Dáil Éireann debate -
Tuesday, 21 Nov 2006

Vol. 627 No. 6

Adjournment Debate.

Crime Levels.

Mr. Costello

My motion concerns the need for the Tánaiste and Minister for Justice, Equality and Law Reform to address the serious anti-social behaviour in the Oxmanstown area of Dublin 7, particularly the vandalising of 14 cars last Sunday morning.

I condemn in the strongest terms the wanton damage caused to so many vehicles on 19 November 2006. At least 14 cars had their windscreens smashed in a trail of mindless destruction in the early hours of the morning. That is the number reported to gardaí, but we do not know how many others there were. In addition, a member of the Polish community was assaulted. The previous Wednesday, there had been a spate of tyre-slashing in the same area. Those are the instances regarding which residents have reported damage to gardaí. They do not necessarily represent the entirety of damage caused. We do not know the full extent of the mayhem perpetrated in the area in the course of a single week.

I gather that no one has been identified or apprehended in connection with the crimes. Some of the offences took place in areas covered by CCTV cameras, but no arrests were made. Perhaps the cameras are there for show or deterrence rather than serving any purpose regarding serious ongoing investigations. Local inhabitants are extremely worried that such wanton destruction should occur so regularly in such a settled residential community. They are further concerned that gardaí appear incapable of identifying the culprits and bringing them to justice, thus eliminating the problem.

Such serious anti-social behaviour causes fear and apprehension in a community with a high percentage of elderly people. It makes existence difficult and miserable for many, destroying their quality of life. Moreover, it is expensive for vehicle-owners to have their windscreens and tyres replaced several times a year. Whole communities should not be held to ransom by a small group of hooligans who run amok when pubs close at weekends or midweek. It is a sad reflection on the state of policing in the neighbourhood.

The Tánaiste and Minister for Justice, Equality and Law Reform, who should be here in person, regularly bluffs and blusters on various issues, but he has no answer and no plans to address those very serious problems, which are replicated across Dublin city and in other urban communities throughout the country. It is a disgrace that the Tánaiste has totally failed to address either gangland crime or anti-social behaviour after four and a half years in office as Minister for Justice, Equality and Law Reform, and he should seriously consider his position.

We clearly require a more comprehensive and targeted Garda approach, more gardaí on the beat, more in uniform, and more out at weekends so that rampages of this nature might be prevented and the culprits apprehended and prosecuted. At present, it seems that they can act with impunity, and only the certainty of detection and prosecution will put a stop to the mayhem. This small community has suffered greatly in the space of a week. The problem will recur at least once before Christmas, and the Tánaiste seems to have washed his hands of the matter. While he may have tossed his head around, he has not provided any solution, and we need answers. We cannot have such activity going on indefinitely or allow this anti-social behaviour to continue. We need action and results. I ask that the Tánaiste make practical proposals to resolve the situation and a commitment to put the necessary resources in place.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank the Deputy for raising this matter. I am speaking on behalf of the Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell, who is unfortunately unable to be present this evening, as he is speaking on the Government's behalf at another function. I assure the Deputy that the Tánaiste and I share his concerns about anti-social behaviour, and in particular the vandalising of cars, in the area concerned.

Before commenting on the matter raised by the Deputy, it may be helpful to put the issue of crime into perspective. Headline crime in 2005 was 4.4% lower than in 2002. Furthermore, in 1995, with a population of almost 3.6 million people, there were 29 crimes per 1,000 of the population, while in 2005, with a population of over 4.1 million, there were 24.6 crimes per 1,000 of the population. The most recent crime figures, for the third quarter, released for the first time by the Central Statistics Office, show a decrease of 1.6% compared with the same quarter last year.

The Tánaiste is giving the highest priority to providing the resources to the Garda Síochána to tackle and prevent crime. He is very pleased to be informed by the Garda authorities, who are responsible for the detailed allocation of resources, including personnel, that the personnel strength, all ranks, of the Garda Síochána increased to a record 13,000 on Thursday, 16 November 2006, following the attestation of 299 new members. That compares with a total strength of 10,702, all ranks, on 30 June 1997 and represents an increase of 2,298, or 21.5%, in the personnel strength of the force during the period since. The induction of 280 new Garda recruits to the Garda College on 6 November resulted in a combined strength, of both attested gardaí and recruits in training, of 14,137.

The year 2007 will see more than 275 fully trained gardaí graduating from Templemore every quarter — 1,100 in total over the year — allowing the Commissioner to provide a highly visible policing presence throughout the country. The Tánaiste has asked the Commissioner to devote significant resources to policing RAPID programme areas where residents experience persistent vandalism, intimidation and other forms of anti-social behaviour.

I am further informed that the personnel strength, all ranks, of the Dublin Metropolitan region north central division, which includes the Bridewell Garda station, which has responsibility for the area concerned, increased from 585 to 642 between 31 December 1997 and 31 October 2006, representing an increase of 57, or 9.74%, in the number of Garda personnel allocated to the division.

In addition, I point out to the Deputy that the division's resources are further augmented by several Garda national units, such as the Garda national drugs unit and other specialised units.

It is the responsibility of Garda management to allocate personnel to and within divisions on a priority basis in accordance with the requirements of different areas. Those personnel allocations are determined by several factors, including demographics, crime trends, administrative functions and other operational policing needs. Garda management states that such allocations are continually monitored and reviewed along with overall policing arrangements and operational strategy. That ensures that optimum use is made of Garda resources and that the best possible service is provided to the public.

The Government continues to provide record resources for anti-crime strategies. The publication of the Estimates for 2007, which show an increase of 10% on this year's budget, serve to underline the Tánaiste's commitment in this respect. The additional overtime allocation will yield almost 3 million extra personnel hours of policing by uniformed and special units throughout the State. That significant increase in funding, and the continuing increase in the strength of the force, will enhance the capacity of the Garda Síochána to combat crime.

Strong provisions are already in place to combat anti-social and unlawful behaviour. The primary basis for the law regarding public order offences is the Criminal Justice (Public Order) Act 1994, which modernised the law in this regard. Furthermore, because of the Tánaiste's concerns about the abuse of alcohol and its contribution to public order offending and broader social problems, he brought forward tough new provisions to deal with alcohol abuse and its effect on public order in the Intoxicating Liquor Act 2003. In addition, the Criminal Justice (Public Order) Act 2003 provides the Garda Síochána with additional powers to deal with late night street violence and anti-social conduct attributable to excessive drinking.

More recently, the Tánaiste brought forward additional provisions in the Criminal Justice Act 2006 to deal with anti-social behaviour. This Act empowers a senior member of the Garda Síochána to apply to the District Court by way of a civil procedure for an order to prohibit an adult from behaving in an anti-social manner. Separate provision is being made in regard to young people. The relevant provisions of the Act will be commenced following consultations between the Tánaiste's Department, the Office of the Minister for Children and the Commissioner of the Garda Síochána. These consultations are ongoing.

The Tánaiste was informed by the Garda authorities that they received several complaints concerning criminal damage to vehicles parked in the area concerned on Sunday, 19 November. These incidents are under active investigation and every effort, including the examination of CCTV footage from the area, is being made to identify those responsible for these acts of criminal damage. The Tánaiste is assured that the local community policing unit has been directed to make contact with all of the injured parties to inform them that their complaints are being actively investigated by the Garda authorities.

The Tánaiste has been advised that additional Garda patrols by uniform and plain clothes personnel, on foot and mountain bike, have been put in place in order to ensure a visible Garda presence in the area concerned. Local Garda management will continue to utilise the resources necessary to combat this unacceptable behaviour.

Mr. Costello

I will not hold my breath.

Health Services.

Mr. Connolly

I am sure people who are not from the north east consider the Teamwork report as nothing to do with them. Moreover, some of my colleagues from the north east, including counties Cavan, Louth and Meath, consider it to be none of their concern. The perception is that it only applies to Monaghan General Hospital. However, if such persons were to consider the implications of patients being unable to avail of services in Monaghan, they would realise that the facilities in Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda are unable to cope with increased demand.

One may well ask how it can be proposed to close a hospital on which so much funding has been expended. I acknowledge that the level of resources assigned to Monaghan General Hospital in the past three or four years is unprecedented. Some €4.5 million has been spent in renovating two wards and a state-of-the-art six-bay accident and emergency unit has been constructed. Despite this, however, the hospital is about to be gutted in terms of services.

What is happening in the north east is part of a pilot project. People sometimes forget that a pilot project will eventually get to their door also. It is proposed to roll out these changes nationally but a mess has been made of the project in the north east. The Teamwork report is not short on glossy, flowery language; one could describe it as five star language. It is laced with references to "world class services", "international best practice", "evidence based practice", "safer services" and so on. It is also laced with references to non-existent staff grades. There are no advanced paramedics in the State, for example, and we have only one advanced nurse practitioner in Monaghan General Hospital. These grades represent the backbone of what is envisaged in the Teamwork report but the staff are not in place.

Whose view of "safer services" should we accept? Should we listen to the experiences of the patient who has suffered a heart attack, for example, or the mother who has taken her child in the throes of an asthmatic attack to hospital? Should we listen instead to the views of a health administrator based in Dublin on what constitutes safer services?

In addition to the problems of the language in the report, what is also evident is the confusion that exists in regard to services in the north east. I cannot use the word "lie" because that is not a nice word to use in the House and I will be asked to withdraw it. There seems to be an attempt to confuse people and divide opinion. We have several versions of the future of health services in the region. The Minister for Health and Children tells us that Monaghan General Hospital will not close, but this assertion was scuppered by the Pat Joe Walsh report which recommended that the name "hospital" be removed altogether and that the facility should be closed as quickly as possible. That report has never been debated and there is no official acceptance or rejection of its findings. If it has not been rejected, it must be in the pipeline.

We were told last week that Monaghan General Hospital will lose its seven-day, 24-hour services. In other words, we will lose the hospital per se. We are told, however, that a vast volume of work will continue to be done there. I can only assume that assigning appointments at other hospitals to the people walking up and down the corridors there will be classified as work. Professor Brendan Drumm stated that no service would be removed from Monaghan General Hospital until a better service is in place. We would be fools not to want better services and we would be greater fools not to use them. These improved services should be installed and people will then be able to vote with their feet.

Five days after Professor Drumm made that statement, however, the general manager of the five hospitals in the north east stated that acute emergency services at Monaghan General Hospital would cease in March. Although he made this statement in front of several county councillors and other concerned persons, he now denies it. The head of the implementation group in the north east then said that services will be phased out over a two-year period rather than in March. In other words, the services will be removed in the night when nobody is watching.

It is not the case that people do not understand what is being proposed in regard to the services to be provided in the north east. We had a practice run in the region from June 2002 to January 2005, during which time at least 17 lives were lost at Monaghan General Hospital. The lives of some patients were saved because they were brought in cars to other hospitals. We were accused by Professor Drumm of scaremongering in this regard. Despite the 17 lives lost, the attitude was that we must move on and secure "safer services". Can anybody claim that a safer service is one in which so many lives are lost? I cited three examples of people who died while being brought from Monaghan General hospital and three examples where lives were saved when people were brought there in that period. I could have given many more examples of each but I was met simply with a shrug of the shoulders.

At last Thursday's meeting of the Joint Committee on Health and Children, of which I am a member, two representatives of Teamwork Management Services attempted to sell their wares. In the course of this meeting, Mr. John Saunders said there is no logic to what is being done at Monaghan General Hospital. Somebody should go back and check the record. The co-author of the report is effectively saying that it is not being implemented in the way he envisaged. This is serious and deserves further examination. Mr. Saunders should be invited to address the steering group so he can discover what is happening, after which he should make a further assessment of whether his report is being accurately implemented.

Mr. T. O’Malley

I am replying on behalf of the Minister for Health and Children, Deputy Harney.

The Health Service Executive recently established a steering group and project group to oversee a programme designed to improve safety and standards across the acute hospital network in the north-east region. The decision was taken having regard to the issues raised in the report prepared for the HSE by Teamwork Management Services and the findings of the recent report into the death of Mr. Pat Joe Walsh.

The Teamwork report concluded that the current system, where five local hospitals deliver acute care to relatively small populations in the region, is exposing patients to increased risks and creating additional professional risks for staff. The report highlights the need to develop a high quality and responsive emergency and planned service, in line with international standards, by developing local services within existing hospitals and other local centres supported by a new regional hospital.

The HSE recently published the report of the independent inquiry into the death of Mr. Walsh. The report details the difficulties that arose in trying to secure Mr. Walsh's transfer from Monaghan General Hospital to either Our Lady of Lourdes Hospital, Drogheda, or Cavan General Hospital. It also exposes a failure in communications between clinicians and hospitals in the region.

Since the death of Mr. Walsh, the HSE has confirmed that a new protocol was put in place which provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda, be granted and processed immediately. International best practice demonstrates that patients have better outcomes when treated in hospitals with appropriate numbers of specialist staff, high volumes of activity and access to the right diagnostic and treatment facilities. It must be ensured no patient is exposed to increased risk because specialist services are being provided in some hospitals that lack the necessary critical mass of activity and patient throughput. Patient safety and quality must be paramount and the key drivers in the reconfiguration of our acute hospital services. Government policy is to provide safe, high-quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery to ensure those services that can be safely delivered locally are and more complex services that require specialist input are concentrated at regional centres.

Led by the HSE's National Hospitals Office, the north-east steering group has representation from key stakeholders including clinicians and primary care providers. The project group is led by Dr. Eilish McGovern, a renowned consultant surgeon. The Minister, HSE representatives and Dr. McGovern met recently with Members, including Deputy Connolly, and members of Monaghan County Council to specifically discuss the future configuration of services at Monaghan General Hospital arising from the recommendations in the two reports. The HSE has given the Minister an assurance that, in progressing the implementation of these reports, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Mr. Connolly

On a point of order, the Minister of State referred to protocols being in place.

An Leas-Cheann Comhairle

That is not a point of order. I call on Deputy O'Dowd. There is no provision for questions on the Adjournment Debate.

Mr. Connolly

There are no protocols in place. Five weeks ago a young man who came off a motorbike was left begging for a bed for two hours.

Mr. O’Dowd

Deputy Connolly is eating into my time. Throw him out, a Leas-Cheann Comhairle.

Mr. Connolly

The protocols are not in place.

An Leas-Cheann Comhairle

Deputy Connolly should resume his seat. I call on Deputy O'Dowd.

Hospital Services.

Mr. O’Dowd

Serious concerns have been expressed by general practitioners in Drogheda and the surrounding area about Our Lady of Lourdes Hospital, Drogheda. This evening I spoke to a doctor in the area for over 27 years who finds the normal arrangements he had with the hospital for those years have now been changed. Doctors in the Drogheda area are making the charge against the HSE that they can no longer refer patients to the hospital for blood tests. Their patients have to wait six to eight weeks for routine X-rays. No physiotherapist or ultra sound is available for referral patients. Blood samples are sent out of the hospital for analysis. Their most serious charge against the Minister for Health and Children and the HSE is that both refused to meet with them.

The knock-on effect is that it is driving patients lucky enough to have health insurance into private care or other hospitals. It is a drive by the Department to force people out of the health services into private hospital care. The ordinary medical cardholder is getting a dreadful service. It is a serious matter when the doctors of Drogheda town and district are up in arms. I hope the Minister of State will ensure a change of course in the hospital's management. In Dundalk or Navan, one only has to wait one week for an X-ray. In Drogheda, one waits eight weeks. People in Drogheda want the previous service restored. The Government is on a course of conflict to drive them into private hospitals. The State health system is not providing the services which the people and the doctors are demanding.

Mr. T. O’Malley

The HSE has confirmed that Our Lady of Lourdes Hospital, Drogheda is experiencing some difficulty in the provision of services as outlined by Deputy O'Dowd. The executive is working to address these difficulties, which appear to have arisen due to staffing issues. The executive has confirmed there has been some curtailment recently in phlebotomy services due to staffing deficits resulting from staff resignations and increased activity pressures. The executive considers the phlebotomy service can appropriately be provided to patients in a community setting. Accordingly, hospital management and the primary, community and continuing care directorate are working together to finalise plans to facilitate the taking of bloods from GPs' patients in a local primary care setting.

Due to the refurbishment of the digital X-ray room at the hospital, patients referred to Drogheda by GPs will experience a delay until this refurbishment plan is completed. The HSE has advised that the refurbished facility will be operational by the end of December. However, GPs have been advised that their patients can be facilitated in the interim at both Louth County Hospital and Our Lady's Hospital, Navan.

There has been a temporary curtailment of outpatient physiotherapy services at the hospital due to staffing difficulties. A recruitment process is under way to replace staff who have left and appointments are to be expedited. While there has been some improvement as a result of existing staff working overtime, full restoration of the service will be possible only when the full staff complement is in place. The Department supports the achievement of this as soon as possible.

Health Services.

Mr. P. Breen

The Minister of State is aware of the critical situation with orthodontic services in the mid-west. It is not an exaggeration that orthodontic services in the mid-west are in a mess. The several reviews established in this area are also in a mess. Since 1998, five reviews have been held, three from the Department of Health and Children. This is a shocking number which gives the false impression that the Department is engaging with the problem. The Department appears to be proud of these reviews when it should be ashamed of them.

In 1998 the Moran report was produced. The Joint Committee on Health and Children carried out a review of orthodontic services in 2002. This was followed by a review by the former health board chief executive officers of the orthodontic service to consider the committee's report and assess progress on implementing the Moran report, a review of the reviews.

We were then blinded by the conclusion that the shortage of trained orthodontists was restricting the provision of orthodontic services. The committee published a follow-up to its 2002 report which recommended a return to the regional orthodontic training programme which ran successfully between 1985 and 1999 and where trainee orthodontists were treating 250 patients a year.

Not to be put off by such a simple and effective solution, the Department sanctioned yet another review called the orthodontic review group, established in April 2005 but which has yet to report although it was supposed to in June 2005. The Minister of State will go into detail about the great work this group is doing. I believe its conclusions will claim the delivery of orthodontic services through the HSE is a shambles. It will continue to be so unless firm action is taken. I do not know whether the review group will ignore the committee's recommendation that the regional training programme be reinstated.

In today's edition of The Irish Times, an eminent consultant orthodontist, Dr. Ian O’Dowling, has dissociated himself from its findings. The work of the group must be in doubt. Dr. O’Dowling directly addressed the issue of the number of children damaged, pointing out that this has not been addressed. I want an estimate of the number of children who have suffered irreversible damage to their teeth, gums and faces after orthodontic regional training programmes ended in 1999. I dread to think what the answer will be. Year after year frustrated parents of children in dire need of orthodontic services beat a path to the door of every Oireachtas Member in the country, asking what has gone wrong and why a public health service in one of the richest countries in the world is letting them down so badly.

In Clare, there were 982 patients on waiting lists last year, 682 waiting for assessment and 300 waiting for treatment. Those are staggering figures for one orthodontist, under the guidance of a consultant orthodontist, to cope with. Parents tell me of their teenage children being bullied at school, of the emotional damage done to them, and of their despair at having to wait up to four years at such a vulnerable stage in their lives.

The figures, bad as they are, do not represent the true picture because many hard-pressed parents take one look at the waiting lists and decide, correctly, that they have no option but to seek private treatment. Other children are put on the waiting lists when the specialists know they will be too old and mature to be treated properly by the time they come to the top of the list.

It is a sad situation in which even Government backbenchers feel powerless. They have no faith in the Minister for Health and Children to grasp the nettle on this issue and take on the vested interests that are frustrating the delivery of a properly run orthodontic service.

In a recent article in my local newspaper, The Clare Champion, I saw that a Fianna Fáil Senator was blaming orthodontic consultants in private practice who were “using a dominant position to prevent the delivery of the service through the public service”. No doubt there is some truth in that but I was under the impression that it was the Government that formed and implemented public health policy. If it is reneging on this commitment it should come out and say so.

I urge the Minister of State to ask the Minister for Health and Children, in the few months she has left in office, to take a firm stand on this issue and to re-instate the regional training programme over the objections of the dental schools which have so spectacularly failed to come to terms with the problem. This is a big problem in Clare and the mid-west. Parents come to my office every day wanting to know why their children are not receiving treatment.

Mr. T. O’Malley

On behalf of the Minister for Health and Children I am happy to have the opportunity to address the issue raised by Deputy Breen. The Minister and I understand from the Health Service Executive that during a dispute in 1999-2000, some patients undergoing active orthodontic treatment had their treatment delayed. The Minister and I are not aware of any clinical evidence of irreversible damage because some patients' treatments were delayed.

We also understand from the Dental Council, which deals with serious clinical issues, that the matter has not been referred to it. If any such clinical evidence is available, it should be brought to the attention of the relevant authorities. The provision of orthodontic treatment to eligible persons is the statutory responsibility of the HSE in the first instance. The Department and the HSE have the shared objective of developing sustainable quality, standards, treatment capacity and outcomes of our orthodontic services.

The Joint Committee on Health and Children carried out a review of orthodontic services which culminated in the publication of its report, The Orthodontic Service in Ireland, in 2002. The committee published a follow-up to that report in June 2005.

The HSE established a national orthodontic review group to draw together an agreed national approach under four principal headings: guidelines, training, service provision and manpower planning. The group consists of representatives from consultant orthodontists, management from the HSE, the Department and the dental schools in Cork and Dublin. The review group has concluded its meetings and is finalising its report and recommendations, which will be presented to the chief executive of the HSE soon. This will include recommendations on training. I look forward to considering this report, which my Department will receive shortly.

At the end of June 2006 there were almost 25,000 patients receiving orthodontic treatment in the public orthodontic service. Over twice as many patients are getting orthodontic treatment as are waiting to be treated. Over 5,500 extra patients are receiving treatment compared with four years ago. This tangible improvement will be further enhanced as the HSE develops the orthodontic services.

Our aim is to continue to make progress and to develop a high quality, reliable and sustainable orthodontics service for children and their parents.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 22 November 2006.