I wish the Minister for Health and Children, Deputy Harney, was in the House. I hope she is not still in the departure lounge.
Adjournment Debate.
Hospital Services.
Shell-shocked.
A recent international study by the OECD showed that Ireland has one of the highest breast cancer death rates in the developed world and a 6% higher rate of deaths from prostate cancer than the OECD average. This is proof positive that we are at grave risk under the current health regime. Another report by the National Cancer Registry highlights the fact that women suffering from cancer in the midlands have a 30% higher chance of dying from the disease than those living in Dublin.
What has the Minister for Health and Children and the HSE decided to do in reply to these findings? Following the closure of the cancer unit in Tullamore Hospital, the cancer care services at Longford-Westmeath General Hospital were subsequently shut down, leaving 600 women without care. This makes no sense. The midlands has continually been overlooked in terms of health provision but what we are talking about here is a life and death situation. Leaving the midlands without breast cancer units is madness and, in fact, is a gross negligence of care to cancer patients. Setting up eight centres of excellence, none of which is in the midlands, condemns hundreds of cancer patients to hours of unnecessary travel, in effect, penalising them for being ill rather than easing their burden.
With the closure of the Mullingar facilities, the midlands does not have access to the 20 centres for multidisciplinary team meetings either, which according to the HSE are being set up in all but two of the 22 hospitals that are currently providing breast care services. Those two exceptions are both in the midlands, namely, the hospitals in Mullingar and Portlaoise and the people are paying the price. This is not acceptable by any standards. Something must be done for cancer patients in the midlands. I propose that the Minister reconsider cancer care in the midlands and set up a centre of excellence in the Longford-Westmeath General Hospital to cover all of the midland counties — Longford, Westmeath, Roscommon, Cavan, Laois, Offaly and south Leitrim — as provision of cancer care centres in Dublin or Galway is an insult to the people living in these counties and accessing hospitals in these cities is unrealistic for very ill people who find travelling difficult.
The Government is yet again failing to operate any form of joined-up thinking. Bringing the cancer services under eight centres of excellence based in Dublin and other major cities is tantamount to driving services back into areas that are already looking to decentralisation to ease the stress on infrastructural and service provision, in other words clogging up the very areas that decentralisation was meant to free up. While many civil servants and other personnel are vacating the cities, the demand for hospital places fills the gaps, even to the point that hotel rooms are being taken up by those awaiting hospital procedures. We witnessed this recently. The Mater Hospital and St. Vincent's Hospital are not set up to cope with cancer patients from the midlands and again the patients will pay the price. Poor quality train and bus services from the midlands put extra pressure on those who are extremely ill and the mini-bus ambulance, for those who get a place on it, does not have the siren of a standard ambulance so cancer victims are forced to sit in traffic jams for up to three hours, adding to their distress.
The provision for taxi services for patients is not satisfactory and must be updated and extended. A young patient in my area is still waiting to be compensated for the cost of taxi services to St. James's Hospital and St. Luke's Hospital for treatment since 2003. This is a shocking way to treat cancer patients and cannot be excused by any protests of ignorance on the matter. This is a regular occurrence and until the cancer service that the people of the midlands have a right to expect is put in place, such shameful neglect of the ill and vulnerable will continue.
I support centres of excellence but I cannot understand why the Government has neglected the midlands. Parts of my constituency are over 100 km from the centres of excellence. When the Government proposed decentralisation in the budget four years ago, the objective was to move people out of the cities. It has not happened yet, but it should happen in the health sector as well as other sectors. It is important that a centre of excellence is established in the midlands to accommodate people living in the region instead of requiring seriously ill people to drive long distances for treatment. This is a good idea which should be adopted by the Government.
I welcome the opportunity to set out the current position with the reorganisation of cancer services, with particular reference to the midland region. Recent events, particularly with regard to cancer services in the midland region, underscore the absolute need for the HSE national cancer control programme to be implemented without delay. Let us all agree that the development of quality assured cancer control services, as set out in the national strategy for cancer control, is the best way of ensuring that the risk of such events is minimised in the future.
The HSE has appointed Professor Tom Keane as national cancer control director to lead and manage the establishment of the national cancer control programme. The decisions of the HSE on four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis. The designation of centres aims to ensure that patients receive the highest quality care while at the same time ensuring local access to services, where appropriate. Patients enjoy a 20% improvement in survival if they are treated in specialist centres which provide multidisciplinary care. Where diagnosis and treatment planning is directed and managed by multidisciplinary teams based at the cancer centres, much of the treatment, other than surgery, can be delivered in local hospitals.
The HSE has designated St. James's Hospital and St. Vincent's hospital as the two cancer centres in the managed cancer control network for the HSE Dublin mid-Leinster region, which includes Laois, Offaly, Longford and Westmeath. University College Hospital Galway and Limerick Regional Hospital are the two cancer centres for the western region, which includes Leitrim and Roscommon. Patients in County Cavan will be served by the two designated cancer centres in the Dublin north-east region, Beaumont Hospital and the Mater hospital. The HSE has confirmed that services will not be transferred until appropriate capacity has been developed in the receiving centres.
Arising from the designation of eight cancer centres nationally and to comply with the national quality assurance standards for symptomatic breast disease services, the HSE announced earlier this month that within the coming weeks, breast cancer services at the Midland Regional Hospital, Mullingar, will be transferred to the Mater hospital in Dublin. It should be noted that only 19 breast cancer procedures were carried out in 2006 in the Midland Regional Hospital in Mullingar. The standards require each specialist breast cancer centre to manage a minimum number of 150 new breast cancer cases per year.
The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland, including in the midland region, in accordance with best international standards.
Health Service Staff.
We have been discussing putting cancer programmes in place. Unfortunately, in Kildare and west Wicklow it will be necessary to put an occupational therapy programme in place, if one takes account of the letter I received from the HSE. It states:
I am writing in response to your letter to our general Manager, Mr. Billy Quinn. As you are aware the Senior Occupational Therapist assigned to the District Care Unit in the Athy area, has been on maternity leave as of 14 9.07 and is not due to return until 6.5.08.
Under normal circumstances we would have received approval to fill her position with a temporary Occupational Therapist. Unfortunately due to the overspend by the HSE, a staff moratorium was put in place as of September 4th. We were told at that time we were not allowed to fill any previously approved new posts or replace any vacant/maternity leave posts.
On October 5th we were informed that we could make individual representations to replace vacant posts through a new derogation process. We immediately did this for the above post, and for two more upcoming maternity leave posts covering the Celbridge, Maynooth and Leixlip areas. After much follow-up by us about these posts we have been told that only one post, covering the Celbridge area, has been approved for replacement.
As Managers of the Occupational Therapy Services for Kildare/ W. Wicklow, we are acutely aware of the devastating effect this is having on clients referred to our services and the huge stress that is being placed on our understaffed Therapists.
With our present inadequate staffing levels, we simply are unable to provide a service where posts have been made vacant. Also, due to the staffing crisis placed on our service through the moratorium, our Union has informed our Therapists that they are not to take on the roles and responsibilities of positions affected by the HSE actions.
We sincerely hope this staff moratorium can be removed as soon as possible so that we can provide a fair and equitable service to all our clients.
This letter is from the occupational therapist manager. The basic issue is that there are four areas in Kildare. The first, second and third areas each made an application for a therapist, but the applications were turned down. The HSE decided to provide an occupational therapist for the fourth area, the last to make an application.
We have discussed and debated the HSE for a number of weeks but still we see occurrences such as this. Everybody agrees that maternity leave is essential and must be granted. However, there must also be a built-in service available for those in need of it. I sent my letter because a man suffered a major tumour on his brain and needed immediate occupational therapy. It was not forthcoming and will not be forthcoming because a therapist will not be available in Athy until August 2008. The HSE spent more than €20,000 on an agency to determine if top staff in the HSE should get bonuses. In Kildare, however, there is no service for the basic needs of the community. Children and senior adults need this service but it is not available.
One can see the frustration, annoyance and torment of the staff reflected in the letter, which is dated 19 November last. One seldom gets such a reply, an honest endeavour to have the matter raised in public so something can be done about the scheme. There are three positions and only one is filled. It is impossible for people in the Kildare and west Wicklow area to get occupational therapy until next August.
I plead with the Minister. Last night, I said there must be responsibility for resolving such problems. We see them every day. Every Deputy in the House, from the Taoiseach down, encounters this type of problem. I can honestly say I have never been as angry about anything as I am about this situation. The staff are crying out for assistance in trying to secure extra staff for the service. The problem is affecting the existing staff, with attempts being made to give them extra workloads. I ask the Minister to get the HSE to reconsider this matter. People in my community are suffering because of it.
I thank Deputy Wall for raising this issue and for giving me the opportunity to outline the current situation with regard to occupational therapy in the Kildare and west Wicklow area. There are close to 130,000 people employed in the delivery of our public health and personal social services, the vast majority of whom provide direct service to patients and clients. Staff costs make up 70% of the HSE's overall budget and must be carefully managed if the HSE is to live within its budget.
As the Deputy will be aware, a temporary recruitment pause has been put in place as part of the HSE's financial break-even plan for 2007. In any instance where a critical or essential vacancy arises it may be filled through redeployment of existing staff by the relevant line manager or reassignment of responsibilities based on assessment of priority need. Notwithstanding this, it has been recognised that during the period of this temporary recruitment pause, there are some circumstances where appointment of staff may be necessary in frontline services. Accordingly, the HSE has put a process in place to evaluate, monitor and approve requests for derogation from the general recruitment pause. A small group has been established which meets regularly to consider such applications. Of the applications received to date, derogations to the value of 520.8 whole-time equivalents have been approved throughout the entire HSE where posts have been identified as critical to service delivery.
Demand for occupational therapy in the health services has been significant, hence the substantial investment which has been provided over the last number of years. The number of occupational therapists, OTs, employed in the public health service has grown from 287 whole-time equivalents in 1997 to 1,102 in September of this year. This is an increase of 725 whole-time equivalents, which represents growth of almost 253%. The Government has also committed to further investment in disability services via the multi-annual investment plan, and in primary care services, and this will result in a further increase in the resources available for occupational therapy.
A particular priority for the Department of Health and Children and the Department of Education and Science in recent years has been to increase the supply of therapy graduates, including OTs. New courses in occupational therapy were established in three universities, UCC, NUIG and UL, with an initial intake of 25 places on each of the three courses. The UL course is at Master's level and the first cohort graduated in 2005. The first cohorts from the bachelor's degree programmes in UCC and NUIG are graduating this year. The number of training places for OTs has increased by 86, from 29 in 1997 to 115 in 2007. This represents an increase of almost 297% over the past ten years.
The House will agree that these changes clearly demonstrate the commitment of my colleague, Deputy Mary Harney, the Minister for Health and Children, the Government and the HSE to ensuring focus on patient care and the recruitment of frontline personnel.
On the matter raised by Deputy Wall concerning the provision of occupational therapy in the Kildare-west Wicklow area, the HSE has advised that the current complement for OTs in the area is 21.5 whole-time equivalents. Thirteen of these posts are currently filled and 8.5 posts are vacant. The Department has been advised by the HSE that of the vacant posts, two posts in primary care were advertised in June of this year and 2.5 posts in the area of older persons — one in the community, one in Baltinglass Hospital, and 0.5 posts as hospital liaison — were advertised in August 2007 locally and through the international recruitment programme. One OT is due to commence work in the near future, so 1.5 posts remain vacant. Two OTs are on maternity leave and the HSE is attempting to fill these vacancies on a temporary basis. One post in palliative care has yet to be advertised. A job description is being discussed and prepared in consultation with the recently appointed palliative care consultant and palliative care team. One post in the area of disability has yet to be advertised.
Working within the parameters of the current recruitment pause, the HSE has advised that it is committed to filling these posts as soon as possible. I will convey to the HSE the concerns outlined by Deputy Wall this evening.
The Minister of State said that two OTs are on maternity leave and the HSE is attempting to fill these vacancies. That is not true.
Special Educational Needs.
A new specialist unit for children with autism has been lying idle for a number of months, almost a year, in the Castleknock Educate Together school in Dublin 15. Similarly to many other parts of Ireland, Dublin 15 — Castleknock, Blanchardstown, Mulhuddart and Clonsilla — has a significant number of children with autism. When the Department of Education and Science decided, with the agreement of the Castleknock Educate Together school, to include a special unit for the education of children with autism, there was general delight. The special facility has now been built as part of the new permanent school which was opened earlier this month amidst celebration by the Minister for Education and Science and the Minister for Justice, Equality and Law Reform, for whom it was the third official opening in a year. It has a special purpose-built unit with spaces for two classes of six children, a playground, shower facilities and special rooms for therapists.
It seems extraordinary that in the context of the current crisis with respect to the number of children needing autism services, this wonderful resource could now be left lying idle. The school community at Castleknock Educate Together, the teachers, patrons and parents, are all anxious to see this facility up and running. There are many children in the area who would benefit hugely from these services and who are currently facing two two-hour commutes per day to very distant services all over Dublin and, in some cases, in County Meath. Like other Deputies, I met many families affected by autism during the recent election campaign. The demand for the service is enormous.
It appears that disputes between the Department of Education and Science and the HSE over financial contributions towards the staffing of the centre are at the heart of the failure to open this facility. I am delighted that the Minister of State with responsibility for children is here. Is it true that Beechpark Special Schools, which provides services for children with autism, is ready and willing to take over responsibility for specialist service provision for this unit, including the selection of children and the provision of ancillary specialist help such as therapists? Beechpark is under the control of the HSE. Can the Department of Education and Science discuss this with the HSE and sort it out, or are we back to the HSE recruitment embargo yet again?
The Department of Education and Science has indicated several times that it is ready to open the unit and would like to see it open, but the key question is whether the Minister is prepared to resource the unit appropriately. The bulk of the money for the unit has already been spent on building this lovely facility. It is a pity to see it lying idle, particularly when there is such need. Can the Minister of State say whether the negotiations on resourcing and opening the school have been concluded? Can he tell us definitively when the unit will open? Castleknock Educate Together waited seven years for a permanent building. The board and the school community positively sought and welcomed this facility.
The idea behind the special unit is that children with autism can get the special attention and services they require while being fully integrated into the national school. This is a positive development in Irish education. However, it is unclear what the Department proposes for these units and what their policy is towards the educational philosophy of these units. The Department has so far issued no detailed guidelines, provided no additional resources and offered no special training for the primary teachers in the national school who want to work in the unit. It is difficult to envisage how the Minister expects an ordinary primary school to open up a specialist unit without some additional resources. We should bear in mind that the Castleknock Educate Together school has many classes in which there are more than 30 children. The school has been in temporary accommodation for seven years. Can the Minister specify what the Department proposes to do and when this facility will be opened?
I thank Deputy Burton for raising this issue. I will be replying on behalf of my colleague, the Minister for Education and Science, Deputy Mary Hanafin.
The House will be aware of the commitment to ensuring that all children, including those with autism, receive an education appropriate to their needs. I therefore welcome the opportunity to discuss the opening of the special classes for autism in Castleknock Educate Together School in Dublin 15.
As the Deputy will be aware, the preferred approach of the Department of Education and Science is that children with autism receive the appropriate education through the primary and post-primary school network. I am pleased to report that in the past year alone more than 75 autism-specific classes were sanctioned by the National Council for Special Education, NCSE, to cater for pupils with autism, bringing the total now sanctioned to more than 275. A specific function of the NCSE, through its network of local special educational needs organisers, SENOs, is to identify appropriate educational placement for all children with special educational needs. I can confirm that the SENO with responsibility for the school in question has approved staffing for one special class for autism and is considering approval of a second class in the school to meet demand. The NCSE continues to establish additional autism classes where the need arises in both special and mainstream primary and post-primary schools.
The Deputy may be aware that the recently completed building project in Castleknock Educate Together school incorporates accommodation for the autism unit. Additional supports available from the Department for special classes for pupils with autism include start-up and enhanced capitation grants, and the school authorities in question have been advised accordingly. In addition, extra training support for staff engaged in education provision for children with autism can be accessed through the special education support service. This service will, as appropriate, consolidate, co-ordinate, develop and deliver a range of professional development initiatives and support structures to the relevant staff.
However, I understand the delay in the opening of the autism classes is associated with concerns the school authorities have surrounding the provision of therapeutic and clinical support for the autism unit which, as the Deputy will be aware, falls within the remit of the HSE. Officials in the Department have raised the concerns of the school with the Health Service Executive and will continue to liaise with the school management authorities in this regard.
The Minister for Education and Science, Deputy Hanafin, shares Deputy Burton's desire to see this purpose built facility for children with autism in Castleknock Educate Together school utilised to full potential and opened without further delay. I thank Deputy Burton for raising the issue. I will bring her comments directly to the attention of the Minister.
Human Rights Issues.
I thank the Ceann Comhairle for the opportunity of raising this urgent matter. It had been our understanding that with the change of Government would come an interest in implementing the capacity of the Government through, for example, the civil aviation Acts of 1978 or 1987, to achieve inspections of planes that had a record of participation in extraordinary rendition.
I raise this because of some recent events in Shannon Airport. A complaint was made to the Garda Síochána by Mr. Edward Horgan and that statement, which was recorded on 30 October 2007, has drawn the following reply of 1 November:
Dear Mr. Horgan,
I refer to the Statement you made at Shannon Garda Station on October 30th, 2007 to Garda Edward Henderson.
I wish to inform you that the Gardaí will not be taking any action on the information contained in your Statement.
Mr. Horgan was referring to the arrival in Shannon of Gulfstream VI aircraft registration No. N475LC. This aircraft, along with another, has the highest record of participation in extraordinary rendition flights, as established without doubt by the European Parliament and other European agencies. The other aircraft is No. N478GS. Between the two, they made 76 rendition flights. Anybody who has seen the conditions that prevail at Guantanamo Bay at present will know the consequences or end point of extraordinary and illegal rendition.
I do not have time to say more than this. I believe the members of Government and ourselves are opposed to extraordinary rendition, as are the Irish public. However, the Irish Human Rights Commission and several other bodies are totally dissatisfied that while we have the capacity to search aircraft under the legislation I mentioned, we resolutely refuse to do so. This is not to give sufficient compliance with the United Nations Convention Against Torture. Every legal opinion offered on the anti-torture convention suggests that compliance requires being able to say that you are certain you have not participated, even indirectly.
This plane arrived in Shannon. In plenty of time Mr. Horgan approached Garda Pat Harte and Garda Fitzgerald. As the conversations developed Garda Fitzgerald said to Mr. Horgan that they had instructions from the Attorney General not to inspect such planes. I place this statement on the record of the Dáil. It requires an answer. If such an instruction was given in this, or any, instance, it would be an outrageous breach of international law. It would be an incredible reflection on this country, apart altogether from the substance of what is going on.
I understood that when the Green Party, for example, was deciding to participate in the Government, it had at least secured some form of commitment to inspection. I have the greatest respect for the Minister of State, Deputy Carey, but this is such a flagrant departure from what is required in international law. This is a view that is not mine only but is shared by Dr. Maurice Manning, the Irish Human Rights Commission and nearly every legal expert I know.
Is it a fact that gardaí have been issued an instruction not to inspect planes? Why are planes not being inspected? Why are planes with a demonstrated unequivocal record of participation in illegality able to put down in Shannon and take off again without being inspected, and all on the basis that we have been given a special assurance by a friendly nation? It is not the action of a friendly nation to put another country into such a position that it is not able to say to the international community that it is in full and clear compliance with the anti-torture convention. While we go on like this we are allowing our commitment to that convention, perhaps the most important in international law, to be called into question.
On behalf of the Minister for Justice, Equality and Law Reform, Deputy Brian Lenihan, I thank Deputy Higgins for raising this matter.
At the outset, let me state unequivocally that the Government is completely opposed to the practice of so-called extraordinary rendition, and our concerns in this regard have been made clear at the highest level of the US Government over an extended period of time. In response, the United States has provided categorical, unqualified assurances that Irish airports or territory have not been used for this purpose. These assurances have been specific, unambiguous and not circumscribed by any "technical legalities".
In the current programme for Government, the Government has already committed itself to prioritising enforcement of relevant legislation, including the Criminal Justice (United Nations Convention against Torture) Act 2000. In particular, Garda investigation and enforcement efforts are being supported principally by making all necessary resources available for specialised training in the provisions of relevant statutes. The Minister, Deputy Lenihan's, Department has engaged with the Garda authorities in this regard. The goal is, of course, to ensure the practice of extraordinary rendition does not occur in the State in any form.
Moreover, although not within the ambit of the Minister, Deputy Brian Lenihan, the Government has also committed itself to seeking EU and international support to address deficiencies in elements of the regulation of civil aviation under the Chicago Convention. As Deputies may be aware, this 60-year-old convention provides no requirement for the supply of information on passenger, crew or cargo if the flight is a transit flight.
Moving to the specific concerns of Deputy Higgins, the Minister, Deputy Brian Lenihan, understands that a private aircraft with registration No. N475LC——
On lease to the CIA.
——landed at Shannon Airport on 30 October last at 1.14 a.m. and departed at 2.03 a.m. It is understood this aircraft is owned by a private company based in Las Vegas. The landing was for a technical/refuelling stop and, in accordance with the Chicago Convention, aircraft may come into Ireland for such technical stops without notifying any national authority.
The Minister further understands that the presence of this aircraft at Shannon Airport was the subject of a contemporaneous complaint to the Garda Síochána, with the complainant requesting an aircraft search. The Garda response to this complaint did not include an inspection of the aircraft in question.
However, the Minister wishes to strongly contest any claim or suggestion that this occurred because of an "instruction" that searches in general or searches of particular types or classes of aircraft should not occur. Let me emphatically and unambiguously state in this House that no such instruction has ever been given or would or could be given by any Irish authority. On behalf of the Minister, Deputy Brian Lenihan, I cannot be clearer or more unambiguous in this regard.
In considering when and where the Garda Síochána can conduct inspections of aircraft on Irish soil, members of the Garda Síochána are as much bound — rightly bound — by the rule of law as anyone else. The Garda uniform does not entitle the wearer to dispense with common, statute or international law, as and when they please.
The legal position in the matter of aircraft inspections is relatively straightforward. So-called "State aircraft" such as foreign military aircraft generally enjoy sovereign immunity from search by Irish officials. However, in the case of all other aircraft registered to another state, whether used by foreign officials or otherwise, such as the one mentioned by Deputy Higgins, powers of search are available to the Garda Síochána.
However, these powers can be deployed only where there are reasonable grounds for their utilisation, capable of withstanding scrutiny in a court of law. In much the same way that a Garda needs reasonable suspicion——
The plane has an outrageous record.
——supported by hard evidence to conduct a search of a private dwelling, so too must gardaí have similar standards of suspicion before inspecting an aircraft. The mere assertion of wrongdoing by a member of the public is clearly and obviously insufficient in this regard.
We will never know.
Moreover, that a particular aircraft is rumoured to have been associated with the CIA on, for example, certain Internet blogs does not constitute probable cause to ground an inspection.
It is on the European aircraft register of flights.
The Minister for Justice, Equality and Law Reform has repeatedly stated that any person with credible information that Irish airports have been used for any alleged unlawful purpose should report his or her concerns to the Garda Síochána. It remains the case that on the basis of such reporting or any other information on foot of which the Garda Síochána has reasonable cause to suspect that an offence is being committed, statutory powers of entry and arrest are available subject to international law.
To date, where complaints of alleged unlawful activity concerning the use of Irish airports have been made to the Garda Síochána, Garda investigations have ensued and, where appropriate, files have been submitted to the Director of Public Prosecutions. In all cases, no further action was found to be warranted, owing to a lack of evidence of unlawful activity.
Having regard to the foregoing, the Minister for Justice, Equality and Law Reform considers that all reasonable, appropriate and sufficient measures have been and are being taken to ensure that Irish airports are not being used for unlawful activity.
Should we submit that to the Council of Europe?
The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 4 December 2007.