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Dáil Éireann debate -
Wednesday, 10 Mar 2010

Vol. 704 No. 4

Adjournment Debate.

General Practitioner Education.

I welcome the Minister of State at the Department of Health and Children, Deputy John Moloney, to the House to give details of the Government's recent announcement to increase the number of general practitioner, GP, places in the medical school system, a long overdue decision. It is a correct decision to increase the level of training for GPs when finances are available at the earliest opportunity. It is also important when one considers the home and community-orientated direction international best practice has taken in the delivery of primary medical care to patients. With the advances in, for example, keyhole surgery and other medical practices, people tend to spend less time in hospital and more time recovering at home.

The precursor to all of this is the necessity for a much more enhanced level of primary care. The GP, therefore, is the medical person best positioned to decide on the care of any particular patient. The practice, heretofore, where GPs were under high levels of stress and pressure, was to refer patients to a hospital environment for further investigation or treatment. International best practice indicates this is not best way. There is a need for much more of the work to be done in the community to ensure the best outcome for the patient.

The Government aims to increase primary care centres in the environs of doctors' surgeries, at which more diagnostics can be done in the community. It follows there will be a requirement for a greater number of GPs. It is welcome that the Government will increase the number of GPs. It recognises the greater degree of interest from GPs to perform much more of this work in their communities as they wish to develop primary care centres

It is interesting that the Finance Bill has been passed because, while not relevant to this discussion, there is a desire among groups of general practitioners for favourable taxation measures to ensure the development of these centres. They will not happen on their own or out of the blue. There is a requirement to assist doctors and investors to ensure the facilities are built and the necessary equipment is provided so these procedures can be carried out in the community. In welcoming the Government proposal to increase the participation of students at training level, I ask the Minister of State to outline the proposals to ensure an even spread of GPs throughout the country. As places become available, they should not be concentrated only in large centres of population. It is important that rural areas get a fair crack of the whip.

I give credit to the difficult work GPs do in the community in attempting to work within the change in policy of having more work done in the community. I pay tribute to the efforts GPs are making and the pressure they are under to deliver that. We owe a tremendous debt of gratitude for those who managed to deal with the reconfiguration programme in the system. They continue to provide an exemplary and exceptional service to the communities. The provision of extra places and extra GPs will help to lift the considerable burden many GPs are under.

I apologise that Minister for Health and Children cannot attend. There are about 2,600 full and part-time GPs in active practice in the State and some 300 doctors working in a locum capacity. Of these, about 2,100 GPs are contracted by the HSE under the GMS scheme to provide services to medical card and GP visit card patients.

The ESRI published a report entitled General Practitioner Care in October 2009. It found that Ireland has a low ratio of GPs to population compared to other western European nations, with 56 GPs per 100,000 of the population. In contrast, France, Austria and Germany have more than 100 GPs per 100,000. The increasing age profile of GPs means the ratio of GPs to population is decreasing. At the same time, demand for GP care is increasing due to demographic change. The report predicted total GP consultations will increase by 20% by 2015 and by 33% by 2021. The ESRI stated that if GP training numbers were increased to 150 per annum, this would make a substantial impact on the shortfall.

There is currently one model of GP training in Ireland, which is provided by the Irish College of General Practitioners, ICGP. It is a four year model, with two years based in hospital and two years on an approved GP training programme. There are currently 12 GP training programmes with 120 training places available per year. A report on primary medical care in the community by the Joint Committee on Health and Children published on 10 February included a recommendation that there be an immediate expansion of GP training places to a minimum of 150.

The HSE and the ICGP have agreed to increase the number of GP training places to 157 from 1 July. The expansion of GP training places is a significant initiative and demonstrates the commitment of Government to the pivotal role of general practice in the Irish health service. It will support the continued development of primary and community care services, facilitate the delivery of care to patients in their own communities and reduce the need for unnecessary hospital admission. The increase in GP training places has been brought to fruition by a partnership approach between the HSE and the ICGP. The Royal College of Physicians of Ireland has also been extremely supportive. The work of GP training programme directors and the engagement of consultant clinicians on a number of hospital sites have also been critical success factors. It is also pleasing to note that this expansion has been achieved from a more effective use of existing resources and without the need for any extra funding. The HSE, with the support of the Department of Health and Children, is pursuing a number of initiatives to increase the number of GPs working in the health service.

It has held discussions with the ICGP to identify a mechanism to upskill long-term locums or assistants who have not passed the requisite examination or obtained an award of the certificate of satisfactory completion of training from the Medical Council. It is estimated that up to 250 doctors are involved. A recruitment drive has been undertaken in the UK and in other EU countries to attract qualified GPs to apply for available posts here, particularly in regions experiencing difficulties attracting GPs. There is also more active management in each local health office to encourage GP assistantships and partnership for upcoming retirement where such doctors could potentially take over from GPs retiring. The HSE is continuing to expand primary care teams and primary care centres so that GPs are attracted to high quality, well-supported posts in suitable premises.

Health Services.

I thank the Minister of State for attending to reply to this topic. I compliment Deputy Dooley for the motion and the Minister of State for the reply to the previous matter. As someone who was involved in GP training for many years, I welcome this move. I am particularly delighted that the expansion has been achieved from a more effective use of existing resources and without the need for extra funding. This is a good news story. It is a message the Government must get out there.

Obesity is a serious problem here. There are more than 4,000 people who die from obesity-related diseases every year in this country. In 1960 we had the leanest children in Europe; in 2010 we have the fattest children in Europe. These are not my words but the words of Dr. Donal O'Shea, an expert in this field. Recently I and 14 of my colleagues had the honour of participating in "Operation Transformation", the RTE television programme, hosted by Gerry Ryan. It allowed us to participate and get benefits of taking simple measures to achieve weight reduction. The public has a major interest in this topic. The website received more than 3 million hits over the course of eight weeks and more than 500,000 people watched the programme every Wednesday night. The public wants information on this issue and it is imperative that Members of the Dáil, and particularly the Government, provide this information.

Yesterday, the Oireachtas Joint Committee on Health and Children, under the chairmanship of Deputy Seán Ó Fearghaíl, held a long meeting on obesity. It was a very good discussion, with many contributors. It mainly dealt with the curative aspect, which is very important. I emphasise two points that arose from the discussion. There is only one HSE clinic in the country that deals with this problem. As Dr. O'Shea and others said at the meeting, we should have four, with one in each HSE area.

Surgery is essential for those who are morbidly obese. We need some 400 operations every year and at the moment the HSE has the capacity to carry out 100. I request that the Department considers providing the facilities to allow it to happen. However, I am conscious that we live in a severe economic situation. We must be cognisant of the costs involved. Prevention is better than cure and "Operation Transformation" showed the way we can achieve excellent results by prevention rather than having to spend a major amount of money currently needed to effect a good cure.

There are three actions that can be taken at minimal cost, the first of which being that we publicise the benefits of exercise. Obesity is not a complicated problem. It results from people taking in more calories than they use up. If one exercises — walking is a simple exercise and costs no money — one can achieve great results. Second, we could use the traffic light system in respect of food labelling, namely, green for foods that allow one to go; amber for foods that are potentially dangerous and red for foods that are dreadful. Third, we could request the public health system to weigh at neo-natal and primary school level every child in the country and to then send home to parents the message that Johnny or Mary is 10% or 20% over weight and setting out the health risks that implies.

I am aware there exists a task force dealing with this issue and that it is doing very good work. I am interested to hear from the Minister of State what the task force is doing. I appeal to the House to provide time to for a full debate on the huge epidemic of obesity currently threatening our country. Some 4,000 people die every year from obesity.

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, who cannot be here tonight. I thank Deputy Devins for raising this matter.

The report of the national task force on obesity , Obesity the Policy Challenges, provided the policy framework for addressing the high prevalence and rising levels of overweight and obesity, in particular childhood obesity. It attributed the development of overweight and obesity to many factors. The involvement of this wide range of factors made it essential that a multi-sectoral approach be taken to deal with the relevant issues. The report provided 93 recommendations of action aimed at six sectors, including central Government, the education, social and community and health sectors, food production and supply and the physical environment.

An inter-sectoral group on obesity, comprising relevant Departments and key stakeholders was established early in 2009 to oversee and monitor implementation of the recommendations of the taskforce. The group published a report in April 2009 detailing progress on each of the recommendations. Its examination showed that significant progress was made in respect of 30 of the recommendations, partial implementation has occurred in respect of 29 and action is progressing on a further 26, leaving only eight where little progress was reported.

The report indicated that while significant progress had been made across all sectors, there is a continuing need for concerted action to halt the rise in obesity. The group also considered key priority areas for action in the short to medium term. The group's overriding concern was the need for concerted Government action driven at the highest level to ensure a consistent approach to the implementation of the recommendations of the taskforce. Among the areas highlighted were measures to increase physical activity among children, continued awareness programmes about the dangers of excessive consumption of foods high in fat, sugar and salt, increased control of the advertising and marketing of food and drinks aimed at children, improved training for health professionals in obesity prevention and diagnosis and counselling for those at risk of obesity.

Since the April 2009 report a significant development has been the publication in 2009 of the first national guidelines on physical activity and accompanying Get Ireland Active website. Based on best international practice, the guidelines specify the recommended levels of daily physical activity for people of all ages and abilities. The work of the inter-sectoral group on obesity is currently being examined in the context of a wider review of policy in regard to lifestyle-related illnesses to which obesity is a major contributory factor. Elements of this work will also be progressed in the forthcoming policy on cardiovascular disease which will be completed shortly.

I have taken account of Deputy Devins's remarks in respect of the importance of the deliberations of yesterday's meeting of the Oireachtas Joint Committee on Health and Children. I will take up his request this evening for a full Dáil debate on obesity with the Minister and Whips' Office.

Child Care Services.

I thank the Minister of State for being here this evening but I would have liked if the Minister or Minister of State with responsibility for children had come to the House to take this Adjournment matter.

I regard this issue as extremely important and worrying. We have unfortunately debated in this House in recent times a number of cases of abuse and inappropriate treatment of children in State care, often with tragic effect. As recently as January last, just six or eight weeks ago, a young Chinese national arrived at Cork Airport from Barcelona. She was stopped by Garda immigration officers at Cork Airport and was found to have false documentation and was put into HSE care. She spent her first night in what is termed "emergency foster care" in Carrigaline. She arrived at Cork Airport on 22 January and spent 23 and 24 January, which was a weekend, in emergency foster care. On the Monday, the HSE child care services in the south of the area, accompanied by a social worker, spoke to her with an interpreter as she did not speak English and decided to move her from emergency foster care into what is described as "supported lodgings", again in Carrigaline in Cork. As I understand it, the following day, 26 January, she left the lodgings to walk down the main street of Carrigaline and has not been seen since. This is another case of a child in HSE care — her nationality is not the main issue — who has gone missing. She is a child who was in the State's care and she is now missing. No one knows where she is.

There are seven cases involving Chinese children between the ages of 16 and 17 years who have during the past 12 months gone missing while in State care. If one visits the website and searches for children who have gone missing during the past 12 months, one will see all of the photographs and names, of which there are 12, on the list of missing children. They are all girls, seven of whom are Chinese. What is happening that we can allow young Chinese girls to come into Ireland illegally, put them into State care and allow them to disappear without trace? This is what has happened for the first time in Cork. It happened on a street outside my constituency office. I spoke in detail about this matter with officials from the HSE today. They were open in regard to the procedures they put in place and are insistent they applied the appropriate protocol required of them in terms of initially putting this child into emergency foster care and then moving her into supported accommodation. That standard practice is not good enough. We have now allowed a child, the responsibility of this State, to disappear.

Perhaps this child was trafficked; perhaps not. We do not know. The evidence suggests that given the number of young girls who have disappeared, all of whom come from the same country, China, and were in State care, that there is something seriously awry that we need to resolve. The reality is that this girl could be in the basement of a brothel somewhere in Ireland or Britain. This girl was in State care and after only four days she went missing. If this were an Irish 16 year old from Carrigaline, Crosshaven or Cork city, there would be a national outcry to find her. Yet, because this girl and the other six young girls who have gone missing without trace, are Chinese nationals, there is no significant political crisis or requirement to change practise to ensure we do not allow this to happen again.

I want the Government to give me a comprehensive answer as soon as possible, to explain how this has happened, what are its consequences and what the State is now doing to locate this child to ensure that she is not being exploited or abused.

I am replying to this Adjournment matter on behalf of the Minister of State, Deputy Barry Andrews. The HSE is not in a position to provide information in respect of the issue raised by the Deputy, due to ongoing industrial action. In the absence of such information, I will set out the current policy position on unaccompanied minors.

The immediate and ongoing needs of separated children seeking asylum relating to accommodation, medical and social needs, as well as their application for refugee status, are the responsibility of the Health Service Executive in accordance with the Refugee Act 1996 and the Child Care Act 1991.

Where separated children are identified by the Garda Síochána at the point of entry, the circumstances are investigated and if there are any concerns about the welfare of the child, he or she is placed in the care of the HSE. Where a separated child is in the company of an adult and there are concerns about his or her welfare, then he or she is also placed in the care of the HSE.

Research indicates that the tendency to equate all missing children with trafficked children is unsubstantiated. Some of the missing individuals are recorded as children on the basis of their referral to the out of hours social work service, but there is substantial operational experience to indicate that some of these individuals may be adults, as they have disappeared before a comprehensive age assessment process could be conducted by the dedicated social work team for unaccompanied minors.

With respect, the Minister of State should put the notes down and give me some assurance that the State will take this particular case seriously. I understand that he cannot give me a comprehensive response due to industrial action, which is a disgrace.

I understand the Deputy's point. The fact that he has compared this case to six other cases is quite serious. I cannot be specific because of the industrial action, but I do not want to hide behind that. The Deputy has given me the opportunity to reply some time tomorrow rather than tonight and I would prefer to take that course of action.

I thank the Minister of State.

Architectural Heritage.

I welcome the opportunity to speak on this issue, but I had hoped that the Minister for the Environment, Heritage and Local Government would have been here.

The 19th century chapel on the grounds of Saint James's Hospital was recommended by Dublin City Council for addition to the record of protected structures. The following recommendation was presented to the area committee on 20 April 2008 by a conservation officer and planner for Dublin City Council.

The chapel at Saint James's Hospital is considered to be of a certain level of architectural significance and consequently of local importance. It is also considered to be of sufficient social and historical value within the meaning of Part 4 of the Planning and Development Act 2000 to merit inclusion in the Record of Protected Structures.

This was an unequivocal recommendation that it should be placed on the record, and it was passed by the south central area committee at the meeting of May 2008. Procedure requires that a public notice is placed in the newspapers giving notice of the intention to add the building to the list of protected structures. This was done on 3 July 2008. One submission was received requesting that the structure should not be added to the record of protected structures

A report was then prepared for the city council and signed off on by the assistant city manager on 21 August 2008. This report included a recommendation from the area committee to add the building to the list of protected structures. On 25 August 2008, a letter from a Dublin City Council conservation officer was forwarded to an executive manager of Dublin City Council, stating that a "recommendation to add this building to the record of protected structures on grounds of historical association is insufficient to warrant inclusion". A decision was taken by a city council official or officials not to proceed with the process. From correspondence received under the Freedom of Information Act, a letter dated 10 September 2008 was sent to the CEO of Saint James's Hospital by a senior planner in Dublin City Council, stating that "it has been decided not to proceed with the proposed addition to the record of protected structures in relation to the above, as it would be premature pending the formulation of an agreed Master Plan for Saint James's Hospital".

What is the basis on which Dublin City Council officials decided, without reference to the elected representatives, to take this decision? The addition or deletion of a building on the record of protected structures is a reserved function of democratically elected city councillors. This means that only they can make a decision. In this case, the non-elected city council officials unilaterally made a decision not to include this item on the agenda of the full city council meeting. Why did they do this? On whose authority did they do this? The city council officials refuse to answer these questions, so now I am requesting the Minister to get this information and put it in the public domain.

Saint James's Hospital has stated that the chapel impedes development of the site, which contains the largest hospital in the State. However, the proposal for development of the site is not to extend the availability of services for the public, but rather to build a private hospital on the grounds of the public hospital. Meanwhile, the developer has been given planning permission by Dublin City Council to go ahead with the building of the private hospital, subject to a number of conditions. This decision has been appealed to An Bord Pleanála. This is a hospital that will not be available to all the citizens from Dolphins Barn down to Kildare. The recommendation of Dublin City Council planners is that the chapel is to be demolished to allow the building of a private hospital, available to those who can pay for the privilege.

The city council has given a series of answers to Councillor John Gallagher, none of which addresses the questions posed. This attitude, combined with the decision to grant planning permission, is simply not acceptable. The Minister needs to undertake an inquiry or, alternatively, commission the Comptroller and Auditor General to undertake an urgent investigation.

I have listed a number of days, dates, records and so on. In summary, the conservationist from the council made an initial recommendation and then reversed it, following a submission from the hospital. The assistant city manager failed to bring a recommendation of the area committee to the full council. A developer now has planning permission to demolish the chapel, and the building can go ahead without reference to the elected representatives. This procedure flies in the face of democracy and needs to be investigated.

I am replying on behalf of the senior Minister. Under the provisions of the Planning and Development Act 2000, each planning authority is required, for the purpose of protecting structures or parts of structures which are of special architectural, historical, archaeological, artistic, cultural, scientific, social or technical interest, to include a comprehensive record of protected structures in its development plan. The making of an addition to, or a deletion from, a record of protected structures is a reserved function of the planning authorities.

The Act also enables the Minister for the Environment, Heritage and Local Government to make recommendations to a planning authority concerning the inclusion of specific structures in its record of protected structures, and a planning authority must have regard to any such recommendations. These recommendations are based on the National Inventory of Architectural Heritage, NIAH, surveys conducted by the Department of the Environment, Heritage and Local Government. The aim of the NIAH surveys is generally to include structures which are of international, national and regional importance.

The initial scoping of the NIAH survey for Dublin City has commenced. The survey will represent a significant undertaking and considerable further planning is required.

A planning authority must decide whether a structure is worthy of inclusion in the record of protected structures by identifying the characteristics of special interest which would merit its inclusion. The Architectural Heritage Protection Guidelines for Planning Authorities issued by the Department indicate features that may contribute to the character and special interest of a structure. The guidelines also set out criteria that should be applied when selecting proposed protected structures for inclusion in the record of protected structures. There are also a number of means by which planning authorities can identify structures of special interest within their functional areas including the national inventory of architectural heritage surveys and inventories carried out by the planning authorities themselves.

As regards the assessment of structures of local interest, it is the responsibility of the planning authority to make its own assessment of the most appropriate way to protect structures that have not been inspected by the NIAH or that have been given a rating of local importance by the inventory.

On foot of a request by the Department of the Environment, Heritage and Local Government, Dublin City Council has provided details to the Department as to the sequence of events in connection with the listing procedure it had initiated for inclusion of the chapel at St. James's Hospital in its record of protected structures; the listing was subsequently not progressed. Further information on this matter is being sought by the Department from the city council.

The Dáil adjourned at 11.35 p.m. until 10.30 a.m. on Thursday, 11 March 2010.