Dáil Éireann debate -
Tuesday, 23 Oct 2007

Vol. 640 No. 1

Adjournment Debate.

Health Services.

Deputy Joe Costello

I appreciate that the Ceann Comhairle selected my issue for discussion. It is not new and relates to the Health Service Executive, accident and emergency services and the hospital system. I have raised it on a number of occasions and I am doing so today because of an incident which occurred last weekend.

I called into the accident and emergency department at the Mater Hospital at about 1 p.m. on Saturday where I met a number of people who had been in the department overnight. I was particularly concerned about one family whose elderly mother, afflicted by Alzheimer's disease, was sitting on a chair. She had pneumonia and had been in the department since 1.30 p.m. the previous day. The family wished that she would get a bed but there was no sign that this would happen. I contacted them later that evening and she still had no bed. During the evening she had wandered around looking for the toilet, but got lost and was not found for some time. I spoke to staff in the bed management section of the hospital who indicated there was little that could be done because there were no beds available. The family telephoned me the following day and the situation was the same. At one stage on Saturday the woman in question had been in second position for a bed but on Sunday she had sunk to fifth in line. Eventually she was given a bed at 9 p.m. that evening, having spent almost three days sitting on a chair or lying on a trolley. She was not given a permanent bed but rather a bed in the admissions lounge, a halfway house between the accident and emergency department and the area where she would be given a permanent bed where she could be treated on a regular basis. She is still in the admissions lounge, a kind of limbo to where patients can move from the purgatory of the accident and emergency department without going to the heaven of an actual ward where they can be treated properly.

Clearly, it is very unsatisfactory that anybody should be placed in these circumstances, particularly an elderly person suffering from Alzheimer's disease and pneumonia. It is not satisfactory from the point of view of the staff either because they wish to treat patients properly. In order for them to do this a bed is required; otherwise patients suffer and staff are unable to carry out their duties properly.

That is the case of an individual who presented last weekend. Although she forms part of the statistics, she is a person. We receive statistics every day, Monday to Friday, from the HSE, indicating no one is in an accident and emergency department for more than 24 hours and that very few are there for more than 12 hours. Weekend arrivals are not included in such statistics, when the backlog and bottlenecks are evident. From that perspective, what we are getting is a series of statistical works of fiction rather than the facts. The Minister has had a number of years to resolve this problem. She reminded us at one stage that Rome had not been built in a day and told us that she would sort the issue out. Clearly, her solution has not worked. She must provide the necessary beds in public hospitals and stop talking endlessly about the fine beds she will provide in the private sector on public hospital grounds.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I will be taking this Adjournment matter on behalf of my colleague the Minister for Health and Children, Deputy Mary Harney, who is not in a position to attend.

The Department has made inquiries today of the Health Service Executive and is advised that the person concerned presented at the Mater Hospital last Friday afternoon. A decision was made later that day that she required admission to an acute bed but due to the lack of a suitable bed, she was obliged to remain in the accident and emergency department until Sunday night when she was admitted to a bed in the admissions unit. It is a matter of particular concern that the patient is an elderly woman and, as the Minister has previously stated to the House, unacceptable for older people to have to wait on trolleys for such a length of time.

There are currently 15 beds closed in the Mater Hospital due to construction work taking place at the hospital relating to the building of an essential new unit. Although it will be of no comfort to the lady concerned — I regret very much she had bad experience last weekend — improvement of accident and emergency services continues to be a top priority for the Government and the Health Service Executive. There have been considerable improvements.

Our objectives are to reduce the numbers waiting for admission, the time spent waiting for admission and the turnaround time for those who do not require admission. The HSE continues to report a significant reduction in the number of patients awaiting admission as compared with the same period 12 months ago. Over the first nine months of this year, the average number awaiting admission each day was 91.

Deputy Joe Costello

Not at the weekend.

Deputy Máire Hoctor

This compares with an average of 165 patients over the first nine months of 2006, representing an average reduction of 45%. There has also been a significant reduction in the number of hospitals reporting patients waiting frequently for admission in excess of 24 hours. However, as this case indicates, hospitals can still experience difficulties in meeting the needs of those who attend accident and emergency departments. The HSE is continuing to work closely with hospitals, particularly those in the greater Dublin area, to bring about sustainable improvements in the delivery of accident and emergency services. As part of this process, an action plan for hospitals on the north side of Dublin is being prepared and due to be implemented in the coming months. The initial target waiting time of 24 hours from decision to admission is being met by the majority of hospitals but as this case indicates, we must see further improvements to ensure no patient waits for an unacceptably long period before he or she is admitted to an acute bed.

At the beginning of this month, the HSE introduced a revised target of 12 hours within which a patient should be admitted following the clinical decision to admit. The ultimate objective is a total wait-time target of six hours from the time a patient presents at the accident and emergency department to the time he or she is either admitted to an acute bed or is treated and discharged. A system-wide approach is required if the revised target and the ultimate target are to be achieved. Such an approach will include a movement to best in Ireland standards in average lengths of stay, an increase in day surgery rates in line with international practice, a change to the way in which patients are admitted, particularly for surgical procedures, and a major drive to increase the efficiency in discharging patients from hospitals.

Following the publication of the emergency department task force report, the HSE is working with the Irish Association of Emergency Care with a view to further lowering the target waiting time, which will include the standardisation of patient processes and pathways within accident and emergency departments throughout the country. The programme for Government contains a number of new commitments in respect of the improvement of accident and emergency services. These are as follows: to increase the number of accident and emergency consultants available around the clock, to further develop chest pain and respiratory clinics to ease pressure on accident and emergency services and to establish a national network of local injury clinics. The target regarding the latter is 20 clinics within five years.

The HSE recently announced the approval of 60 additional consultant posts under the 100 plus performance incentive scheme. It expects that the additional posts will increase the number of senior decision-makers available in accident and emergency departments, as well as improving GP access to diagnostics and speeding up the delivery of diagnostic results. The additional consultants will also enable the relevant hospitals to streamline their internal processes, including discharge planning, to enable accident and emergency departments to operate at their most efficient.

The development of additional fast-track specialist consultant-led clinics was identified by the HSE emergency department task force as having the potential to improve services for patients within accident and emergency departments. An analysis of the number and optimum location of the additional clinics will need to be undertaken. Consideration must also be given to the role that might be played by the private sector in further developing the service.

The programme for Government indicates a commitment to ensure that only those in need of the high level of expert attention available at an accident and emergency department should attend for treatment and that patients should be assessed immediately and treated quickly. The development of local injury clinics is intended to help in achieving this objective.

Search and Rescue Service.

Deputy Martin Ferris

On 17 October, a decision was announced, via e-mail, to all staff by the director of the Irish Coast Guard, Mr. Chris Reynolds, to the effect that a two-tier operation will come into being, that the marine rescue co-ordination centre will be co-located with headquarters in Drogheda and that a second centre will be established at a new west coast location. This decision was apparently taken by the Minister for Transport, Deputy Dempsey, and relayed to the employees of the Irish Coast Guard at Malin Head, Valentia and Dublin.

Until 17 October, an agreement was in place, which was signed off by the then Minister, Deputy Dermot Ahern, to the effect that the Dublin operation would be closed and that the Valentia and Malin Head coast guard radio stations would be kept open and expanded. Staff were informed that the latter was the position but, after three years, they have been informed that matters have changed. The decision made by the Minister for Transport, Deputy Dempsey, represents a complete U-turn on an agreement made by the then Minister, Deputy Dermot Ahern.

The station on Valentia dates back to 1914 and, as the Ceann Comhairle will testify, it is an intricate part of the life of the island and of Kerry as a whole. The staff there have saved countless lives and its history is a testament to the their dedication and hard work. Valentia is by far the busiest of the three stations in operation and it receives the highest number of distress communications. What will be the status of Valentia in the wake of the announcement by the Minister? Will it be unmanned or will it be closed down?

None of this makes sense. The station was refurbished in the recent past and the staff who were working there at the time went to great lengths to ensure that everything necessary for future development was put in place. In that context, a suspended ceiling that could be removed was erected and underground cables, which are not currently in use, were laid. Every effort was made to protect the future of the station.

If the station is to be unmanned or closed down, and in light of the fact that under decentralisation staff are only obliged to relocate on a voluntary basis, what will be the position regarding the staff currently employed there? Where will these people go? Will they be compelled to move to another station? What will happen to them and their families? I am aware that there will be a new intake of staff in the coming months and that 53 applications have been made in respect of about nine vacancies. I understand that quite a number of the 53 individuals who applied listed Valentia as their preference.

Will the Minister provide an indication as to where the new station will be located? Does he intend to close the stations at Valentia and Malin Head or does he intend them to be unmanned? What is the status of the people currently employed at these locations?

Deputy Máire Hoctor

I am taking this matter on behalf of the Minister for Transport, Deputy Dempsey, who cannot be here.

The Minister wishes to dispel any suggestion of a reduction in the quality of service to those engaged in maritime activities, to which a reference to decommissioning might give rise. On the contrary, recent decisions have been taken against a background of renewed investment and support for maritime safety. The Irish Coast Guard and the maritime administration within the Minister's Department is the national authority with responsibility for the promotion, regulation and enforcement of maritime safety, which includes maritime security and emergency management.

The Minister recognises its strategic role in respect of safety and security. He has already signalled his intention of giving increased focus to this sector and to doing all possible to minimise incidents and to respond effectively when they occur. While the ultimate outcome will be positive, getting there is going to present challenges for all as they work to improve and develop the service.

The search and rescue process relies totally on clear, effective and reliable communications and is, therefore, ultimately dependent on the performance of Irish Coast Guard radio and telecommunications equipment. It is this communication infrastructure which provides co-ordination centres with the capability of receiving distress messages and communicating with and co-ordinating rescue resources. The Irish Coast Guard currently has its main radio switch and control equipment located at three manned sites around the country. These are at Leeson Lane in Dublin, Malin and Valentia. Dublin is the marine rescue co-ordination centre, MRCC, while Valentia and Malin are marine rescue sub-centres, MRSCs, each with delegated authority from the MRCC to co-ordinate responses to marine emergencies in its area of responsibility.

A Deloitte & Touche report on the Irish Coast Guard in 2002 recommended that two centres should be operated on the basis that each would be capable of supporting the entire national network. Much of the equipment at the three centres is old and in urgent need of replacement. The decision to operate the service from two centres will allow the required upgrade and replacement of equipment to proceed. Any delay in this process could leave the Department of Transport vulnerable to serious failure in the system. Since the report was issued, consideration has been given to a number of options as to how best to proceed. These included proposals to close Dublin and retain the other two centres. Consideration was also given to retaining an east coast centre and one of the other centres.

Following the transfer of the maritime transport functions to the Department on 1 January 2006, the Minister's predecessor asked officials to review current and proposed arrangements for the delivery of these services. As part of this review, the needs of each of the rescue co-ordination units were finalised with a view to undertaking the necessary development and re-equipping work. As a result, the Minister has confirmed that the Irish Coast Guard and maritime administration will decentralise to Drogheda. He has confirmed that there will be a two-centre operation geographically separated as previously recommended. The MRCC will, in line with decentralisation decisions, be co-located with headquarters in Drogheda. The MRSC will be in an urban or near-urban location on the west coast. The Irish Coast Guard is to proceed with the tendering process for new integrated communications system equipment for a two-centre operation for delivery and commissioning in 2009.

It is important to stress that there is no suggestion that Malin or Valentia will be closed or disposed of as Irish Coast Guard locations nor will there be a diminution in the quality of the emergency response capability on the west coast. The stationswill be retained as part of the Coast Guard infrastructure and some operations will continue to be delivered from these locations, although the precise nature of their long-term function has yet to be finalised.

It is important to emphasise that detailed proposals on the implementation of the strategic decisions have now to be finalised. The Minister has given direction for the medium to long-term development and improvement of the Coast Guard. The process of migrating from the present situation to the new developments will be planned and implemented in consultation. That process will take account of the safety needs of local communities, the ongoing improvement of the service to the public and the concerns of individual staff members.

Physical Education Facilities.

Deputy James Bannon

I thank the Ceann Comhairle for affording me the opportunity to speak on this important issue in respect of Ardscoil Phádraig in Granard, County Longford, on whose behalf I have made numerous representations for some time. As the Minister of State is aware, a state-of-the-art sports facility had been built for the students of Ardscoil Phadraig and the people of Granard under the provisions of the dormant accounts fund.

However, the cement was not even dry when, to the great disappointment of the people of the area, water damage to the roof of the new hall meant that it could not be opened to the public. A problem has arisen with the flat section of the roof which resulted in water leaking into the building from outside. This setback was a major blow to the area as the people contributed to the development on the understanding that it would be open for public use.

This project has been a huge community effort in Granard, with grant aid received not only from the dormant accounts fund but also from Longford Community Resources Limited, various clubs and, as I previously stated, members of the public. Instead of being able to enjoy this new sporting facility, which should have been opened last April, water damage brought a new funding problem as €106,000 was needed for repairs. This was a heart-breaking blow for the community and the school.

However, I am delighted that representations have paid off and that pressure kept the Government on its toes. I welcome the outcome which means that the building unit of the Department of Education and Science is funding these essential repairs under the contingency fund provisions, which will, hopefully, cover the full cost of the repairs. In this, I know I am joined by the people of Granard who will be delighted with the news. I also take this opportunity to congratulate everyone in Granard associated with this project whose untiring work helped it to become a reality.

However, as the Minister of State is aware, there are other outstanding building issues in County Longford which urgently need completion in the interests of health and fitness. Chief among them is the Lanesboro Community College sports hall, which is urgently needed to provide a healthy, fitness-based educational facility for the pupils in Lanesboro. This school had a long struggle to gain necessary funding for the refurbishment of its built environment. In this case, like that in Granard, representations and the pressure brought to bear on the Department eventually resulted in a new and safe learning environment. However, the sports hall is still outstanding. I again thank the Minister for the positive response to the problems experienced by Ardscoil Phadraig and ask her to give similar consideration to Lanesboro at the earliest opportunity.

Deputy Máire Hoctor

I extend apologies on behalf of the Minister for Education and Science, Deputy Hanafin, who could not be here. I thank the Deputy for giving me the opportunity to outline the Department's current position regarding the allocation of funding under the emergency works grant scheme. The main purpose of the emergency works grant scheme is to ensure the availability of funding for urgent works to those schools that are most in need of resources as a result of an unforeseen event of a capital nature that can arise during the course of a school year.

The application process under the scheme elicits specific relevant information to enable a verifiable, speedy and equitable response to emergencies as they arise. Primary and post-primary schools requiring emergency works to be undertaken should apply under this scheme. The purpose of this scheme is solely for unforeseen emergencies. It is not intended that this scheme will be used to supplement previous applications under other schemes that have not been successful in securing funding. All relevant and supporting information in respect of an application must be provided in order to support a claim for emergency grant aid. All applications are dealt with on an individual basis.

I am pleased to inform the Deputy that the school submitted an application for funding in respect of the roof works at the sports hall under the emergency works grant scheme and that a grant was approved on 16 October 2007 to cover these works. In addition, I am also pleased to inform the Deputy that under the dormant accounts scheme, Ardscoil Phádraig received grant approval for the provision of outdoor play facilities. I again thank the Deputy for giving me the opportunity to outline the current position to the House.

School Places.

Deputy David Stanton

I thank the Ceann Comhairle for allowing me to raise this issue this evening and I thank the Minister of State for coming in to respond. I wish to draw attention to an issue in east Cork, which is one of the highest growth areas in the country. The population in the town of Midleton and the area around it has increased by 22% from 25,000 to 30,000 in the past five years.

This raises the issue of the need for more school places at primary and second level. I am specifically concerned about second-level school places. There are four second-level schools in the area. Midleton CBS boys school is full and I understand that it was forced to turn away students this September. St. Mary's High School will be under pressure to do the same next year. St. Colman's Community College is almost full. Midleton College, which is a private college, is full, while St. Aloysius College in Carrigtohill is also full.

A situation is fast approaching where, in a few short years, there may not be enough places in east Cork for second-level students. I carried out a census of the primary schools and discovered that in the next five years, there will be 700 extra students seeking second-level places, which almost amounts to a new school.

I previously raised questions about this with the Minister and also wrote to the county manager. There are no plans to construct a new school. Will the Minister ask her officials to meet the principal teachers in all the schools? Somebody has to take leadership of this situation before it becomes a crisis, which is why I am raising it this evening. I do not want people knocking on my door in two years time because their children do not have second-level places.

The population has increased dramatically over time. I wrote to the county manager in July expressing concern about this. He replied to me but his letter revealed that there are no plans to provide a second-level school. Land can be zoned but that does not mean it is available. As far as I am aware, land is not zoned. What kind of action has the Department taken with the schools locally to project into the future and make provision for second-level places? As far as I am aware, very little has been done.

Midleton CBS has been looking for an extension for quite some time but has not received it. St. Mary's High School needs extra science laboratories but has not received them. St. Aloysius College in Carrigtohill needs extra work which has not been carried out. Perhaps there is an opportunity for the boys' second-level school and the girls' second-level school in Midleton to co-operate. Such a solution could be a shared campus on a greenfield site. All these things take time, as the Minister is aware. This can take years when the crisis is approaching very quickly.

East Cork has been designated as a special growth area because of the railway coming into the area and building has been phenomenal. It would be very useful if the Minister organised a briefing involving officials from her Department with possibly myself and other Deputies from the area. I want to be proactive on this issue and draw attention to the fact that a situation is rapidly developing and I would like to see some action and plans before it becomes a crisis. I look forward to hearing the Minister of State's reply.

Deputy Máire Hoctor

I apologise on behalf of the Minister, Deputy Hanafin, who was not in a position to be here to take this matter.

I thank the Deputy for raising it as it affords the opportunity to outline to the House the Government's strategy for capital investment in education projects and to outline the position regarding second level places in Midleton.

Modernising facilities in our 3,200 primary and 750 post-primary schools is not an easy task given the legacy of decades of under-investment in this area as well as the need to respond to emerging needs in areas of rapid population growth. Nonetheless, since taking office, the Government has shown a focused determination to improve the condition of our school buildings and to ensure that the appropriate facilities are in place to enable the implementation of a broad and balanced curriculum.

As evidence of this commitment, more than €540 million will be spent on school building and modernisation projects in the coming year on primary and post-primary schools throughout the country. Since 1997, a total of €3 billion has been invested in school buildings and this has delivered more than 7,800 school building projects. This further investment of more than €540 million will build on these achievements and will focus in particular on the provision of school accommodation in areas where the population is growing at a rapid rate. As further evidence of our commitment, the national development plan funding of €4.5 billion will be invested in schools over the coming years. I am sure the Deputy will agree that this record level of investment is a positive testament to the high priority the Government attaches to ensuring that school accommodation is of the highest standard possible.

Turning to the specific issue of the second level school places for Midleton, the Department of Education and Science has a number of proactive strategies to ensure that the accommodation requirements for schools in developing areas such as east Cork are addressed in a manner that will meet the long-term education needs of the population. The process of assessing the need for new or additional accommodation facilities at second level in any given area entails consideration of all relevant factors, including enrolment and demographic trends, housing developments and existing school capacity to meet current or future demand. As part of the process, the Department of Education and Science is included among the prescribed authorities to whom local authorities are statutorily obliged to send draft development plans or variations to development plans. As a matter of course meetings are arranged with local authorities to establish the location, scale and pace of housing developments and their implication for both current and future school provision. In this regard, officials in the school planning section of the Department plan to meet senior officials from Cork County Council and Cork County VEC to discuss potential and anticipated developments in the general area with a view to making informed decisions in regard to the long-term accommodation needs of the second level schools in the area and in particular to those schools that have made application for major capital investment in their buildings.

I thank the Deputy once again for raising the matter and allowing me to outline the position regarding the provision of second level places in Midleton.

The Dáil adjourned at 10.05 p.m. until10.30 a.m. on Wednesday, 24 October 2007.