Dáil Éireann debate -
Wednesday, 17 Oct 2007

Vol. 639 No. 5

Adjournment Debate.

Audiology Services.

Deputy Tom Hayes

I thank the Ceann Comhairle for giving me the opportunity to raise this important subject on the Adjournment. The matter I wish to raise concerns the provision of audiology services in the south-eastern region which includes Carlow, Kilkenny, Wexford, Dungarvan, Clonmel and the whole south Tipperary area, which will be the focus of my few words.

The south-eastern audiology service is supposed to be staffed by two qualified audiologists working full time. One of these has been absent for a number of months due to training, which has resulted in a considerable reduction in clinic hours. The audiologists provide an essential service in assessing the hearing needs of the people of the south-eastern region and providing them with hearing aid devices, if necessary. In the Clonmel office there is a two and a half year waiting list. Many have been waiting since 2005 to obtain an appointment to be assessed and will have to wait a further month to be fitted with any device deemed necessary. I beg the Government to tell me how this is acceptable. How can we ask elderly, vulnerable people, some of whom live alone and in fear for their personal safety, to wait two and a half years to obtain a hearing aid which would alleviate some of that fear?

There are more than 300 on the waiting list in the Clonmel area. Despite the fact that the audiologist is working hard to see ten people in a day, the list is not getting any shorter. Due to the considerable work involved in following up on initial appointments — for example, when fittings are required — the waiting list is never fully tackled but remains at roughly the same length. The European Consumer Health Index report which was issued recently indicated that Ireland had the worst waiting times in Europe. The people of Tipperary are, sadly, examples of this shameful fact. The waiting list for the equivalent service in Cork is three months, while in Tipperary it is two and a half years. Surely, in the aftermath of the recent successful Positive Ageing Week, we owe it to the older people in our community who have worked so hard their whole lives to provide them with the services they deserve. In the last budget, in the area of services for the elderly, funding was allocated to improve this service, but there has been no clear improvement for the people of south Tipperary.

This does not affect only the older people in our community. Younger people, including children, also desperately require this service in order that their auditory needs can be met. What is the point in parents and teachers giving their all to educate young children when the children cannot be assessed to ensure their hearing is satisfactory? Children in Tipperary who have problems hearing struggle in a near silent world, isolated, waiting for their names to move forward on the list which is now so long that staff must check whether a patient is still alive before offering an appointment. I strongly advise the Minister to do something about this, as it affects the quality of life of so many.

Minister of State at the Department of Health and Children (Deputy Brendan Smith)

I will be taking this Adjournment matter on behalf of my colleague, Deputy Mary Harney, the Minister for Health and Children.

I am happy to have the opportunity to address the issue raised by Deputy Hayes. As the House will be aware, the Health Service Executive has the responsibility in law to manage and deliver health and personal social services or to arrange for them to be delivered on its behalf. This includes the delivery of audiology services and the prioritising and resourcing of the development of national community audiology services.

I am happy to explain the situation in the area of audiology services, as well as to convey the information provided by the HSE on the specific question raised by the Deputy. The national community audiology service provides free audiology services for all children, irrespective of parents' means, and for adults who have eligibility. For an adult to be eligible, he or she must be in possession of a current medical card. A total of 4,822 clinics were held in 2006 and 39,432 patients were seen.

The post of audiologist was advertised in May this year and interviews for the position were held in September. As a result of the interview process, a person was offered the post. Unfortunately, this person has declined the offer of the position. The HSE intends to advertise the post again. However, the HSE national management team has developed a financial break-even plan, aimed at remaining within its Vote for 2007, which includes a temporary pause in recruitment. This was reviewed by the team on 1 October. Based on this review, the HSE has decided that the financial situation is such that it is necessary and prudent to continue the overall pause in recruitment to the end of October.

The HSE hopes to establish a national review of audiological services to explore the delivery of audiology services in the most appropriate setting. Meanwhile, it has been working to achieve national standardisation of approaches to waiting lists and waiting times using a standardised template. Data based on this revised template is due to be reported at end of the first quarter of 2008.

A further imperative is to develop an integrated service at primary care level, involving audiologists, general practitioners, speech and language therapists, public health nurses and others, for those with hearing loss. The HSE also envisages the development of fully integrated audiology services, involving acute hospitals and community services, which will be delivered in the most appropriate setting. I will bring the issues the Deputy raised to the attention of the HSE.

Child Care Services.

Deputy Kathleen Lynch

I would like to share time with Deputy Ciarán Lynch.

An Ceann Comhairle

Is that agreed? Agreed.

Deputy Kathleen Lynch

Anyone who has reared children should not need a "heads-up" on this issue. The NCIP community child care subvention scheme which was in place from 2000 to 2007 had a capital programme element but also provided a grant for every qualifying child. There was some talk about this around two years ago, when the then Minister for Justice, Equality and Law Reform, former Deputy Michael McDowell — I can never understand why the scheme was administered by that Department — decided to change the conditions under which people qualified. There was such an uproar that those plans were dropped.

From January 2008 we will have a new scheme which will be in place for two years until 2010 but it will be so narrow in its focus that it will ensure women and men — there are some single parents who are men — will need to rely on social welfare or will be forced to take their children out of child care. One will have to be in receipt of social welfare or family income supplement before one will be able to get this grant for child care. That leaves an entire group of people outside the remit of this scheme. There will be those who can afford to pay, and the middle group of people who are just about surviving and whose children can receive child care with this subsidy. On the other hand there will be children whose parents are in receipt of social welfare and, therefore, fall within the scheme.

We all know that for children to grow up into worthwhile adult members of society there must be a combination of all of the sectors in society and they need to contact people in other strands of society. We have seen child care schemes which have enabled women to participate in society by returning to education or even part-time work.

However, from January we will have a system whereby people who can afford to put their children into child care will continue to do so, while on the other side of the fence there will be people who will qualify because they are in receipt of social welfare. That is not what child care is all about and it is most definitely not the intention of the child care community. I appeal to the Minister to change his mind on this scheme.

Deputy Ciarán Lynch

I support the points raised by my party colleague, Deputy Kathleen Lynch, on the proposed restructuring of the child care service which will result in radical changes to the existing scheme.

Independent examination of this issue shows that additional charges will be placed upon parents. It also shows that the operational costs for community child care services will be recreated and will have to be recouped locally because of the additional costs arising from the restructured process. This will also result in a reduction of services at local level and possibly lead to the closure of numerous community child care services across the country.

Furthermore, the new process will remove the social flexibility and mobility which are currently built into the service and which are a key aspect of it, namely, that children from different income groups can come together just as they do in the primary school sector. In fact, if we applied the logic that the Minister is applying in the child care area to the primary school sector, we would see how bizarre that thinking is. It will also make it impossible to maintain standards and will undermine years of work in developing standards in this area.

The irony of all of this is that European funding and local effort have developed a good model of practice for child care in this country. This has taken community child care out of the Dark Ages, yet the Minister is now proposing to make these child care services a victim of their own success by using these measurements against them.

In effect, the Minister is proposing to create what is called — I use the terms that local community child care services propose — a ghettoisation of the service, driving out working parents on low incomes who will now be penalised by no longer being able to afford or to avail of child care in their local community.

Deputy Brendan Smith

I thank Deputy Kathleen Lynch for raising this matter.

The main supports the Government makes available to parents to assist them with their child care costs are child benefit and the early child care supplement. The latter payment, which is in recognition of the higher child care costs of pre-school children, is the responsibility of my office, and it alone amounts to expenditure of over €400 million in a full year. These payments are universal and benefit all parents, regardless of their income, labour market status or the type of child care they choose. In addition to these universal supports, Government child care policy has also recognised the need to target additional supports towards disadvantaged families.

Under the Equal Opportunities Childcare Programme 2000-2006, EOCP, which was initiated by the Ceann Comhairle when he was Minister for Justice, Equality and Law Reform, and which was co-funded by the Irish taxpayer and by the European Union, targeted support was provided through the staffing support grant scheme. Community based not-for-profit child care providers with a strong focus on disadvantage were awarded grant aid towards their staffing costs to allow them to offer reduced fees to disadvantaged parents. Funding under this scheme was originally awarded for a limited period during which services were expected to move towards sustainability. This funding was subsequently continued to the end of 2007, where it was considered necessary to enable services to remain accessible to disadvantaged parents. This continuation funding was subject to the condition that tiered fee structures were implemented by the services in question.

Under the National Childcare Investment Programme 2006-2010, NCIP, the successor programme to the EOCP, a new scheme to support community child care services with a focus on disadvantage will be introduced in January next and will continue to complement the universal supports in place for all parents. The community child care subvention scheme, CCSS, has been allocated €153 million over the next three years, representing a 16% increase in funding over the EOCP staffing scheme. Under the new scheme, services will be grant aided according to the service they provide and the profile of the parents benefiting from them. In turn, the subvention received by the services will be reflected in the reduced fees for parents who qualify as disadvantaged under the scheme.

I am sure the Deputies will agree that the provision of additional targeted support for disadvantaged families is a necessary component of any equitable system for supporting families with the cost of child care. Any such targeted approach must have a cut-off point and it was considered that the income limits for family income supplement were the most appropriate, given the scale of the scheme and its focus. The Deputies may be aware that the current FIS limit for a family with three children under 18 stands at €625 per week after tax, while the minimum wage currently stands at €8.65 per hour, or €346 for a 40 hour week, and the average industrial wage as of March this year amounted to €615 per week.

It is considered that the new scheme will provide an effective framework for the continued targeting of additional resources towards disadvantaged parents and their children while continuing to support community child care services generally. The scheme has been informed by and takes account of a number of enhancements recommended by the report of the value for money review of the EOCP, which consulted widely with stakeholders, including child care providers, before reaching its conclusions. These enhancements include the fact that the subvention to services will be more responsive to the level of service provided, as well as the degree of parental disadvantage supported. The ceiling for funding which existed under the previous scheme is being removed. Account will also be taken of all of the operational costs of the service rather than staffing costs alone. Services, including full-time, part-time and sessional ones, which at present are, in some cases, inaccessibly priced for disadvantaged parents, will be available to them at more appropriate rates under the new scheme.

Existing EOCP staffing grant recipients who enter the new scheme will continue to be funded at their current level until July of next year. My office has recently concluded a series of regional meetings with existing grant recipients to outline the details of the new scheme and to gather feedback from the services themselves. These meetings have been useful, both in explaining how the scheme will work, and in allowing groups propose changes to how the scheme will be operated, a number of which have been taken on board already.

It is important to restate that the more detailed and comprehensive data which will be generated by the new scheme between now and the end of December will be analysed by officials in my office. If appropriate, any adjustments necessary to secure the best outcomes for child care services and for disadvantaged parents and their children will be considered by the Government in early 2008 and well in advance of the commencement of the new funding levels in July of next year.

In the meantime, groups can continue to receive funding at their current rate up to the end of June 2008. To qualify for the continued funding, groups must submit the information required for the assessment of the impact of the new scheme by early November and I would appeal to them to do so, and ask other Members of the Oireachtas to do so. It is important to emphasise that there are no changes between now and July of next year.

It is worth repeating that this Government has built a formal child care structure from a low base. Since 2000, we have created over 35,000 new child care places in the community and private sectors and supported over 26,000 more. Under the EOCP, €500 million has been allocated from 2000-2006, accounting for over 3,300 grants to a mixture of community and private providers.

In real terms, this Government will have spent over €1 billion of public money on the child care sector by 2010. Given the fact that the new subvention scheme actually increases funding by 16% over the EOCP staffing scheme, I refute in the strongest possible terms the suggestion that the Government has suspended such support. Nothing could be further from the truth and as I have said, any adjustments which might be considered necessary will be considered by the Government once the relevant data has been analysed.

Eating Disorders.

Deputy Deirdre Clune

I thank the Ceann Comhairle for allowing me speak on the important issue of eating disorders. These disorders have become increasingly prevalent, especially among young people. There is a need to provide funding and resources to deal with the problems experienced by individuals and their families who have to face the terrible trauma of anorexia, the more prevalent bulimia and binge eating.

The 2006 report of the expert group on mental health policy, A Vision for Change, estimated that 200,000 persons are affected by eating disorders in Ireland. Each year, a total of 400 new cases emerge and, alarmingly and sadly, these result in approximately 80 deaths. Eating disorders are more prevalent among females in the 15 to 40 years age group. Approximately 4,000 people suffer from anorexia and 15,000 suffer from bulimia. One in ten males suffer from anorexia and bulimia. An estimated 7,000 adolescents currently live with bulimia or anorexia. Approximately 500 of these will die of medical complications or suicide.

Alarmingly and more tragically for these young people and their families, there are no designated public services in Ireland for the management of eating disorders in children or adolescents. The Minister must ensure the provision of appropriate intervention, which is so important, because without the necessary supports, the parents of a young person who has an eating disorder have few options. This is a frustrating situation which makes people angry. Local GPs can do nothing as they have nowhere to which they can refer young people. When a young person deteriorates to a serious extent, he or she is admitted to hospital through the accident and emergency department. We do not want this to happen.

In many cases, eating disorders are caused by low self-esteem and a lack of confidence. Early intervention such as counselling is important, as having someone to talk to can help build up a young person's self-esteem and help prevent full-blown anorexia. Child psychiatrists are non-existent, regardless of whether one is a public health patient or a member of the VHI. Many parents are driven to distraction and have to bombard their GPs and accident and emergency units to get attention for their sons and daughters.

Only three beds are designated in the public health service for persons with eating disorders but they are for patients aged over 18 years. Two eight-bed units operate in the private sector, in St. John of God's Hospital and in St. Patrick's Hospital in Dublin. The turnaround is very slow in this area as it takes a long time to reach recovery and the needs that exist are not being serviced. What is required is a dedicated bed capacity with the establishment of multidisciplinary teams in each Health Service Executive area.

Given that early intervention in this area is so important, we also need significant investment in child and adolescent mental health services. The situation is becoming difficult and alarming. Media reports appear every day about how eating disorders are affecting young people but media images also affect young people. Thankfully, the Madrid fashion council would not accept size zero models but the UK continues to accept them. I shudder to think what size they are.

All these issues have an effect on young people who are bombarded with images by the media, through the Internet and international television. This is a serious issue. There is a sad deficit of public and private services to address the problem of eating disorders. I am delighted the Minister of State with special responsibility for children, Deputy Smith, is present in the House to take on board what I have said and address this issue, but not in terms of A Vision for Change which would take too long to implement. We need services to be provided as a matter of urgency.

Deputy Brendan Smith

I thank Deputy Clune for raising this important matter and for the pertinent points she made. I am replying on behalf of the Minister for Health and Children, Deputy Harney.

As Deputy Clune is aware, the report of the expert group on mental health policy, A Vision for Change, was published in January 2006. The report addressed all aspects of mental health services, including services for those with eating disorders. A number of recommendations were made concerning mental health services for people with eating disorders. These include support for health promotion initiatives that encourage greater community and family awareness of eating disorders, the further development of primary and community care services and the provision of full multidisciplinary teams in a national centre for eating disorders for complex cases that cannot be managed by local community mental health teams. Responsibility for implementing these recommendations rests with the Health Service Executive.

The Health Service Executive has established an implementation group to ensure that mental health services develop in a synchronised and consistent manner across the country and to guide and resource service managers and clinicians in making the recommendations a reality. The Government has accepted the report of the expert group as the basis for the future development of mental health services. An additional €26.2 million was allocated for the further development of mental health services in 2006 and a further €25 million was provided in 2007, bringing the total allocation for 2007 to €1 billion.

A total of €7.95 million of the additional 2007 funding has been provided to significantly improve both community and hospital-based child and adolescent services and facilitate the provision of early intervention services. The multidisciplinary nature of existing child and adolescent mental health teams will be enhanced, with eight new teams being developed in 2007. The implementation of A Vision for Change requires the recruitment of 40 additional child and adolescent mental health teams. It is envisaged that these will be provided on a phased basis over a five year period — 16 of which have already been funded.

With regard to specific funding for eating disorders, €750,000 of the additional funding in 2007 was allocated for the development of designated eating disorder services. A total of €500,000 has been allocated to enhance the service in the Elm Mount Unit, St. Vincent's Hospital, Dublin, which will provide a national service to support local mental health services in addressing eating disorders. The balance of €250,000 has been allocated to the Health Service Executive, south area, to commence the development of an eating disorder service. The Health Service Executive also works with the independent sector to provide specialist care on an inpatient or outpatient basis, which can result in referrals to specialised eating disorder services.

An independent monitoring group was established early last year to monitor and assess progress on the implementation of A Vision for Change. The group's first report was published in May 2007. The report acknowledged that 2006 was a year of significant challenge and change for the mental health services. However, in recognising that some positive developments had taken place, the report highlighted a number of issues which would require further attention. These include a systematic approach to implementation of A Vision for Change and clarity in responsibility for implementation in the Health Service Executive.

In acknowledging the need to provide a dedicated and co-ordinated response to A Vision for Change, the Health Service Executive appointed a full-time project manager to progress the prioritised implementation plan. This plan, which will include a timed and prioritised set of short, medium and longer-term goals, is expected to be finalised in the coming weeks.

I assure Deputy Clune the Government is fully committed to the development of services for those suffering from eating disorders and to ensuring that services will continue to be improved and enhanced in the coming years.

Crime Levels.

Deputy Paul Connaughton

I greatly appreciate the opportunity to speak on this matter. Currently, burglaries and break-ins have reached an unacceptable level in County Galway. People in every town and village and in isolated areas have experienced houses being ransacked in one way or another by marauding thugs who operate in the dead of night. That is the only way I can explain them. Shops, supermarkets, pubs, garages, churches and houses have been affected.

There appears to be no end in sight to this crime epidemic. We always had a certain level of crime but in the past three or four months the criminals have gone into overdrive. This current spate of crime is a mirror image of the dreadful attacks on the elderly a number of years ago in the west. The Ceann Comhairle will remember the Government and the Garda had to introduce drastic measures to put an end to it. This was known as Operation Shannon and employed gardaí at checkpoints during the night at bridges crossing into the west. A helicopter added a sense of urgency to the project. The good news is that the Garda operation was successful.

However, there are some major differences in what is happening currently. As nobody has yet lost a life, this vandalism and thuggery does not attract the same national media attention. However, serious damage is done to property and much income is lost. There is fear among people that their houses and business will be burgled. It is a psychological issue in that nobody knows who will be next.

Nobody knows who is responsible for that behaviour, and that is the worst scenario. However, a trend is emerging. When the vandals strike they invariably use precise and accurate local knowledge. Who is supplying the information? Nobody knows that either, but I hope my raising this matter in the House today will improve the chance of these thugs being apprehended. If so, it is vital the local mole, spy or parasite is deemed to be as culpable as the thugs themselves. What is happening throughout County Galway could not be organised if extremely local knowledge was not available. For example, when a family is away for a wedding, its house is targeted. If a farmer sells cattle at a mart, a few days later his house is burgled.

I do not have time to list all the examples but incredibly local knowledge is involved. The situation is so bad that nothing short of a ring of steel by the Garda is warranted. I ask for more gardaí, more resources and more equipment so the Garda will be able to handle this scourge before it gets out of hand.

The Minister of State should ensure my comments are delivered directly to the Minister for Justice, Equality and Law Reform. The people of County Galway have a problem on their hands. While I assume the situation is as bad in other areas, we are going through a storm at present and I want action to be taken.

Deputy Brendan Smith

I thank the Deputy for raising this important matter. I reply on behalf of the Minister for Justice, Equality and Law Reform, Deputy Brian Lenihan, who is unfortunately unable to be present. I assure the Deputy that the Minister and I share his concern, and that of the public, with regard to raids and break-ins carried out in rural areas in County Galway in the recent past.

Engagement with the rural community and rural policing is one of the priorities of the Garda Síochána. Senior Garda management continually monitors resources and policing initiatives to ensure the service being provided is continuously improving. The Garda inspectorate, which was established under the Garda Síochána Act and is led by former Boston Police Commissioner, Ms Kathleen O'Toole, recently submitted a report to the Minister which is a comprehensive examination of the current state of the Garda Síochána and makes recommendations for the ongoing reform of the force. The report and its recommendations on the service being provided will be taken on board. Rural policing is continually being reviewed and developed and the enhanced liaison structures between Garda management and local authorities through the joint policing committees and community policing fora will be of enormous benefit to the policing of rural areas when these are fully up and running.

The Minister is informed by the Garda authorities that detective inspectors have been appointed in each division with specific responsibility for the investigation of serious crime in rural areas. The quality of criminal intelligence becoming available to the Garda Síochána is continually being improved

To enhance rural policing a number of initiatives have been implemented in Garda divisions nationally. Checkpoints are set up at strategic locations in rural villages to detect criminals travelling to commit crime outside the areas in which they live and to prevent the commission of crimes and offences. Crime prevention officers are available to offer crime prevention and security advice to residential and business groups and regularly provide such advice through local media outlets, newspaper and radio broadcasts. In addition, residents in rural areas are encouraged to establish and rejuvenate community alert schemes, assisted by members of local community policing units.

Initiatives under Operation Anvil have been implemented in every Garda district in the country. These incorporate special crime prevention and detection patrols in rural areas which have been identified as being particularly vulnerable to crime. Such patrols include all available Garda resources, including uniform and plain clothes personnel, district detective and drug units, as well as divisional crime task forces and traffic corps personnel. Patrol times are also varied to maximise coverage in such areas.

An important partnership for the Garda Síochána is its partnership with the community alert programme. This is a community-based initiative in rural communities, set up in 1985 by Muintir na Tíre in association with the Garda authorities. There are currently 1,300 community alert groups nationwide dedicated to improving the quality of life of people in rural communities who are vulnerable, in particular the elderly. The partnership between Muintir na Tíre and the Garda Síochána is formalised in a memorandum of understanding between both organisations for the development and operation of the programme. In conjunction with Muintir na Tíre, the Minister intends to launch the new community alert strategy for the period 2007 to 2011 on 26 October. This new strategy will inform the implementation of community alert over the next five years.

Community policing is a central feature of current Garda policing policy and members of community policing units are encouraged to engage with the local communities where they are assigned. An internal Garda working group has been established to develop a comprehensive model of community policing. This model is being informed by an extensive public consultation process.

I would now like to address the particular matter raised by the Deputy. The Minister is informed by the Garda authorities that a number of the burglaries referred to are occurring in rural areas of County Galway during the night. Very often the occupants of the house are asleep and remain undisturbed. In most cases the offenders take only items that they have access to from the floor to which they gained entry. Frequently the houses targeted are two storey houses, with the ground floor being the only one searched. On most occasions the injured parties only discover the break-in the following morning.

Local Garda management, through increased patrolling, strategically located checkpoints and the targeting of criminals, are actively seeking to reduce this type of crime and disrupt the activity of criminals in the area concerned. The visiting and checking of vulnerable premises during the course of patrols is also part of the crime prevention initiative. In addition, individuals who are suspected of criminal activity are being targeted. Furthermore, local residents are being encouraged to establish and rejuvenate community alert schemes assisted by local gardaí. In the Galway west division, an inspector has been appointed to co-ordinate the community alert schemes with a view to reactivating schemes and the introduction of new schemes. Local gardaí and liaison gardaí are also reviewing all neighbourhood watch schemes throughout the Galway west division with a view to reactivating dormant schemes and initiating new schemes.

Operation Anvil is implemented in each of the Garda districts in the western region. Special crime prevention and detection operations have been implemented and are ongoing. Rural areas in each of the divisions are included in operational orders taking cognisance of crime trends when implementing operations.

The Minister is aware of the concern which incidents like those referred to by the Deputy cause to the people directly affected and the wider community. He is confident the Garda Síochána is using all resources available to ensure a proactive and co-ordinated approach to prevent such incidents occurring in the future.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Thursday, 18 October 2007.