Dáil Éireann debate -
Thursday, 27 May 2010

Vol. 710 No. 3

Hospital Services

Deputy Willie Penrose

I thank the Ceann Comhairle for allowing me to raise this important matter in the Adjournment debate on the floor of the Dáil tonight on behalf of the people of Longford-Westmeath. I am flabbergasted and frustrated that, once again, I find myself compelled to stand in this forum of the people this evening on behalf of up to 120,000 people throughout Longford and Westmeath to reflect the fears, concerns and apprehensions which they have raised over future developments at this important regional hospital in Mullingar. I do so in the context of speculation or rumours that there is a plan afoot to move general surgery of an elective nature from the very fine operational and surgical facilities available in Mullingar to Tullamore General Hospital as and from 15 June. I am unsure whether this is a done deal or a concluded plan or if it is simply speculation but, as a Labour Party representative of the people who has continually championed the cause of this important hospital in every forum available to me and at every opportunity, I make no apologies to the Government and the HSE for doing so again this evening and for seeking straight answers to the queries raised.

I seek an assurance that there are no plans to remove the important service of general surgery from this hospital for any period, no matter how short, because we have had a bad experience already with the HSE in respect of how it operates services at our hospital. Generally, we wake up and find that they are gone, moved by stealth, notwithstanding numerous assurances that no such move was planned or contemplated.

I refer to the speculation concerning our general surgery facilities. Even if it is planned to move them to Tullamore for the summer period or another short period, I hereby launch a pre-emptive strike on behalf of the people. We in Longford-Westmeath want no diminution or dilution of the excellent service we have in the hospital, provided by excellent and competent staff and professionals who work remarkably hard to ensure we are well looked after. Let us consider what the position would be were there any truth to the speculation or any basis in fact. There is no direct public transport service for the people of Mullingar to Tullamore, but that pales into insignificance when one considers the distance a patient who might require surgery would have to travel from north Longford if the surgery service was relocated to Tullamore. Certain people in the Government might reply that we are over-reacting but we have been burned too often in the past.

I refer to some illustrative examples to set out the situation. This hospital should have had phase 2A completed in 1997 and was to have phase 2B completed at various times in the past decade. The shell of phase 2B was completed in 1997. Then, for the purposes of delay and obfuscation, phase 2B was subdivided into stages 1 and 2, with stage 2 to include a new, acute psychiatric department or unit to be built as part of the phase 2B capital programme for Mullingar Regional Hospital. This has been scrapped and reneged upon by the HSE without batting an eyelid, despite the solemn commitment given that the plan would proceed. Stage 2 of phase 2B also had as a target that the bed complement would increase to 313 beds. Despite this being clearly set out in the original plan, it was subject to a further independent cost benefit analysis by the national hospital capital steering committee in November and December of 2008. This is another objective or target which has not been met and which, in fact, has been widely missed.

I refer to the question the people of Longford-Westmeath repeatedly ask me and my Labour Party colleagues. Why are we being treated as second class citizens by this Government, which has been in power continuously since 1997, despite the consistent performance of the Midlands Regional Hospital, Mullingar, as one of the top three hospitals in this country? Whenever a decision is made, the Government and the HSE in the midlands always seem to favour Tullamore or some other place which has ministerial influence in preference to Mullingar. I will always argue for resources and support expenditure for other midland hospitals, especially in Tullamore, where the residents avail of the excellent orthopaedic and ear, nose and throat facilities at that hospital. However, the people of Mullingar and Longford seek to ensure we get our fair share. We are suspicious that the aim of the HSE is to regionalise services and to engage in grandiose reconfiguration. If the HSE wishes to reconfigure then, in the words of Dr. Ron Charles, clinical director, Midlands Regional Hospital, Mullingar, "Mullingar should be in the driving seat, as the figures for Mullingar hospital speak for themselves". Mullingar Regional Hospital sees more than 92,000 patients for scans and X-rays, thanks to the excellent team of three consultant radiologists and one locum, led by Dr. Hugh Logan. We have one of the best paediatric and maternity facilities in the country, with almost 3,000 babies delivered in 2009 and a rate of Caesarean section of less than 23%. There is the potential to develop this into a maternity centre of excellence which could deliver up to 5,000 babies per year.

The general surgery services, to which I have referred previously, are excellent and the hospital has the potential to become a major centre for day surgery, with the potential to take patients from Dublin. The hospital is located on the N4 and is only major hospital facility between Dublin and Sligo. The hospital operates very efficiently. However, it is being deliberately starved of resources. For example, some 41 acute beds were taken our of service late last year, a matter I raised in the Dáil, and have never been restored. Why did that happen considering the accident and emergency department is continuously overcrowded and the excellent staff working flat out, beyond the call of duty at all times, and having to contend with people placed on trolleys while these beds lie idle and unused? What sort of mindset in the HSE or the Government would allow such a situation to develop and not take appropriate action to remedy it?

The Minister of State should examine the 2009 figures which are very revealing. The number of acute hospital beds in Mullingar was 185, the total of day beds was 14, the total inpatient and day care capacity was 199 beds, the average length of stay was 3 days, the number of in-patient discharges was 18,866, the day cases outturn was 7,235, the number of accident and emergency attendances was 32,841, the number of outpatient attendances was 74,053 and there was a budget of €64.66 million, which has been reduced to €59 million this year, including €2.9 million for casemix adjustment.

We will be protesting on Saturday, 12 June 2010 in Mullingar. We seek to protect, enhance and maintain the facilities we have in place. We demand that the Minister and the HSE make no attempt to downgrade the Midlands Regional Hospital, Mullingar; that the 24 hour accident and emergency facility should be retained and enhanced with the extra beds provided to accommodate the numbers of people requiring admission thereto; that all existing services at the Midlands Regional Hospital, Mullingar be retained and enhanced; and that this important hospital should get its appropriate and fair share of resources including additional staff and money. This is what we deserve and we will accept no less.

Deputy Michael Finneran

I take this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Deputy's question assumes that there is to be a withdrawal of surgical services at Mullingar hospital. The Minister has been advised by the HSE that at present there are no plans to relocate surgical services from Mullingar hospital to Tullamore hospital. Decisions on the allocation of resources and the prioritisation of service provision at regional level are a matter for the HSE.

The Midland Regional Hospital in Mullingar is part of the Dublin-midlands hospital group. The aim of the hospital is to deliver a quality driven, people centred service to the population of Dublin and the midlands and in particular the Longford-Westmeath area. The hospital in Mullingar operates on a 24 hour, seven day week basis.

Mullingar hospital, in common with all other agencies, is required to manage its services within the approved allocation and to run its services within the approved employment ceiling. The hospital has been recognised as being one of the most efficient in the country in the context of the annual case mix adjustment.

Patient safety is of paramount concern to the HSE across the hospital system. An issue which is currently being addressed by the HSE which is relevant to this situation is a shortage of junior doctors, or non-consultant hospital doctors, that exists in some parts of the country. This situation may become more acute in some areas from early July. A recruitment drive for a new intake of non-consultant hospital doctors is under way and a number of other initiatives are being considered so as to ensure that hospitals continue to offer a high level of care to all patients. Given that this recruitment process is still ongoing, it is too early to say which hospitals and what parts of the country might be affected and to what degree.

However, local management are working with clinical directors in a planned way to devise contingency arrangements which can be implemented in hospitals if and as required. The HSE is also putting in place a number of processes to address the issues contributing to this difficulty on a short, medium and long-term basis.

The Minister remains confident that the issues referred to above will be addressed by the HSE and that services at the Midland Regional Hospital in Mullingar will continue to be designed to deliver the best and most appropriate services to all of its patients.

Adult Education

Deputy Michael D. Higgins

A Cheann Comhairle, I first raised this matter after a visit to the Labour Party advice centre that I run on Saturdays by a young student, Naoise McDonagh, on 30 January 2010. On 10 February, you allowed me to raise the matter on the Adjournment. The same Minister of State was here on that evening. I pointed out the consequences of removing support, as had been announced in the budget, from those who had a reasonable expectation that they had started on the reconstruction of their lives. Students who had taken an access course to prepare themselves for a degree course had every expectation that, if they were successful in the, sometimes, difficult task of getting through the access course, they could proceed to an undergraduate course. Suddenly, and half way through their access course, they were told they could not receive the back to education allowance as well as their unemployment benefit or allowance.

They were, of course, devastated. I raised the matter on 10 February. They came to the Joint Committee on Education and Science on 20 May 2010 and made a positive proposal based on the simple fact that a person who is a graduate has a much better chance of becoming employed than a person who is not. They presented a researched proposal of what the savings to the State would be by making people like themselves more employable. The joint committee appeared to agree with them but the only concession that could be made was that individual hardship cases might be considered by the Minister for Social Protection. Here I am on 27 May, raising this issue again. What message does this give?

Appearing before the joint committee, the spokesperson gave three examples. The first was a woman with five children who does a round trip of 80 km to go back to education and reconstruct her life. The second was a man with three children who is doing the same thing and the third was a single man of 27. The 27 year old man said he had worked as a construction worker, found he was able to understand complex tasks and decided that, perhaps, he should go back and improve himself and qualify. He did that through the access course. Half way through the access course he was told he would not get the student maintenance grant and the back to education allowance.

The Minister for Finance, when responding to our letter regarding the drawing of ministerial pensions by Members of the Oireachtas when we proposed a single action that would affect everyone, said people had a reasonable expectation of a benefit to which they had contributed. These students had a reasonable expectation that, having gone to the access course, they could continue to a third level course and qualify.

Of 200 recently surveyed, between the Galway Mayo Institute of Technology and the National University of Ireland Galway, 100 suggested that they may drop out. What message does that send? In February, the Minister of State read a statement on behalf of the Minister, Deputy Batt O'Keeffe, and made reference to the four different sources of assistance the State gives to students. There is a €5 million student assistance fund for distressed students which covers 170,000 students. In Galway alone last year, 800 students applied for assistance and 400 got some form of assistance. The idea of saying that because that fund is there one can scrap this opportunity of returning to qualification is nonsense.

Let us look at what the students themselves suggested, for example, a mature student supplement. I think the Minister of State is a practical person. Consider a person who is receiving €196 per week, has dependants and must travel to avail of education. The man who came to me last week travels to college from a place in the middle of Connemara where there is no bus service. He has gone through all the difficulty of getting half way through his course and takes the extra cost of travel. One might say he can get a €500 book allowance, but this is all nonsense.

I appeal to the Minister of State to encourage those students who go to the trouble of going back to education, often having the experience of unemployment in the construction industry, rather than penalise them and force them to finance their education out of their meagre €196 per week. This is so outrageous.

Deputy Michael Finneran

I am replying to this Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Education and Skills.

I wish to thank the Deputy for giving me this opportunity to outline the position of the Department of Education and Skills regarding changes announced in the budget in relation to student maintenance grants for those also availing of the back to education allowance scheme.

I am pleased to inform the House that the Department of Education and Skills funds four maintenance grant schemes for third level and further education students. These are the higher education grants scheme, the vocational education committees' scholarship scheme, the third level maintenance grants scheme for trainees and the maintenance grant scheme for students attending post leaving certificate courses.

Deputy Michael D. Higgins

This is, verbatim, the answer given on 10 February.

Deputy Michael Finneran

I am responding on behalf of the Minister——

Deputy Michael D. Higgins

The Minister changes but the script remains the same.

Deputy Michael Finneran

The higher education grant scheme is administered by local authorities. There are three schemes administered by the vocational education committees. Under the terms of the maintenance grant schemes, grant assistance is awarded to students who meet the prescribed conditions of funding including those which relate to nationality, residency, means and previous academic attainment.

The back to education allowance is a second chance education opportunities scheme designed to encourage and facilitate people on certain social welfare payments to improve their skills and qualifications and, therefore, their prospects of returning to the workforce. Eligibility for the back to education allowance, BTEA, and associated payments is determined and administered by the Department of Social Protection and is primarily a matter for my colleague, the Minister for Social Protection.

The Deputy will appreciate that, in the context of the current economic circumstances, difficult choices had to be made by the Government in order to control public expenditure and to ensure sustainability in the long run. It was decided to discontinue the practice of allowing students to hold both the BTEA and a student maintenance grant simultaneously as this represents a duplication of income support payments. It was decided to discontinue the practice of allowing students to hold both the back-to-education allowance and a student maintenance grant simultaneously as this represents a duplication of income support payments.

From September 2010, as announced in the budget, all new applicants who are in receipt of the back-to-education allowance for all schemes, and the VTOS allowances for those pursuing PLC courses, will be ineligible for student maintenance grants. However, the cost of the student services charge and any fees payable to colleges will continue to be met, for eligible students, by the Exchequer on their behalf. Students should apply to their assessing authority to have their eligibility assessed.

As the Deputy will be aware, students currently in receipt of the back-to-education allowance are not automatically entitled to a maintenance grant. However, all students, currently in receipt of the back-to-education allowance or VTOS allowances and the maintenance grant will continue to be eligible for both payments for the duration of their current course provided that they continue to meet the terms and conditions of the schemes.

Deputy Michael D. Higgins

But not those on the Access course.

Deputy Michael Finneran

Students progressing to a new course, with effect from the 2010-11 academic year, will no longer be eligible for student maintenance grants in addition to back-to-education allowance or VTOS support, but can apply for assistance under the student grant schemes towards the cost of the student services charge and any fees payable.

Deputy Michael D. Higgins

It was part of the undergraduate preparation.

Deputy Michael Finneran

Access courses are generally organised by individual institutions and are not approved courses under the terms and conditions of the student grant schemes. The Higher Education Authority recently estimated the number of students currently on full-time Access courses at some 369.

As these are not approved courses, students on Access courses in the 2009-10 academic year would not be in receipt of a student maintenance grant. In addition, progression from an Access course to a degree course is not a continuation of the same course and therefore students progressing from an Access course to an approved course——

Deputy Michael D. Higgins

That is pure theology now.

Deputy Michael Finneran

——would not be eligible to hold the back-to-education allowance and a student maintenance grant for the 2010-11 academic year onwards.

Apart from the maintenance grants schemes and the free fees initiative, financial support is also available to students in approved third level institutions through the student assistance fund. The objective of the fund is to assist students in a sensitive and compassionate manner,——

Deputy Michael D. Higgins

There is €5 million for 170,000 students.

Deputy Michael Finneran

——who might otherwise, due to their financial circumstances, be unable to continue their third level studies. Some €5 million is available through this fund, which is disbursed at college level. Information on the fund is available from the Access officer at a candidate's college.

Regarding the recent presentation made at the Joint Committee on Education and Science by Access students, I understand it was proposed that the recommendations made by the visiting delegation be sent to the Ministers for Social Protection, Enterprise, Trade and Innovation, and Education and Skills. When these recommendations are received, I am sure that responses will issue as appropriate. I thank the Deputy for raising this matter.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 1 June 2010.