Dáil Éireann debate -
Tuesday, 7 Jul 2009

Vol. 687 No. 3

Drug Treatment and Prevention.

Deputy Deirdre Clune

I thank the Chair for the opportunity to raise the concerns of the community in Cork about the escalating use of heroin. There has been some very high profile media coverage of the problem in recent days. However, it is an issue of which those of us who read the local press, discuss the matter with the Garda and speak to local health professionals have been aware for quite some time. The list of those seeking methadone treatment is growing.

Heroin use is growing in the Cork area and there is a fear that it will attract the violence associated with that drug. There has been a recorded increase in drug related burglaries in the Cork area. The Garda set up a dedicated heroin unit in Cork in 2006 in response to the growing problem. The number of heroin detections in 2004 was four but last year that number rose to 159, a fortyfold increase. There were six heroin related deaths in 2007, eight in 2008 and, alarmingly and tragically for the families of those involved, there have been four such deaths in the past five weeks.

There has been a very large increase in the number of addicts seeking treatment, with more than 100 people treated in 2008. It is estimated there are 150 people on the waiting list for methadone treatment in Arbour House, which I visited recently along with the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy John Curran, when he opened the refurbished facility. The Minister of State will be well aware of the excellent service provided by health professionals in the treatment centre. Certain people must wait for more than one year for methadone treatment and during that year those addicts will undoubtedly continue to use the drug, to put their health at risk and continue to place stress on their families as they struggle to find the estimated €100 to €300 per day necessary to feed the habit.

A consultant in emergency medicine in Cork University Hospital has warned of an increasing number of heroin and methadone cases. He also warned the problem will escalate and that by this time next year Cork will have a serious heroin problem. All the signs, evidence and figures are available. We do not wish to see such a drug problem develop with all the negative social consequences it would entail.

All of this takes place against a background of a cut in the budget of the local drugs task force of 20%. Is there a central solution to such a problem? Having to wait for treatment for more than one year is unacceptable, and it is also unacceptable that there is only one doctor available for those in need of methadone treatment. The Garda and the local drugs task force must be involved along with health professionals.

I am conscious that this is taking place in the context of the very gloomy economic background against which we live at present. However, the long-term social consequences, havoc and devastation that this drug can wreak on communities will undoubtedly result in a much higher financial cost and social cost and this must be factored into today's thinking. All the warnings are available. I have outlined them and they have been heard loud and clear by communities in Cork. I call on the Minister to do what he can to support the health professionals, the Garda and those working on the ground to ensure the drug use does not escalate to epidemic proportions as predicted.

Minister for Transport (Deputy Noel Dempsey)

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Deputy for raising this matter and for affording us this opportunity to clarify the position. I will begin by setting out the national context with regard to this issue before dealing with the specific situation in Cork.

At a national level, the HSE provides treatment and rehabilitation services for those misusing opiates and other drugs through a combination of direct provision by the HSE staff, or by voluntary agencies which it funds to provide services on its behalf. There is also a wide range of partnerships with community-based groups and agencies. Individuals presenting for treatment for opiate-related issues are provided with a full and comprehensive assessment of both medical and psychosocial needs. The range of interventions includes assessment, stabilisation, harm reduction measures, care planning, methadone maintenance, counselling and detoxification, either in specialist clinics, in residential settings or in a community setting.

It should be noted that due to the complexity of this client group, people will enter and re-enter services and may need interventions on more than one occasion. The funding committed to addiction services has increased year-on-year over the lifetime of the National Drug Strategy 2001-2008. In 2008, €101.87 million was spent by the HSE on specific addiction services, both those directly provided by the HSE and those which it funded. This represents an increase of over €45.9 million from 2001 levels of funding. In addition, it should be noted that HSE mainstream services such as accident and emergency services, acute hospitals and mental health services address the treatment needs of alcohol and other substance misusers who avail of them. The cost of these services is not included in the figures which I have already quoted.

The numbers of people receiving treatment continue to rise and additional services continue to develop, with an additional 3,686 methadone treatment places from 2001 to 2008. In addition, needle exchange services have been developed in 13 local drug task force areas and five regional drug task force areas covering the areas most affected by opiate misuse.

Training needs have also been addressed. The establishment of the national addiction training programme, in partnership with Waterford Institute of Technology and the community and voluntary sectors, has resulted in the upskilling of 1,645 front line staff. This training has enabled the HSE addiction service to respond to the changing trends in prevalence — for example, polydrug use, cocaine use and the misuse of alcohol as well as maintaining a focus on opiate abuse. The HSE, as the lead agency, has commenced the implementation of the report of the working group on drugs rehabilitation, which was published in May 2007, by establishing the national drug rehabilitation implementation committee and employing a national senior rehabilitation co-ordinator. This committee is developing a rehabilitation framework for all addiction services, as recommended in the report and it is building on co-ordination arrangements already in place in a number of areas.

With regard to the situation in Cork, there are currently 85 clients in methadone substitution treatment in Arbour House clinic in Cork. The medical officers attached to Arbour House clinic commence assessment and treatment planning on the first contact with the client. The assessment process can take up to three weeks. Currently there are 106 opiate users on the waiting list for treatment in Arbour House. However, within this, some people may be prioritised for clinical reasons — for example, pregnant women. Regional drug co-ordinators in HSE south are working with the national GP co-ordinator to increase the number of level one and level two general practitioners in the methadone treatment service. An additional GP has been providing services in Arbour House since January 2009 which has enabled an increased number of sessions to be provided for clients.

To further address the issue of waiting times, the HSE, with the assistance of minor capital grants provided by the Department of Community, Rural and Gaeltacht Affairs, is developing additional methadone clinics in a number of locations — including Cork city. It is expected that this additional clinic in Cork city will be operational in late 2009 or early 2010.

The HSE acknowledges the challenges with respect to waiting times for treatment in certain parts of the country where drug usage has increased significantly in recent years. It points out that while there are approximately 600 clients on waiting lists, more than 10,000 clients received methadone treatment in 2008. Overall, the Minister for Health and Children considers that progress is being made in this area both nationally and in the context of services being provided and developed in the Cork area.

Rural Transport Scheme.

Deputy Seán Sherlock

I was prompted to raise this issue in response to calls to my office and to Deputy Brian O'Shea's office with regard to the probable cessation of the rural bus service between Waterford and Cork. This is a service which specifically serves the towns of Dungarvan, Cappoquin, Lismore, Curraglass, Ballynoe, Conna, Castlelyons, Fermoy, Castletownroche, Killavullen and Mallow. There is a concern that if the mid-day service which is provided by Bus Éireann is stopped, because in the company's words it is deemed to be "not profitable", this will have an untold consequence for those people who are older, who do not have their own transport and who would normally use this service to access general day to day services such as medical, post office and other services that generally keep life and limb together.

I am concerned because if it is the case that Bus Éireann decides to terminate this service, then in the current economic climate, there is no guarantee that the rural transport programme would be sufficiently funded to replace the route and provide the service to what I would call a vulnerable section or our society who do not have the means to provide their own transport and are not in a position to be able to get taxis if they are living in rural areas to the towns I have mentioned.

We saw in 1967 that the railway line between Mallow and Dungarvan or Cork and Waterford through Mallow was stopped and it was replaced by a bus service. I am arguing now, along with my colleague, Deputy O'Shea, that there would be a public service obligation to ensure that those people would continue to be served by some form of public transport and ideally through the auspices of Bus Éireann. It is my view that if we are to go down the line in this country of stopping routes which are deemed to be not profitable, then it will be another nail in the coffin for rural society. At a time when we are talking about the sustainability of the rural economy and rural society, it is vitally important that we would ensure that Bus Éireann and other providers would continue to have some obligation to provide services, particularly during the week when it is predominantly elderly people who avail of these services. It is not only so that they can go into town to purchase groceries but it is also a form of social interaction for them they may not otherwise have without the service.

If Government policy is one that assures that rural transport would be well catered for, particularly in more isolated areas, and if it is the case that Government policy is such that there is a service in existence, I call on the Minister to ensure that the service is maintained, preferably by Bus Éireann, but if not, that the Minister would intervene directly with Bus Éireann to ensure that it is maintained. That will ensure that if we get rid of the railways we do not also get rid of the rural bus routes. People use this service and it is vital that they have access to the services that maintain them in their everyday lives.

I call on the Minister to intervene directly with Bus Éireann on this issue and ensure we maintain that service and other such services that are being threatened. Bus Éireann is undergoing a process of reviewing its routes and those deemed to be not profitable could cease in the future. That would be a bad day for rural society and the rural economy in particular.

Deputy Noel Dempsey

I thank the Deputy for raising the matter, although he strayed somewhat from the subject of the Adjournment matter on the rural transport programme.

There is a commitment in the programme for Government to the rural transport that underpins the rural transport programme launched in February 2007. The principal function of the rural transport programme is to address social exclusion in rural areas arising from public transport needs. It was not established to provide regular inter-urban transport services. That is the function of Bus Éireann and other commercial transport operators. It is a clear principle of the programme that services are to complement and not compete with the existing public transport services provided either by CIE companies or by the private transport operators. Older people and people with disabilities form the core customer base of the rural transport programme, with many of those people living in remote and isolated rural areas.

The programme mainstreamed the former pilot rural transport initiative, and provides significantly increased funding which has led to additional services and expanded area coverage. The bottom-up approach developed during the pilot rural transport initiative demonstrated the effectiveness of community and voluntary innovation and participation in the provision of rural transport services. The programme is building on that concept and the main drivers of community rural transport continue to be the local communities.

As Deputies will be aware, Pobal administers the programme on behalf of my Department and is working with 37 individual rural transport groups around the country to address social exclusion in their rural areas arising from public transport needs. The programme is now operational in every county and the rural transport groups are working towards maximising coverage in their operational areas on a phased basis in response to local public transport service needs and having regard to the availability of resources. The programme has been highly successful. In 2008, 146,000 services were operated and 1.2 million passenger journeys were recorded. The equivalent figures for 2007 were 120,000 services and 998,000 passenger journeys.

The arrangements for the provision of services funded under the programme are a matter for individual rural community transport groups because we believe that local communities know best where the transport needs are in their rural areas and how best to address those needs. The Government's role is one of facilitator, helping local communities to address their transport needs through financial and administrative support.

Funding of €11 million is being provided from the Department of Transport Vote for the rural transport programme in 2009, an increase of €1 million on the provision for 2008. It is envisaged that this funding will lead to small increases this year in the frequency of existing services. In making specific allocations to the individual rural transport groups from this funding, Pobal has been asked by my Department to work closely with the groups to maximise the impact of the funding as well as ensuring continued value for money. Some groups are working at a local level with the Health Service Executive, FÁS, the vocational education committees and a number of disability organisations with a view to achieving transport synergies and getting better value for money.

In addition to funding from my Department, rural transport groups also benefit each year from funding provided by the Department of Social and Family Affairs arising from the application of the free travel scheme. Some groups also benefit from local development funding from the Department of Community, Rural and Gaeltacht Affairs, while most groups also generate additional funds from their own resources. The scheme will continue.

Regarding the Bus Éireann services, Bus Éireann is currently in negotiations in the Labour Relations Commission. I do not want to go into detail on that but it is not the policy of Bus Éireann to cease services that are not profitable. Quite a few of its services are not profitable and it gets a public service obligation, PSO, for that but to discontinue services that are poorly used or under utilised, in the context of trying to secure a cut in its losses of €30 million, it must look at every individual service it provides and I have no doubt this will give an opportunity to rural transport groups to fill in gaps in the years ahead.

Flood Relief.

Deputy Beverley Flynn

I welcome an opportunity to raise this matter. Last Monday in County Mayo I spent five hours going around looking at the serious damage caused by a flood. This happened as a result of exceptional rainfall which occurred on the evening of 2 July. Information provided by the Met Office indicated that 60 millimetres of rain fell in the Newport area alone between 5 p.m. and 9 p.m., and during the most intense period a total of 41.6 millimetres fell in one 60 minute period. This is extremely unusual and I gather it has an annual exceedence probability of one in 150 and therefore is very rare.

The resulting flash floods caused extensive damage in several areas. Newport, Furnace, Keenagh, Glenisland and parts of Tourmakeady were severely damaged as a result of the floods. There were landslides in both of those areas and a great deal of damage done to roads, bridges, land, livestock and even a group water scheme. The Buckagh group water scheme in the Newport area servicing 34 houses was put out of action. Some houses are still waiting to be reconnected to their water supply and when their sole source of water is a mountain stream, one can imagine the quality of the water they have currently.

In the Newport, Furnace and Keenagh areas in particular, the Yellow River Bridge was damaged and Treanlaur Lodge had damage to the road. The Buckagh road had extensive damage. Treenbeg Road had a lot of damage. The Leena and Glendavoolagh Roads, Newport town, Glenhest Road and Quay Road all proved impassible on the night in question.

Mayo County Council and the fire services were mobilised and they put into place a temporary measure to make the roads passable, and by Friday and Saturday of last weekend most of the roads were passable.

In the Newport area alone, costings have been done for the damage that has occurred to bridges in the area and it has been costed at €400,000. In the Glenisland area we would be looking at costings of a similar amount but as yet they have not established if some of the bridges will remain stable. It may take another week to establish that so further costings will be made.

In the past I approached the Minister for emergency funding following flooding in the Ballinrobe area and he was good enough to provide €200,000 this year under a miscellaneous provision to assist with that. What happened in this area last weekend is very unusual and, having been accompanied on my trip by the county council engineers, Ann Sweeney and Shane O'Donnell, and by local farmers, Seamus O'Donnell and Gerard Nolan, I saw that the extent of the damage was unbelievable. Roads were ripped up, there were craters in the road and the amount of repair work that will have to be done is extensive.

The Minister will also be aware that the council budget for this type of work this year has been trimmed to the minimum. When the full costings are made available to him I ask the Minister to consider providing emergency funding, as an exceptional item, to Mayo County Council to deal with this job. I will talk also to the Minister's colleague, the Minister for Agriculture, Fisheries and Food, to ask him to provide assistance to the farmers who lost extensive fencing and livestock. Many sheep were lost and a huge amount of damage was done to land and private property generally.

I welcome the opportunity to raise this issue and I ask the Minister to engage with the county council to discuss the possibility of his Department providing some assistance. If some of the bridges prove to be unstable, as I believe they will, the council will not have the necessary funds to carry out repair work this year. All of these bridges are on roads which service rural communities. Many of the families have been cut off and major work will be required in the near future. I ask the Minister to give careful consideration to this matter.

Deputy Noel Dempsey

I thank the Deputy for raising this matter. I also take the opportunity to express my sympathy to all those who have been affected by the recent flooding in County Mayo, outlined by Deputy Flynn.

In September 2004, the Government confirmed the Office of Public Works as the State's lead agency in flooding, to be tasked with delivering an integrated, multifaceted programme aimed at mitigating future flood risk and impact.

As regards flooding of roads, the improvement and maintenance of regional and local roads is a matter for the relevant local authority, to be funded from its own resources supplemented by State road grants paid by my Department. The initial selection of works to be funded from these grants is also a matter for the local authority. Funding of national roads is a matter for the National Roads Authority.

When road grants for regional and local roads are allocated each year, my Department does not hold back a reserve allocation at central level to deal with weather contingencies. Such an arrangement would mean a reduction across all local authorities in the road grant allocations to them at the beginning of each year. Instead, the allocation made to local authorities is inclusive of the weather risk factor. Local authorities are expressly advised that they should set aside contingency sums from their overall regional and local roads resources to finance necessary weather related works. That stipulation is contained clearly in the circular letter sent with the allocations.

In 2009, grants totalling €22.316 million were allocated to Mayo County Council for works on regional and local roads. This included a discretionary maintenance grant of €1.952 million and a discretionary improvement grant of €826,000, which are available at the discretion of Mayo County Council to fund contingency works arising from weather conditions. My Department would also be prepared to consider sympathetically any request from Mayo County Council to adjust its multi-annual restoration programmes in order to prioritise work necessitated by severe weather conditions. In 2009, Mayo County Council was allocated a restoration improvement grant of €7.638 million and a restoration maintenance grant of €5.614 million.

It should also be noted that Mayo County Council's own resources expenditure on regional and local roads in 2008 amounted to €5.4 million, which represented only 15% of the total expenditure on regional and local roads in the county, with the other 85% funded by State road grants. The expenditure of €5.4 million in 2008 is also €1.95 million less than the council spent from its own resources in 2007. Mayo County Council needs to address this issue with a view to assigning more of its own resources to the regional and local road network.

Disability Services.

Deputy David Stanton

I thank the Ceann Comhairle for allowing me to raise this matter.

We all take the Ombudsman's report very seriously. When the Ombudsman addresses the issues I am about to raise we should take it even more seriously. She maintains that out of the 2,747 formal complaints made last year, only six related to the Disability Act 2005. She expressed her concern that this is a remarkably low level of complaint.

She observes that many public servants have a serious lack of knowledge about their responsibilities under the Disability Act 2005. Despite having made similar comments in the past number of years, it appears that very little has been done to address this, despite the obligations of the Act. She states that if people with disabilities do not have information easily available to let them know how to make a complaint against a public body, then it is no surprise that complaints from them remain remarkably low, year on year.

Does the Minister agree there is inaction among many public bodies in taking their duties under the Disability Act seriously enough and specifically in tackling the knowledge gap among their staff about their responsibilities under the Act? A code of practice for public bodies about their responsibilities under the Act was developed by the National Disability Authority, but many public bodies seem to be unaware of its existence.

The Ombudsman highlights the failure of public bodies to establish an adequate and effective complaints procedure through disability access officers, covered under section 26 of the Act. These are supposed to assist clients with disabilities in accessing public buildings, services and information which has led to people with disabilities simply not being able to seek assistance. The lack of information about access officers has led people to make what are classified as premature complaints to the Ombudsman. These are complaints made before using the complaints mechanism of the public body concerned as this complaints system remains inaccessible to people with disabilities. In fact, of the 105 websites surveyed by the Ombudsman, only 20, that is 19%, contained information about access officers and for many of these, ease of access to the information proved difficult. Only five of the websites surveyed contained information about how to make a complaint specifically in relation to the failure of the body to comply with Part 3 of the Disability Act. As the Minister's Department is charged with monitoring and overseeing the implementation of the Disability Act, in particular measures in relation to Part 3 and Part 5 dealing with the public sector, I ask him what will be done to address this issue.

This is a serious issue when coupled with the failure of the Government to introduce a personal advocacy service through the Citizens Information Board. When legislation was passed it was envisaged that a personal advocate would assist people with disabilities in accessing all public services, not just health services, and acting as their representative in dealing with public bodies if they were unable to do so.

Would the Minister agree that these failures undermine the statutory right of people with disabilities to complain where public bodies fail in their duty to them? I agree with the Ombudsman, and I am sure many people with disabilities, their carers, families would agree, that this situation is "wholly unacceptable". When the Ombudsman uses language as strong as that we should all take note and act to protect vulnerable citizens in their endeavours to secure the services to which they are entitled under the law.

I will be interested to hear what the Minister has to say on this very important issue.

Deputy Noel Dempsey

I thank Deputy Stanton for raising this matter. My colleague, the Minister for Justice, Equality and Law Reform, has asked me to reply to the Deputy on his behalf.

I wish to outline the comprehensive policy and strategy that is in place in this area. The National Disability Authority, NDA, received a formal request from the then Minister for Justice, Equality and Law Reform, Mr. Michael McDowell, to develop a code of practice on accessible information and services to support public bodies in meeting their new statutory obligations under the Disability Act 2005.

In September 2005, the NDA engaged in consultations with Government Departments that would be impacted by the code and by October 2005 had developed an early draft code. This draft code was circulated to over 600 stakeholders, including representatives of persons with disabilities and was also advertised in the national press with a general call for comment. As a result of this consultation phase, an advanced draft of the code was prepared and circulated to Government Departments for final comment. The code of practice was finalised and submitted to the Minister in late 2005 and was declared an approved code of practice under the Disability Act 2005 in April 2006 under Statutory Instrument No. 163 of 2006. The code of practice was launched in July 2006 as part of the national disability strategy and this launch was attended by the Taoiseach and seven Government Ministers.

In presenting the code, the then Minister for Justice, Equality and Law Reform indicated that the code was intended to support public bodies in meeting their new statutory obligations under the Disability Act and would provide public bodies with general guidance and practical examples of how they might approach it. To ensure that public bodies were aware of the code, the NDA organised a series of regional briefings on it in October 2006 and circulated copies of the code to each of the then 570 public bodies impacted by it. The NDA code of practice was also presented at the 15th annual European social services network conference held in Berlin in June 2007 at which considerable interest was shown in the scope and content of Ireland's national disability strategy.

At the recent annual conference for access officers held 3 May, presentations on improving accessibility of information were made by the ESB and Mayo County Council. The Railway Procurement Agency and Monaghan County Council presented on accessible procurement processes in line with section 27 of the Disability Act and Cork County Council and the Department of Social and Family Affairs presented on improving accessibility of websites.

To establish the most appropriate way to monitor implementation of the code of practice, the NDA commissioned preliminary independent research. This research was conducted in consultation with all key stakeholders and indicated that the best approach would be a self-report monitoring survey. Accordingly, the NDA developed a draft monitoring questionnaire. Following extensive consultations with 15 Departments, 568 public bodies and representative groups for persons with disabilities, a finalised questionnaire was issued for completion by public bodies in April 2008.

The findings of the NDA's 2008 monitoring survey provide ample evidence of awareness of statutory requirements and commitment to providing accessible information and services among the public bodies that made returns. However, it must be borne in mind that non-responses may well be indicative of some lack of completeness or confidence in implementation and compliance achieved at the time of the survey, which is part of the Deputy's point. It should also be noted that some organisations that have recently been established and are newly impacted by the code were included in the survey. Such organisations will require some time to identify properly and address fully all of the accessibility issues that will pertain to the services and information they have been established to provide.

Among public bodies that made returns on the survey, many important achievements have been observed. Notable examples of best practice were observed in respect of some particular organisations and actions. Notwithstanding this, a small number of important areas of underachievement requiring attention were also identified.

In so far as the Department of Justice, Equality and Law Reform is concerned, in 2006 the Department prepared an accessibility action plan to set out the steps it is taking to deliver accessible public services. This elaborates on the general commitments in the Department's customer charter and takes into account its obligations under the Disability Act 2005. The Department has also formed a disability advisory committee with a view to improving access to public services provided by the Department for people with disabilities. The committee comprises representatives from a number of relevant divisions within the Department. To provide additional expert input, the Department's disability policy division also participates in this exercise. The remit of the committee does not extend to the public bodies under the Department's aegis, but there are proposals to ensure liaison with such agencies with a view to pooling experience in this field. The Department also has a disability liaison officer, an accommodation officer and access officers to monitor services for people with disabilities.

In consultation with OPW and other parties, the Department intends to undertake regular reviews of its accommodation and related accessibility issues in its facilities and services and will carry out reasonable modifications to improve access to its accommodation. To date, the measures taken to improve accessibility include modifications to the built environment, disability awareness training for departmental staff and website redevelopment. The Deputy will appreciate from what I have stated that a considerable amount of work and attention is being given to promoting the code of practice and ensuring implementation. That work will continue and I am sure that account will be taken by all concerned of what the Ombudsman has stated in her annual report.

The Dáil adjourned at 12.55 a.m. until 10.30 a.m. on Wednesday, 8 July 2009.