Dáil Éireann debate -
Wednesday, 12 Mar 2008

Vol. 650 No. 1

Adjournment Debate.

Hospital Services.

Deputy Kathleen Lynch

I appreciate the opportunity to raise this issue. This week is national brain injury week. The Ceann Comhairle and I, coming from a part of the country that is some distance from the National Rehabilitation Hospital in Dún Laoghaire, know the difficulties experienced by people who acquire brain injuries. I attended a talk today in the audiovisual room in Leinster House on acquired brain injuries, the definition of which is an injury to the brain that is acquired after birth. An interesting throwaway comment made by one of the speakers was: "Look after your head because your head looks after your mind."

With a serious head injury, immediate intervention is essential to ensure the person returns to normality, if normality can be achieved. A number of years ago, a huge amount of work was put into bringing an outpatient section of the rehabilitation service to the Cork area. In fact, its location was already earmarked, namely, St. Mary's orthopaedic hospital, which has significant grounds, but the plan came to nothing — it simply did not happen. Yet, not a week goes by without public representatives in the southern region receiving phone calls from the parents, wives or siblings of someone who has acquired a brain injury and needs to be in the National Rehabilitation Hospital.

It is conservatively estimated that there are 10,000 new brain injuries every year in this country. When one considers the level of car accidents, building site accidents and assaults at the weekends, we know what is causing them. There are just 110 beds in the Republic to deal with these people. In any man's language, it is not possible to treat 10,000 new cases every year with 110 beds. A recent report tells us that there are 20 neurologists in the country when for our population base there should be 42, and nine neurosurgeons when for our population base we should have 16. The Netherlands has 12 times the number of rehabilitation consultants per head of population than Ireland. At present, there are approximately 700,000 people with acquired brain injury and, because of the process of ageing and with people living longer, it is estimated that there will be 800,000 in ten years.

The stories, one after the other, are horrifying — I am sure we could all relate at least one or two. People with a brain injury may spend three years in a long-stay care bed but if they get the proper treatment and a proper rehabilitation process, they can be up and about, returning to normality and looking after themselves. Without doubt, this is where our resources should be invested because the impact a brain injury has on the individual and his or her family is immeasurable. The cost of keeping someone in long-term care is equally immeasurable when that person could be up and about and returning to productive life.

I raise this issue as a result of an incident that occurred in Cork in the past six months. In that case, the person was very lucky. As a result of persistent pressure, he got a bed in the National Rehabilitation Hospital and is still there and doing extremely well. The staff at the hospital are extremely professional and expert in what they do but for every one person the hospital can accommodate, it is turning away at least ten. We need a rehabilitation service in the south and we need at least double the number of beds that are available at present.

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

I thank Deputy Lynch for raising this important issue. I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The National Rehabilitation Hospital in Dún Laoghaire is a 120-bed hospital which provides treatment and rehabilitation for patients with spinal cord injuries, head injuries, amputation, traumatic and non-traumatic brain injury, strokes and neurological disorders. The hospital also provides wheelchair and mobility aids assessment, and pre-vocational and vocational training programmes involving a wide range of social, personal and work related skills with a view to enhancing opportunities for each individual for further training, employment and educational options. In addition, there is also a 12-bed hostel to enable patients from outside the greater Dublin area to access day services at the hospital and attend the vocational training unit.

A new hospital is in the planning stages and once built will provide additional capacity at the hospital. This project will increase the bed capacity and the diagnostic capabilities of the National Rehabilitation Hospital. I understand a project team is working with an appointed design team to develop the brief for the new hospital and plan for the development of a new hospital.

The Health Service Executive has also informed the Department that a project team has just completed a needs assessment on the development of an acute medical rehabilitation unit of 25 beds which is recommended to be built at Beaumont Hospital. This unit would provide acute medical rehabilitation services and early rehabilitation for those suffering from brain injury who access the national neurosciences unit at Beaumont and who currently have to access services at the National Rehabilitation Hospital. In addition, plans have been prepared in some regional areas for rehabilitation facilities.

The Department and the HSE are aware of the need to review the potential benefits of a regional network of rehabilitation facilities and services. The development of such a network will be considered in the context of a national strategy for rehabilitation services. The Department and the HSE are developing a national strategy for the provision of medical rehabilitation services. A number of issues will be considered, including an assessment of the need, the structure and location of facilities and services and the nature of the rehabilitation facilities, that is, whether they should be hospital-type, step-down, or preparation for independent living.

Increasing demand for neurology services with the rapid pace of technological advances in neurology were drivers for the strategic review of neurology services undertaken by the Health Service Executive. It was overseen by a multidisciplinary steering group, the aim of which was to identify the current level of service provision and future requirements for neurology and neurophysiology services. The specific objectives were to describe the epidemiology of neurological conditions in Ireland; evaluate current neurology services, including paediatrics and neurophysiology; review the evidence in regard to models of service delivery and make a recommendation on the preferred model for the health system; identify requirements for the development of neurology and neurophysiology services nationally and prioritise service requirements; and report to the director of the National Hospitals Office.

The HSE has advised the Department that work on the review has recently been completed and that the final draft report has been submitted to the director of the National Hospitals Office for consideration. In recognition of the need to develop services in this area additional development funding of €4 million was allocated to the HSE in 2007 to support the ongoing development of neurology, neurophysiology and neurosurgery services. This investment builds on the investment of €3 million additional revenue funding in 2006 for neurology and neurophysiology services.

The HSE has advised the Department that there have been improvements in the number of consultant neurology posts since the publication of a report in 2003 on neurology and neurophysiology by the former Comhairle na n-Ospidéal. There are 24 approved posts of consultant neurologist, an increase of ten posts since the publication of the report. In addition, there are seven approved posts of consultant clinical neurophysiologist, which represents a doubling of the number of posts since 2003. I thank Deputy Lynch for raising this important issue.

Deputy Tom Hayes

I wish to share time with Deputy Mattie McGrath.

An Ceann Comhairle

Is that agreed? Agreed.

Deputy Tom Hayes

I thank the Ceann Comhairle for the opportunity to raise this important issue for my constituents in south Tipperary. A 23-bed unit that was completed in July 2007 lies idle. This is an utter disgrace. It is one of the issues which has been highlighted in the debate on the HSE. Why would anybody spend money on developing a unit only to leave it idle when patients lie on trolleys in South Tipperary General Hospital week in, week out? This is an abuse of public money. It is unfair of the HSE and the Minister to allow this to happen. I impress on the Minister the urgency with which the Department needs to handle this issue. It is unfair to expect HSE officials and management in the hospital in south Tipperary to continue to have to put patients on trolleys. That is unfair and unjust and totally wrong. This unit could deal with asthma patients or patients with chest pains. It could be the first point of care after patients are admitted to the hospital through the accident and emergency department. It could also be a backup unit for the medical and surgical units and for patients with pneumonia, who have had a stroke and a range of illnesses.

Limerick Regional Hospital which is not far away has a unit only one quarter the size of this unit which is left idle. The unit has been fitted out with new equipment. This is a blatant abuse of taxpayers' money. I hope that as a result of my raising the issue jointly with my colleague, Deputy McGrath, something will be done with this unit.

Deputy Mattie McGrath

I also thank the Ceann Comhairle for allowing us to raise this matter tonight. I further thank my colleague for sharing his time with me.

I, too, am extremely concerned about the situation in South Tipperary General Hospital where a new state-of-the-art 23-bed acute unit lies idle, although it was designed and constructed to the highest possible standards and is fully equipped. I pay tribute to the hospital staff who, from the receptionist at the front door to the top surgeons, are under pressure in trying to deal with the awful conditions under which they operate. Many patients are on trolleys or wait for hours to be seen while this unit lies idle. There are similar cases around the country. I condemn out of hand the HSE's lack of joined-up thinking and the inability of senior HSE staff to visit hospital management to explain why the unit remains closed. It is unbelievable that this unit which has been designed and built to the highest standards is allowed to lie idle. It is a travesty that millions of euro have been spent on the unit but it remains idle. Significant investment has been made in the hospital in general in the past ten years since the decision to relocate all services to Clonmel. This unit was part of the package which the nursing staff, doctors and other medical staff bought into and which is now being reneged on.

I call on the Minister to visit the hospital and meet senior management to give a date when this magnificent service can be put into operation. This would allow staff to deal with patients on a daily basis in the conditions to which they are entitled. A total of 790 staff work in the hospital. We have 247 beds in addition to those in this unit. The staff are doing a top quality job and in need of our support. People in south Tipperary do not need such confusion, which is leading to morale being at an all-time low in the hospital. I do not know how staff continue to work there on a daily basis with decisions like this.

Another outstanding issue is the provision of palliative care beds which were promised but have not been delivered. The situation is unfair to all concerned and the public which supports the hospital. The catchment area includes approximately 80,000 people. I plead with the Minister to come and see the unit for herself at first hand.

Deputy Brendan Smith

I thank Deputies Hayes and McGrath for raising this issue. I am taking this adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The provision of services at South Tipperary General Hospital and across the south-east region in general is the responsibility of the Health Service Executive. The Government is committed to providing a high quality service for all patients. South Tipperary General Hospital is a key element of hospital services, as outlined by both Deputies Hayes and McGrath. It has 253 beds providing acute services for the south Tipperary population of 82,000 people. It also provides services for the bordering areas of north Tipperary and west Waterford, thus increasing the catchment area to in excess of 100,000 people.

Activity in South Tipperary General Hospital in 2007 included 12,346 inpatients discharged; 4,907 day cases seen; 39,004 outpatient attendances; and 28,139 emergency department attendances. The number of births in the hospital, at 1,138, was the highest recorded since 1987 when 1,202 babies were born.

Following the amalgamation of Our Lady's Hospital, Cashel and South Tipperary General Hospital, Clonmel, in January 2007, major capital development was required to facilitate the transfer of accident and emergency services, general surgery and oncology services from Our Lady's Hospital to Clonmel. The Government has facilitated this strategic development with capital funding of €30 million. Phase 1 of the development included the new radiology unit; the medical emergency room; an ongoing refurbishment programme to upgrade wards, including the maternity ward, and the refurbishment of the new areas for the laboratory and pharmacy services. Other capital works to facilitate the amalgamation of the hospitals included the extension and refurbishment of the staff restaurant, the temporary outpatients building and the extension of car parking facilities for patients and staff.

I understand the national capital steering group will meet shortly to consider the extension of the emergency department and the addition of a ten-bed medical assessment unit. The commissioning of services flowing from the capital developments completed in the recent past, including the 23-bed acute care unit in South Tipperary General Hospital, will be considered within the HSE's overall budget. The National Hospitals Office of the HSE must operate within budget, in common with the entire health service. The HSE will continue to do all it can to ensure the provision of a high quality, patient-focused, service for the people of south Tipperary.

I will bring the contents of the Deputies' contributions on the Adjournment to the attention of the Minister.

Sports Capital Programme.

Deputy Olwyn Enright

I am sure the Ceann Comhairle will be interested in this issue. This is an attempt to get clarity on this problem and reach a solution. The situation has been explained to me by a particular club in my constituency but it affects several clubs to which I have spoken and my Fine Gael colleague Deputy O'Mahony has told me the issue has been brought to his attention by several clubs around the country. The Minister will be aware of how the sports capital programme operates. The club I am using as an example applied for funding in 2006 and was successful in obtaining a grant of €120,000, for which it was very grateful. It delivered on its project on time and on budget, which is as much as we can ask of any club. It was given permission to apply for grant aid for further development in 2007. It applied and was granted €100,000. It followed all the rules, put in its three tender bids and got approval to proceed with the lowest bid. Again, it completed on time and within budget, paid the developer and applied to draw down the grant. Then it hit the problem.

Under the rules, if a total grant aid comes to more than €150,000, a deed must be procured from the Chief State Solicitor's office to ensure that the State would have a hold over the asset if the club is ever sold. I have no difficulty with this as part of the sports capital funding, but the time involved in obtaining this is causing difficulty. In this instance the club has been tied up for months. The club was very conscious of the Department's vigilance in ensuring clubs drew down the funding on time in the same tax year and on completion of the work. However, as a result of following the rules this club is servicing a loan of €100,000. That was originally a bridging loan, and the Minister will be aware of the cost of bridging finance. However, realising the length of time involved the club has switched to an interest-only loan, which is not as expensive but is still a large draw on a voluntary resource.

The other problem is that this is eating up the club's funds so that it is starved of development funding and as a result is unable to apply under this year's programme. I appreciate that strict criteria are required, it is taxpayers' money and it is important that money can be reclaimed if facilities are sold on. This makes sense. However it is unfair that clubs must foot a significant cost as a result. I also appreciate how busy the Chief State Solicitor's office is. I ask the Government to engage with the Chief State Solicitor's office so the problem which affects many clubs around the country can be resolved as the only winners are the banks charging interest. Nobody in the House will disagree that all the clubs do invaluable voluntary work catering for people of all ages and abilities and this places an unnecessary extra burden on very limited voluntary resources.

Deputy Brendan Smith

I thank Deputy Enright for raising this important issue. I am taking this adjournment debate on behalf of the Minister for Arts, Sport and Tourism, Deputy Brennan, who is unavoidably absent.

The social and economic benefits of sport are acknowledged by this Government and are reflected in the unprecedented level of Government funding for sport. The level of funding available for spending on sport in 2008 is €336 million, compared to just €17 million in 1997. The commitment by Government to sport was further emphasised by the publication of the National Development Plan 2007-2013 which included a commitment to provide €991 million for sporting infrastructure during the period up to 2013. This increased investment in sport in recent years has supported the promotion and development of Irish sport and the provision of a modern sporting infrastructure, with high quality facilities catering for the participation, coaching, training and competition needs of all levels and types of sport.

Under the sports capital programme, which is administered by the Department of Arts, Sport and Tourism, grants are allocated to sporting, voluntary and community organisations for the provision of sports and recreational facilities and equipment. Since 1998, more than 6,700 projects have been funded, providing a range of essential sports facilities throughout the country, bringing the total allocation of sports capital funding in that time to €568 million. In addition, more than €107 million has been allocated towards the development of Croke Park. The success of that programme is evident when any of us have the opportunity to visit that world-class stadium.

Applications under the 2008 sports capital programme were invited by way of advertisement in the national press on Sunday, 13 and Monday, 14 January this year. The deadline for paper-based applications was Friday, 29 February at 5 p.m. and the deadline for receipt of on-line applications was Friday, 7 March at 5 p.m. The Department of Arts, Sport and Tourism is sorting the applications received. My colleague, the Minister for Arts, Sport and Tourism, Deputy Brennan, will announce the projects to be funded after his officials have completed the assessment of the applications.

The House will appreciate that the scale of these investments warrants protection of the State's interests, as Deputy Enright adverted to. Under the terms and conditions of the sports capital programme, grantees — other than those solely seeking sports equipment — in receipt of funding over a cumulative total of €150,000 must enter into a deed of covenant and charge to protect the Minister's and taxpayers' interest and to ensure that the property remains in sporting use. This places a charge on the grantee's property, which depreciates over the course of fifteen years.

The Minister understands that the Chief State Solicitor's office issues a comprehensive legal pack to all solicitors acting on behalf of grantees, which includes all necessary documents. When the documents are returned they are checked by the Chief State Solicitor's office and, if in order, the deeds can be sent to the Department for sealing. A proportionate amount of time is required for legal documents to be checked by the Chief State Solicitor's office. If the documents are not in order the grantee's solicitors will be notified.

There can be a number of reasons for a delay in the process such as delays on the part of the clubs in having the deed of covenant and charge put in place or delays in the submission of fully completed paper work or the provision of a prompt response to queries raised. The State must ensure that the legal formalities are complied with by the clubs otherwise the necessary securities will not be available to the State. This necessity to ensure that the requisite security is provided inevitably results in delays from time to time. The Department's officials have a very good working relationship with the Chief State Solicitor's office and together they are constantly trying to improve the operation of the programme to assist clubs in meeting these necessary conditions required to protect significant Government investments. In this context, grantees are informed that they should not start any work in advance of the completion of the deed and other procedural requirements of the programme. This is to protect the grantees as no payment can be made until these requirements are met. If the Deputy is aware of projects where a serious delay is occurring, the Minister would be happy for his officials to raise the matter with their counterparts in the CSSO.

I am sure Deputy Enright will join me in complimenting our Ceann Comhairle on the outstanding success of the programmes he ran as Minister for Arts, Sport and Tourism over several years. Many facilities around the country owe a great deal of gratitude to our Ceann Comhairle.

Deputy Seán Haughey

Hear, hear.

Deputy Olwyn Enright

They certainly do.

An Ceann Comhairle

I second that.

School Transport.

Deputy Niall Collins

I am grateful for the opportunity to raise this important issue and the wider issue of catchment boundaries which is causing a dilemma for many parents and their children. In County Limerick and up and down the country the boundaries as presently constituted are outdated. They were drawn up 20, 30 or 40 years ago and do not reflect the demographics, geographical spread of people and population centres in County Limerick. Many parents who work long and hard are severely affected by the effect on school transport of the catchment boundaries.

I have been contacted by the parents and friends association of Caherconlish national school in county Limerick with their concerns on their location within the catchment areas in County Limerick and its impact on Limerick city catchment areas. Approximately 12 km from Limerick city, Caherconlish is growing as a population centre. At the 2002 census it had a population of 618 people and this is predicted to rise to approximately 2,200 people by 2011. Approximately 90 children attend the school in the village but this number is predicted to rise substantially in the near future. In the past year there were approximately 60 baptisms in the parish. That gives an indication of the present and predicted size of the population centre. Caherconlish is in the Limerick city catchment area but the parents feel that due to the admissions policy of the various schools in the Limerick city area, it is almost impossible for children from the Caherconlish area attending national school in Caherconlish to access appropriate second level education in Limerick city. Parents from Caherconlish and the wider area feel that competition in the Limerick city schools placement process is not on a level playing pitch at the moment, and they are seeking change. Children from Caherconlish currently seem to attend secondary school in Doon and Cappamore, which are approximately 20 km to 30 km from the village. They also attend Saint John the Baptist Community School in Hospital, which is approximately 10 km from the village. As they are not part of the catchment area of that school, there is no provision for transport for children from the Caherconlish area. The parents must rely on the goodwill of neighbours and must plan transportation themselves, which impacts greatly on their daily lives. They asked the Oireachtas Joint Committee on Education and Science to seriously consider the idea of extending the catchment area of the school to include Caherconlish, so that the pupils from Caherconlish could have the opportunity to avail of school transport. They should not have to rely on concessionary arrangements which arise whenever there is spare capacity in the transport provided.

I have been asked to raise this issue on behalf of the parents and friends association of Caherconlish national school. It is a very important issue and it mirrors quite a number of areas around County Limerick and probably up and down the country. In my home parish of Patrickswell, I have a number of constituents who are in a similar situation as they live outside the catchment area of Coláiste Chiarán in Croom. We would be grateful if the Minister and the Department could give consideration to this through the review process of the catchment areas, which is also being conducted by Deputy Paul Gogarty in the Joint Committee on Education and Science. I hope the process adequately reflects the demographics on the ground in County Limerick.

Minister of State at the Department of Education and Science (Deputy Seán Haughey)

I thank the Deputy for raising this matter as it provides me with an opportunity to outline the position on the commitment in the programme for Government to review the school transport system, including catchment boundaries.

Before I address the issue, I will provide an outline of the extent of the school transport service. School transport is a very significant operation managed by Bus Éireann on my Department's behalf and covers more than 82 million km annually. Around 135,000 children, including more than 8,500 children with special needs, are transported in more than 3,800 vehicles on a daily basis to primary and post-primary schools throughout the country. This includes more than 9,000 school children who travel on scheduled bus and rail services, including those operated by licensed private contractors.

Government investment in the scheme has increased very significantly over the years. Expenditure in 1998 stood at just over €51 million, while this year's allocation is just over €175 million. This investment has been targeted towards the development of new services, improvements in the quality of service and extensions and alterations to existing services, mainly relating to transport for children with special needs.

In 2001, the following improvements were made to the school transport scheme. The number of pupils required to establish a new primary school service was reduced from ten eligible pupils to not less than seven eligible pupils. The threshold for maintaining a post-primary service was reduced to four eligible pupils, provided there is a minimum of six fare-paying pupils using the service. At post-primary level, the combined daily travelling and waiting times were reduced from a maximum of three hours to two and a half hours. The distance requirement for the remote area grants for primary pupils was reduced from 4.8 km to 3.2 km, and the distance requirement from the nearest route was reduced from 4.8 km to 3.2 km in respect of fully-eligible post-primary pupils.

Further significant improvements were made since 2005. The three for two seating arrangement was phased out on post-primary services by December 31 2005 and on primary services by December 31 2006. Bus Éireann was given approval to acquire 161 buses, including 50 new buses. In addition, more than 300 extra vehicles were hired from the private sector. All buses in the school transport scheme have been equipped with safety belts.

A major focus of the increased investment is the provision of improved services for children with special needs. It is estimated that more than 30% of the financial allocation for school transport is now being expended on transport services and grants for such children, who account for about 6% of the overall number of children carried. Costs are high in this area because it is not always possible to accommodate these children on regular school transport routes and special transport has to be provided, such as minibuses, wheelchair-adapted vehicles and taxis.

This substantial expansion and improvement in school transport services is best illustrated as follows. The total number of vehicles in the school transport fleet went up from more than 2,400 in 1998 to more than 3,800 in 2007. In the same period, taxis were introduced as a new category of school transport and now more than 550 are in service. Taxi services are primarily for special needs children, for whom transport by car is often the most appropriate option. The number of mini-buses in service during that period went up by almost 250, again reflecting the expansion in the special needs area. A further enhancement has been the funding provided for escorts to accompany some children with special needs. More than 1,000 of those escorts are now employed at a cost of more than €13 million per annum.

At post-primary level, eligibility for transport is based on both distance and residence in a particular catchment area. These areas have their origins in the establishment of free post-primary education in the late 1960s and were determined following consultation with local educational interests. The programme for Government includes a commitment to review the school transport system, including catchment boundaries. My Department is currently developing proposals to progress this commitment and the intention is to make substantial progress during the current year. However, I cannot pre-empt the outcome of the review by giving commitments on any specific changes to particular catchment boundaries.

My Department is conscious of the complexities involved in the review and the challenges likely to arise. Nonetheless, we intend to approach the task constructively and with an open mind. Furthermore, we propose to use the opportunity to consult relevant interested parties and to tease out the issues involved. Consultation with Deputy Collins should occur in that process. I again thank the Deputy for raising the issue and for giving me the opportunity to outline my intentions.

The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 13 March 2008.