Adjournment Debate.

Hospital Services.

I thank the Ceann Comhairle for allowing me to raise this important issue, namely, the Teamwork report for the north east and whether it will be applicable to services in the mid-west, specifically Ennis General Hospital, and the future of 24-hour accident and emergency services.

The report to which I refer is entitled Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, which was produced last August by Teamwork Management Services on behalf of the Health Service Executive. I agree with a recent statement by my party colleague, Deputy Twomey, that there is a major gap between proposals made in the report and the experience of those on the front line trenches of the health service.

The report recommends the development of one regional hospital for the north east and changes in care at local level. The proposals include changing the status of five acute hospitals in the area to local hospitals which would perform a wide range of day surgery and outpatient procedures. While we all recognise that centres of excellence must be based at major hospitals and some services are not suitable for county hospitals, a growing body of evidence in the United Kingdom indicates that the trend towards developing super-regional hospitals and downgrading acute hospitals to local hospitals is an inappropriate model.

One of the reasons for this conclusion is the emergence of hospital superbugs and life-threatening illnesses such as MRSA, which are spread much more easily in large hospitals with high volumes of patient turnover. This trend also discriminates against people living in remote areas with poor transport infrastructure, which greatly reduces the chances of having timely and appropriate treatment. In this context, I refer to people in villages in west Clare such as Carrigaholt, Cross and Kilbaha, who are more than one hour's journey by car from Ennis General Hospital and face considerable disadvantage when compared to their counterparts in urban areas.

It is a pity the Government does not recognise this problem. The Minister believes the issue relates solely to Ennis General Hospital, but I am extremely disappointed at the news that Galway will not receive a neurosurgical unit. The review of neurosurgical services has advised against establishing such a unit in Galway. People in the west have died from head injuries due to the lack of speedy access to a neurosurgical unit. The units in Dublin and Cork are too far away for people in counties Clare and Galway and other counties in the west to access them quickly. Health services in the west are the poor relation of those in the east and when one considers the outcome of the Comhairle na n-Ospidéal review of neurosurgical services, those in the south are also in dire need of improvement.

I raise the Teamwork report because of concerns raised over how its conclusions might apply to Ennis General Hospital. These concerns have been passed on to me by members of the Ennis General Hospital development committee who have done trojan work on behalf of the hospital in recent years. The committee is concerned that accident and emergency services at the hospital could be cut in line with proposed changes at Monaghan and Cavan hospitals and other hospitals in the north east, with the result that the hospital will essentially become a nurse led clinic.

We have had these arguments in County Clare before. When Kilrush Community Hospital was closed in the early 1970s we were assured that the moving of maternity services and other hospital functions to Ennis General Hospital would enhance overall health services for the county. Maternity services have long since decamped to Limerick and the threat of a reduction in current accident and emergency and acute services is ever present.

It has been reported to me that a HSE official informed a delegation from Monaghan, in the presence of the Minister for Health and Children, Deputy Harney, and the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, that the conclusions of the Teamwork report would be applied to the rest of the country. Neither Minister has contradicted this statement. In addition, I have been informed that the value for money audit of hospital and health services in the mid-west, due to be completed before the end of the year, will oppose retention of the consultant led accident and emergency service at Ennis General Hospital.

Not only are our services under threat but our speedy access to centres of excellence is denied. When a patient in the Clare area suffers serious head injuries which necessitate removal to the Cork neurosurgical unit, no helipad is available at Ennis General Hospital to facilitate transportation. The Minister and the Taoiseach have sent conflicting signals on their intentions for Ennis. The Taoiseach has disowned the Hanly report conclusions without indicating what would replace them, while the Minister chooses her words carefully. For example, she recently stated:

There is no question of downgrading. We want to make sure that wherever patients are treated they get appropriate care and that their lives are not being put at risk or in danger by being taken to the wrong hospital.

The point is that Ennis will only become the "wrong" hospital if it is stripped of its accident and emergency and acute services. The Minister in her statement seems to be endorsing the centralisation of all critical services to Limerick.

There have been other incidents which have rung alarm bells in County Clare. Last May the HSE, after delaying for six months, responded to the Ennis General Hospital development committee with an assurance on the future of accident and emergency services. Within hours of that letter arriving, it was withdrawn and replaced by another with the all-important assurances on accident and emergency services removed.

I would appreciate tonight a clear commitment on the part of the Minister on the future of accident and emergency and acute services in Ennis General Hospital.

I will be taking the matter on behalf of my colleague, the Minister for Health and Children.

The Deputy's motion tonight refers to the Teamwork report on the acute hospital services in the north east and its relevance to the mid-west. Accordingly I would like to address the Teamwork report first.

The HSE commissioned Teamwork Management Services to undertake a review of hospital services in the north east and to provide an action plan for achieving the best possible acute care for patients in the region. The report, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North-East, was presented to the board of the Health Service Executive in June 2006.

The report concludes that the present system, where five local hospitals in the north east deliver acute care to relatively small populations, is exposing patients to increased risks and creating additional professional risks for staff. This does not serve patients well, is not sustainable and must change. The report highlights the need to develop a high quality, 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 to be provided in the region.

The HSE has established a steering group and a project group to oversee the implementation of the recommendations of the report with a view to improving safety and standards across the acute hospital network in the north-east region.

With regard to the mid-west region, the Health Service Executive has initiated an independent review of acute hospital services in the region. The aim is to determine the optimum configuration of acute hospital services in the mid-west. The HSE is currently in the process of selecting an external consultancy to undertake the review, with a view to work commencing early in 2007.

The configuration of acute hospital services is a complex and difficult issue. Government policy is to build up health services in all regions of the country to provide safe, high-quality services that achieve the best possible outcomes for patients. Quality care and patient safety come first. No matter what county or region they come from, all patients should receive the same standard of quality assured care. This will mean that those services that can be safely delivered locally are delivered locally and the more complex services that require specialist input are concentrated at regional centres, or in national centres of excellence. Every report that has been produced in the past number of years has highlighted this requirement.

Health Service Charges.

I attended a meeting in St. Raphael's in Celbridge on Sunday. St. Raphael's is run by the St. John of God Brothers and the meeting was called to explain the new HSE long-stay charges. While the Health Act 2005 provided for charges, the context was the illegal charging of elderly people in nursing homes. I looked at the speech made by Minister of State, Deputy Seán Power, at the time and it focused heavily on the elderly. Indeed, the explanatory memorandum states that such weekly rate shall not exceed 80% of the maximum of the weekly rate of old age non-contributory pension within the meaning of the Social Welfare Acts.

We heard on Sunday of two categories of charges. Where a nurse is employed on a 24-hour basis, the charge is €120, and where the nurse is rostered for less than 24 hours the charge is €90. While I am focusing on St. Raphael's which cares for those with an intellectual disability, the charges also apply to those in community residences with a physical disability.

Many of those in the €90 category are occupied during the day with jobs in a sheltered environment on the campus. Some are in receipt of a social welfare payment of €168.50 per week but they will now be allowed to keep only €55. Many of these residents enjoy a trip to the cinema, bowling or selecting and buying their own clothes. This has a direct impact on them because €55 will not be enough.

A further category of people attached to St. Raphael's are in capital assisted houses with a house parent. This programme is paid for by the Department of the Environment, Heritage and Local Government, while the house parent is paid for by the HSE. They live within the surrounding community. This group will not have anything deducted from their welfare payment — an equity issue. Some of those who live in St. Raphael's are on the housing waiting list and aspire to living in a house within the community. That option, however, is not available to them. Not only are their housing aspirations not being met, but they are having their independence curtailed.

A young man described to me how he takes his brother out each weekend. Their parents are dead and he has very limited means himself, so he is concerned that he not will be able to continue to do this. He is also concerned about how his brother's needs will be met in terms of clothing, shoes and incidentals. The mother of a girl who requires 24-hour care talked to me about the extra costs of replacing clothes because her daughter has behavioural problems. Many of those who were at the meeting on Sunday were elderly and, while the scheme allows for exceptional needs, many do not wish to ask for such help.

It is not at all clear if the annual allocation to St. Raphael's will be cut by the amount collected; indeed, the administration will be an additional burden. One man on Sunday expressed the view that the net result may be that administration will wipe out the earnings from the charges.

St. Raphael's, unlike private nursing homes, relies to a great extent on fund-raising by the parents and friends of the institution. On Sunday as the relatives of residents were arriving to hear about the new charges, tickets were being sold for another fund-raiser to keep the show on the road. Without this support the State would have to fully fund other services and it is short-sighted that the same people are being hit twice. The expert group had the opinion of three different barristers and came to the conclusion that unless the law was changed the charges would have to be imposed. This is a particularly vulnerable group in society, who are in effect paying the price for illegal charging of those in nursing homes.

Not everyone is born with an equal chance in life. Some people, through accident or illness, lose part or all of their independence. These charges are mean. They go nowhere near covering the cost of the care provided, but that is not the point. I ask that a commitment be given to reconsider this issue with a view to introducing legislation to right a wrong.

I am taking the matter on behalf of my colleague, the Minister for Health and Children.

The charging for long-stay care under the Health (Amendment) Act 2005 is being implemented by way of the Health (Charges for In-Patient Services) Regulations 2005. These regulations were signed on 14 June 2005 and reinstated charges for inpatient services and provided for the levying of a charge in respect of the maintenance of persons in receipt of in-patient services. The regulations were prepared following extensive consultation with the HSE and others. Section 53 of the Health Act 1970, as amended by the Health (Amendment) Act 2005, provides, inter alia, for the levying of a charge where services have been provided for a period of not less than 30 days or for periods aggregating not less than 30 days within the previous 12 months.

The regulations, in keeping with section 53 of the Health Act 1970, as amended, have provided for two different classes of persons on whom charges can be levied. Class 1 refers to people in receipt of inpatient services on premises where nursing care is provided on a 24-hour basis on those premises. In this case, a weekly charge can be levied of €120, or the weekly income of that person less €35 or 80% of the weekly income of that person, whichever is the least. Class 2 refers to people in receipt of inpatient services on premises where nursing care is not provided on a 24-hour basis on those premises. In this situation, a weekly charge can be levied of €90, or the weekly income of that person less €55 or 60% of the weekly income of that person, whichever is the least. In this regard, charging of patients in long-term care commenced on 14 July 2005, which was after the expiration of 30 days after the regulations were signed. These regulations provide for the maximum charge to be levied on either class of person. The actual charge will vary from person to person depending on individual circumstances and under the legislation, the Health Service Executive can waive or reduce the charges to avoid undue financial hardship.

Following the enactment of the Health (Amendment) Act 2005 and the Health (Charges for In-Patient Services) Regulations 2005, the HSE established an expert group to deal with this complex area and to develop a set of national guidelines to deal with the provisions of the legislation. This expert group developed a comprehensive set of guidelines in line with best practice, having considered legal opinion and its implications in relation to complex cases.

Legal opinion received by the HSE advised that the legislation and the regulations apply to all persons who are provided with inpatient services either by the HSE or by an agency or service provider on behalf of the HSE where those persons are residing in a long stay institution or those persons with an intellectual, physical or mental disability are residing on community type residences where nursing or medical care is provided.

When drafting the guidelines, the expert group considered section 4(b)(4) of the Health (Amendment) Act 2005 which provides that the HSE may reduce or waive a charge imposed on a person if it is of the opinion that having regard to the financial circumstances of that person it is necessary to do so in order to avoid undue hardship for that person.

This was particularly relevant in the case of community hostels where the residents live largely independent lifestyles, assisted by appropriate supports, with the objective of realising their maximum potential to integrate with the local community.

In light of the above and in consideration of the additional expenses incurred as a result of this independent lifestyle, the criteria for assessment for residents in community hostels include an allowance up to a maximum of €90 per week towards socialisation and care plan expenses. This allowance relates to the additional expenses incurred as a result of greater independence and integration into the community.

When calculating the charge, the HSE also makes an allowance up to a maximum of €60 per week, for any contribution that the resident makes to the weekly running costs of the community hostel. In addition to these allowances, there are also other allowances listed in the national guidelines which can be factored into the assessment for a charge, if applicable. These include dependent child, life assurance, medical insurance, rent or mortgage allowances, loans or repayments, maintenance payments, travel costs, rehabilitative employment allowance and other outgoings.

Job Losses.

Is mian liom buíochas a ghabháil as ucht seans a bheith agam an t-ábhar seo a chur os comhair na Dála — na postanna a bheidh caillte i gceann tamaill bhig i mo bhaile féin, Ros Cré.

Alexander plc has a reputation of being the UK's number one producer of a range of uniforms and work wear, including medical, hospitality and catering clothing. As a leading supplier of work clothing dedicated to innovative garment design with top quality work clothes at the best prices and the highest level of service and support, the workers involved in a subsidiary in Roscrea could have expected that their employment was secure.

Corporate Apparel, based in my home town of Roscrea, was bought out by Alexander plc in 2002. It was previously owned by Edward and Chris Condren and before that by Mara work wear. They supplied companies such as Linen Supply Company, Celtic Linen, which are laundry companies and have contracts with Dublin Bus, Bord Gáis, Aer Rianta and major hospitals as well as a number of local suppliers.

Given the publicity about the success of this international company and the profitability associated with its activities, the announcement of the closure of the Roscrea plant came out of the blue for workers. It was a thunderbolt for workers on Tuesday last, coming just a few weeks before Christmas. There was no complete statement and no explanation. This is an extremely harsh way of doing business with loyal workers. Many of the employees have worked with the former owners and their service was continued. They have family, financial and other commitments. They deserve to be treated more fairly. I ask that Alexander plc be contacted and that the maximum redundancy payments be made available to the displaced employees, and that the company be asked to support the IDA, Shannon Development and Roscrea Chamber of Commerce in the transitional period in order to source alternative employment. Retraining of the redundant employees is another essential factor in the preparation for alternative employment. I ask the Minister of State to ensure FÁS does the needful in providing the necessary courses.

I was very sorry to learn today that certain political parties, themselves bereft of any positive solution for these workers, are trying to make political capital out of the difficulties these people are facing so unexpectedly. What is needed is not that kind of wasteful exercise but a positive approach to keep and secure new jobs for the people concerned. Neither is it necessary to nail down Roscrea town as a black spot and as a consequence make it more difficult to attract new investment in industry and service employment.

Roscrea is a thriving, energetic and welcoming town. It has major infrastructural advantages in terms of industrial sites which are fully serviced and it is only one and a half hours from sea and air ports. Its people have a tremendous work ethic and record and there is no history of striking or stoppages. It is a heritage town that prides itself on its architectural heritage and monuments and other strengths.

I ask the Minister of State to use his good offices in conjunction with IDA Ireland, Shannon Development, FÁS and other agencies, to see that new jobs are created, that priority is given to those people who tonight face a daunting task as a consequence of their jobs being terminated and that proper and generous redundancy payments are made available.

I thank Deputy Michael Smith for raising this matter. I concur with him in expressing my concern for the workers who have lost their jobs and for their families, as well as for the people in the local community and the surrounding area. This is very stressful news for those who will lose their jobs. I wish to assure the people concerned that the State agencies will provide every assistance they can and the priority will be to find alternative employment for those involved at the earliest opportunity.

The role of FÁS, the industrial training agency, will be of particular importance in providing assistance to the workers concerned. I understand the agency only heard about the forthcoming closure this morning. It will make arrangements to contact the company and offer its full range of services to the staff who are to lose their jobs.

The Department has not yet received a redundancy notification from the company. However, I understand from media reports that the clothing manufacturer will close its factory, with the loss of 32 jobs, by the end of February 2007. I also understand from this source that the closure is due to rising costs and the company will offer positions in Dublin to a number of staff if they wish to relocate there.

The development agencies, under the aegis of the Department of Enterprise, Trade and Employment, will instigate a strong response to these job losses. The strategy of IDA Ireland for Roscrea and the surrounding area involves the promotion of new foreign direct investment in innovation-driven, high value and high skills sectors. It also involves working with its existing company base to expand their presence in Ireland by the addition of increased strategic functions. The decision by Taro Pharmaceutical Ireland to invest over €8 million in its plant in Roscrea will result in significant additional employment for the town.

IDA Ireland recognises the need to achieve high value employment in Roscrea and is committed to marketing the area as part of its national goal of achieving balanced regional development. The attractiveness of Roscrea for inward and indigenous investment has to be seen within a regional context, with the national spatial strategy providing a framework for the achievement of this goal. The agency is committed to the development of north Tipperary and is actively promoting the county for foreign direct investment, as part of the mid-west region.

Responsibility for the provision of industrial property solutions within the mid-west region lies with Shannon Development, and IDA Ireland works closely with Shannon Development in the promotion and marketing of these tailored property solutions. Shannon Development, in association with the local authorities, is spearheading the drive to bring high Internet access to the region. Roscrea, as well as other towns in the area, have been scheduled as priority towns for phase two of the broadband roll-out programme.

Shannon Development will shortly commence the development of a site in Roscrea with a view to the development of a business park that is appropriate to the needs of the area. It is envisaged that, because of its location, the park will be attractive to office, logistics and industrial enterprises. The main strategy will be to capitalise on Roscrea's excellent central location for foreign direct investment or indigenous industry, or indeed for companies that might wish to relocate to the less congested Shannon region. Shannon Development is currently evaluating the tenders for the business park project that it has received. There were 473 people on the live register in Roscrea in October 2005, and the most recent data available, which is for October 2006, shows that this figure has fallen to 430, a drop of more than 9%.

I am confident that the State development agencies will strengthen their marketing and promotion efforts and will make every effort to secure alternative employment for those affected by the closure of the company. This will be done in partnership with other key players to maximise the flow of potential investors for Roscrea and to convert these into investment and job opportunities. I believe the policies being pursued in Roscrea, together with the Government's ongoing commitment to regional development, will bear fruit in terms of job creation for the area.

Traffic Management.

I am raising the issue of traffic management around our two major international stadia, namely, Croke Park and Lansdowne Road. Traffic is a nightmare at the best of times, but it is an additional nightmare everywhere in the north inner city whenever there is a football match, concert, or other event in Croke Park. Planning permission was granted for the development of Croke Park 12 years ago on the understanding that a cordon sanitaire would be introduced. It was also understood that park and ride facilities would be provided on the city’s perimeter and that public transport would be the major form of transport to Croke Park. However, nothing whatsoever has been done to relieve the hard pressed and beleaguered residents in the communities surrounding Croke Park and further afield. If anything, the circumstances have worsened. The construction of Croke Park has now been completed and the stadium has a capacity of 82,000.

As well as Gaelic football and hurling matches in the spring, summer and autumn, Croke Park hosts Australian Rules football and a number of concerts in the summer. Moreover, during the redevelopment of Lansdowne Road, Croke Park will host numerous international rugby and soccer matches for the next number of years. These games will start in February 2007 and will almost certainly attract capacity crowds. Floodlights are currently being installed and even more sporting events will be held in Croke Park. Croke Park is also a major conference centre attracting large numbers of people and vehicles throughout the year.

Despite this intense activity and use, planning conditions did not require the GAA to provide even one parking space in Croke Park or elsewhere for the visiting public. The long-awaited pilot park and ride scheme was to start in August 2006. However, nothing happened and the GAA has informed Dublin City Council that it is not financially feasible for it to contribute to the provision of park and ride facilities for the travelling public. The GAA is an exceedingly profitable corporate entity that has received close to €100 million from the public purse towards the reconstruction of Croke Park. Moreover, it has benefited enormously from its downtown city centre location. It has taken much but is prepared to give little. It is unacceptable that the greatest voluntary organisation in the country should put profit before people in such an arrogant manner.

The only way the public interest can now be served is for the Minister for Transport to introduce special legislation governing parking and traffic management for the two city centre national stadia, namely, Croke Park and Lansdowne Road when it is rebuilt. The legislation would regulate such matters as the reservation of parking on public roads in the vicinity of the sports stadia for residents on event days; the provision of park and ride facilities on the perimeter of the city; the use of public transport; and an integrated ticketing system to cover such parking and transport. Direct statutory intervention is the only way to resolve the impasse and action must be taken immediately.

I thank the Deputy for raising this issue. Under the Road Traffic Act 1994 responsibility for traffic management was devolved to individual road authorities. Responsibility for the implementation of traffic management measures and the application of road traffic regulatory provisions in the Dublin city area is therefore a matter that falls to Dublin City Council to address in the first instance.

The issue of parking has been the focus of the traffic management issues that have been raised with the Minister for Transport. In the course of the past year, representations have been made to the Minister on parking problems that arise on the roads in the environs of Croke Park and other stadia on match and other event days when a large influx of motorists from outside the area park on residential roads for the duration of the events. The Garda authorities put in place extensive traffic management plans on such days. This includes a Garda cordon area to provide for crowd safety controls and to regulate access to the venue. This has been in place for many years in respect of the streets in the immediate vicinity of Croke Park and Lansdowne Road when matches or other major events are held. Divisional traffic corps units also patrol the outlying areas prior to and subsequent to any event, ensuring the traffic flow is maintained.

Vehicle owners who reside within the Garda cordon area may apply for an annual permit to allow their vehicles to enter and exit through the cordon barriers. The regulation of access and resident's permit measures are implemented and administered by the Garda Síochána as are other traffic management and parking prohibitions that are applied in the greater stadium area on event dates.

The issue now being raised is that residents on roads that lie outside the existing cordon area are seeking that parking be reserved on a residents-only basis in their areas on match and event days and that vehicle permits and visitor permits be issued in respect of each premises. If accepted, this proposal would effectively prohibit or exclude the general public from parking on a public road.

Last summer, the Minister for Transport, Deputy Cullen, met a deputation from a local residents' association from the Croke Park environs and some local public representatives to hear their case. In the past six months, this issue has been the subject of 12 parliamentary questions and featured also in amendments that were proposed by Opposition parties when the Road Traffic Bill was being debated in the Houses. It is important bear in mind that road traffic regulations have national application. Therefore, the issue of reserving parking on public roads for local residents is complex and much broader than the context of match days at Croke Park or Lansdowne Road.

The discussion and debate on this issue has also drawn attention to the inconvenience experienced by residents where parking congestion can arise on a daily basis on public roads in residential areas countrywide. At some locations, parking spaces on residential roads are now taken up on a daily basis, and not just on periodic match or event dates, by motorists who work nearby, or as park and ride facilities by people who commute to work by bus, rail or tram.

An argument that has also been put forward is that resident-only parking schemes operate in the vicinity of stadia in other countries and that Ireland should follow suit. The law is applied by way of a traffic sign in most other jurisdictions, but a different legal system operates in Ireland. The Irish system requires law to be stated in primary or secondary legislation, and the provision of a traffic sign at any location or the application of a traffic and parking measure must be underpinned by a legal provision in every instance. Provisions in relation to the regulation of road traffic and parking on public roads are contained in the Road Traffic Acts and in the Road Traffic (Traffic and Parking) Regulations 1997-2005 and supported by road traffic signs.

Responsibility for traffic management, including the implementation of parking controls, such as prohibitions and restrictions, was devolved to individual road authorities under the Road Traffic Act 1994. An examination of the present road traffic legislative provisions was carried out in the Department to ascertain if new measures to reserve parking to local residents in any circumstances would be appropriate or feasible. This examination indicated that there is no existing legislative provision to exclusively reserve parking on a specified public road on specified dates to the persons who reside in premises on that road. The legal issue that must first be established is whether it would be appropriate or feasible to provide for parking restrictions of this nature on a public road. In this regard, the matter has been referred to the Office of the Attorney General for advice and will be considered further when advice is received.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Thursday, 30 November 2006.