I wish to clarify that Deputy Ciarán Lynch will not be in this slot. It will be Deputy Allen and myself, so we will have five minutes each.
Adjournment Debate.
Health Services.
The time is divided by two instead of by three.
No wonder the Ceann Comhairle got the good job. He is much better at it than I am.
I wished to ask the Minister for Health and Children if she is aware that the number of children attending for care at the paediatric diabetes unit at Cork University Hospital has risen to 270, which is more than twice as many as were attending four years ago; if she will outline the extra resources that have been given to the unit to cope with this extra demand; if she will explain why the clinical nurse specialist who was to take up her post on 23 September has not been appointed; and if she will make a statement on the matter.
It is not normal for a Deputy to read out his or her entire request for the Adjournment debate, but it is important, for many reasons, that this one be read out. It is virtually the same Adjournment request that was made on 7 March 2006. Since then the numbers being diagnosed with childhood diabetes at CUH have risen from 207 to 270. We should bear in mind that we are talking about children as young as 18 months. They are sometimes younger, but 18 months is near the average. In one instance a mother told me that she was in shock at having discovered that her child had diabetes and that she was given a syringe and an orange and told to practice on that and she would be fine, and to go home and treat her child.
All that is available to the parents in Cork is the help they can give to one another. They do not have a 24-hour service, as exists in Dublin, where if a child's blood sugar seems to be fluctuating a parent can pick up the telephone to the nurse specialist. They do not have a full-time paediatrician. As and from today, even though it has not been confirmed, there is the possibility that a dietitian with specific interest in children and childhood diabetes may have been appointed, but this is not fully confirmed. There is have one nurse when there should be three, and that one nursing post is filled by two half-time nurses. This time last year an additional nurse was promised, but that appointment was not made. There is no oncologist. There is a specialist who also works with other specialties.
Where do we go from here? There were parents outside CUH this morning and they did not want to be there. These mothers and fathers have other things to do. They have sick children to look after but they know that if they do not take a stand, the quality of their children's lives will be immeasurably worse.
The outcome for children with diabetes is good if they get the proper care and attention. If one lives in Dublin, one gets the proper care and attention. In fairness, the staff in Temple Street hospital have taken in children from Cork. Parents are willing to travel every three months to have their children get the proper treatment, but why should children in the south, from where the Ceann Comhairle comes, have less of a chance of proper health care than those in Dublin? Clearly, we are not treating all the children of this nation equally.
I may get the same answer tonight as I got on 7 March 2006, the end of which stated:
Hospital management has reported that the suggestions made at this meeting [between hospital management and the parents] are currently being examined. The development of the paediatric diabetes service remains a priority for the executive management board of Cork University Hospital. The Tánaiste is confident that the Health Service Executive will continue to monitor the delivery of this service to ensure that the needs of the service users are prioritised and met.
When will we see that and what about the health of these children?
I thank the Ceann Comhairle for the opportunity to raise this issue again tonight. With other Deputies, I raised it in 2006 and we are forced to raise it again tonight. Effectively, Professor Brendan Drumm, who is the chief of the Health Service Executive, has given the two fingers to the Oireachtas Members of Cork North-Central and Cork South-Central. We all signed a letter, which was one of the few signed by all Deputies in both constituencies, in March last. We requested a meeting with him to discuss this serious issue and we have not even got a reply. That is accountability in the style of the Health Service Executive, which will go through another one in a series of charades of meeting public representatives — I intend no insult to the Ceann Comhairle who will chair a meeting next week — preaching to us and not giving us an opportunity to interact or to communicate properly. We sent a request, signed by all Oireachtas Members concerned, for a meeting but we received no response. That is why we must raise the issue here.
No doubt I will be told tonight this is a matter for the Health Service Executive. Accountability has gone out the window. We do not know what is happening within senior management of the Health Service Executive. They are all promoting themselves. There are many managers but there is no management of the health services and we will not stand for that because the people of Cork deserve better.
The parents of chronically sick children were forced to take to the footpaths of Cork University Hospital again this morning because of the situation, as outlined by Deputy Kathleen Lynch. I will not repeat much of the detail the Deputy has given.
I hope the Minister of State, Deputy Hoctor, will not tolerate the attitude and the behaviour of Professor Drumm and his management team who seem to think that public representatives are just a crowd of nuisance makers. The Ceann Comhairle and I served on a health board for a number of years and we saw that on every item on the agenda, and even items that were not on the agenda, we could challenge and question management on the burning issues of the day. Now one cannot even get a response. A parliamentary question I tabled to the Minister for Health and Children, Deputy Harney, on 2 October was referred to the Health Service Executive and I have yet to get a reply on that urgent and important issue.
In November 2006 there was need for a consultant paediatric endocrinologist, who has still not been appointed. There was need for a consultant paediatrician — there is a part-time one in place at present. There were supposed to be three clinical nurse specialist to help the 270 children, to whom Deputy Kathleen Lynch referred, but there is the equivalent of 1.1. There is no dietitian, there is a half-time social worker and there is no dedicated clinical space.
This matter has been rolling on for many years with no accountability and no real response. This issue is not being taken seriously. Cork and the southern area is out of touch totally with what is happening in the rest of the country in the treatment of child diabetes. This should not continue.
I ask the Minister of State, Deputy Hoctor, who is representing the Minister for Health and Children, to carry out a departmental investigation into the mismanagement of this entire affair by Professor Drumm who, as I stated, is giving the two fingers to Oireachtas Members by not even responding to a request for a meeting where we could discuss with him and his many highly paid managers this ongoing burning issue. He should be brought to task for non-performance, despite his large bonus, and his contempt, not for public representatives but for the parents and sick children of the greater Cork area.
I know Deputy Allen does not mean any discourtesy, but we cannot refer in a disparaging way to people who are not Members of the House because they do not have the opportunity of defending themselves in the House. That is a long-standing rule of the House.
I know but if he does not have respect for Oireachtas Members, I do not think——
I have to remind the Deputy of that.
I accept the Ceann Comhairle's ruling.
I am taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank Deputy Kathleen Lynch, Deputy Allen and, indeed, Deputy Ciarán Lynch for raising this issue today.
The Minister is aware that the number of children diagnosed with insulin dependent diabetes who are attending Cork University Hospital, CUH, has increased from 122 in 2000 to 275 in 2007. She is pleased to note that the HSE is taking steps to boost the service for these children.
The HSE has succeeded in recruiting a senior dietician for the paediatric service and a suitably qualified dietician commenced providing the service from Tuesday, 30 October. The funding and whole-time equivalent for the post has been ring-fenced and the post will be established in the hospital in a permanent capacity. A clinical nurse specialist post has been offered to a nurse who is already working in the paediatric unit at the hospital. She will be able to take up duty when her current post has been back-filled. It is likely that approval for her replacement will be granted shortly.
The CUH provides a service whereby a dietician and the clinical nurse specialist for diabetes attend the general paediatric clinics to see urgent cases of children with diabetes, for example, those who are newly diagnosed, have a new regime or are experiencing difficulties with control. The hospital management has given an assurance that every effort will be made to ensure that all the relevant staff attend these clinics.
The HSE has under consideration the following additional staffing level requirements for the paediatric diabetic service in the south for 2008: 1.2 whole-time equivalent, WTE, clinical nurse specialists; 0.20 WTE dietetic support; 0.5 WTE consultant paediatrician — a share of 1.0 WTE who has a special interest in diabetes and endocrinology and has a general paediatric commitment; and 0.3 WTE social worker support, who also shares the general paediatric commitment.
That is exactly what they have.
These posts would form part of a multidisciplinary team with the nursing and dietician posts currently being put in place. The general manager and nurse service manager of Cork University Hospital, together with the business manager for the division of paediatrics, have met with representatives of the support group and are fully aware of their concerns in regard to the paediatric diabetic service. The Minister is satisfied that every effort is being made to address those concerns.
At the end of 2006, the Health Service Executive established an expert advisory group, EAG, on diabetes to draw up standards of care for persons with diabetes. This process will take account of the Department of Health and Children document, Diabetes: Prevention and Model for Patient Care. The EAG has subdivided its work into six areas: standards of care, retinopathy, paediatrics, education and patient empowerment, podiatry and model of shared care. The EAG will report in 2008 and the allocation of any additional resources for diabetes will be informed by this process.
The Minister is confident that the measures being adopted by the Health Service Executive will bring about much improvement in the paediatric diabetic services in the Health Service Executive southern area.
That is exactly what is there at present. There is nothing new in the reply.
We cannot go into the matter now.
I am sorry about that.
Mental Health Services.
I thank the Ceann Comhairle for allowing me to raise this issue. I plead for the life of Emer Carroll and many others like her who are suicidal and who have been discharged from hospital because of a lack of facilities to deal with them. I also wish to highlight the broader issue of the neglect of those who are suicidal.
Emer suffers from an eating disorder and now weighs just six stone. She has made seven suicide attempts and feels her life is worth nothing. She wants assistance. She has stated:
I want help, I don't want to be like this anymore. But because I am not eating, my brain is just telling me I don't want to live anymore and that I have no worth. I don't want to hurt my family, but I feel so bad that my brain just tells me they'd be better off if I was dead. And the fact I feel like this is not helped by the lack of treatment that is available to me. They told me they were discharging me from Tallaght because they do not have the facilities to treat eating disorders.
Funding has been made available in Tallaght Hospital by the National Office for Suicide Prevention for a suicide prevention nurse. Although the money is available, the Health Service Executive prevented the hospital from taking on a nurse because of the embargo on staff recruitment. This is nothing to do with controlling the overspend by the Health Service Executive. The money is available, yet the Health Service Executive is allowing a person like Emer Carroll to probably die because it will not allow the recruitment of a suicide prevention nurse.
Emer's father said that as far as he is concerned, this is tantamount to murder. I will not comment on that other than to say it is a sign of how upset the family is about the issue. This is similar to the experience of so many families around the country. I speak with people every week who are put under unbelievable pressure because members of their families who are suicidal are not getting the services they require. Many of them have attended funerals that could have been prevented if the recommendations of the various reports were implemented, including last year's report of the joint Oireachtas committee that has been totally ignored.
I was informed today by the Minister of State at the Department of Health and Children, Deputy Devins, that we are spending only 7.7% of the total health budget on mental health services, yet one in four people suffer from a psychiatric illness that will require intervention at some stage in life.
I do not expect any great answer on this matter from the Minister of State, Deputy Hoctor, because I have not received any in the 18 years I have spent campaigning on this issue. I urge her to think of Emer Carroll who suffers from anorexia nervosa, who has attempted to take her life seven times, who went for help to Tallaght Hospital only to be told the facilities were not available to help her because the Health Service Executive prevented the resources being expended for bureaucratic reasons.
I have a copy of Healthmatters, a Health Service Executive publication. It contains 36 pages of information but only one small article is devoted to mental health.
The Deputy is aware we cannot have illustrations in the House.
I beg your pardon. One small column is devoted to a report on a mental health conference in a 36 page publication. That is indicative of the attitude of the Health Service Executive and the Minister towards psychiatric services.
I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank Deputy Neville for raising this matter. However, I do not consider it appropriate to comment on the clinical management of this individual case. All of us wish the young woman involved well and we want her to be treated with great sensitivity.
I wish to deal with the general issues. The decision to suspend recruitment temporarily was taken as part of a financial break-even plan developed by the Health Service Executive national management team to ensure it remained within its Vote for 2007. The Health Service Executive must be able to manage within the resources made available to it by the Government and voted by the Dáil. Operating within budget and making the best use of the available resources should be a key priority for any organisation. Reforming our health system is not just about extra funding and extra posts; it is about ensuring that the extra money which has already been invested by the Government on behalf of the people is being used wisely and efficiently.
Approximately 130,000 people are employed in the delivery of public health and personal social services, the vast majority of whom provide direct service to patients and clients. The current pause in recruitment must be viewed in this context. It is a temporary measure put in place by the HSE to operate within budget which is reviewed every month and is monitored by the HSE on a week-by-week basis.
There are some limited, critical or exceptional circumstances where appointment of staff may be necessary in frontline services. A small group has been established with representatives of the national employment monitoring unit, the National Hospitals Office, primary community, continuing care and other directorates, to evaluate, monitor and approve requests for derogation from the general recruitment pause. This group meets every week. To date, 340 essential posts in frontline and stand-alone critical areas have been exempted from the employment pause.
The provision of mental health services is underpinned by the comprehensive policy framework outlined in A Vision for Change, the report of the expert group on mental health policy and Reach Out, the national strategy for action on suicide prevention. The current level of expenditure on mental health is unprecedented, having trebled since 1997. This year approximately €1 billion will be spent on specialist mental health services. It is important to bear in mind that approximately 90% of public mental health services are provided at primary care level, which is not captured in the €1 billion.
A Vision for Change was adopted by the Government in January 2006 as the basis for the development of mental health services for the next seven to ten years. This policy envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. Reach Out was published in September 2005 and represents Government policy on suicide prevention. Additional funding of €3.05 million was provided in 2006 and 2007, which brings the total funding available to support suicide prevention initiatives in 2007 to €8 million.
The €1 billion expenditure on mental health services generally is also of benefit to persons who may be suicidal. This substantial support for suicide prevention must be taken into account when considering the availability of individual posts. I have been informed that the Health Service Executive's National Office for Suicide Prevention has provided funding to Tallaght Hospital for the recruitment of a suicide prevention nurse. While this post is currently affected by the recruitment pause, it will be kept under review by the Health Service Executive as part of the monitoring process to which I have referred.
Other important supports are already in place to help people who may be suicidal. For example, funding has been provided in 2007 to complete the availability of self-harm services in accident and emergency departments. Self-harm services are in place in the vast majority of accident and emergency departments whereby, in addition to receiving medical care, people presenting with deliberate self-harm also receive a psycho-social assessment following which they are admitted to the treating hospital, a psychiatric hospital or discharged.
Another positive initiative is a national mental health awareness campaign which was launched earlier this month by my colleague the Minister of State, Deputy Devins. The main aim of the campaign is to influence public attitudes to mental health. It is specifically designed to alter negative attitudes and promote positive attitudes and a greater understanding of mental health.
Thankfully, the level of discussion and openness on mental health issues, including suicide and self-harm, has increased significantly in recent years. However, we need to ensure public discussion and media coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress will feel they can seek help from family, friends and health professionals. The Government is committed to the provision of quality care in the area of mental health.
School Accommodation.
I thank the Ceann Comhairle for agreeing to this important debate.
The Sundai campus or site is an important one in the overall plan for educational development in the greater Newbridge area. It is important in that it has supplied a site for Gaelscoil Cill Dara and a proposed site for the Newbridge Educate Together national school. Both schools were operating in facilities that were not suitable for their needs and in which we would not ask any educational facility to operate.
It was with the goodwill of two local landowners and a local sports club that the new facilities were made available. This proposal has overcome problems to some degree. The gaelscoil was offered a section of the campus and provided with a number of classrooms and a play area. However, when the second aspect of the proposal, the co-location of the Educate Together national school, emerged following the Department's planning application to Kildare County Council, there was suddenly a great awareness among the parents of gaelscoil students of major deficiencies in the proposal with regard to equal provision of facilities for children on the site. While welcoming the development, there must be serious concerns regarding the safe transfer of pupils from the main road, known locally as the green road, to the co-location site. Questions have also been raised about what appear to be excellent recreational facilities contained in the Educate Together application when compared to those contained, or in reality not contained, in the gaelscoil proposal.
With regard to the first point, the transfer of pupils from the green road or main road to the site, the most important consideration must be the safety of the children which must not be compromised in any way. It seems the treatment of this issue in the planning application leaves much to be desired. Given the fact that the planning application is in the name of the Department of Education and Science, the importance of underpinning all of the safety factors involved in ensuring the safety of children using the school is increased. In such instances, the Department should set the example for others to follow.
Irrespective of the decision of the local authority, there can be no compromise in regard to child safety. Sadly, however, this expectation has not been realised in the way one would expect from the Department. The section of the planner's report dealing with the safety factor states:
Road design is no objection to the proposed development subject to the following conditions... As permission has already been granted...
It beggars belief that this is the situation in regard to a planning application in the name of the Minister. Subsequently, an appeal was made by the parents to An Bord Pleanála. Even in this case, a subsequent letter from the road design section of the council was not accepted by the board because it was late for submission. In making this application the Department has not observed the necessary safety factors one would expect in regard to the safety of pupils in both schools. This leaves much to be desired.
A second consideration applies to the recreational facilities aspect of the application. Both schools have totally different values set down, as one will note from the planning application. On the face of it, the Educate Together national school has excellent facilities, including a PE hall, a junior play area and two other play areas, whereas Gaelscoil Cill Dara has just one play area. What has been offered to the Educate Together national school is wonderful but one cannot relate this to what was offered to the gaelscoil. Given that the average numbers attending both schools on the campus are practically equal, it is extremely difficult to understand how this is acceptable.
I have always found the Minister for Education and Science, Deputy Hanafin, and the Minister of State, Deputy Hoctor, to be honest and hardworking, with a vision of the educational needs of the country. While one may not always agree with this vision, that is politics. However, in this instance there is a need for basic provision for both schools using the campus. It is a simple issue. There should be fair play and safe access for both schools, which is not much to ask. Will the Minister agree to consider the file and see for herself the deficiencies in what her Department is seeking to provide for one school when compared to what it has offered the other? How can the Department stand over the obvious safety concerns in both educational facilities? In the interests of fair play to all students in both schools and their families, the Minister should have a rethink on the proper development of the campus.
On behalf of the Minister for Education and Science, Deputy Mary Hanafin, I thank the Deputy for giving me the opportunity of outlining to the House the position of the Department of Education and Science on Gaelscoil Cill Dara and Newbridge Educate Together.
A major building project is at an advanced stage of architectural planning for the provision of a 16-classroom school for Newbridge Educate Together national school. A project to provide additional classrooms at Gaelscoil Cill Dara is also at an advanced stage of architectural planning. Stage 3, developed sketch scheme, of architectural planning is under review in the Department and expected to be completed shortly.
With regard to the Deputy's questions on traffic control at the school, the position is that following a pre-planning discussion between the design team and officials from the roads section of Kildare County Council, it was confirmed that a traffic impact assessment was not necessary. During this discussion Kildare County Council suggested alterations to the scheme to take account of traffic requirements and these have been incorporated into the design of the scheme. The council granted planning permission for the prepared scheme which has subsequently been appealed to An Bord Pleanála. The Department is awaiting the outcome of the appeal.
The position generally is that individual school authorities are responsible, in the first instance, for ensuring the safety and welfare of children and others in their care, including traffic management measures. The Department is prepared to consider applications from school authorities for grant-aid towards improving safety arrangements, including car parking, inside the vested area of the school, but would require that the integrity of the outdoor play area be safeguarded in so far as is possible. Issues relating to traffic safety, pay car parking and so on outside school grounds are the responsibility of the relevant local authority. Grant-aid is not available for works outside the vested area of the school.
The design and planning of the project are covered by stages 1 to 5, during which the project is developed from the assessment of site suitability, through detailed design, which includes the obtaining of planning permission, to the point where detailed bills of quantities are prepared. In the case of all large capital projects currently in hand within the school building section, progression of a project to tender and construction will be considered in the context of the multiannual school building and modernisation programme. The Minister is committed to providing suitable high quality accommodation for both schools at the earliest possible date.
The Dáil adjourned at 10.20 p.m. until10.30 a.m. on Thursday, 1 November 2007.