Dáil Éireann debate -
Tuesday, 26 Feb 2008

Vol. 648 No. 2

Adjournment Debate.

Health Services.

Deputy Denis Naughten

I thank the Ceann Comhairle for the opportunity to raise this important issue.

At present there is a crisis relating to home help provision in County Roscommon. Emergency cases are being denied home help hours due to a ban on the recruitment of home help staff by the Health Service Executive, HSE, though it has no difficulty in recruiting additional home help managers. The crisis has also been caused by a HSE management directive issued in the past week that states home help hours for needy patients are not to be increased and new clients are not to be provided with a home help service. In addition, the HSE has instructed that home help staff, even if sanctioned, cannot be appointed unless they go through a formal, 12-week recruitment process. So much for dealing with emergency and vulnerable cases.

This is extremely frustrating as there is plenty of money available to provide home help hours because less money has been spent in the first two months of this year than was provided for in the service plan. So much for the Minister for Health and Children's commitment that there would be the same level of service in 2008 as 2007.

A similar situation has arisen with the much sought after home care packages due to the same policy direction. For an individual to avail of such a package a person currently in receipt of such a package must pass away. Why should families be forced to monitor the death notices to see whether they will receive a service? This is a national disgrace.

The Government-supported HSE policy is having a disastrous impact on the quality of life of the elderly and disabled and their families. John is 80 years of age and is in an acute hospital bed but medical staff can do no more for him. He requires care 24 hours a day and seven days a week. He is doubly incontinent, 6 ft., 4 ins. tall and is completely bed-bound. He wants to spend his final days in his own home and will rely on his only child, who has three young children between four and seven years of age, to provide the necessary care. He has no other support. The HSE is prepared to give over €350 per week for a nursing home but it is not prepared to sanction even one hour per week to help this man live with dignity in his own home. So much for the Minister for Health and Children's commitment to a fair deal for the elderly.

Mary suffers from Parkinson's disease, has three young children and is in receipt of home help hours. She cannot peel potatoes for her children's dinner yet she cares for her father-in-law. All she wants is home help for one night each week to allow her one decent night's sleep.

Bridie has just been released from hospital and has been granted four hours home help per day but the individual who is to provide that help has only one hour free each day. As a result, Bridie is using her State old-age pension to provide private home help.

The HSE is not using its full budget in County Roscommon and other counties; the money is there and that is not the problem. The problem lies in the policy direction issued by the HSE with the Government's blessing. We have been told time after time in this House that the Government has nothing to do with the day-to-day running of the health service but deals with policy issues. This is a policy issue that is having a direct impact on the elderly and the most vulnerable people in my county and throughout the country. The situation is very frustrating because funding is available. The HSE can appoint managers to supervise the existing home help staff but cannot provide home help staff for much-needed emergency services in my community and throughout the country.

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

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

I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to services for older people generally and, in particular, to the importance attached to developing home help services locally.

Government policy on older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. When this is not feasible, the health service supports access to quality long-term residential care, where this is appropriate. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016.

The Government's objective of continued development of community-based services for older persons is reflected in the funding given to the system in recent times and I am glad the Deputy acknowledged this. In the budgets of 2006 and 2007 over €400 million was provided to enhance service developments across the sector. Of this, just over €190 million was for community-based services over the two years.

Arising from budget 2008, a full-year package of €22 million has been allocated for new services for older people. This gives a total funding of over €422 million for new services for older people over the past three years.

Regarding the specific area of home help services, an additional €33 million was given in 2006, which funded an extra 1.75 million home help hours. This was augmented by a further €18 million in 2007 that resulted in 780,000 extra hours coming on-stream.

In 2007 the highlights of community-based services for older persons provided by the HSE nationally included the following: over 12.3 million home help hours; nearly 55,000 people had availed of home help services by the end of the year; over 4,000 home care packages assisted some 10,500 clients during the course of the year and these packages included an important home help element in many cases; and the use of over 21,000 day centre and respite places.

The new funding package of €22 million provided in the recent budget is designed to enhance important community initiatives, including €4.6 million additional expenditure by the HSE for 200,000 extra home help hours this year. The HSE expects to provide about 11.98 million home help hours nationally in 2008.

The new services coming on-stream will improve the service delivery thresholds that the Government already had in place. In this context, nearly €56 million has been provided in the last three years for new home help services, thus expanding the service nationally by nearly 2.75 million hours over this period.

As the Deputy is aware the Health Service Executive has the responsibility for the management and delivery of health and personal social services, including the operational details relating to home help for the Roscommon area.

The HSE has provided the following information. The total number of clients in receipt of home help services in County Roscommon in January was 808, while the number of new applications for the month was 108. The total number of home help hours provided for this period was 19,990. With regard to the most recent local demand, the HSE indicates that 14 clients are waiting to start the service and 25 existing clients await increased hours.

Deputy Denis Naughten

They will be left waiting.

Deputy Máire Hoctor

This situation is being addressed by the HSE in the context of the ongoing delivery of the service to individual clients.

It is clear from the measures I have outlined that the Government has made considerable improvements nationally to home help provision and other community-based services for older people generally. It is our intention that such services, including the home help initiative, will be improved incrementally in the coming years, in line with Government policies envisaged for the sector. There is no doubt that demand can at times exceed service resources and that this problem can manifest itself in particular at local level. However, it is a matter for the HSE to deliver services both nationally and locally in the context of its evolving priorities and overall resources.

Hospital Services.

Deputy Ciarán Lynch

I wish to share time with Deputy Kathleen Lynch.

As the Minister of State is before us in the House I ask her to explain the actions she will take to address the substandard gynaecological services provided by Cork University Maternity Hospital. Is the Minister of State aware of local general practitioners' concerns that delays in the provision of gynaecological services are likely to result in delayed prognoses, creating a situation in which the health of women in the Cork area will be put in further danger.

Patients with cancer, and those suspected of having cancer, are enduring undue suffering and unnecessary risk due to the current situation. Correspondence I have received from a GP in the Cork area states that in a very short time some patient will suffer the terrible consequences of delayed diagnosis of cancer with a worse prognosis because of the inadequacy of the service, as currently delivered.

There is a problem in Cork at present. The problem is not in seeing the consultant which is the standard difficulty with the health service; a consultant can be seen in a short time in this area. The problem is getting the tests and whatever procedures are necessary carried out. Two theatres which are set up are lying idle. The machinery and the equipment are in place. Women are waiting at the doors of these theatres and cannot get in.

In the Minister's response I do not want to hear words such as commitment, moving forward and budgetary expenditure, rather an explanation of how we have arrived at a situation where women's lives are in danger while two theatres are lying idle, although fully equipped. Does she think this is acceptable? What timeframe will she put in place to rectify this matter? This is an ongoing problem with the HSE where project management is not being delivered. We have seen it with the maternity hospital where a state-of-the-art facility was created and lay idle for more than a year because the Department could not get the agency operational. That the same is happening in this department is unacceptable.

Deputy Kathleen Lynch

I thank Deputy Ciarán Lynch for sharing time. From a position of having had three maternity hospitals, we now have one maternity hospital in Cork. It is about time the Minister for Health and Children came into the House and took responsibility for what is happening in our health services. I know what the Minister of State will say when she stands up.

One does not have a choice in Cork. There is one maternity facility which is, by any standard, probably one of the most modern in Europe. However, the difficulty is that what is available in that hospital is not available to the public. On 22 November 2007 I tabled a series of parliamentary questions about this issue. In every instance, the replies I received were about how good was the hospital, the number of theatres and the number of gynaecologists but what the Minister and the HSE did not say was that there are two theatres in that new facility which are chained. There are chains on the doors of the fully equipped facility but there are no staff. Neither was I told the number of women awaiting procedures.

When a GP has to write to politicians to tell them their patients' lives are being put at risk, it is a sad state of affairs. At the Joint Committee on Health and Children today I listened once again to news of a delayed inquiry into awful things that happened in our health service. Are we looking at another possible misdiagnosis in the whole area of women's health and is that what the Minister is prepared to stand over?

I have heard the Minister say on numerous occasions that this facility is one of the best hospitals in the country. Would the staff of any hotel go out and tell the outside world that the hotel was not working properly? The answer, of course, is no. We are not talking about bed and breakfast here but people's lives. The Minister has to take responsibility for the fact that the taxpayers have put in place a state-of-the-art facility. It is her job to staff it and ensure patients get the best treatment possible.

One of other answers I got in regard to the da Vinci robot was that the first procedure was carried out in September. This particular robot will continue to give a service which will ensure that patients will have very little scarring, very little invasion and will spend less time in hospitals. Is this not the way forward? What that reply did not tell us was that robot has yet to come into operation. It was an insult to be told that the consultants in this area are putting together a cohort of patients to be treated by this robot. The patients are queueing down the road. There is no need to put a cohort of patients in place, they are waiting for this treatment. The Minister has to take responsibility. It is an absolute scandal.

Deputy Máire Hoctor

I am taking the Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Government is committed to the provision of high quality gynaecological services throughout the country, including in the Cork region. The gynaecology service in Cork University Hospital currently provides five gynaecology theatre slots. There were approximately 1,152 elective gynaecology procedures carried out in 2007.

Deputy Kathleen Lynch

That is not true.

Deputy Máire Hoctor

In addition, approximately 17 emergency procedures are carried out each month. There are three operating theatres in Cork University Maternity Hospital——

Deputy Kathleen Lynch

A Leas-Cheann Comhairle, may I ask your advice?

An Leas-Cheann Comhairle

Does the Deputy have a point of order?

Deputy Kathleen Lynch

When clear misinformation is given, how does one rectify that?

An Leas-Cheann Comhairle

The Chair is not responsible for the information given but I am sure the Deputy will find a way to deal with any difficulty she senses has arisen in the debate.

Deputy Máire Hoctor

I have to confirm that no misinformation was given in the House earlier nor will there be.

Deputy Kathleen Lynch

Sorry, misinformation has been given.

Deputy Máire Hoctor

I am not prepared to be accused of providing misinformation.

Deputy Ciarán Lynch

The Minister said in her address this evening that there are three units. Will the Minister of State please clarify that?

An Leas-Cheann Comhairle

The Minister of State to continue without interruption.

Deputy Máire Hoctor

There are three operating theatres in Cork University Maternity Hospital — one obstetric and two gynaecological theatres. The obstetric theatre is fully staffed and the hospital is currently recruiting senior nursing staff to open and lead the gynaecology theatre service. In the interim, the gynaecology procedures continue to be carried out in the main theatres in Cork University Hospital.

The HSE advises that preparations are under way for the phased opening of the gynaecology theatres in the maternity hospital. It is planned that some minor surgical procedures will be carried out there on a trial basis on Thursday, 27 March with the aim of expanding the gynaecology from the first week in April. The ultimate aim is to have the gynaecology theatre open on a five days per week basis. These developments illustrate that gynaecological services continue to be improved in Cork University Hospital.

In regard to the wider issue of cancer care, the HSE has designated Cork University Hospital as one of two cancer centres in the managed cancer control network for the HSE South. The decisions of the HSE on four managed cancer control networks and eight cancer centres will be implemented on a managed and phased bais. The delivery of cancer services on a programmatic basis will ensure equity of access to services and equality of patient outcome irrespective of geography. Professor Tom Keane took up his position as interim director of the national cancer control programme last November. Professor Keane will be engaging in detailed planning to facilitate the progressive, gradual and carefully managed transfer of services between locations over the next two years or so.

A decision on the location of gynaecological cancer services for the HSE South cancer control network will be made by Professor Keane and the national cancer control programme. The development of cancer services, and the continuing emphasis on improving cancer care, underlines the Government's commitment — which I am glad to have the opportunity to put on the record — to providing accessible and safe services for patients in the southern region.

Deputy Kathleen Lynch

The Minister is not living up to that commitment.

Child Care Funding.

Deputy Kieran O’Donnell

I thank you, a Leas-Cheann Comhairle, for allowing me to raise this matter. This issue came to light when Limerick youth services contacted me a short time ago. Since June 2006 more than 14 lone parents involved in FÁS-funded community training schemes, including leaving certificate applied and FETAC programmes, have left these two-year courses which are designed to enable participants to assimilate into the workforce. Under this scheme, up to June 2006, a child care allowance was provided for the full duration of the course. In early 2006 the Department of Enterprise, Trade and Employment instructed FÁS to carry out a review of the scheme and further instructed it to reduce the period of payment for the child care allowance to 52 weeks. It is ludicrous that FÁS community training schemes must be for a period of two years but those taking them cannot continue, as they only receive the child care allowance for 52 weeks. To make matters more ludicrous, a person who began the course in May 2006 will receive the payment for 104 weeks but someone who began in July 2006 only received it for 52 weeks.

There are approximately 119 people undertaking the leaving certificate applied and FETAC programmes which come under Limerick youth services which do fantastic work. Since June 2006 14 people have left the programme, while another three are hanging on by their fingertips and have family members and friends minding their children in an effort to stay on the programme. There is no consistency of care for their children and they find it is impossible to continue on the course.

The Minister must as a matter of urgency reverse the decision made in 2006. It was not made as part of any budget measure. It was done by stealth by the Department without full public knowledge of what was happening. The allowance is €63.50 per child attending day care and €37.50 per child attending part-time day care because the child is attending primary school. As a matter of urgency the Minister must reinstate the child care allowance for these FÁS-funded community training schemes, including leaving certificate applied and FETAC programmes, in order that the allowance is paid for the duration of the course — two years — rather than imposing a penal 52-week cap. The purpose of the training schemes is to encourage people to enter the workforce. In one way, they are being encouraged to take a course but in another the Government is pulling the rug from under them by reducing the duration of the allowance from 104 weeks to 52. I want this decision reversed and await the Minister of State's comments.

Minister of State at the Department of Enterprise, Trade and Employment (Deputy Billy Kelleher)

I understand FÁS provides support for the child care costs of persons who wish to undertake FÁS vocational training programmes. The rates paid are a contribution towards the costs of child care and payment is made on the basis of the child care costs incurred by the person as a result of attending the FÁS training programme.

The following categories are eligible for payment of the child care allowance: unemployed persons, those returning to work, early school leavers, refugees, members of the Traveller community, people with disabilities and lone parents. The contribution is to be paid to those in the above categories who have been unemployed, unoccupied or working in the home for at least six months prior to commencing the FÁS training programmes. A primary carer of a child or children who needs child care in order to take up a training opportunity with FÁS is also eligible for the allowance. A primary carer is "a person who is not employed outside the home, not attending an educational or training course or not engaged in community or voluntary work for more than 15 hours per week". Workers who have been made redundant may also receive the child care contribution on commencing a FÁS training course.

Eligible training is restricted to specific training schemes, namely, bridging training programmes, specific skills training, traineeships, community training, return to work programmes, community training workshops and linked work experience. Eligible children include children up to five years of age who have not started school and children attending primary school up to 13 years of age and who are in after-school care, with the allowance applying for the hours the recipient is on the FÁS training programme. No payment will be made for the hours the child is at school. However, if a child is still attending primary school after the age of 13 years and a trainee provides documentation to support this claim, the trainee can continue to receive the child care allowance.

In 2001, having received approval to proceed with the payment of child care support for trainees, FÁS was directed to make the payment to the providers of child care rather than the trainees individually. This requirement was based on the principle that the FÁS scheme should be as similar to that already in place within the Department of Education and Science. FÁS reviewed the effectiveness of the child care payment in terms of the progression of trainees in 2003 and at the same time reviewed the internal procedural aspects of the payment. A fundamental recommendation by FÁS staff and management from this review was that payments should be made directly to the trainee in place of it being made to providers of child care. In June 2004 the Department of Finance and the Department of Enterprise, Trade and Employment responded that they were willing to consider payment directly to the trainee if FÁS tightened the payment procedure further and if any new arrangements or schemes had a sufficiently tight auditing system to prevent exploitation. To this aim, the maximum number of weeks for which FÁS will contribute to child care payments has been capped at 52 weeks.

My Department is willing to examine the situation regarding the 52-week cap with provisos on the need to consider the numbers and costs involved, and the impact of certain issues, including the potential ripple effect in terms of monetary and other impacts. In order to progress this, FÁS is gathering the following information: the number potentially affected by the cap; the names of specific programmes or target groups, for example, specialist training providers and community training centres, and also the duration of relevant programmes; the additional costs if the cap was extended — a pro rata formula based on numbers could be applied; the potential impact this would have, for example, if FÁS extends this for particular groups, whether other groups would also be entitled to the same, or, if FÁS extended it to other groups, whether it would have budgetary implications; and any other issues or concerns.

I understand that once this information is to hand, FÁS will present it to my Department outlining the historic context and the reasons for this condition to be reconsidered. There is an undertaking by the Department to review the matter.

Deputy Kieran O’Donnell

We should have as speedy a resolution as possible.

Schools Building Projects.

Deputy Ulick Burke

I thank the Ceann Comhairle for allowing me to raise this matter, namely, the urgent need for the Minister for Education and Science to indicate her plans for the provision of a new community school in Glenamaddy, County Galway. The frustration felt by the board of management, parents, students and teachers has reached a level I have never before witnessed on an issue such as this. For the past seven years all of the partners in education in Glenamaddy have co-operated fully with the Minister and the Department in order to achieve an amalgamation of Coláiste Seosaimh and St. Benin's vocational school in the town. All of the community supported this move from the beginning and were promised a new school in return. The Department has denied a rural community the opportunity to survive.

Glenamaddy is located in a CLÁR area. Will the Minister and the Department further disadvantage the area by denying construction of the school? Planning for a new school was processed quickly when a site was identified and secured. The tendering process finally identified a contractor who was ready to start construction immediately. Five years have passed and the patience of the board of management, parents, teachers and students has been exhausted. What other community would tolerate a divided campus for a school? One section of the school is a mile away on the other side of the village which presents a serious danger from traffic for students who travel from one part of the school to the other. Educationally, students are losing out on classroom time and teacher contact.

The school has one science laboratory and six science teachers. So much for the Department's commitment to the improvement of science teaching in schools. The school has one home economics room and three home economics teachers. Construction studies are held one mile away from the main school. PE facilities are totally inadequate. The list goes on. Is that satisfactory in the eyes of the Minister? Are these facilities good enough for a school in County Galway? Why are students in Glenamaddy disadvantaged in this way? It is unacceptable that students currently in the school have to receive an education without proper facilities for all their second level education in this school, while others in leafy south Dublin, for example, have a state-of-the-art school with proper facilities. Is this equity in education?

It is of little use for the Minister of State, Deputy Kelleher, to tell me tonight of the resources that are being spent by the Government on the construction of new schools. Nearly all the expenditure for 2008 will be spent in the Dublin and east coast area that was prioritised. According to the Minister:

Approximately €600 million be spent this year on school buildings. This is an unprecedented level of capital investment...This investment will facilitate the provision of new schools and extensions in developing areas and the improvement of existing schools...The progression of all large-scale building projects from initial design stage through to construction phase is considered on an ongoing basis...[The] Department is committed to providing a new community school for Glenamaddy at the earliest possible date.

We have heard this jargon coming from the Department time and again. What we want to hear tonight is a date when the new school will commence.

I urge the Minister to immediately sanction the funding for this school so that the work can begin on the much-needed facilities. Planning permission for the original school will run out in approximately six months' time. The Minister should honour the promises that were given at the time the amalgamation agreement was made seven years ago. The priority that has been given solely to the east coast must be spread to the rest of the country. I hope that Glenamaddy will be prioritised at this stage.

Deputy Billy Kelleher

Because of the song, everybody has a fondness in their heart for Glenamaddy. I apologise for the Minister's absence. I thank the Deputy for the opportunity to outline to the House the Department's position regarding the provision of a new community school for Glenamaddy, County Galway.

It is proposed to build a new community school in Glenamaddy with a floor area of approximately 5,200 m2 to cater for a long-term projected enrolment of 550 pupils. This new school is to cater for the amalgamation of St. Joseph's convent school and the vocational school. The amalgamated school is currently housed on the site of St. Joseph's convent school in a mixture of temporary and permanent accommodation.

Tenders were originally received for the proposed new school in 2004. However, due to delays in acquiring the site under the redress scheme it was not possible to accept a tender at that time. The project was re-tendered in 2007 and a tender report for the project is currently under examination by the Department. The contract for the project has not yet been awarded.

Under the lifetime of the national development plan approximately €4.5 billion will be invested in schools. Approximately €600 million will be spent this year on school buildings.

Deputy Ulick Burke

Here we go again.

Deputy Billy Kelleher

This is a fact and it is important that we put it on record. This is an unprecedented level of capital investment which reflects the commitment of the Government to continue its programme of sustained investment in primary and post-primary schools. This investment will facilitate the provision of new schools and extensions in developing areas and the improvement of existing schools through the provision of replacement schools, extensions or large-scale refurbishments in the coming years.

The progression of all large-scale building projects from initial design stage through to construction phase is considered on an ongoing basis in the context of the national development plan and the Department's multi-annual school building and modernisation programme. The project referred to by the Deputy will likewise be considered in that context. I reassure the Deputy that the Minister and her Department are committed to providing a new community school for Glenamaddy at the earliest possible date.

Deputy Ulick Burke

Seven years later.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 27 February 2008.