-primary projects throughout the country.

Ballygarvan national school is a co-educational primary school. Enrolments have been increasing in recent years from 140 pupils in September 2000 to 183 pupils in the current year. The Department has received an application from the school authority for a new school building. Having examined the application and ruled out the possibility of extending the existing school to provide the accommodation required, the need for a new school building was acknowledged. The property management section of the Office of Public Works, which acts on behalf of the Department in site acquisitions generally, was requested to identify and acquire a suitable site for the new school building for Ballygarvan national school. A site has been identified comprising three adjoining parcels of land belonging to three different owners. Negotiations have concluded with the vendors of one of these parcels of land and draft contracts are currently with the Chief State Solicitor's Office. A price has been agreed for a second parcel of land and contract documents are now awaited. The matter of the acquisition of the third parcel of land is ongoing. When site acquisition is finalised, the delivery of the new school building will be considered in the context of the school building and modernisation programme.

Star of the Sea, Passage West, is a co-educational primary school with a current enrolment of 277 pupils. On foot of its application, a decision was taken to provide a new school building on a new site. A site has been acquired to facilitate the construction of a new school building. The long-term projected staffing, on which the precise accommodation needs of the school will be based, is almost finalised. When this is completed, the project will be considered in the context of the school building and modernisation programme.

Gaelscoil Carrig Ui Leighin is a co-educational primary school. Enrolments have been increasing in recent years from 239 pupils in September 2000 to 386 pupils in the current year. The Department has received an application from the school authority for an extension consisting of six classrooms. The long-term projected staffing on which the accommodation needs will be based has been determined. The proposed project will be considered in the context of the school building programme.

The need for a new primary school in the Rochestown area of Cork is acknowledged. A site has been reserved by the local authority. Acquisition of the site and the building project required to deliver a new school building is being considered in the context of the school building and modernization programme 2006-10.

Ashton School is a co-educational second level school with a current enrolment of 523 pupils. It was included in the 2005 building programme for the provision of a new school. The appointment of a design team is under way.

Coláiste Chríost Rí is an all boys school with a current enrolment of 684 pupils. The Department has an application for a PE hall at the school. This project is being considered in the context of the school building programme.

I thank Deputy Boyle for giving the Minister the opportunity to outline to the House the method used by her Department in determining in an open and transparent way how projects are included for funding in the school building programme and I assure Deputy Boyle and the House that the schools referred to and all others will be treated in a fair and equitable manner.

The Dáil adjourned at 11.50 p.m. until10.30 a.m. on Wednesday, 8 March 2006.