Dáil Éireann debate -
Thursday, 26 Oct 2006

Vol. 626 No. 3

Adjournment Debate.

Health Services.

Mr. O’Shea

Approximately 1,000 patients every year from the south-east region must travel either to Dublin or Cork for treatment due to the lack of radiotherapy services at Waterford Regional Hospital. In 2004, some 815 patients were referred from Waterford Regional Hospital to St. Luke's Hospital in Dublin while 209 patients were referred to Cork University Hospital. In 2005, some 721 patients were referred from Waterford Regional Hospital to St. Luke's Hospital in Dublin and 205 were referred to Cork University Hospital.

Some of these patients are being referred for short radiotherapy daily sessions but because of the travel involved are forced to stay away from home while undergoing treatment. Some patients are quite ill, requiring either therapeutic or palliative treatment for their cancers. If these patients could be treated within the south-east region the issue of staying away from home and of long harrowing journeys for treatment could be eliminated or very significantly reduced.

The Taoiseach indicated on his visit to the Waterford constituency on Monday, 16 October, at the launch of the new Whitfield Clinic in Butlerstown, that Waterford is to get an integrated satellite centre for radiotherapy services based at Waterford Regional Hospital. However, the date set for this public private partnership project is 2011. By taking the public private partnership route, the people of Waterford and the south east will not have their radiotherapy service for another five years, at the earliest.

Yet, radiotherapy treatment for both public and private patients can be provided in the very near future at the University of Pittsburgh medical centre at the Whitfield cancer centre. The planning permission for Whitfield includes a condition that two linear accelerators, the equipment that provides the service, be installed at the centre. Although the two linear accelerators could be installed by now, only one is in place. However, it has been indicated by the clinic that they will proceed with the installation of the second linear accelerator even in the absence of any arrangement for the funding of public patients.

When he was in Waterford, the Taoiseach said he knew the Whitfield clinic had approached the Health Service Executive in relation to providing radiotherapy services to public patients. However, there is absolutely no indication that funding is going to be provided by the Department of Health and Children for the HSE to fund patients needing radiotherapy at the centre. The Taoiseach also said he understood the clinic and the National Treatment Purchase Fund had entered into discussions with a view to providing treatment for public patients. It is not clear if the Taoiseach's comment refers to radiotherapy. The National Treatment Purchase Fund provides for patients who have been on a public waiting list for three months. This is hardly an appropriate vehicle for cancer patients waiting for radiotherapy service.

As the one who started the campaign for radiotherapy services in Waterford, I am absolutely appalled and find it utterly unacceptable that now, when a solution is at hand to prevent cancer patients having to endure harrowing journeys or unnecessarily being away from home at a time when they need the help and support of their families and friends, the Government is not availing of this opportunity. The Government parties dither while the most vulnerable sick people continue to suffer. The people of Waterford and the south east will not stand for this.

I demand that the Minister gives an undertaking that immediate steps will be taken to provide radiotherapy for public cancer patients in the south-east region at Whitfield clinic, Waterford. The lack of urgency and commitment on the Government's part is shameful, barbaric and unacceptable. I put it to Fianna Fáil and the Progressive Democrats that failing the public patients of the region on this occasion will probably be the greatest low in the very chequered existence of the Government.

Minister for Health and Children (Ms Harney)

I fully recognise the motivation of Deputy O'Shea in tabling this matter for debate. However, what he is asking the Government to do sits better with the Government's open approach to independent providers than the motion debated in the House this week, which condemned me for encouraging private health provision. I am being asked to procure services for public patients from a private provider, in this case a for-profit organisation. This is a highly respectable organisation but it is a for-profit private hospital. What Deputy O'Shea is suggesting is in total conflict with what he voted for last night and what his party moved in the House this week. I respect Deputy O'Shea's motivation in tabling the matter for discussion.

The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland. Best outcomes for patients are achieved when all aspects of cancer care, surgery, radiotherapy and chemotherapy are delivered by multi-disciplinary teams based around major centres.

The HSE is implementing the Government's decision to create a national network of radiation oncology with two centres in Dublin, one in Cork, an integrated satellite service in Waterford and one in Galway, with a satellite in Limerick. We have also now agreed arrangements to have the major centre at Belfast City Hospital offer treatment for patients from Donegal.

Public patients are being treated at a centre in Limerick that was created by the Limerick hospital trust and is being run by the Mater private hospital. The HSE is working closely with that centre so that its services are used productively and fit in with cancer policy and quality guidelines.

There has also been recent contact between the HSE and the University of Pittsburgh medical centre's Whitfield centre to explore the scope and conditions for the procurement of its radiation oncology services. The HSE will comply with relevant procurement and quality guidelines in any contracting for these or, indeed, any other services from private sector providers.

As Deputy O'Shea is aware, I am open to all solutions from the public and private sectors that deliver quality care faster to patients. That is why today I have announced the approval of a capital investment in six new linear accelerators for St. Luke's, St. James's and Beaumont hospitals, in advance of the completion of the radiotherapy PPP.

The HSE has my full support in procuring quality services for patients from private, not-for-profit, independent providers or from the public sector. I share Deputy O'Shea's view that we will be able to procure services at the Whitfield centre for patients from the Waterford region in advance of our investment opening there in 2011.

Mr. Gogarty

The Minister is fully aware that more than 400 medical card patients were told at short notice that they had to change doctors by 1 November 2006. These clients live in Newcastle, Rathcoole, Saggart and Brittas, and as far afield as Clondalkin, Lucan and Tallaght. They have been enjoying a high level of patient care from their doctor for as long as 14 years. After all this time, however, it turns out that Dr. Graham is not qualified to practice as a general practitioner under the GMS scheme. Despite his qualifications as a consultant, EU legislation, as a member of the Minister's staff informed a meeting recently, prevents him from providing general practitioner services to medical card clients in his own right. I know the "whys" and "wherefores" and I also know that changing EU directives cannot be undertaken at short notice. Sometimes they cannot even be implemented in the long term but I am concerned about patient care. If patient care is truly at the heart of the Department's and the HSE's remit, a solution can and must be found.

I have met many of Dr. Graham's patients who are adamant that they do not wish to transfer to the doctors recommended by the HSE. Instead they want to continue being treated by him as their current GP. They insist they will not allow their medical records to be transferred. Many have personal reasons for this, which I do not wish to go into here, even under Dáil privilege. There are also issues of access and further issues regarding the suitability of the proposed new surgery, which some people have described charitably as a stable. However, the most important reason for wanting to maintain the status quo is that hundreds of clients have built up a long-standing relationship with Dr. Graham and they can see no logical reason for that relationship to be torn apart now. They trust their doctor and, for older patients in particular, trust is an important issue.

So far the HSE is not in favour of turning. It has behaved in a negative way. When my office contacted the HSE to get more information on the situation I was fed a cock and bull story. I was told the reason Dr. Graham would not be working as a medical card GP any more was that he had not applied for the position. As an elected representative, I expect more than to be treated in this manner. The poor treatment of Dr. Graham's patients is the most important issue, however. I urge the Minister to force the HSE to meet Dr. Graham's patients and come up with a workable solution that will acknowledge the situation regarding his continuing practice but will also allow him to continue to work with his medical card clients under whatever terminology and position is appropriate.

At the recent public meeting to which I referred, I highlighted the rapid manner in which the Government was able to introduce legislation when it was found to be illegally charging elderly people for nursing home care. It would be great if the Government applied itself so creatively to the needs of patients within the health service. The buck stops with the Minister. She should use her good offices to ensure that a solution is reached which is agreeable to all and which will allow Dr. Graham to continue providing his important services.

I do not want to hear excuses. The Minister and I share the same constituency. If she wants to use legal terms or say it is a matter for the HSE or that her hands are tied, that is up to her, but, if so, she will have let a lot of patients down. I hope the Minister will have some good news in her reply for our constituents. She should put patients' care first and let the people be treated by someone they know and trust. There are ways around this situation and they need to be explored.

Ms Harney

I know the area well and I happen to know the various parties as well. This is the local village where I grew up. This is not a question of Irish law, it concerns an EU directive. If I broke the rules and overruled EU directives, which I am not empowered to do, Deputy Gogarty and his colleagues would be the first to criticise me.

One of the Health Service Executive's functions is to make contractual arrangements with general practitioners to provide services under the GMS medical card scheme. Since 1995, entry to the GMS scheme for general practitioners has been carried out through open competition and interview, following the advertisement of posts in national and medical newspapers. All suitably qualified persons may apply for these positions.

Applicants for GMS GP contracts must satisfy the provisions of EU Directive 93/16/EEC, which stipulates the requirement in respect of vocational training for persons seeking to be considered for such posts throughout the European Union. In accordance with that directive, the arrangements for the recruitment of general practitioners have operated well for over ten years.

The qualifying criteria are well known to all doctors who wish to secure a contract within the QMS scheme. Many who do not comply go through the training in order to comply. The arrangements have ensured that a large number of well qualified, highly competent contractors provide modern, comprehensive and high quality services to public patients at primary care level.

The Health Service Executive has advised that the general practitioner providing services to medical card and GP visit card holders in Newcastle resigned in November 2005. While the process to fill the this vacancy was being conducted, a doctor from the area, who had been acting in the capacity of a private assistant to the recently retired GP, was contracted by the HSE in a locum capacity to provide services to the medical card and GP visit card patients. This was clearly an interim arrangement until the permanent post was filled and would have been understood to be so.

The HSE advises that five doctors applied for the post in Newcastle initially but that only one doctor actually attended for interview. The HSE has now completed the recruitment process and, with effect from 1 November 2006, the panel of medical card and GP visit card holders will be assigned to the successful candidate who will provide a GP service at both Rathcoole and Newcastle.

The arrangements to be implemented in Newcastle will bring significant improvements in services to the people of the area. The new doctor will provide clinics from an existing practice initially and within a short period intends establishing a new practice premises near the village centre. He intends to provide a full range of care, including special chronic care clinics, and he will be assisted by a female general practitioner.

Alternative Energy Projects.

Mr. Neville

I welcome the opportunity to raise this important proposal concerning my constituency. It is a proposal to establish a bioenergy production facility at Foynes, County Limerick. The world faces unprecedented energy and environmental challenges and both sectors are inextricably linked. A company named Capway Bioenergy intends to be part of this new system. It commenced operations early in 2005 and, to date, has constructed a pilot research facility for biodiesel production and a laboratory at Shannon, County Clare. It has also developed a skills base in biodiesel technology, operating procedures and quality control systems. In addition, it has developed a core staff whose expertise is transferable to a commercial-scale plant.

Capway Bioenergy proposes to construct a large-scale, state-of-the-art biodiesel processing plant at Foynes Port, County Limerick, that will use Irish raw materials. To this end, the company has submitted an application to the Government under the biofuels and mineral oil tax relief scheme 2 for excise duty relief for 57.1 million litres, which is 50,000 tonnes of biodiesel per annum.

The raw material of biodiesel is produced from agricultural products and residues. Capway Bioenergy will use Irish-grown rape seed oil and other oils and fats of Irish origin. Towards this end, it signed a provision supply agreement with Dairygold Co-operative and Acorn Independent Merchants Group. Capway Bionergy has provisional distribution agreements in place with three of Ireland's leading mineral oil distributors, Topaz Energy Products, Maxol Group and Tedcastles Oil Products. Furthermore, Capway has signed provisional supply arrangements with three high profile capital fleets, Roadstone Provisions Limited, STL Logistics and Pallas Foods.

In tandem with bolstering demand for native agricultural products, the project will generate high quality employment during construction and operations phases. Up to 80 jobs will be created during construction and direct employment during the operational phase will comprise more than 30 full-time positions. Indirect benefits will also be significant. I need not remind the Minister that my constituency has been devastated by three closures over the past 18 months which resulted in 1,000 job losses. This is an opportunity to reverse those losses and could represent the start of an exciting period for the development of bioenergy on the Shannon Estuary.

When fully operational, the project will offer net savings of approximately 160,000 tonnes of CO2 emissions per annum. Capway Bioenergy has selected a site for the biodiesel site at Foynes port on the basis that it supplies easy access for native and imported raw materials and an efficient distribution route to the Irish market. It is intended that the processing plant will comprise two 50,000 tonne per annum modules, with construction of the first module to commence as early as possible. It will take two years from the date of the granting of excise duty relief before the first module becomes operational and the construction project cannot commence until relief is formally granted. In August, Capway lodged an application for excise duty relief with the renewable and alternative energy division of the Department of Communications, Marine and Natural Resources.

This project merits support because, by improving energy sustainability, increasing the sustainability of the transport system, addressing the decline in the agricultural sector, bolstering and diversifying the rural economy and reducing greenhouse gas emissions, it will address many of the challenges currently facing Ireland. It would also be an excellent partner for the miscanthus experiment currently being conducted in Adare. The challenge of creating an environmentally sustainable and indigenous energy supply for Ireland's transport sector may seem insurmountable and sustainability is unlikely to be achieved in a single step. However it can be achieved through a series of small steps — through evolution rather than revolution. Capway Bionergy is committed to making a positive step towards that goal, so I urge the Department of Communications, Marine and Natural Resources to allow Capway Bionergy to ameliorate the difficulties which have arisen in my constituency over the past 18 months.

Ms Harney

I propose to take this Adjournment matter on behalf of the Minister for Communications, Marine and Natural Resources. A number of initiatives are in place to support the development of a biofuels sector in Ireland. In 2005, the Minister for Communications, Marine and Natural Resources introduced a pilot mineral oil tax relief scheme for biofuels which has awarded excise relief to eight projects. As a result of the scheme, 16 million litres of biofuels will be placed on the Irish transport market by next year.

Building on the success of this scheme, the Minister launched the second biofuels mineral oil tax relief scheme in July 2006. The new scheme will be rolled out between this year and 2010 at a cost of over €200 million and will enable Ireland to reach a target of 2% market penetration of biofuels by 2008. When fully operational, the relief is expected to support the use and production of some 163 million litres of biofuels each year. The scheme was launched on 25 July and had a closing date of 28 August. Approximately 100 applications have been received across the four categories covered by the scheme. An assessment panel comprising officials from the Department of Communications, Marine and Natural Resources, Sustainable Energy Ireland and Enterprise Ireland has been convened and is currently in the process of assessing the applications received. The promoters of the project to which Deputy Neville referred have applied for excise relief under the scheme. Reflecting the requirements of openness, transparency and equal treatment of all applicants in the competition, and given that the deliberative process is ongoing, the Minister is not in a position to comment on or discuss the details of any application under the scheme. I do not therefore propose to discuss the details of the project in question.

The Government is firmly committed to the development of an Irish biofuels market and to the increased development of bioenergy generally in Ireland. In July, the Minister established a new ministerial taskforce on bioenergy as part of the ongoing policy to increase the share of indigenous renewable energy in the Irish heating, electricity and transport markets. The taskforce's members include the Tánaiste and the Ministers for Communications, Marine and Natural Resources, Finance, Agriculture and Food, Environment, Heritage and Local Government, Transport and Enterprise, Trade and Employment. The Taoiseach's office is also represented. The primary objective of the taskforce is to draw up a cohesive national bioenergy strategy by the end of the year. This strategy will also take account of EU developments and the views of stakeholders. The taskforce is being supported in its work by a senior officials' group representing the Departments concerned. Consideration of options to further increase market penetration of biofuels is a critical element of the work of the ministerial taskforce. The Green Paper on energy, which was published by the Minister, Deputy Noel Dempsey, last month, suggests a target of 5.75% market penetration of biofuels in Ireland by 2010 and the taskforce is considering the options available to Government in achieving such a target.

Fire Services.

Aengus Ó Snodaigh

I wish to speak on the urgent need to put in place better provisions for dealing with a fire emergency such as occurred last night in a hostel in the north inner city. Calls have been made to provide additional resources to the fire brigade services in Dublin and throughout Ireland. In addition, a proper system of emergency planning is needed so that there will not be a recurrence of the disgraceful events in which the people rescued from the fire were accommodated in Mountjoy Prison. If a flight is delayed, passengers have the luxury of being accommodated in a hotel, yet one would appear to have to spend time in Mountjoy Prison in the event of a fire emergency. Several community halls are located in the inner city, as well as a number of hotels and hostels, which would be more appropriate for people who have just suffered the trauma of having escaped from a fire.

I congratulate Dublin Fire Brigade on its heroic efforts last night and, thankfully, nobody was seriously injured, although five people were hospitalised for smoke inhalation. An urgent need exists for a proper fire risk assessment to be conducted in Dublin. No such assessment has been carried out over the past 20 years. In some instances, people are crammed into hostels that resemble the Dublin tenements of yore. As is clear from last night's events and recent reports on RTE, some of these hostels represent grave fire risks and should be closed immediately. The 25th anniversary of the Stardust tragedy has just passed. While I hope such a disaster will never again be visited upon Ireland, it could happen if we do not invest in fire prevention or conduct a proper risk assessment in Dublin. The city has grown substantially over the past 20 years, so an assessment is needed. Comparisons should be made with the approaches taken in other cities. There is an immediate need for additional fire brigade ambulances. We have only 11 fire brigade ambulances, the same number as for the past 20 years even though emergency calls to the 999 number have increased from 26,000 per annum to 80,000. It is a tribute to the fire brigade and the emergency staff who deal with these calls that they have managed to keep going without a tragedy. If this city had another disaster last night, we would have suffered greater consequences because our emergency services would have been stretched to the limit. In 2004 the fire brigade service attended to more than 10,000 fires and more than 2,000 road traffic accidents, and there were nearly 70,000 calls to the 999 number, which indicates the level of work being done. The service needs to be properly resourced.

The Government needs to provide proper resources to ensure that we address longer-term planning for responding to fires and other major emergencies on an all-Ireland basis. We need to resource properly the fire brigade and ambulance service throughout the country.

Ms Harney

I thank the Deputy for raising this matter. I am responding on behalf of the Minister for the Environment, Heritage and Local Government, Deputy Roche. I would like to place on record my gratitude and that of the Government to the members of the fire service for their work last night and for continuing to safeguard the community on a daily basis. I also extend my sympathies to those caught up in the fire and wish them well in their recovery.

I understand that last night's fire occurred in private rented accommodation which was formerly a hostel. The Department of the Environment, Heritage and Local Government issued guidance, addressed to local authorities and to property owners and occupiers alike, with a view to reducing fire risk in apartments and hostels. In 1994 the Department published Guide to Fire Safety in Flats, Bedsitters and Apartments. In 1998 the Department published Fire Safety in Hostels.

Dublin City Council homeless services and the homeless persons unit, which is operated on a 24-hour basis by Health Service Executive community welfare officers on an agency basis for the city council, are available at all times to assist persons who may face a crisis regarding their housing accommodation.

With regard to the present case, the Homeless Agency in Dublin has advised the Department that the landlord has 24 additional apartments in the area, which will be used to accommodate residents. The community welfare officer in the North Strand and Dublin City Council have organised 14 beds in private bed and breakfast accommodation in Fairview and an additional 12 beds in a nearby hotel. Interpreters have also been organised to work with the residents to ensure that they are supported and that they understand the situation.

I again thank the frontline services for their speedy and effective response to last night's incident, which minimised more serious consequences to the victims. A more comprehensive response is now being provided by the housing and other social agencies.

The Dáil adjourned at 5.15 p.m. until 2.30 p.m. on Wednesday, 1 November 2006.