Dáil Éireann debate -
Thursday, 21 May 2009

Vol. 683 No. 2

Adjournment Debate.

Ambulance Service.

Deputy Pat Breen

I thank the Ceann Comhairle for the opportunity to raise this matter. The removal of 24-hour emergency care from Ennis General Hospital has left people living in remote and peripheral areas of County Clare isolated. We were assured by the Government and the HSE in County Clare that the reconfiguration of accident and emergency services in the mid-west region was being implemented for patient safety reasons and to provide us with a better service. The people are not convinced and the reality is that many of them are worse off, as acute emergency care at Limerick regional hospital is further away from them.

When the issue of advanced paramedics replacing 24-hour emergency care was first mooted I warned that they should not be centrally located and, instead, they should be available 24-7 in each local ambulance station. With the best will in the world, the advanced paramedics and the ambulance service, who are doing their very best, cannot replace acute hospital treatment within the "Golden Hour". In the absence of 24-hour emergency care and, bearing in mind the isolated and remote areas where people live, the provision of an air ambulance service in the mid-west region must be fully examined and investigated. The one trolley, one patient rule causes particular problems, especially if there is a major road accident where two, three or four people who have sustained injuries require hospitalisation. Recently, there was a road accident near Lisdoonvarna, County Clare, and two people had to wait two hours for an ambulance. Thankfully, their injuries were not life-threatening. The ambulance crews did great work but they cannot be in two places at the one time.

When the HSE made the decision earlier this year to bypass Ennis General Hospital and transfer all future trauma cases from Clare to Limerick, I highlighted the need for the introduction of an air ambulance service. Thankfully, a helicopter pad is in operation at the Mid-West Regional Hospital in Limerick. I had campaigned for this since 2005 because, prior to this, patients had to be transferred by road. During a recent briefing of Oireachtas Members by Professor Drumm and his team from the HSE, I pressed them on the need to base an advanced paramedic team in Kilrush. They highlighted the huge expense of training paramedics and claim this expense could not be justified because of the low turnover of patients and it would not be viable. However, during the briefing, Dr Drumm urged Members to campaign for an air ambulance service to be based at Shannon Airport, which could service isolated areas in Clare and the entire region. It could be crewed by a medical team from the Mid-West Regional Hospital in Limerick and the HSE told us that it would cost approximately €5 million a year to run.

This is not a large amount of money if it saved one life. The emergency coastal air service is already working exceptionally well in Shannon. The Air Corps has new helicopters and has the necessary experience. Similarly, the Garda helicopter is working successfully in its work, also.

As an island nation the provision of an air ambulance service is necessary. The ball is now firmly in the Government's court and the Minister must take the lead. Negotiations with the HSE must be initiated with the Department of Transport and the Department of Defence with a view to providing an air ambulance service in the mid-west region. It should not be left to charities to fund this essential service.

I welcome the efforts being made by the All-Ireland air ambulance to launch an air service, but it is a charity-funded service and will require over €85,000 per month for it to happen. It is hoped that future funding will be raised through fund-raising events and donations. However, Ireland is the only country within the EU that does not have a dedicated air ambulance service. No such essential service should have to depend solely on fund-raising to survive. We know how difficult fund-raising is at the moment.

It is already well proven that air ambulances save lives and that the mortality rate for patients who are transported to hospital increases the further one is away from a hospital. Over 44,000 people living in Clare are outside what is termed the "golden hour". The geography of the area creates huge difficulties, whether a person is in Loop Head, Kilbaha, Carrigaholt, Fanore or Ballyvaughan. If the Minister is serious about patient care then the highest standard of clinical care should be available to everybody irrespective of where they live. It is about time that serious consideration is given to the provision of an air ambulance service. All avenues should be explored to encourage and support the provision of such a service for the people of the mid-west region. This should be done in conjunction with the Minister's colleagues in the Department of Defence and the Department of Transport.

An Ceann Comhairle

I call the Minister of State, Deputy Áine Kitt.

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

I thank Deputy Breen for raising this Adjournment matter, which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

As the Deputy is aware, the reconfiguration of acute hospital services in the HSE mid-west area involves the reorganisation of the regional accident and emergency structure. As part of this reconfiguration, HSE ambulance services in the mid-west have been significantly enhanced and an advanced 24-hour paramedic service is now in operation. Protocols are in place to ensure that all trauma, paediatric and obstetric emergency cases will be brought directly to the major tertiary centre at Limerick Regional Hospital.

Advanced paramedics are trained to a high standard which equips them to provide more complex pre-hospital care than their colleagues in other ambulance service grades. Advanced paramedics can administer a wider range of drugs and carry out urgent assessment and treatment of patients with life-threatening conditions prior to arrival at the hospital, including immediate resuscitation as necessary. These skills constitute an invaluable contribution to maximizing outcomes for patients who become seriously ill or injured.

As the Deputy may be aware, an air ambulance service is currently provided by the Air Corps on behalf of the HSE. The service operates on the basis of a service level agreement prepared by the Department of Defence and the Department of Health and Children, in consultation with the Health Service Executive and the Defence Forces, including the Air Corps, all of which are signatories to it.

The air ambulance service is provided for the following categories: inter-hospital transfer of patients with spinal or other serious injury or illness, neonates requiring immediate medical intervention in Ireland, patients requiring specialised emergency treatment in the UK, organ retrieval teams within Ireland, and paediatric patients requiring immediate medical intervention in Ireland. In addition, the Irish Coast Guard provides air ambulance inter-hospital transfers as part of its work and also provides for emergency medical evacuation from the islands around Ireland. In situations where the coast guard service is not available, the Air Corps may transport patients from offshore islands to mainland hospitals.

The focus of ambulance service policy for the medium term is on the consolidation and development of land ambulance services. This includes ensuring that ambulance personnel have the requisite skills and training to enable them to provide more complex pre-hospital care. The continuing development of control and deployment arrangements will also enable the most effective and efficient use of available resources.

There are no plans at present for the HSE to become involved in the development or use of private air ambulance services, as any funding that might be diverted to another air ambulance initiative would be at the expense of the ground fleet. However, the Minister will bear the question of air ambulances in mind as a possible option in the longer term.

Deputy Pat Breen

With all due respect, the Minister of State did not answer my question. I wanted to have an air ambulance service to bring patients in as quickly as possible from around the region.

Psychiatric Services.

Deputy Dan Neville

I welcome the opportunity to raise this matter on the Adjournment concerning the Monageer tragedy in County Wexford. I want to raise in particular the fact that the psychiatric services were not involved in drawing up of the report. The key to the tragedy was the suicidal ideation and intention of Adrian Dunne and that of his wife. One can deduce from the report that she was heavily influenced by Mr. Dunne.

The report of the inquiry concluded that if the services had intervened with the family on the weekend of their deaths it is unlikely the tragedy would have been averted. I profoundly disagree with this assumption, however. Intervention should have taken place and the failure to complete a suicide risk assessment with Adrian Dunne had the most serious of consequences. The failure of the Government to invest in suicide prevention programmes again highlights its serious neglect in this area, which has tragic consequences for so many victims and their families through the country.

The decision of a person to take their life is complex and multifaceted. It is wrong and dangerous to attribute this terrible decision to one simple factor. A superficial suicidal risk assessment in relation to Mr. Dunne suggests a high possibility of serious suicide ideation and intention. The following issues, when combined, would lead one to such a conclusion. I wish to outline these ten issues as follows. First, he was a young father who was making detailed plans for his funeral and that of his family. This alarmed the funeral undertaker who was so concerned that the gardaí were notified. Second, Mr. Dunne was in mourning for his brother who took his life the previous month. Third, Mr. Dunne was mourning his father who died the previous year. Fourth, he had recently finalised his will. Fifth, he and his family were socially isolated. Sixth, he had intellectual and physical disabilities. Seventh, the family had a high level of engagement with health and social services. Eighth, he had unmanageable debts. Ninth, there has been an incidence of suicide-related tragedies in the Wexford area, which introduces a copy-cat dimension. Finally, another brother of Mr. Dunne's died in a car accident. He made reference to this in his conversation with the funeral director. He also spoke of eight different people who had been in accidents. It is accepted that some deaths on our roads are suicides.

This superficial assessment should alert the services that there was a high level of suicide ideation and that the victim was suffering deep psychological, emotional and-or psychiatric trauma. All the services available to save his life, including the psychiatric services, should have been engaged immediately. If this had happened, he and his family could have been saved. The fact that this did not happen, demonstrates again the serious neglect of funding services for people in crisis and allocating resources to develop suicide prevention proposals.

The Minister for State says that funding of €15 million to introduce the main recommendation of the report "is an issue at the moment" demonstrates the value placed on the lives of those who are suicidal. I repeat that the decision to take one's life is highly complex and there is no easy answer. Those who die by suicide do not intend to take their lives, but know of no other way to remove the deep psychological and sometimes physical pain which they are suffering. I am concerned that Mr. Dunne's psychiatric condition, including a suicidal tendency and psychological mindset, was not considered deeply by the inquiry into the tragedy. A psychiatric consultant should have been on the board of the investigation because this issue was such a key one in the tragedy.

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I thank Deputy Neville for raising this Adjournment matter and I welcome the opportunity to respond to it. In April 2007, the Government took the decision to convene an independent inquiry to examine the full circumstances of the tragic case of the Dunne family, whose bodies were discovered at their residence in Monageer, County Wexford. The three-member inquiry team commenced its work in January 2008. Under its terms of reference, the inquiry was to deliver a report to the Minster for Health and Children and the Minister for Justice, Equality and Law Reform by 7 April 2008. The timeframe of the inquiry was extended on three occasions, and the report was finally submitted to both Ministers on 6 October 2008.

In establishing the inquiry, officials from the Office of the Minister of Children and Youth Affairs, OMCYA, were at all times cognisant of the need to provide the inquiry with all necessary assistance while at the same time recognising the need for the inquiry team to maintain its fundamental independence. Indeed, the independence of the inquiry team was seen as crucial in enabling it to fully carry out its task. The conduct of the inquiry was a matter for the inquiry team and the Department respected its independence in that regard.

A number of communications took place during the setting up phase of the inquiry between the chair and officials from the OMCYA to determine the requirements of the team and to ensure that these requirements were met to the fullest possible extent. A conscious decision was made at this time to allow the inquiry team to determine and specify its own requirements. No attempt was made to second guess the team's requirements as this could have been construed as an attempt to direct or otherwise influence the direction or outcome of the report.

It was open to the inquiry team, in determining its own programme of work, at any stage of its work to seek access to assistance in any field. On every occasion when the inquiry team sought such expertise it was made available to them. The inquiry team had in its membership legal, social work and policing expertise and this was considered entirely appropriate for the work of the inquiry when the three-person team was nominated. It is worth noting that the final version of the inquiry team's report presented to the Ministers for Health and Children and Justice, Equality and Law Reform contained no reference to any perceived lack of availability of expertise in any particular area, including mental health.

My office, in all of its dealings with the Monageer inquiry team, worked to support the inquiry through the provision of every possible assistance, while at the same time being cognisant of the team's independence in setting its own agenda in terms of completing its task. I note that the inquiry team made reference in its report to the increased incidence and need for review of familicide nationally and internationally. I understand that the HSE in late 2008 established a group headed by Mr. Geoff Day, director of the National Office for Suicide Prevention to examine this area.

Schools Building Projects.

Deputy Joe Costello

On a number of occasions I have raised the issue of the future of Gaelscoil Bharra in Cabra. This issue has been ongoing for the past 13 years and we are entering the 14th year in which this particular Irish school will be located in totally unsatisfactory prefabs. I will not rehearse the description of the circumstances but suffice it to say that in the elections of 1997, 2002 and 2007 the school was made promises which were never delivered and a member of the Government in a position of importance has been based in the constituency for all of this time. Thirteen years down the road, after the school has been shown to be viable, it is based in smelly outdated prefabs in weather like today's, with the toilets backing up and young children in damp smelly conditions.

The second full generation of children is going through the school. As far back as 2000, the Department of Education and Science commented on the prefabs, which had been in existence for only four years at that time. It stated that the deplorable state of the temporary accommodation made it imperative that the planning process be initiated as soon as possible. That was nine years ago and the planning process has not been initiated to date.

The problem, which has still not been overcome, is the provision of a suitable site. The Department went to the byways and highways — at least in theory — seeking a suitable site but did not find one. At present, the option of a suitable site on the site occupied by the prefab temporary school is being explored. These negotiations are taking place between the Department of Education and Science, the local GAA club — Naomh Fionnbarra — the school itself and Dublin City Council which has the lease on the area.

I understand that the proposal up for agreement is the site itself plus a portion of the roadside which has a green area public space. A technical assessment is being done, which as far as I can gather has been ongoing for the past three or four months with no solution or resolution appearing. There has been toing and froing with the Department of Education and Science, the local authority, the GAA and the board of management but the log-jam is still there and we do not have a site. The site has not been acquired and no agreement has been entered into, unless it has happened in the past couple of days.

We are facing into another election in 2009 with the school authorities pressing as much as they can to get the public representatives to resolve the matter, particularly the party in power. Regular meetings are being held, including one tonight. The Department of Education and Science has been invited to the meeting, as have the local authority and all public representatives. We hope to have some good news to announce to the weary parents and long-suffering children and staff of the school.

An Ceann Comhairle

I apologise to Deputy Áine Brady for calling her Deputy Áine Kitt earlier but I suppose, as Shakespeare stated, a rose by an other name.

Deputy Joe Costello

I congratulate the Minister of State on her appointment.

Deputy Áine Brady

I thank Deputy Costello and the Ceann Comhairle.

I will reply to this Adjournment matter on behalf of my colleague the Minister for Education and Science, Deputy Batt O'Keeffe. I thank Deputy Joe Costello for raising the matter as it provides me with the opportunity to outline to the House the Government's strategy for capital investment in education projects and also to outline the current position on the future plans for Gaelscoil Bharra in Cabra.

Modernising facilities in the existing building stock as well as the need to respond to emerging needs in areas of rapid population growth is a significant challenge and one which the Minister for Education and Science intends will be one of his priorities. The Government has dramatically increased investment in the school building programme to 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. It will underpin a particular emphasis on the delivery of additional school places in rapidly developing areas while continuing to develop the Government's commitment to delivering improvements in the quality of existing primary and post-primary accommodation throughout the country.

Turning to the specific matter in hand, as the Deputy will be aware the Office of Public Works which acts on behalf of the Department in site acquisitions generally had been requested to source a greenfield site for this gaelscoil. On foot of advertising, no proposals were received for a greenfield site in the Cabra area. As a result, the issue of providing a permanent school on the existing temporary site then came into focus. To pursue this further, meetings have taken place between the Department and Dublin City Council regarding the potential availability of this site and the Department wrote to the council with a proposal suggesting that a lease arrangement be put in place.

Officials from the Department have met with the city council and representatives of the GAA club to discuss the issue of entering into a lease arrangement with the city council which in time will require the GAA club to surrender its interest on some of the lands required for a building project. In February 2009, Department officials met separately with representatives of Naomh Fionnbarra GAA Club to discuss three potential design options available to allow for the provision of an eight classroom school on the site. The club responded by way of letter in March 2009 indicating its preferred design option based on the options presented by the Department and highlighting their concerns that car parking for their members as well as the teaching staff be addressed.

On foot of this, the Department wrote to Dublin City Council advising it of the design option favoured by the GAA club and requested the local authority to consider a technical assessment of the site incorporating the views of the GAA. This response is awaited. The further progression of the acquisition of this site and the accompanying building project will be considered in the context of the capital budget available to the Department for school buildings generally. I thank the Deputy once again for affording me the opportunity to outline to the House the current position on the future plans for Gaelscoil Bharra in Cabra.

The Dáil adjourned at 4.10 p.m. until 2.30 p.m. on Tuesday, 26 May 2009.