Adjournment Debate.

Hospitals Building Programme.

This issue is very important and I thank the Ceann Comhairle for placing it on the agenda.

Our Lady of Lourdes Hospital, Drogheda, is the major acute hospital for the region and the majority of regional services are based there. The hospital represents a critical mass of consultants, doctors and nurses for the region and its future is in doubt following the Teamwork report. I tabled the motion because I want to know the nature of the process being used to determine the location of the new acute hospital the Health Service Executive proposes to build in the north east. This process must be transparent and open. What criteria will be used? Will the public have direct access to the consultants who will produce a report and make a recommendation?

Members of the public have a democratic right to express their views and have an input in the democratic process. Political accountability for the eventual decision is needed at Cabinet level. Having met last week with the chairperson of the implementation group and the acute hospital manager for the north east, Mr. Lyons, I rang the HSE yesterday to ask what process would be used in selecting a site for the new hospital and how members of the public could secure direct access to the consultants. I was informed by the HSE that the matter was "under consideration" and it could not guarantee that a public consultation process would take place. It could not tell me what was the truth of the matter.

A lack of transparency, accountability and openness lies at the heart of the Government. People in Drogheda are extremely angry and concerned that the formula for progressing the process does not include a procedure to allow them to make representations regarding the consultants' report.

The recent HSE report examining the current level of services at Our Lady of Lourdes Hospital, Drogheda did not consider as a potential hospital site a property owned by the Medical Missionaries of Mary and located adjacent to the Lourdes Hospital site, nor did it examine the possibility of relocating two primary schools immediately adjacent to the hospital. It did not consider using GAA grounds, which are currently up for sale, 20 acres of land owned by the HSE in the area or soccer grounds located immediately adjacent to the hospital. The Health Service Executive has not objectively considered Drogheda as a site for the new hospital or examined all available sites immediately beside the hospital.

People in Drogheda are up in arms and deeply concerned that the hospital will be moved to wherever our political masters or the unaccountable and undemocratic Health Service Executive decide. They are extremely angry and will vote on this issue in the forthcoming general election.

I make my comments without knowing what will be the Minister of State's response. People in south County Louth and Drogheda and the staff of 1,500 who work in Our Lady of Lourdes Hospital, Drogheda, will not be moved by an undemocratic and unaccountable HSE.

I will take the adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The Health Service Executive established a steering group and project group to oversee a programme designed to improve safety and standards for patients 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, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East.

I did not ask about the report.

I will address the Deputy's concern in a moment. The Teamwork report included a number of recommendations to improve patient care in the region. It specifically highlighted the need to develop a high quality, responsive emergency and planned service in line with international standards. It recommended that there be one major regional hospital in the north east supported by five local hospitals. The new hospital is to provide emergency and trauma services on a 24-hour basis and planned specialist procedures which are complex and require the facilities of a large regional hospital.

The hospital reconfiguration process is being overseen by the HSE steering group which is leading the project. No decision has been made to date on the location of the new hospital. A sub-committee of the steering group has been established to progress the issue of site selection. A consultancy is to be awarded shortly for an independent site location study. The study will take account of various criteria, including demographics, access, planning and development considerations and interdependencies. The HSE expects the consultancy will be awarded by the end of March, with an eight-week timeframe thereafter to undertake the study and produce a report for the executive recommending a location for the new hospital.

The election will be over at that point. It is a whitewash.

A key element of this process will involve the Health Service Executive inviting the public and other interested parties to make a submission on the hospital location. The HSE will place advertisements in the national and local newspapers in the north east shortly and submissions will be analysed by the consultancy as part of the location study. The consultancy will produce an independent report, which will be submitted to the steering group and then brought to the management team of the HSE and the HSE board for consideration. It is expected that the recommendation of the board will be brought when this process is complete.

It should be emphasised that the HSE has given the Minister an assurance that, in progressing the re-organisation of services in the north east, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

The policy has changed since yesterday.

Hospital Services.

I thank the Ceann Comhairle for affording me the opportunity to raise this issue. I bring to the attention of the House the chronic circumstances in the maternity unit in Kerry General Hospital in Tralee, which should shame and embarrass the Minister for Health and Children and other members of the Government.

The maternity unit in Kerry General Hospital is bursting at the seams. While the delivery rate at the unit has increased dramatically in recent years, staff numbers and facilities have not changed and are completely inadequate. Since 1999, for example, the number of births recorded annually at the unit has increased from approximately 1,000 to more than 1,600 but there has not been a corresponding increase in the number of personnel or level of facilities available to cater for and cope with the increased birth rate.

The position is so grave that the maternity unit is experiencing a shortage of cots for newborn babies. I understand that in some cases new mothers are required to look after their newborn babies 24 hours per day for the first few days after birth because of the shortage of nursery beds. This places them under untold pressure.

I am sorry to report that staff shortages at Kerry General Hospital have resulted in Polish women living in County Kerry returning home to have ante-natal scans. The waiting time for an ante-natal appointment in Tralee averages 24 weeks, which is longer than Polish women living here need to secure an appointment in Poland. We have reached the stage, in our booming economy, that we are sending women who live here to the other side of Europe for maternity appointments. Irishwomen have no facility to arrange an appointment elsewhere and must wait for 24 weeks. This waiting time is appalling.

The problems at the maternity unit in Kerry General Hospital do not end there. Despite an increase of 50% in the number of births in the hospital, it does not have dietitians or counsellors to attend to the needs of new mothers.

The Minister of State, Deputy Brian Lenihan, and his colleagues have done nothing in the past decade to alleviate pressures experienced in the maternity unit of the hospital. Despite receiving the first submission from the hospital requesting a new maternity unit more than four years ago, no progress has been made. A new maternity unit is urgently needed and would free up 40 beds for use elsewhere in the hospital.

Unfortunately, maternity services are not the only crisis facing the hospital. No full-time accident and emergency consultant has been in place for more than a year, the accident and emergency department and other departments are experiencing major bed shortages and no progress has been made on extending the accident and emergency department.

I need answers from the Government outlining how it proposes to address the ongoing crisis at the maternity unit of Kerry General Hospital. It is an abomination that no progress has been made on this facility after ten years. How much longer must the women of County Kerry wait? It is unacceptable that they must wait for 24 weeks for an ante-natal appointment.

I am taking this matter on behalf of the Minister for Health and Children, Deputy Harney. Operational responsibility for the management and delivery of health and personal social services is a matter for the Health Service Executive. The department of obstetrics and gynaecology at Kerry General Hospital provides a range of ante-natal and post-natal services, including a foetal assessment unit, early pregnancy clinics, outpatient clinics, breast-feeding support, physiotherapy services and discharge classes.

The HSE has advised that the department of obstetrics and gynaecology has experienced a significant increase in demand for its services in recent years. The executive has further advised that a capital projects development team was established by the management of Kerry General Hospital in September 2000, which prepared a strategy plan for the current and future needs of the hospital. The construction of a purpose built maternity unit was included in the plan.

The provision of a new maternity unit at Kerry General Hospital was considered for inclusion in the HSE capital plan for 2006 as part of the rolling capital programme for 2006-10. Due to competing demands for capital funding, however, including other significant capital projects in the Kerry area, this project was not prioritised for inclusion in the capital plan that was approved by the HSE board and the Minister for Health and Children. It is a matter for the HSE to consider the progression of the new maternity unit at Kerry General Hospital in the context of overall capital and revenue funding resources available to it.

The recent report by the Institute of Obstetricians and Gynaecologists refers to the future of maternity and gynaecology services in Ireland. The report sets out the institute's views on a range of issues including, for example, the need to develop clinical maternity networks throughout the State. The HSE will have regard to the institute's findings in developing these services.

Nursing Home Subventions.

I thank the Ceann Comhairle for selecting this issue for debate. I look forward to some answers from the Minister of State in regard to the nursing home subvention scheme. It is my understanding that changes to legislation should improve the lot of citizens, most especially in matters relating to the welfare of the elderly. The recent changes to the legislation on nursing home subventions, however, have been particularly hurtful for elderly people.

The situation prior to 1 January 2007 was that subvention was paid at a rate of €190 per week. Patients then contributed some €180 per week from their pensions, retaining €40, or €42 if they were over 80 years old. This gave a total of €370, with an additional enhanced subvention being met by the HSE to give a total of €650, which met the average cost of a bed in the Cavan-Monaghan area. Since 1 January, however, the nursing home subvention was increased to €300. Patients must still contribute €180 from their pension, giving an amount of €480, and the shortfall of €170 must be met by the patients or their families.

I understand the information I have supplied is correct. The first casualty in this new situation will be the few euro in pocket money that is left to patients every week. This will effectively be stolen by the HSE as the extra charge is imposed on patients and their families. The average cost of a bed in the Cavan-Monaghan area is anywhere between €650 and €800 per week but the HSE has set a minimal rate of €540. I cannot understand this. Many of the staff who must deliver these subvention programmes are unhappy.

It is unfortunate that the contract is between the patient and the nursing home and that the HSE has stepped out of the way. I have spoken to nursing home owners who say their prices will increase, if they have not already done so, because of the rising cost of oil, gas and electricity and as a result of rising staff wages. I heard of one nursing home with some 50 beds where the wages bill alone will increase by €100,000 per annum. In such circumstances, it is inevitable that the cost of beds will increase.

Another difficulty relates to the processing of subvention payments in general hospitals. Time is often wasted in trying to identify whether a patient is entitled to subvention, during which time a bed continues to be occupied in the hospital. When a patient is in hospital his or her charges are met by that hospital but it is a different situation when the patient enters a nursing home, where a different budget is in operation. There is constant internal wrangling about who pays for what. It is little wonder we have difficulties in Beaumont Hospital, for instance, given that one in six beds there are occupied by patients who are already fit for discharge. Many such patients remain there for three months or more at a high cost to the community.

Attempts to deal with this problem between August 2005 and December 2006 focused on five discharge initiatives. These initiatives helped to free up beds in Beaumont Hospital but people with elderly relatives realise quickly that if there is one discharge initiative followed by four others, it is most likely there will be further such initiatives.

Discharge initiatives are favourable to patients. It pays them to stay in the hospital bed because there is no means testing of discharge initiative patients. They are asked only to contribute €120 per week from their pension on an ongoing basis. This is not the way forward. We must ensure there are more nursing home beds in the community. Another difficulty is that some nursing homes are charging more than €1,200 per week for a bed. It is not the best use of health service resources to subsidise such a luxurious level of accommodation.

It is vital that more geriatricians are appointed in the health service. In County Meath, for example, there is not one geriatrician available to patients. This has knock-on effects. It is unacceptable that patients should have to wait up to 18 months for geriatrician appointments and occupational therapy assessments.

Hospice cover is also required for patients at weekends. Such patients receive excellent care from Monday to Friday but those families who wish to look after their relatives at home are isolated at weekends.

I will take this matter on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the question as it provides me with an opportunity to outline to the House the improvements made to the nursing home subvention scheme. The scheme was introduced in 1993 to assist with the cost of private nursing home fees. A subvention may be paid where a person has been assessed as needing nursing home care by the Health Service Executive and where he or she has satisfied a means test.

Since 1 January 2007, there are no longer three separate rates of subvention. Persons who apply may receive any amount up to a maximum of €300 per week. Additional funding of €55 million was provided for this purpose in budget 2007. The change in the rate means that as many as 1,800 people not previously eligible for subvention may now qualify for a payment. In addition, the HSE has finalised national guidelines for the standardised implementation of the nursing home subvention scheme. These were circulated on 29 January 2007 to all subvention officers working in local health offices.

Nothing in the guidelines shall operate in a way that is inconsistent with the proposed new scheme for 2008, A Fair Deal. Furthermore, nothing shall worsen an applicant's overall position in 2007 by comparison with 2006. Under the guidelines, the assessment of means will now be carried out using a national standard financial assessment method. This should address past complaints about inconsistency in the administration of the scheme and the amounts of subvention paid from place to place.

The guidelines detail a number of improvements to the subvention scheme, all of which are consistent with the proposed new scheme, A Fair Deal. First, the means assessment process will ensure that a remaining spouse or partner is not left with less than the current maximum rate of the non-contributory State pension. A further improvement is that the HSE will cease imputing income from the principal private residence where it has already been imputed for three or more years. This is again consistent with the new scheme. In addition, the HSE will not automatically exclude individuals from applying for subvention, and consequently from the means assessment process, on the basis of the property or asset thresholds. Everyone will be eligible to undertake the means assessment process.

In addition to the increased rate of basic subvention, additional funding of €30 million has been made available in 2007 for enhanced subvention. This is a supplementary subvention that may be paid by the HSE to a person in or entering private long-term care. The amount of enhanced subvention paid is at the discretion of the HSE and varies according to the cost of care and the circumstances of the applicant. The additional enhanced subvention will be used to develop a consistency between the payment of subvention during 2007 and the new nursing home support scheme for 2008, and to work towards equalisation of the level of support paid to people in different areas, taking local prices and a person's means into account.

The HSE guidelines provide that it is not necessary to qualify for a basic subvention payment in order to apply for an enhanced subvention payment. However, an applicant for enhanced subvention will be subject to the means assessment. In light of the above improvements, the HSE is reassessing all those already in receipt of a nursing home subvention. I advise people in private nursing homes who do not currently receive a subvention payment to apply to the HSE for an assessment.

Social and Affordable Housing.

I thank the Minister of State for coming into the House to take this matter. This is an extraordinary situation. In early 2004, 16 hectares of land were made available to Cork County Council to provide affordable houses to people in west Cork. From the outset, this land, in an idyllic setting beside a church and school in a local village, was ideal for the provision of housing for those who cannot afford to purchase a site and build their own house. The Fine Gael councillors in west Cork, however, tried to prevent the scheme. I want the Minister of State and the Department to ensure that three years later, this project will commence. Not a sod has been turned so far.

The entire project was frustrated and every possible obstacle put in its way from the outset, something I find astonishing after a quarter of a century in public life. A total of 16 hectares of prime land was made available and the architectural department in Cork County Council put its expertise and professionalism to work, designing a beautiful eco-village where young people could make a home in a location with every facility for children and adults. Out of nothing short of rural snobbery, the local Fine Gael councillors decided to stop this because they did not want to lower the tone of the area. It is incredible.

This culminated on 22 May 2006 in a motion before a meeting of Cork County Council to allow the scheme to go ahead. An amendment was put down by Councillor Maura Cal McCarthy, seconded by Councillor Kevin Murphy, to reject this eco-village at Darrara, Clonakilty, County Cork. A vote was taken and Councillors K. Murphy, Kelly, Ryan, Canty, Pyne, O'Doherty, M. Murphy, Buckley, Sheahan and McCarthy voted against it. Thankfully a majority of the council voted in favour. To this day, however, the project is progressing at a snail's pace and no work has been done on the site.

I want to ensure the people in the area I represent can get an affordable home of their own and that the land in this idyllic village is put at their disposal. I would like a commitment from the Minister of State that the Department will ensure the project will go ahead despite the obstruction of the Fine Gael councillors. It is so incredible. In my 25 years in this House representing the people of Cork South-West, I have never come across anything like it. It is down to nothing other than sheer rural snobbery, not wanting to bring what Fine Gael would regard as people who are looking for social or affordable housing into a locality where they would lower the tone. I reject that.

This means nothing to me politically, I am not standing in the next election, but I want to ensure before leaving public life that this project goes ahead. I have only until May and I want the Minister of State who has responsibility for affordable housing schemes to give me a commitment that the project will go ahead. There will only be 100 houses but it is vital that local people have a chance to buy their own homes and the Department of the Environment, Heritage and Local Government pushes ahead with this project.

I thank Deputy Walsh for raising this matter.

The site in Clonakilty was one of the sites released to the affordable housing initiative announced in December 2003. It was released by Deputy Walsh during his tenure as Minister for Agriculture and Food. I acknowledge that fact because the Deputy and the Department were helpful at the time in putting forward a number of sites for the initiative. The support and co-operation of Deputy Walsh and the Department were significant.

Lead responsibility for planning and developing this project rests with Cork County Council and officials in the Department are in regular contact with the council to ensure the project is advanced as quickly as possible. On completion of the development, the site will comprise a mix of affordable, social, voluntary and private homes, with 74 of the 104 homes being made available under the initiative. Affordable homes are private homes. There are people who try to mix them up with other forms of housing. They come with a discount but they are private homes owned by those who move into them.

I appreciate the Deputy's concerns about the lack of pace in progress on this project. I am anxious to see the project moving ahead as quickly as possible and that is the basis on which my Department is engaging with Cork County Council on the matter. We want this to happen quickly. From the time a site is acquired, it can take a couple of years before houses are ready for people to move in but progress in this scheme has been painfully slow.

A crucial stage in advancing this project is the completion of the design phase and the submission of an application under Part VIII of the Planning and Development Regulations 2001 for the approval of the elected members before it can proceed. Having advertised for expressions of interest for the preparation of the relevant documentation required for the Part VIII process, and for the preparation of cost plans, tender documentation and the construction contract, the council will be holding interviews on 23 March. This should allow for consultants to be appointed in April, clearing the way for the commencement of the Part VIII preparatory work.

The successful completion of the Part VIII process will determine the date that construction can commence on the site. Given the central role of the elected members of the council in this regard, I urge the councillors to engage proactively with council officials with a view to expediting the matter. I assure the Deputy that the Department will also continue to monitor progress and liaise with the council to ensure the project is completed as speedily as possible.

Throughout the process to date, I have stressed the importance of avoiding any unnecessary delays and ensuring, where feasible, that processes are paralleled. That, unfortunately, has not happened. When the plan went through in May 2006, I thought the Part VIII process would proceed quickly, but here we are talking about doing it nine months later. At every stage, for whatever reason, be it council members or officials, we are moving at a snail's pace. The election is coming and because Deputy Walsh was so centrally involved in granting the site, some council members are determined there will be no sign of the houses starting before the election. The Department, however, is determined this will commence and that is what will happen. Given that things have gone so slowly, they will not start now because the Part VIII process will take a number of months and we need the co-operation of the members. They have probably boxed themselves into a corner and will not be able to do it within that timeframe. However, life does not end whenever the election takes place in May or June. The Department is determined that this work will proceed and it will keep pressing the matter. The Government originally designated this site as part of the affordable housing initiative in December 2003. It is very disappointing that we have not yet got planning. However, it will happen. I hope the people down there and all elected representatives will be in a different mood once the election is over. Regardless of who might be Minister, the Department will continue to push to get those badly needed houses built. I thank the Deputy for raising the matter.

The Dáil adjourned at 10.40 p.m. until10.30 a.m. on Thursday, 1 March 2007.