Dáil Éireann debate -
Tuesday, 20 Jun 2006

Vol. 621 No. 7

Adjournment Debate.

Cancer Incidence.

Mr. Costello

I welcome the Minister of State, Deputy Power, to the House. The issue I raise is the need for the Minister for Health and Children to address the high incidence of cancer in disadvantaged urban areas. As the Minister of State is aware, Ireland has among the highest cancer incidences and mortality rates in western Europe and in the western world. Each year, approximately 28,000 new cancer cases are diagnosed and 11,000 die from the disease on this island of 5.5 million people.

Statistics I recently obtained from the National Cancer Registry clearly demonstrate that the incidence of cancer is higher in Dublin city than in surrounding counties and that there are major differences within Dublin city. Certain areas such as Ballybough, west Cabra, Arran Quay, my own constituency of Dublin Central, Ballymun in Dublin North-West and Merchant's Quay in Dublin South-Central have cancer rates over 50% higher than the national average, or what is called the standardised incidence ratio, SIR. Such a high variation from the norm cannot be due to chance and clearly indicates that there are real and substantially greater cancer risks in certain parts of the city over other parts.

A 50% variation from the norm is a very serious matter for the residents of the areas affected. Material deprivation and high smoking levels are suggested by the National Cancer Registry as major factors contributing to higher cancer levels, but it is clear these are not the only factors as other traditionally deprived areas in the city of Dublin have only average rates of cancer. As lung cancer is by far the commonest cause of death from cancer, it is likely that fumes from motor vehicles are a significant factor. However, there may be other local but unknown causes and it is not sufficient for the health authorities simply to speculate about the causes of such a huge variation in the incidence of cancer in the city of Dublin. They must research and determine the causes.

I call on the Health Service Executive to conduct an urgent investigation into the five district electoral divisions in Dublin city where the incidence of cancer exceeds the standardised incidence ratio by 50% or more. By way of information for the Minister of State, Ballybough A, the district electoral division, is 150%, which is 50% above the norm. Ballymun C is 1.68%, which is 68% above the norm. That is very high. Cabra west A is 57% above the norm, while Merchant's Quay A at 1.64% is 64% above the norm. Those are very high incidence rates. Other areas are 20%, 30% and 40% but the fact that five separate electoral areas have levels over 50% above the norm is a massive variation.

The fact that the city of Dublin has a much higher incidence of cancers than the rest of the country demands that the HSE examine this matter. It is not much use saying we have the statistics and from those we speculate that it may be due to smoking or deprivation. What does that mean? There are many areas in Dublin city where these levels are the norm. They are the norm in the area of the north docks, for example, yet an area like Ballybough is over 56% above the norm, Cabra is 60% above the norm and Ballymun is 60% above the norm. That is very serious statistics. Cancer is one of the biggest killers in this country and we do not know the reason for the clusters of cancer in these inner city areas — Ballybough, Merchant's Quay, Arran Quay, Ballymun and Cabra west.

I would be pleased if the Minister of State accepted my proposal that the Health Service Executive should conduct an urgent investigation into these clusters of cancer in the city of Dublin.

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

I thank Deputy Costello for raising this important matter on the Adjournment. I am happy to reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

Just over a week ago the Tánaiste launched A Strategy for Cancer Control in Ireland 2006, which was prepared by the National Cancer Forum. The forum expects that, mainly for demographic reasons, the number of patients with cancer will double over the next 15 years. One of the most significant strategic issues facing cancer services is the variation in survival rates within Ireland and our relatively poorer cancer survival rates for many common cancers when compared with other European countries. In part, this can be attributed to the fragmentation of cancer services, whereby too many hospitals are involved in the provision of treatment for cancer.

The strategy makes recommendations in relation to organisation, governance, quality assurance and accreditation across the continuum of cancer care from health promotion, prevention and screening through to treatment services, supportive and palliative care and research. There is a strong emphasis in the strategy on health promotion,addressing inequalitiesand quality assurance. Cancer patients should receive multi-disciplinary care from cancer specialists in radiology, pathology, surgery, medical and radiation oncology and oncology nursing, all working together as an integrated team.

Since the implementation of the first national cancer strategy commenced in 1997, approximately €920 million has been invested in the development of cancer services. These screening and treatment services are available free at point of service subject to the basic public charges and are provided on a whole-population basis. A total of 34,000 more people were treated for cancer in public hospitals in 2004 compared to 1998, an increase of 60%. The Vote for the Health Service Executive in 2006 includes a sum of €9 million to continue to meet the additional service pressures in cancer care, improve the quality of care, facilitate better access to radiation oncology services and continue the preparation for the national cervical screening programme.

While cancer services have improved, the prevention and reduction of incidences of this disease has become a priority. Current research suggests that approximately 30% of cancer deaths are potentially avoidable by the modification of diet, making diet second only to tobacco as a preventable cause of cancer. Disadvantage and poor lifestyle habits are often linked and it is acknowledged that those in the lower socio-economic groups are more likely to develop diseases such as cardiovascular disease, diabetes and cancer than their more affluent and educated counterparts. These health inequalities must be addressed or the burden of care which will be required will be enormous. Through modifying lifestyle behaviours in the population, significant gains will be made both for the individual in that they will achieve a better quality of life and for the health services through substantial savings in future health care costs.

The Department of Health and Children conducted a review of the impact of the National Health Promotion Strategy 2000-2005. It found that high levels of implementation at both national and regional level were reported in regard to being smoke free, being more active and eating well.

Tobacco use is the single largest causative factor, accounting for 30% of all cancer deaths in developed countries. Many advances have been made with regard to smoking and smoking control in Ireland in recent years, including a ban on advertising. However, on 29 March 2004 the workplace ban on smoking was introduced in all places of work, including licensed premises. With a 94% compliance rate and a reduction in smoking rates, the health benefits of this legislation will become apparent in the future.

For more than 11 years the health promotion unit of the Department of Health and Children co-ordinated an annual healthy eating campaign, which aimed to promote awareness of specific healthy eating messages and to provide practical information to the general public. These campaigns have enhanced public awareness on healthy eating guidelines on fruit and vegetables, fibre, low fat and being a healthy weight.

The World Health Organisation states that regular physical activity is a significant element in cancer prevention and control. There is consistent evidence that some form of regular physical activity is associated with a reduction in the risk of colon cancer. The protective effect of physical activity on cancer risk improves with increasing levels of activity. Twelve physical activity co-ordinators have been appointed in the HSE and structures have been put in place to provide advice and support in a number of settings including schools, workplaces and communities, targeting in particular the young and older people.

The reorganisation of the Department of Health and Children and the devolvement of executive functions to the Health Service Executive present an opportunity to address, in a more fundamental way, the broader determinants of health, such as lack of education or low socio-economic status, and to reduce health inequalities. There now needs to be sustained focus on the wider social and economic determinants of health to move beyond the lifestyle risk factors. This will require collaboration and collective action across Departments in association with the private sector and other statutory and non-statutory agencies. This Government will not be found wanting in continuing to improve the health status of the population and in particular those who are most vulnerable.

Road Traffic Offences.

Mr. Timmins

I wish to share time with Deputy Mildred Fox.

I am here to try to find out from the Minister for Justice, Equality and Law Reform, or his representative, what went wrong in the prosecution of speeding fines in Wicklow, following the decision of the courts to dismiss 238 speeding cases in the county on Friday, 2 June. In the course of his judgment, the judge criticised Wicklow County Council for not being forthcoming with information about the issue and the resultant confusion led to the dismissal of the cases. A number of issues need to be considered.

Wicklow County Council was not a party or notice party to the case, and it had furnished the relevant information on request to the Garda. The relevant speed limits were correctly adopted by the council and this procedure was outlined in a submission, prior to the judgment. With over 180 road fatalities this year, it is unacceptable that a possible lack of co-ordination between the Garda and the local authority may have led to the dismissal of these cases. If a course of appeal is available I hope the Director of Public Prosecutions and the Garda will avail of it. It is important that I briefly outline the sequence of events.

On 1 March 2000, as part of a countywide review of speed limits by the local authority, a speed limit of 40 mph was set at Kilmacanogue on the N11. In September 2000, the 40 mph speed limit was extended a couple of miles south of Kilmacanogue to an area known as Barry's Bridge, to facilitate work at the Glen of the Downs. On 19 April 2004, following completion of those works, the 40 mph speed limit was redefined in the Kilmacanogue village area. A 50 mph limit was set for the rest of the area south of this through to the southern end of the Glen of the Downs. On 4 October 2004, following numerous representations, an area south of Kilmacanogue to the north of the Glen of the Downs was made a 60 mph zone, while the Glen of the Downs remained at 50 mph. That detail might seem somewhat confusing, but it is important to emphasise that all of that was passed by proper resolution by the members of Wicklow County Council.

In November 2005, at the request of a solicitor defending a client who was being prosecuted for speeding, two certificates were issued by Wicklow County Council, one certifying an extract of the minutes of 19 April 2004 and the other certifying an extract of the meeting of 4 October 2004. The certificates issued, signed by an official of Wicklow County Council, stated that these extracts were true and correct copies taken from the minutes of the relevant council meetings at which the speed limits were adopted. During the course of his defence, a solicitor argued with respect to the offences prosecuted that the certificates issued on 14 November 2005 had the same date as that on which the special limits were adopted. This was not the situation. I want to find out why Wicklow County Council was not a party or notice party to this case, why the Garda was not briefed by the local authority, whose fault it was and whether there will be an appeal process.

It is totally unacceptable, given the number of road deaths and the airing of road traffic issues every day of the week that so many people who should have faced prosecution have slipped through the net.

Ms Fox

I thank Deputy Timmins for sharing time.

I am also surprised at the criticism being levelled at Wicklow County Council as a result of this decision. Wicklow Country Council was not a notice party in these proceedings. Had its representatives been present to clarify matters, it would have saved much time, money and confusion.

The speed limit in Kilmacanogue has not changed since March 2000 when it was set at 40 mph or 60 kph. The same speed limit is still legally in force today. Luckily, from a safety viewpoint, the area in question is a newly constructed dual carriageway and not a more dangerous secondary road. The number of cases which were thrown out is an indication of how well policed that particular stretch of road in Kilmacanogue is. It is one of the most heavily policed stretches of road in the country — and I am only sorry that I was so quick to pay my own fine in that area.

The biggest scandal this case highlights is the fact that gardaí spend so much time on safe stretches of road, on which we have spent millions to make safer. It is very easy to catch soft targets doing 70 kph on a 60 kph stretch of road. It is not so easy to pay attention to secondary roads at 3 a.m. on a Saturday morning, where our young people are dying. Penalty points are only effective when properly enforced, which is not the case. That is why the system has no impact. We are told that speed kills, which is true. Signs remind us how many people have been killed. We see the gruesome advertisements on television, and still young people die every weekend on our roads. The message is lost on us.

There has to be greater communication between local authorities and the Garda in cases such as this, where confusion arises. Local authority staff should be given the opportunity to give evidence and save time and embarrassment and to assist the Garda as much as possible.

Mr. S. Power

I thank Deputies Timmins and Fox for raising this matter. I am speaking on behalf of the Minister for Justice, Equality and Law Reform who unfortunately is unable to be present. I assure the Deputy that the Minister and I are aware of developments in this matter.

The Minister has been informed that a number of cases involving motorists who had been charged with breaking a 60 kph speed restriction on the N11 dual carriageway at the village of Kilmacanogue were dismissed at Bray District Court on Friday, 16 June 2006. The cases involved the issue of the legality of the speed limit. It was argued on behalf of the defence that there had been significant delay between the adoption of a special speed limit and its ratification by a vote of the elected members of Wicklow County Council. The Minister has been informed by the Garda authorities that a representative of Wicklow County Council was present in Bray District Court on 2 June and gave evidence. A representative from Wicklow County Council was not required for the 16 June sitting, as the judge was to come to his decision in relation to the cases at that sitting.

Section 9 of the Road Traffic Act 2004, operative since 20 January 2005, provides the legislative basis for the application of special speed limits. The purpose of special speed limits is to allow the major local authorities — the county and city councils — to replace the default or standard speed limits that would otherwise apply to roads. The making of special speed limit by-laws, to apply a special speed limit in lieu of a default speed limit, is a matter for each individual county council or city council. Section 9(12) establishes that a copy of by-laws made under the section can be used as evidence of the fact stated in the by-law in court proceedings.

Local authorities have had the power since the passing of the Road Traffic Act 1994 to make special speed limit by-laws. Furthermore, section 12(1) of the 2004 Act provides that speed limit by-laws made in advance of the coming into operation of section 9 continue in place but are to be read as applying metric equivalents to the speed limits to which they refer. In other words, it provides for the automatic conversion of the units of measurement from miles per hour to kilometres per hour in respect of any special speed limits that were applied under by-laws made prior to 20 January 2005, the date on which the 2004 Act became operative. By-laws in place on that date remain in force until such time as new by-laws are made by the city or county council under section 9 of the 2004 Act.

From enquiries made I am informed that the special speed limit by-laws in place prior to 20 January 2005 are still applicable across all 34 local authority areas and that five of the local authorities have adopted additional special speed limits. I understand that the majority of the councils either have a review of existing speed limits under way or are planning such a review later this year.

A new policy element was introduced under section 10 of the 2004 Act to enable a county manager or a city manger to make a road works speed limit order to apply a road works speed limit for a limited period. This power has been and is being exercised at road works in various areas.

The Minister for Justice, Equality and Law Reform has been informed by the Garda authorities that where a person is issued with a fixed charge notice for a penalty point offence, the notice sets out the amount of the fixed charge and the penalty points applicable to the offence. The person has an option to pay the fixed charge and, as part of the payment process, completes a declaration that he or she is aware of the contents of the notice. When a payment is made, the Garda notifies the Minister for Transport who is responsible for the endorsement of penalty points on the entry in the licence record of the person. If the person named in the notice opts not to pay the fixed charge, then a prosecution is taken and if a person is convicted the Courts Service is responsible for notifying the Minister for Transport, as in all cases the decision of the District Court may be appealed.

An individual who receives penalty points may write to the Garda national processing office at 89-94 Capel Street, Dublin 1, requesting the removal of penalty points in circumstances such as when the alleged offence had no legal status. The Department of Transport, on the written request of a chief superintendent, may remove penalty points from a driving licence in such circumstances.

As the matter of the cases before Bray District Court is still under consideration by the courts, the Minister is not in a position to comment further at this time.

Schools Building Projects.

Ms O’Sullivan

Tá mé buíoch go bhfuil cead agam an rún seo a phlé. Students, parents and the principal of Gaelscoil Sairséal are so desperate to ensure that there is definite progress in the acquisition of a site for their school before the summer break that they took the extreme measure of protesting outside the Dáil earlier today. I am sure many Members will have seen the children there. That is an indication of the situation in Gaelscoil Sairséal.

Gaelscoil Sairséal is a wonderful school with a dedicated and enlightened principal, staff, board of management and parents who involve themselves fully in the life of the school. However, they operate in atrocious conditions. The main school building was built as a courthouse 240 years ago and has dark, damp, leaking overcrowded classrooms and a tiny school yard. It was declared unsuitable for health and safety reasons for a different school many years ago. The infant classrooms are in St. Mary's Band Hall, which has no playground and which is entirely inappropriate for use as a school, particularly for small children. There is no natural light in some of the classrooms and ventilation and heating are sub-standard. I have visited the school on a number of occasions and have seen the conditions first hand. I have also witnessed the dedication of the staff and parents to that school. It is hard to believe that the Department of Education and Children has not treated their needs as an emergency. Parents in the school have said that if they kept their children in those conditions at home, the children would probably be taken into care.

Gaelscoil Sairséal has been in temporary accommodation for 16 years, the last 12 in the current two sites. They thought a permanent site was secured in February 2001 when the board was informed by the Office of Public Works that a deal had been made with a developer to purchase a site. However, this site was lost because funds were not released in time to finalise the purchase. Parents, children and teachers were told they would have to wait again. There is now another opportunity. There are three acres of land, zoned for educational and community use, available on the outskirts of Limerick city. The school submitted an application relating to this land in January 2005. It has not yet been acquired by the OPW. I have raised this matter on a number of occasions through parliamentary questions. I have been told the OPW is aware of the site and is dealing with the developer, but issues remain to be clarified.

The real fear among the parents, teachers and children at the school is that this site might fall through their hands. They have taken the extreme step of coming to the Dáil to make their protest. They are determined to purchase the site for their school and that this will happen before the summer break. I hope the Minister of State can give me an answer that will ensure is the case.

Any further delay is inexcusable. The children simply cannot be left in these conditions. I call on the Minister for Education and Science to sanction the purchase of the site and to provide the funding to build the school without any further delay.

Mr. S. Power

I thank the Deputy for affording me the opportunity to outline to this House the proposals of the Department of Education and Science regarding the need to acquire a permanent site for Gaelscoil Sairséal in Limerick. I also apologise on behalf of the Minister, Deputy Hanafin, who is unable to be here this evening.

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 in this area as well as the need to respond to emerging needs in areas of rapid population growth. Nonetheless, since taking office, the Government has shown a focused 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, approximately 1,300 building and modernisation projects will take place in our primary and post-primary schools during 2006. Over €500 million is being spent on primary and post-primary projects throughout the country. This unprecedented level of capital investment is testament to the importance the Government places on improving the quality of accommodation in our schools.

This school originated on the north side of Limerick city but had to relocate to the city centre due to accommodation issues. The majority of pupils come from the north side of the city. It is the responsibility of the board of management to secure interim accommodation until such time as the Department is in a position to provide permanent accommodation. The school is currently split between two sites. The main building is on Bridge Street. The ground floor contains three classrooms and the first floor contains three classrooms. The basement contains a staffroom, special tuition room and principal's office. First to sixth classes are located in these premises. The infant classes are based at the other site on St. Mary's Street. The Department of Education and Science currently grant-aids 95% of the rental cost of these premises at a total of £147,000 per annum. The school's contribution to the rental cost is capped at €3,175 per annum.

The school is awaiting the provision of a permanent building. Its priority rating is band two. Architectural planning cannot commence until a suitable site is secured. The property management section of the Office of Public Works has been requested by the Department of Education and Science to source a site for the Gaelscoil. While a suitable parcel of land has been identified, a map of the specific area offered to the Department for sale is awaited from the landowner. This map is required in order to clarify specific suitability issues such as topography, access, availability of services and so on. As soon as the OPW receives this map, these more detailed issues can be examined. When a suitable site has been secured, the proposed building project for Gaelscoil Sairséal will be considered for progression in the context of the school building and modernisation programme for 2006-10.

I thank the Deputy for raising this matter which allows me to outline the progress being made to acquire a permanent site for Gaelscoil Sairséal in Limerick.

Services for People with Disabilities.

Dr. Cowley

I am grateful to the Ceann Comhairle for the opportunity to raise this important matter.

Catherine was a perfect child until she got encephalitis at the age of three. Her balance went and she developed a juvenile form of multiple sclerosis. She is now 22 years old and is in need of full-time care and assistance for all the tasks of everyday life. She suffers from epilepsy and kidney problems, with urinary incontinence. She has tunnel vision and lacks peripheral vision. She needs to use a wheelchair to get out and about.

Catherine attends the training centre in Ballina, County Mayo, two days per week. She has a personal assistant with her in the centre who protects her from falls and looks after her every personal need. Without the presence of this personal assistant on those two days, she would not be safe and would be a danger to herself. She would like to spend more than two days at the centre, but this is not possible because of a lack of funding to hire a personal assistant for the other three days. She must stay a home because of this.

I appeal for funding for the hiring of her personal assistant for the other three weekdays as she is restless and ill at ease sitting at home. Like everyone else, she wants to work five days of the week. She is demoralised when she cannot work as she misses the social contact with her fellow workers. She is not happy because she must stay at home. She must do so only because money is not available to hire her personal assistant for the other three days a week and, unlike her work colleagues, she cannot work those days. She was also refused respite care and her mother was refused a carer's allowance.

I appeal to the Minister of State to act to provide the necessary funding for the hiring of Catherine's personal assistant to enable her to work for five days a week. I cannot understand how that cannot be done — in the interests of equality it should be done. Disability is something with which this girl must live for the rest of her life. She would have a better chance of a normal life and an existence in which she could contribute even more to society like everyone else if she were in a position to work five days a week. It is not fair that she cannot do so and I hope the Minister of State will give her that chance.

Mr. S. Power

I thank the Deputy for raising this matter on the Adjournment and I am pleased to take this opportunity to clarify the matter relating to the provision of health related services to people with physical or sensory disabilities, including the provision of personal assistance services.

Under the multi-annual investment programme 2006-2009, which is part of the national disability strategy, additional funding amounting to €51.5 million is being provided by the Government in 2006 to meet costs associated with the provision of certain specific high profile disability services. In regard to services for persons with intellectual disability and those with autism, this includes 255 new residential places; 85 new respite places; 535 new day places; 250,000 extra hours of home support and personal assistance services; and the continuation of the implementation of the transfer of persons with intellectual disability-autism from psychiatric hospitals and other inappropriate placements.

In addition to these initiatives, additional funding of €22.5 million is being provided this year. This funding has been allocated to enhance the multi-disciplinary support services for children and adults with physical, sensory and intellectual disabilities and those with autism. The funding will also address core under-funding and core staffing issues in services for people with disabilities provided by the voluntary sector. Capital funding amounting to €45 million has also been provided in 2006 to put in place the infrastructural supports associated with these developments.

The provision of personal assistant services by or through the Health Service Executive is based on a careful prioritisation process. This process takes place at local level and draws on the expertise of those active in the voluntary and statutory service. I understand that it also takes account of priorities based on assessment of need.

The development of personal assistant services over the last number of years has led to increased demand for the service and the prioritisation process allows for an equitable division of resources. In the case raised by the Deputy, I understand that the Health Service Executive has taken measures to address the service needs of Catherine. I understand that a local voluntary agency has been contracted to provide a personal assistant service to her for two days a week and this arrangement will continue in the future. I have no doubt that the Health Service Executive will continue to keep Catherine's circumstances under review having regard to the prioritisation process for personal assistant services.

I note that the Deputy refers to Catherine's wish to work outside the home. I understand that FÁS is active in providing people with disabilities with assistance in gaining and retaining employment and it may be in the best position to assist Catherine in achieving her desire to work.

The Dáil adjourned at 10.35 p.m. until10.30 a.m. on Wednesday, 21 June 2006.