Dáil Éireann debate -
Tuesday, 12 May 2009

Vol. 682 No. 2

Adjournment Debate.

Hospitals Building Programme.

Deputy Frank Feighan

The people of Ballinamore and south Leitrim have been waiting for many years for the Ballinamore community hospital. I was informed in a letter from the local health manager on 24 July 2007 that a document had been forwarded to the HSE national headquarters seeking approval to proceed with the next stage, which would provide for the appointment of a design team that would undertake the design, seek planning approval and procure contractors to build the hospital.

As the Minister of State knows, the facilities at the proposed development will include a primary care centre that will facilitate the provision of services by general practitioners, public health nurses, physiotherapists and other members of multidisciplinary teams. A community nursing unit comprising 21 beds and a day service centre will also be incorporated into the design of the nursing unit. The current cost estimate for the project is €7.29 million. I welcome the appointment of the design team. However, I would be grateful for information on when this much-needed development will be built and open to the public. The HSE and the Government talk about the need for primary care. I would, therefore, welcome a favourable reply on this matter tonight.

Minister of State at the Department of the Health and Children (Deputy Áine Brady)

I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to developing community-based services at local level.

Government policy with regard to 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 this is appropriate. This policy approach is renewed and developed in the current 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. Since 2006, over €500 million additional funding has been invested in long-term care supports for older people. This includes the biggest ever investment, over €200 million, to develop community care services.

As the Deputy is aware, the Health Act 2004 provides the Health Service Executive with responsibility for the management and delivery of health and personal social services. As a corporate body, the provision of these services, including progressing community hospitals at local level, is therefore an operational matter for the executive.

The proposed capital development for Ballinamore, which is at design feasibility stage, has a capital requirement in the region of €6 million and an estimated revenue cost of €500,000 per annum. The facility is due to be completed in 2012. The HSE has indicated that the design team for the community nursing unit, 20 beds, and primary care centre in Ballinamore was appointed in October 2008. Significant progress has been made to date. Stage 2, preliminary design, is complete and it is anticipated that stage 3 will be completed by end of June 09, which will enable an application for planning permission. Construction will require further approval to be included in the 2010 NDP plan. It is anticipated a 12-month construction period would deliver the project, if approved to proceed.

The project will provide a community nursing unit of 20 beds on the HSE campus in Ballinamore, as well as a primary care centre. I understand from the HSE that, when complete, the development will include the following: Ballinamore community hospital — to include long-stay care services and palliative care services; day care services, to include a social model of care with interaction activities and personal care needs; and a centre to facilitate the provision of multidisciplinary primary care services which will ultimately encompass the core multidisciplinary team of general practitioners, public health nurses, mental health, occupational therapy, social work, chiropody, community welfare, physiotherapy, dietetic and home help services. The key objective in primary care policy is to develop services in the community which will give people direct access to integrated multidisciplinary teams such as that proposed for the Ballinamore development.

The HSE has indicated that it aims to have 530 primary care teams developed by 2011. This target will allow the entire population to easily access a broad range of health and personal social services through their local primary care team. Some 110 teams are currently in place, with a further 100 planned by year end. Approximately 200 new primary care centres are currently under consideration following the initiation of a programme to procure centres, which involves the HSE entering into fixed-term lease agreements with private providers. This infrastructure programme aims to have all sites identified by the middle of this year, with the first group of 80 to open by the end of 2010 and the full complement to open in the course of 2011. It is planned to have nine centres opened by the end of 2009.

The new high quality facility planned for Ballinamore will complement the significant service delivery thresholds that the Government already has put in place or planned for primary care and for services for older people. However, in light of the current financial difficulties generally, it will be a matter for the HSE to progress this particular project in its priorities under its overall capital programme.

Services for People with Disabilities.

Deputy Kieran O’Donnell

It is with deep regret that I must raise this issue before the House. I raised the same issue on 1 July last year. The issue concerns disabled people, the most vulnerable in society. There is a lack of funding generally from the Government for the disabled. In my constituency of Limerick East, the Daughters of Charity in St. Vincent's do fantastic work for the intellectually disabled children in schools and provide residential units and training. The issue I am raising concerns six young adult school leavers with no place to go as funding is not forthcoming for them. This would be a bottom line issue for any Government.

These six young adults are a concern. Parents have come to me with their concerns. Last year two parents came to me and after raising the issue many times, funding was eventually provided. I do not want to have to go through a repeat of that this year. I want the Government to give a commitment that funding will be provided for these intellectually disabled young adults whose families, parents and friends want to ensure they reach their full potential. The only way they can do that is if they are given the opportunity to do so within a training setting after they finish school. In that way they could have a decent life with fair expectations.

I should not have to raise this issue on the floor of the Dáil. We all know from our dealings with parents of intellectually disabled children of the work involved in caring for those children and of the concerns these parents have for their children's future when they themselves will pass away. Who will look after their intellectually disabled children? These children who are now leaving school should be able to enter a training environment and have adult day places available to them, yet I must beg here for funding for them. They should not have to be put in this position. The funding should be provided.

I want the Minister of State to inform me that the funding for six adult day places for these six school leavers leaving St. Vincent's, Lisnagry, will be provided. I will continue to raise the issue until funding is provided. I seek a positive response.

Deputy Áine Brady

I am taking this Adjournment matter on behalf of my colleague, Deputy Mary Harney, the Minister for Health and Children. I am pleased to take this opportunity to address the issues raised by Deputy O'Donnell.

As Deputy O'Donnell is aware, a range of training, health and personal social day services are provided by several State agencies, including the HSE, non-statutory agencies funded by the HSE, and specialist training providers funded by and on behalf of FÁS, to young people with disabilities when they leave school. A national review of all health service-funded day services for people with disabilities is being completed. This review indicates that a total of 25,302 people with intellectual disabilities, physical and sensory disabilities, and-or long-term mental health difficulties attend day services, including training services, either provided by the HSE or provided by non-statutory agencies funded by the HSE.

It is important that training services are matched to the person's need. In meeting this need the HSE employs guidance officers at local level to assist in the profiling of young school leavers with disabilities to appropriate training and day services. The guidance officers work with the school leaver, their family, school authorities and service providers to ensure that school leavers with disabilities have access to appropriate services.

The coordination and planning of services to meet the needs of people with disabilities form a central tenet of the national disability strategy. A critical element of such coordination and planning is the requirement to provide financial support for the development and implementation of services. In recent years, the Government has provided significant additional resources for services and supports for effecting real change in the development of services for people with disabilities. The multi-annual investment programme, which was a key component of the Government's disability strategy, had by the end of the period 2005-08 provided the following places for people with intellectual disability: 804 new residential places, 307 new respite places, and 1,863 new day places, and for people with physical and sensory disabilities, 275 new residential places and 911,626 extra home care-personal assistance hours.

In addition, in the same period, the services in 195 day places have been enhanced by the provision of additional supports to deal with school leavers or other adults with significant disabilities; 406 places in the residential service for people with intellectual disability have been enhanced, 61 respite places have been enhanced while 43 residential places in the physical and sensory disability services have been enhanced.

Due to the current economic situation, it has not been possible to provide development funding for additional services in 2009. The HSE and voluntary disability service providers, however, are working together to ensure that of the existing resources available for specialist disability, services are used in the most effective manner possible. In the current challenging economic environment, there is a responsibility on all publicly-funded services to review the way in which services are delivered and ensure resources are used to maximum effect. This also applies to disability service providers in the non-statutory sector.

The aim should be to ensure that the needs of as many individuals as possible are catered for within the resources available. Voluntary agencies within the disability sector are working with the HSE to ensure plans are in place in each area to respond to the needs of individuals with disabilities in 2009. While this will be challenging in the absence of significant funding for new developments, the voluntary sector and HSE are committed to the best use of available resources in a creative and flexible manner to be as responsive as possible to the needs that present.

On the specific issue of availability of day places, the Department of Health and Children and the HSE are aware of the particular needs of school leavers in September 2009. The HSE is reviewing, with service providers, whether capacity exists within current day services to accommodate the needs of some of the individuals in question. Some funding may be available in the HSE's service plan to provide additional capacity in the event that existing services are not in a position to accommodate an individual's service requirements. This will be examined on a local and regional level.

I understand from the HSE that in the specific cases of the six young adults raised by Deputy O'Donnell, this need has been identified, assessments have been completed and that the HSE will shortly commence the process of engaging with the families with a view to providing this service.

Deputy Kieran O’Donnell

I wish the Minister of State well in her new position.

Reserve Defence Force.

Deputy Pat Rabbitte

I thank the Ceann Comhairle for selecting this matter on the Adjournment. We are out and about among the people at the moment and a half dozen young people approached me because they are very upset that their time with the Reserve Defence Force has been terminated. They believe that up to 1,200 people are similarly affected. I did not know that there were 1,200 people in the Reserve Defence Force but they advise me that the figure could be that high. These young people were very much enjoying the experience of working with the Defence Forces, having been accepted as reservists.

I do not know the scale of the impact on the Reserve Defence Force of the Government moratorium that took effect on 27 March 2009. Nor do I know if the number affected is that large but it is a most unfortunate and socially undesirable cut. These are young people, many of whom are unemployed, who regard their time in the Reserve Defence Force as being productive, useful and enjoyable. For many it gives a purpose in life when they have little prospect of employment. They believe that they acquire valuable skills and socially the experience is very worthwhile.

The policy seems to be penny wise and pound foolish. Reservists in the Defence Forces are not paid a wage or salary. Only recently I heard the Minister for Defence boast of increased investment in the reserve with new equipment, clothing and opportunities for improved training. He even claimed that plans were well advanced to send members of the reserve overseas.

The Minister of State at the Department of Health and Children, Deputy Áine Brady is responding to this matter and I wish her every success and enjoyment in her role but I hope she is able to tell me what are the statistics in the reserve, how many of these young people are affected as the half dozen who approached me, and how much will be saved as a result of this decision. In the present climate, with the worst unemployment in the history of the State, I plead with the Minister for Defence to reverse his decision. These young people are not public service employees. The cost of their serving in the Reserve Defence Force is minimal and is money well spent. We should be creating opportunities for these young people and designing programmes to keep them occupied while awaiting employment opportunities. For some young people the Reserve Defence Force serves that purpose for very little investment. For those young people who do not proceed with a career in the Defence Forces it is still worthwhile to serve time with the reserve. I hope the Minister will change his mind.

Deputy Áine Brady

I thank Deputy Rabbitte for his kind good wishes. The Minister for Defence has asked me to convey his regrets to the Deputy for not being available to respond to this matter on the Adjournment in person tonight but he is grateful to the Deputy for giving him this opportunity to clarify the position regarding recruitment to the reserve.

The Reserve Defence Force has undergone significant transformation over recent years on foot of the roll-out of the Reserve Defence Force review implementation plan. The intention was to significantly improve Reserve Defence Force capabilities and enhance interoperability with the Permanent Defence Force. The reserve has been re-organised along lines similar to the Permanent Defence Force with a three brigade structure and a dedicated Naval Service Reserve. These revised organisational structures were brought into effect in October 2005. Further progress has been made in implementing the plan over recent years with increased investment in equipment, clothing and the training of the reserve.

All of the actions taken in implementing the Reserve Defence Force review implementation plan were identified as being important motivators to recruitment and retention of members of the reserve. In addition, significant increases to the rate of gratuities paid to members of the reserve were introduced to improve retention and the uptake of training. Notwithstanding these improvements, membership of the Defence Forces Reserve has declined in recent years.

As the Deputy will be aware, the Government has introduced a moratorium on recruitment to the public service, with effect from 27 March 2009. As with the public service generally, the defence organisation is required to operate with reduced funding for 2009. In this context, all recruitment to the Defence Forces Reserve has been suspended for the present.

The current budgetary position requires difficult decisions. The Minister for Defence's primary goal is to consolidate the significant advances that have been made in developing the Defence Forces Reserve over recent years. He is anxious to ensure, to the greatest extent possible, that the current members of the reserve who have devoted significant amounts of their spare time to the organisation in recent years, are afforded the opportunity to maintain their skills. In this context, members of the reserve undertake both paid and unpaid training. In 2008 members of the reserve availed of approximately 81,000 paid man days. The reduced budgetary position this year will allow for approximately 60,000 paid man days.

Deputy Pat Rabbitte

We do not know how many people are involved.

Deputy Áine Brady

No.

Persons applying for membership of the Defence Forces Reserve are required to undergo security clearance and medical screening in advance of being accepted and attested as members. The military authorities conduct a familiarisation course for applicants pending their successfully satisfying medical requirements and while they are awaiting security clearance. The suspension of recruitment applies to these persons and not to persons who have already been attested as members of the Defence Forces Reserve. The Minister for Defence is aware that this is disappointing to those applicants who were hoping to join the reserve.

Membership of the Defence Forces Reserve has provided a character-forming opportunity for young persons throughout the country. The trend in recent years has shown a decline in membership of the reserve but the changed economic environment could halt this trend. Those who have participated have developed skills that are beneficial to the Defence Forces, their personal lives, their careers and broader society. It is important to ensure that the Defence Forces Reserve remain an attractive and challenging option when recruitment recommences. To this end, the suspension of recruitment is being closely monitored along with the efforts to maintain the effectiveness of the reserve within the more restrictive budgetary provision.

The Dáil adjourned at 8.55 p.m. until 10.30 a.m. on Wednesday, 13 May 2009.