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Dáil Éireann debate -
Wednesday, 4 Feb 2009

Vol. 673 No. 3

Adjournment Debate.

Community Care.

I welcome the opportunity to raise the issue of the closure of the Rowan male ward in St. Columbanus Home, Killarney. A total of 21 beds have been closed in the community hospital and I cannot understand why this is happening. On a weekly basis I am in contact with St. Columbanus Home trying to secure beds for elderly people in need of long-term care. It has been the case for a while that one cannot get somebody admitted to the Rowan ward, or to any ward, in St. Columbanus Home. That is euthanasia by the back door whereby the Government is closing those wards.

The fair deal scheme is being introduced under which the Government will be able to take 5% of a patient's estate over a three year period to use towards their care. With the closure of the Rowan ward, 21 beds are being closed and there have not been any admissions to that ward or to St. Columbanus Home for some time.

St. Columbanus Home has 150 beds but with this ward closure that number is reduced to 129. The concern among staff and patients, particularly those who have been there for six, seven and eight years, is that they will be moved. They have not been informed to where they will be moved. There have not been any further admissions to St. Columbanus Home but the patients who have made it their home have not been informed to where they will be moved.

I cannot understand why beds are being closed in a community hospital. The implication for my area is that people will not be able to find long-term care in a community facility. Also, what will be the implications of that on staffing numbers?

I wish to record my utter disgust, as well as that of the staff and patients of the Heatherside Hospital in north Cork, at the HSE's unilateral decision to close the facility which has housed 42 patients for many years. The decision is illogical and without any common sense basis. It was taken without any consultation with the stakeholders, the nursing staff or the patients. This is a facility that has looked after patients with mental health issues for several years. What is happening in society is disgusting. These 42 patients will be moved into a facility that was already closed down, unfit for human habitation and with Dickensian conditions.

I do not know what the Government or the HSE is at, particularly when they give us much rhetoric on how well they look after mentally ill patients. I am calling on them to put a stay of execution on this decision until such time as there is consultation with the patients' representatives, the families and the community to ensure everyone's rights and entitlements are vindicated. If we have any sense of decency, this issue will be re-examined. I call on the Minister for Health and Children to intervene directly with the HSE to ensure the rights and entitlements of the affected patients are protected and common decency prevails.

I am taking these Adjournment matters on behalf of the Minister for Health and Children, Deputy Harney. I thank both Deputies Sherlock and Sheehan for raising these issues which provides me with an opportunity to update the House on these recent decisions and outline the background and the action taken by the Health Service Executive. I also want to reassure the older people concerned, and their families, about the future of their care.

The Government's policy for older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where appropriate. Health services in all regions continue to be developed and improved and quality and patient safety are ensured.

The Health Service Executive has operational responsibility for the delivery of health and social services, including those at facilities such as Heatherside, north Cork, and St. Columbanus Home, Killarney. The executive is working on an action plan to prioritise a phased programme of refurbishment and replacement of existing public homes, where necessary, to meet the proposed new national standards for residential care facilities for older people. Ongoing reviews are essential to ensuring resources are properly channelled and the changing needs of older people are suitably addressed. The executive continues to address infrastructural deficits to meet standards, together with health and safety and fire requirements.

Heatherside is a facility for older adults with enduring mental health issues located remotely in Doneraile, north Cork, but serving the needs of the South Lee population. Staffed by general trained nurses with support from the South Lee mental health team, the current facility falls short of the requirements to meet residential care standards and would require significant and ongoing capital investment to meet fire and safety standards. Heatherside is no longer able to provide appropriate services due to the increasing levels of dependency of its residents. The executive proposes to relocate this service to more appropriate modern accommodation in St. Stephen's Hospital Campus, Sarsfield Court, Cork.

The relocation will provide a higher quality of service to the residents. The majority of these, with a small number of exceptions, originated from the South Lee catchment area. Only two of the existing 42 residents are from the north Cork area, with the remaining 40 from South Lee. The number of residents in Heatherside has decreased from 130 in 1992, to 80 in 2000 and 42 in 2009. There have been no recent admissions and a significant number of families have refused the option of admission to Heatherside on the basis of its location in north Cork. St. Stephen's is closer and much more accessible to residents, their families, relatives and friends. In addition, access to and support from specialist services in South Lee for residents and staff will be much improved.

That is factually incorrect.

St. Columbanus Home, Killarney, provides 150 continuing care beds in Killarney. The building dates back to the 1850s. The Rowan ward is an 18-bed male unit and is situated on the ground floor of the home. The executive has advised that the environment, design and layout of the unit are unsuited to meet the proposed standards published by the Health Information and Quality Authority last year.

Despite a large investment in it.

The executive has decided to reduce the bed complement in the home to 132 beds by closing the unit. This will take place over an appropriate period. There are three additional beds located on the first floor which are occupied by ambulant patients. These will also need to be reconfigured in the overall provision of beds in the unit.

The priority capital developments for long-stay care approved for County Kerry are the new community hospital in Dingle and the new unit at Killerisk, Tralee. In Dingle, construction has been completed at the community hospital and the unit is being commissioned. It replaces the existing 43-bed unit and will also provide an additional 25 beds for the catchment area. A new 50-bed community nursing unit at Killerisk, Tralee, has also been provided which is also being commissioned. This will cater for the Tralee catchment area. The overall capital costs of these developments is in excess of €25 million, with revenue costs of €7.6 million, representing a major commitment to support the development of services for older people in the Kerry area.

The provision of additional beds in both Tralee and Dingle during 2009 provides the executive with an opportunity to reconfigure residential services for older people in Kerry. With the provision of these additional beds, there will be an opportunity to provide residents accommodated in St. Columbanus Home with alternative accommodation closer to their own community if they so wish.

New beds in Dingle and Tralee will not suit the needs of the people of east Kerry.

There will also be a lesser requirement for the concentration of long-stay beds in the Killarney area as the future needs of north and west Kerry residents will be met in the new units.

The reduction in bed numbers in St. Columbanus will be effected as beds become vacant during 2009. Movement in the home will be minimised and the wishes and requirements of the patients on the ward will be taken into account during the process.

This is an unsettling time for all residents of Heatherside and St. Columbanus. We owe them a duty of care and must ensure our primary focus is on each one of them. Each hospital, each local health office, managers, clinicians and others working in the health services have a responsibility to ensure they strive to provide the best possible service to patients and other clients of our health services. I am confident the executive will continue to work with the residents, their families and representatives to ensure they are relocated to the facilities which will best meet their needs.

This was all decided without any consultations.

The House will agree the safety and well-being of older people is of critical concern. Quality care and patient safety come first and all patients should receive the same high standard of quality-assured care.

Services for People with Disabilities.

I welcome the Minister of State, Deputy Barry Andrews, to the House. He is committed to children with autism and attention deficit hyperactivity disorder.

Recently I received a note from a mother which sets out the concerns of parents of children with autism. She states:

I write with reference to my two and a half year old daughter who has recently been diagnosed with autism and attention deficit hyperactivity disorder. As I am sure you are aware autism is a severe disability that affects the normal development of the brain in areas of social interaction and communication. It is a lifelong disability and there is no cure. Approximately 1% of the population has this condition.

In the last few weeks my husband and I have spent over €2,500 on consultation fees to have our daughter privately assessed in the hope that an early diagnosis and the appropriate intervention will help her have a better future. However, many parents in County Clare do not have the financial means to do this. The average wait time for autism screening in County Clare I believe is approximately one year and often when psychologists, occupational therapists and speech therapists are on leave they are not replaced so this results in even longer wait times. I feel that wait times for this screening need to be urgently addressed as it has been proven that early intervention gives these children the best chance of an independent future and ultimately this will save the State money later on.

In the last few days I have contacted the HSE to see what sort of assistance they can provide my daughter in the future. I have been informed that autism is not regarded a long term illness under the terms of the long-term illness scheme. I would like to know why not. If autism is a lifelong disability with no prospect of a cure why is it not included in long-term illness scheme? With regards to attention deficit hyperactivity disorder, this is officially regarded as a mental disorder yet this is not covered by the scheme either. I have been informed by the HSE that they do cover mental handicap and mental illness in children under 16 but ADHD is not covered under the scheme.

She continues:

With regard to the GP visit medical card, I would like to know why my child and other children who have a lifelong disability do not have an automatic right to this facility? It seems outrageous that a child can be found to have a disability under the Disability Act 2005 yet have no right to a medical card because his or her parent or parents would not satisfy a means test. My child is unable to speak or gesture so I have to rely greatly on my own instincts much of the time to determine if she is ill. Like most autistic children she is completely unable to communicate that she is feeling sick, has a sore throat or tummy pain etc.

I have quoted this into the record to give some sense of the concerns of parents, especially those dealing with children with special needs. It was appropriate and important I do so because from time to time, those of us in this House tend to forget or fail to recognise the difficulties parents have with children with special needs.

I am particularly happy with the Minister of State present because of his function as Minister of State with responsibility for children. I ask him to intervene with the Health Service Executive to ensure a greater level of service is made available to parents with children having special needs, especially with regard to early diagnosis. In this case the parent is concerned about the inability to identify the illness at the earliest possible time. Best practice and research to date shows that early intervention plays a major role in ensuring a child develops to the best of his or her potential, whatever it may be. I look forward to the Minister of State's answer and thank him for being here.

I thank Deputy Dooley for raising this very tough issue and I note his interest in it. I will take this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I wish to emphasise the Government's commitment to providing a high quality service to all people with a disability. This commitment is illustrated by the substantial investment we have been making in disability services over recent years.

Very significant additional resources have been provided for services and supports in this area. The multi-annual investment programme, which is a key component of the Government's disability strategy, had by the end of 2008 provided for approximately 980 new residential places, 313 new respite places, and 2,505 new day places for the intellectual disability service. There were 300 new residential places and 950,000 extra home care and personal assistance hours for people with physical and sensory disabilities.

In the period 2006 to 2008, more than €500 million has been allocated to the Health Service Executive under the multi-annual investment programme, of which €425 million was for disability services and €125 million for mental health. The Government has further emphasised this pledge to people with disabilities by allocating additional funding to the continued development and enhancement of services in 2009. In the 2009 budget, an additional €10 million was allocated to the HSE for services in the area of disability and mental health. The funding for 2009 will provide for 125 additional therapy posts in the disability and mental health services area, targeted at children of schoolgoing age. In addition, once-off funding of €1.75 million is being provided for suicide prevention initiatives and mental health projects supporting service users and carers.

With regard to the matter raised by the Deputy, the HSE states that up to the middle of 2008, the waiting times for children receiving psychology services increased owing to the fact that there were major difficulties in recruiting psychologists because of a shortage of qualified candidates for the position. This relative scarcity also presented challenges to the HSE in retaining psychologists to provide services. Both of these factors contributed to an increase in waiting lists.

The HSE states that the current position on the provision of psychology services to children with suspected autism in Clare is that there is a full complement of psychologists working within the Clare children's services since November 2008. Work has been commenced by the HSE on reviewing children who were assessed, diagnosed and put on a waiting list for psychology services. The HSE states that this review will take approximately four to five months to finalise. This review does not impinge on the level of existing services being provided in the area.

The HSE also states that a new development in the provision of services to children with suspected autism is the establishment of a revised assessment and diagnostic procedure which is in line with best practice. All new referrals of children with suspected autism are covered by this process. The assessment process for the diagnosis of autism is complex and can take up to one week per child.

The HSE states that notwithstanding the introduction of these quality improvements and the associated increase in workload, it expects that, on the assumption that staff can be retained, waiting times will reduce from the present average of one year. The HSE states that while approximately a third of referrals are children with suspected autism, the other two thirds are non-autistic children with very complex needs. The HSE maintains that these non-autistic children are also in need of appropriate services and this impacts on the quantum of service available at any given time for autistic children.

Health Services.

I thank the Ceann Comhairle for allowing this matter to be raised on the Adjournment. The decision by Iarnród Éireann to discontinue the FasTrack service from 31 March will have life-threatening consequences for a number of individuals who depend on the service for the transport of blood samples to Dublin hospitals from different locations throughout the country.

A deeply distressed mother recently contacted me about the consequences of the discontinuation of the service. Her daughter suffers from a life-threatening and lifelong metabolic disorder, maple syrup urine disease. If this condition is not treated aggressively, it can lead to convulsions, brain damage and even death. This disease requires the mother to send a blood sample to Temple Street Hospital weekly and sometimes daily when the child suffers from illnesses such as chest infections, sore throats, toothaches, kidney infections or any condition which puts stress on the body. The sample must be analysed on the day it is taken to get an accurate reading so the mother of the child, under direction of the metabolic unit in Temple Street, can administer the appropriate dosage of medicine to treat the child's condition. If the sample is not received on the day it is taken, the consequences could be fatal. Sometimes the metabolic unit might advise the mother to have the child admitted to Kerry General Hospital or even to be taken by ambulance to Temple Street.

Currently the child's blood sample is transported on FasTrack from Limerick. Her mother finds this a very satisfactory arrangement, as there is an almost hourly service from Limerick to Dublin. The service is also used by two other families from Foynes and Askeaton in County Limerick which have children affected by a similar condition.

In January the Health Service Executive in Tralee was informed that the service will be discontinued on commercial grounds because it was losing money. The mother in question has contacted a number of courier services operating in the Kerry and Limerick region but they could not give a guarantee delivery of a sample on the day it was taken on every occasion because of weather conditions or other circumstances.

I appeal to Iarnród Éireann to review this decision and consider providing a scaled-down service to facilitate the transport of blood samples, X-rays and, in some cases, even blood transfusions from individuals and hospitals. These are not bulky items and would need very little space on a train. If there is space available for bicycles on new trains, surely there could be a provision for medical items.

This could be a matter of life and death for a number of families and it warrants the Minister of State's intervention with both the HSE and Iarnród Éireann. The company made a very insensitive decision on this without consultation with unions, the HSE or the Department of Health and Children. It did not realise the consequences of its actions because the service operates very well currently for both hospitals and individuals. If it is taken away, there will be repercussions and it will be a source of intense worry for the families and people affected. These people are under much strain already and they want to ensure the health of their children is protected, with the children given every chance of survival and hope to lead normal lives. Without this service, it will be very difficult to transport the blood samples to Dublin and get proper advice and medical intervention. I appeal to the Minister of State to take this matter seriously. I hope he can progress it further following this debate.

I thank Deputy Deenihan for raising this matter, to which I am replying on behalf of the Minister for Health and Children, Deputy Harney.

I assure the Deputy that the Minister and the HSE are committed to the highest level of patient care in our hospitals and throughout the health service, including in those circumstances where sick persons are enabled to remain in their homes. It is particularly important in the case of a child suffering from a severe illness that there should be no additional cause for concern for the family due to a failure in a system which is outside their control and, indeed, that of the health service.

In the case in question, the child's illness requires that, when a certain status prevails in her condition, a blood sample must be brought to Dublin to be tested in Temple Street Hospital on the same day. The HSE has been reimbursing the family for the cost of the rail transport whenever the service is required. It is understood that this occurs approximately 70 times per year. The family has been informed by Iarnród Éireann that it will no longer be able to provide the conditions for carrying the blood samples by the fast track service from the end of March 2009. The termination of this service has understandably given cause for alarm and concern to the family, particularly because the facility provided through the service had been instrumental in enabling the child to remain in her home in Listowel.

The HSE is fully aware of the withdrawal of the rail service and understands the implications for the patient and her family. I am pleased to inform the Deputy that it is now in communication with the family and is examining the alternative arrangements that can be put in place to transport the samples as required. In light of the fact that the existing service will continue until the end of March, there is some time to make suitable alternative arrangements in order that there will be no gap in services. The HSE is committed to finding a satisfactory solution to this problem and has assured the Minister that it will pursue the matter in the coming weeks.

Ferry Services.

On 25 November 2008, I received a reply to a parliamentary question I tabled to the Minister for Foreign Affairs in respect of the Government's commitment to ferry services between Greencastle and McGilligan's Point. The opening of this ferry connection in 2002 was an important demonstration of the expanding nature of links between the Republic and the North and of the Government's commitment to the north west. However, that was then and this is now. The ferry service between McGilligan's Point and Greencastle and that between Buncrana and Rathmullan are in serious jeopardy as a result of funding issues at local authority level.

Limavady Borough Council and Donegal County Council initially offered a subvention in respect of these services. However, as the level of this subvention decreased, the operators were obliged to increase fares. Consequently, passenger numbers dropped and the ferries may not operate this year.

The north west has one opportunity in the summer months to help sustain small businesses in the services and tourism sector and bring money into the Exchequer. Earlier today the House debated the public finances and from where we are going to obtain money. A major opportunity exists to allow us to benefit from visits from UK tourists this summer. Last year alone, 400,000 tourists visited the Giant's Causeway in County Antrim and surveys indicate that people tend to travel from there, through McGilligan's Point, on to Greencastle and then across to Rathmullan via Buncrana. They visit tourism attractions such as Glenveagh National Park and Doe Castle and places such as Malin Head. Essentially, they complete the entire historical and cultural tour.

We need to retain this product. This summer will be one of opportunity. I am trying to be as positive and as constructive as possible because we need to considers ways in which potential might be created. Fáilte Ireland and Tourism Ireland have indicated that tourists from the UK — the Welsh, the Scottish and the English — are going to visit Northern Ireland. If they do so, we must try to benefit by encouraging them to travel across the Border. The only way this will happen is via the ferry links to which I refer.

This is a massive opportunity. The UK is committed to providing £22 million in respect of the construction of a new visitor centre at the Giant's Causeway. The figure of 400,000 tourists to which I referred earlier is approximate and may possibly be an underestimation.

I am not seeking funding. However, I am seeking that a meeting involving the Minister for Transport, Deputy Dempsey, the North-South Ministerial Council and the special EU programmes body in respect of funding opportunities should be facilitated. Some €300,000 would be required to retain and maintain the two ferry services to which I refer. The British authorities see the route at Lough Foyle as an international crossing. In the context of the British-Irish Agreement, our Government does not perceive it as such. However, it is a vital item of infrastructure for tourism in the north west. It is a natural corridor that leads out onto the north Atlantic passage.

As already stated, I am not seeking money. All I want is the facilitation of a meeting involving the special EU programmes body and the Minister for Transport. Limavady Borough Council and Donegal County Council do not have the money to pay for the ferry services. However, the EU might potentially be in a position to provide it and this could assist us in raising revenue for the Exchequer. In recent days the EU committed €100 million to an interconnector between Wales and Ireland so there is obviously funding available. I ask the Minister of State, Deputy Noel Ahern, to use his influence to facilitate a meeting between the Minister and the special EU programmes body.

I thank the Deputy for raising this matter and I commend him on the enthusiasm with which he put his case. I have not visited the north west as a tourist for a number of years, but I recognise the potential to which he referred. However, I do not have any good news for him.

As Minister of State at the Department of Transport, I do not have a function in respect of the ferry services to which he refers. I understand Donegal County Council provides funding for ferry services on Lough Swilly. The Department of the Environment, Heritage and Local Government has indicated that in the past, some funding for the Lough Foyle ferry service was provided by the UK authorities, with the balance from Donegal County Council.

I accept that this is an important issue for people in County Donegal and Deputy Keaveney spoke to me yesterday in respect of it. I can outline the broader position with regard to what we do in the Department but I am not sure whether any of the information I will provide is specific to the matter raised by the Deputy.

As Minister of State, I have responsibility for national ports policy, which relates to the provision of commercial port infrastructure and services. In addition, the Minister for Transport is the primary shareholder in the ten State-owned port companies.. However, neither he nor I have a role in the day-to-day operational matters of those companies. Current policy is that ports should operate commercially without Exchequer support.

I also have responsibility for policy in respect of the shipping and maritime commerce sectors. It is important that the market, in the context of tourism and trade, should offer a diverse range of maritime links into and out of the State. The Deputy made a case in respect of the tourism aspect in this regard and I can see the value of that. It has not, however, been the practice of the Department to subsidise shipping routes, nor are there any funds available for this purpose.

As the Deputy is probably aware, there are two European Commission programmes that encourage the development of transnational shipping routes with the objective of shifting freight from the roads network. These are the motorways of the sea and Marco Polo programmes and they are governed by a specific set of rules and a framework. The Irish Maritime Development Office, IMDO, regularly publishes full details of these programmes on its website, www.imdo.ie. The IMDO is the shipping sector’s statutory, dedicated development and promotional agency. When I first heard about this issue the Departments of Arts, Sport and Tourism and Community, Rural and Gaeltacht Affairs and local authorities came to mind because they may be involved in this area in the west and on the islands.

On a point of information——

Points of information are not permitted during the Adjournment debate.

I wish to be helpful because I appreciate the Minister of State's position and the fact that the issue falls between numerous stools.

The Deputy may not contribute again.

I ask the Minister of State to facilitate a cross-party meeting to which Senator Keaveney should also be invited.

The issue does not have a home, as it were, and the Office of the Ceann Comhairle decided my Department should address it. I hate to deliver bad news but shipping services do not come within the remit of the North-South body and are not one of my responsibilities. I will relay the Deputy's request for a meeting to the Minister for Transport, Deputy Noel Dempsey. I do not wish to raise hopes, however, as I do not believe the North-South body has addressed this type of issue to date.

I appreciate that.

The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 5 February 2009.
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