Adjournment Debate

Hospital Services

Deputy Joe McHugh

In recent days there has been a conversation through the public domain in my constituency about fears and anxieties concerning future funding for Donegal Hospice. In the response from the HSE, I hope for confirmation and reassurance for existing patients and those who have contributed in a voluntary capacity through their time and financially over several years. It is equally important that we reassure those directly and indirectly involved in the hospice that there will be an answer to their concerns and reassurance for the wider community in Donegal, which has been extremely active in the genesis of the hospice movement through the continuation of the care and voluntary contributions to the hospice.

There is concern about the reduction in posts at the hospice from January 2011. At present there are three junior doctors working under a consultant along with other staff. We are at a period where we must consider reductions and funding withdrawals as a result of the financial situation. However, in the answer from the Minister of State I hope for reassurance for the people of Donegal, the patients and the volunteers in this movement so that even if there is a withdrawal of staff, we can have proper standards of patient safety. That is the matter I wish to highlight tonight. Will the Minister of State and the HSE reassure the public of Donegal and those involved in the hospice movement? This includes every person who has contributed time or a euro in a bucket in voluntary fund-raising and the organisations that have put their hearts into this movement. A hospice is not part of the Government. It may be a wing of the Government in terms of the Government providing financial input but it is part of the fabric of our society in Donegal. It belongs to the people and the people require answers on future commitments to patient safety. Patient safety is key to my raising this matter. Reassurance can only be provided through the Minister of State and the HSE, for which the Minister of State and the Minister for Health and Children have accountability. I want assurance provided to the families, to the patients and to the wider Donegal community. The Donegal community not only contributes to this but has been an integral part of the hospice movement in Donegal for years and intends to be part of it for years to come.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael Finneran)

I respond to this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Deputy for raising this issue. It provides me with an opportunity to update the House on the matter.

Government policy on palliative care is contained in the report of the national advisory committee on palliative care. The provision of modern, quality services remains high on the Government agenda and is reflected in various significant policy and service developments in recent years. In this context, more than 4,000 patients received palliative care services in 2009, with overall expenditure by the HSE on these services last year approximately €79 million. Expenditure this year will be approximately €74 million when public service pay cuts and so on are taken into account. The investment now directed to palliative care, in the context of the HSE national service plan 2010, allows for the provision of a wide range of supports, including specialist inpatient beds, other palliative supports in acute hospitals and the provision of community-based services. These include 25 palliative care consultants and 26 home care teams nationally.

While robust financial management systems are an essential feature of any health service, our primary focus has to remain on patients. The range of professional and other essential staff involved in each hospital or local health area must aim at all times to provide the best possible service to patients and other clients, in line with available resources.

The palliative care services five year medium-term development framework was published by the HSE in July 2009. It details the actions and initiatives necessary to address the gaps in palliative care service provision, thus adopting a more patient-centred approach overall in the future. The HSE recently established an implementation and development committee to monitor progress on the strategy at national level. It is chaired by the HSE and membership includes representatives from organisations previously represented on the National Council for Palliative Care, including the Irish Hospice Foundation and the Irish Association for PalliativeCare.

The quality standards for end of life care in hospitals were launched in May. These were advanced as part of the hospice friendly hospitals programme. The standards aim to support and enhance the provision of quality patient-centred end of life care within all hospital settings, particularly in acute care facilities.

There are several other initiatives under way at national, regional or local levels. These include, for example the extending access programme being undertaken by the Irish Hospice Foundation and the HSE. This focuses on life-limiting conditions and involves pilot projects to develop best practice models for chronic illnesses.

A bereavement support service has been established in each HSE region. Palliative care has been included as one of the initial national programmes under the Health Service Executive directorate of quality and clinical care. A specific standard is included in the national quality standards for residential care settings for older people relating to end of life care.

The Donegal Hospice is an eight-bedded unit in Letterkenny. The executive has provided funding of just over €2 million towards the service this year. The facility is currently staffed with one consultant in palliative care and three non-consultant hospital doctors, NCHDs. The medical staff is rostered Monday to Friday, with out-of-hours service provided through on-call and overtime. The estimated occupancy figure for the hospice is 70%, with no weekend admissions. The Health Service Executive is reviewing current medical pay costs at the hospice. A significant portion of pay costs is associated with issues such as overtime and on-call arrangements.

The Health Service Executive has indicated that options to provide some of the out-of-hours services via NorthWestDOC, or other doctors at Letterkenny General Hospital, are the subject of detailed and ongoing consideration. I understand that a meeting has been arranged next week between the Health Service Executive and the Irish Hospital Consultants Association, IHCA, to advance matters. While discussions are ongoing on restructuring the service, no decision has been made to suppress posts. The Health Service Executive has no plans to close the hospice inpatient unit in Letterkenny. The suggestion of closure is without foundation and caused regrettable concern for families and patients in the county.

It will be clear to this House from what I have just outlined that the Government's commitment to palliative care is obvious. However, the Deputy will appreciate that the Health Service Executive has operational responsibility for delivering and supporting specific services at local level, including those at the Donegal Hospice.

Mental Health Services

Deputy Dan Neville

I thank the Ceann Comhairle for giving me the opportunity to raise this matter. A very serious situation has developed within the mental health services. To date, resources have been cut unfairly and disproportionately with spending reduced by 9.2% between 2006 and 2009. Currently, 5.3% of the overall health budget is allocated to mental health. That is its lowest level in modern history. In 1997, the allocation was 7%. Some years prior to that it was 13%. In the 1960s the allocation was 20%. The allocation on mental health in England and Wales is 13% while it is 18% in Scotland, yet we are down at 5.3%. This is at a time when there is an increase in mental health difficulties resulting from the economic crisis. The effect on public health is severe.

Having caused or contributed significantly to the economic crisis the Minister has a responsibility to respond to the resulting needs arising from the difficulties. People are coping with job insecurity, economic uncertainty and strain, loss of income, home repossession and restricted access to credit. That has led to a reduction in mental health well-being and marriage breakdown resulting in divorce. Serious difficulties arise due to tensions caused in families. Families break up because of the strains resulting from the economic situation. People in those positions have a loss of perceived self-worth. They suffer from a loss of daily purpose and structure. People have reduced social contact and they experience an increase in social isolation and suicidal behaviour both in terms of non-fatal self-harm and completed suicide.

It is accepted that suicide rates in 2009 increased by 25% due to the economic crisis. Each of the cases concerned represents a family in crisis. A single suicide is one too many. An increase in the rate of suicide by 25% indicates a significant increase in the level of difficulty created in many families and communities. The Government must respond to the developing situation. To date, 527 deaths have resulted from suicide. It is accepted that such deaths are under-reported for a variety of reasons. A conservative estimate is that more than 600 people died by suicide last year.

There has also been a 10% increase in self-harm. Approximately 11,000 people present at accident and emergency units having self-harmed. It is accepted by the experts that when one adds those who are treated by their general practitioner or whose families hide the fact that they self-harm, the figure rises to 70,000 people who attempt suicide and self-harm in this country every year.

The report of the independent monitoring group on the Government's policy, A Vision for Change — a blueprint for improving the psychiatric service — is a severe indictment of the Minister for Health and Children. It is not acceptable that little substantial progress was made in 2009 in implementing A Vision for Change. The lack of clarity around the new assistant director for mental health is a serious issue, as it was one of the key recommendations of A Vision for Change in terms of developing mental health services.

The monitoring group expressed frustration and confusion about constantly changing management structures in the mental health service. The revenue allocation envisaged for A Vision for Change was not delivered in 2009 and 2010 as promised. In the absence of new capital and revenue it is difficult to see how the Health Service Executive and the Government can achieve their objective to implement A Vision for Change. The Minister should seriously examine the matter before there are any cuts and ensure that people have some hope of a response from the system in their crisis so that suicides will not increase any further.

Deputy Michael Finneran

I am taking this Adjournment on behalf of my colleague, Deputy Harney, Minister for Health and Children. I thank Deputy Neville for raising this issue as it provides me with an opportunity to update the House regarding funding for mental health services. As the Deputy is aware, I worked in psychiatric services for a number of years. I continue as chairman of the Roscommon Mental Health Association so I have a particular interest in the matter.

The Government will consider the 2011 Estimates for the health service over the coming weeks in the context of the strategy for economic recovery and the target to reduce the general Government deficit to 3% of GDP by 2014.

Deputy Dan Neville

That means there will be a cut.

Deputy Michael Finneran

However, I want to make it clear to the House that our current financial difficulties do not in any way dilute the Government's commitment in the area of mental health. I fully accept that the impact of any cuts to front line services must be minimised and that we must ensure that the needs of service users remain the highest priority. However, I am confident that this can be achieved, and that staff at all levels will work together to deliver services in a more flexible way. Given the substantial resources already invested in mental health——

Deputy Dan Neville

Substantial resources. Is the Minister of State serious?

Acting Chairman (Deputy Brian O’Shea)

The Minister of State should be allowed to speak without interruption.

Deputy Michael Finneran

——the reconfiguring and remodelling of resources will be the main focus for the immediate future.

Deputy Dan Neville

The Acting Chairman knows where I am coming from.

Deputy Michael Finneran

Deputies can be assured that this Government is determined to do everything possible to protect services, to respond to priority needs and to support ongoing reform of the public health services within the resources available for health.

We are all too aware that the Health Service Executive must work within limited financial resources. The health sector represents more than 27% of public expenditure so the appropriate management of the public finances means that the Health Service Executive must operate within the approved budget set out at the start of the year. Under the Health Act 2004, the HSE is required to prepare an annual national service plan which must indicate the type and volume of health and personal social services to be provided by the Health Service Executive. This plan must be approved by the Minister for Health and Children. The appropriate management of the health services also means that mental health services must be funded in an equitable and sustainable manner.

There is no doubt that the current economic situation is putting greater stress on individuals, families and communities. In response, the Government has provided additional funding of almost €l million this year under the dormant accounts fund for a programme of suicide prevention measures to help communities develop integrated local action plans for suicide prevention. The special needs of the mental health service have also been recognised in the context of the 2010 employment control framework for the health service, which provides for an exemption from the moratorium in respect of 100 psychiatric nursing posts.

I should also draw attention to the innovation fund for disabilities and mental health, which was established to help support the transition from institutional to person-centred models of care. Some €3 million in funding has been allocated to Genio, a non-profit organisation that supports self-determination, inclusion and equality for disadvantaged and vulnerable people. Genio has established a fund with support from the Atlantic Philanthropies to support the transition from traditional, expensive group-based services to more effective individualised, person-centred supports. During 2010, 50 projects were awarded grants totalling €3.6 million. Fifteen of those projects were mental health projects with funding of €1.4 million.

It is fair to say that, despite the economic downturn, we are still making tangible progress on the implementation of A Vision for Change. It is important to recognise that in many parts of the country, services are pressing ahead with the implementation of the policy and we should not lose sight of this. Significant progress has been achieved, including shorter episodes of inpatient care, improved child and adolescent mental health services, fewer involuntary admissions and the involvement of service users in all aspects of mental health policy, service planning and delivery.

Acute admissions to St. Brendan's Hospital, Grangegorman, have ceased following the opening of a new admission facility for north-west Dublin mental health services in Connolly Hospital, Blanchardstown, in September 2010. Construction on a 54-bed unit to replace the current facilities for long stay patients at St. Brendan's Hospital is due to begin later this year. It is also worth noting that plans for the transfer of acute inpatient admissions from St. Ita's Hospital, Portrane, to a new purpose built unit on the Beaumont Hospital campus are proceeding. A tendering process has been completed and the successful contractor has been notified. It is anticipated that construction works will commence in February 2011.

New community nursing units in Ballinasloe and Mullingar have been developed and it is anticipated that two new 20-bed child and adolescent inpatient units in Cork and Galway will be commissioned before the end of the year. Other construction works have commenced around the country, including the development of a new acute psychiatric unit in Letterkenny and a new child and adolescent day hospital and ancillary facilities at Cherry Orchard, Dublin. These developments will be funded from the proceeds of the sale of psychiatric assets. The House will recall that budget 2010 provided for a multi-annual programme of capital investment in high priority mental health projects and an initial investment of €50 million in the mental health capital programme.

The Government is acutely aware that mental health is a resource that needs to be promoted and protected, particularly in times of economic difficulty. I wish to assure the House of the Government's unwavering commitment to developing our mental health services in line with A Vision for Change.

Social and Affordable Housing

Deputy Michael Moynihan

I thank the Ceann Comhairle for the opportunity to raise this issue on the Adjournment. I apologise for my voice, as I might not be able to get my message across.

The Freemount Housing Association in north County Cork successfully applied some time ago for funding for the development of social housing units, but a balance was due at the end. I thank the Minister of State, Deputy Finneran, for his considerable help in negotiating the last tranche of funding for the association in recent years. It is almost 12 months since he approved the last amount of funding, so I am pleased he is present to take this debate. He has been involved in many projects in north County Cork during the past year.

We have landed ourselves in a legal dilemma where the transfer of funding from the Department and Cork County Council to the housing association to pay off the debts accruing on the development of the social housing project is concerned. This is causing significant difficulties, as the voluntary housing association wants to clear its account and pay off outstanding bills, which is difficult to do when finances are tight and the times are tough economically. Through the good offices of the Minister of State, the Department has allocated money to Cork County Council to complete the transaction. However, the handing over of the last cheque by the council to the association is in a legal quagmire that involves the Department, the Attorney General's office, the Chief State Solicitor's office and the council. This matter has been ongoing for six or eight months. Will the Minister of State use his influence in Dáil Éireann and beyond to try to ensure that the funding can be provided? The voluntary housing association in Freemount has taken on board this fantastic project, but not without unexpected difficulties.

The last tranche of funding was agreed on 19 or 20 November 2009. Unfortunately, between the Chief State Solicitor's office, the Attorney General's office, the council and the Department, the last instalment is stuck in a logjam. A legal question arose because all of the association's tenants needed to be approved council tenants for the last tranche of funding to be provided.

Will the Minister of State do everything possible to ensure that Cork County Council releases the last tranche of funding to the Freemount Housing Association? I cannot stress enough the amount of work and commitment that has been involved. Like every voluntary organisation, it only comprises one or two people but they need to get the account cleared and pay their outstanding commitments. It is a fright that the money required, despite having been allocated by the Minister of State, is in a legal quagmire between the council and the housing association. The association needs that money to discharge its duties. Will the Minister of State do everything he can to ensure the money is paid to the association?

Deputy Michael Finneran

I thank the Deputy for raising this issue. I addressed this matter in the House last June when I outlined the details of my Department's capital funding schemes, which provide up to 100% of the cost of voluntary and co-operative housing projects. Since March 2007, funding under the capital assistance scheme for the provision of voluntary housing covers up to 100% of the capital cost where all prospective tenancies are taken from the local authority housing waiting list. Grant assistance is also available towards site costs and funding towards the cost of communal facilities is provided, through my Department, from national lottery funding.

The Freemount Community Development Association Limited project is composed of 11 units of accommodation for older people at Freemount, County Cork, and was approved for funding of €1,046,466 in November 2002. Following receipt of a submission from Cork County Council advising that all of the tenants would be drawn from the housing waiting list, my Department increased the grant to €1,913,315 in March 2010. In addition, funding of €82,500 was provided toward the cost of associated communal facilities for the project.

A total of €1,817,649, amounting to 95% of the approved amount, has been recouped so far to Cork County Council on foot of payment claims for this project, leaving a balance of €95,666 yet to be claimed. Under the terms of the scheme, expenditure of up to 97.5% of the approved funding may be claimed on a project prior to completion of the accommodation. The balance is paid on the completion of the project and after a mortgage charge has been created on the dwellings. Approved housing bodies are required to enter into a legal agreement with the local authority, creating a mortgage charge on the dwellings provided under the schemes. This is to ensure that the accommodation is used in accordance with the terms of the funding schemes. Pending the completion of the mortgage deed agreement between the local authority and the housing body, an agreement may be made whereby the local authority can accept a letter of guarantee from the housing body, agreeing to sign the mortgage deed on completion of the scheme.

In 2002, my Department circulated a sample mortgage deed for use by local authorities in creating mortgage charges on dwellings. As a result of changes arising from the enactment of the Conveyancing Act 2009, my Department is liaising with the Chief State Solicitor's office and awaiting legal advice in regard to any amendment considered necessary to bring the sample mortgage deed into line with the requirements of the Act.

My Department will liaise with Cork County Council with regard to drawing down the outstanding funding on foot of a letter of guarantee, pending the circulation of a revised sample deed.

Job Losses

Deputy John O’Mahony

I thank the Ceann Comhairle for selecting this important topic. Last week, the House spent two days discussing the serious financial position of this country with agreement on all sides on the need to do something about it. There was agreement, too, to offer some hope to people on the employment front in order that any potential growth would not be stifled and that some jobs would be provided. Only a few hours after that debate news began to filter through from Castlebar about 200 job losses in Baxter Healthcare in coming months. These include jobs in administration, manufacturing and people employed on temporary contracts. Baxter has been a fantastic employer in County Mayo for the past 38 years and is committed to keeping the 900 jobs it still has in the county. It is very important that the Government puts everything in place, first, to find new jobs for the people being let go and, second, to support the jobs already in place.

I have a few suggestions. The four multinational companies that directly employ 3,000 people in the county, namely, Baxter Healthcare, Allergan in Westport, Hollister and Coca Cola in Ballina, appealed to the Taoiseach at a meeting on the need to address the infrastructural deficit of access to and within County Mayo, with particular reference to the N5 and the N26. If I am correct, that meeting was arranged by the Minister of State, Deputy Calleary. One of the reasons given last week for the recent job losses was the need to improve cost competitiveness. One of the points made at that meeting concerned the terrible condition of the N5, the main access road to Mayo, and the urgent need for bypasses in Ballaghderreen and Longford. The leader of one of those companies stated directly to the Taoiseach that because of the poor condition of the road his company has to increase the quality of the packaging on its products in order to have them survive the journey to Dublin. This put €400,000 extra on the costs of one company. I have no doubt if that cost was not there cost competitiveness would be improved.

The availability of broadband in many areas in Mayo is totally deficient. A small business contacted me in recent weeks to say it would be in a position to employ five or six extra staff if it had acceptable broadband reception.

Why can small businesses, which employ 800,000 people in this country, not be supported in protecting the jobs they have and be incentivised to take on extra workers with PRSI relief or in other ways? Another way would be to get rid of the stifling regulations that hinder and put obstacles in the way of small business. One need only look at any town centre throughout the country and in my county, Mayo.

I urge the Government to create the environment and provide the infrastructure — the N5, N26, broadband, the western rail corridor — to make Mayo an attractive location for inward investment for jobs in the county. Almost 13,000 people are on the live register at present in County Mayo. It needs action now.

I conclude by offering the Minister of State a direct quote from the chief executive officer of one of the companies that give substantial employment in Mayo, taken from a recent newspaper interview. The words are his, not mine.

There just doesn't seem to be any realisation at Government level that failure to address the N5 situation is putting jobs at risk. We are competing with plants in other parts of the world where there is excellent infrastructure and we are at a serious competitive disadvantage. If any one of these companies go they will not be replaced in this part of the world.

This is not a matter of whether we can afford to take on board the outlined suggestions. We cannot afford not to. Three thousand people employed directly provide €350 million annually to the Exchequer. We need to secure those jobs and improve the situation and attractiveness for new ones.

Minister of State at the Department of Enterprise, Trade and Innovation (Deputy Dara Calleary)

I apologise to the House. I made some late changes to my script and no copy is available. I shall provide one to the Deputy and the House first thing in the morning.

I thank Deputy O'Mahony for raising this issue on the Adjournment. I share his concerns. As he is aware, Baxter Pharmaceuticals announced last Thursday that it planned to seek 150 permanent voluntary redundancies and the conclusion of 50 temporary contracts. As Deputy O'Mahoney indicated, the company stated this position was due to the economic downturn and its subsequent impact on European health care cost saving measures and the ongoing need to improve cost competitiveness. However, it is important to stress that the company will continue to employ almost 900 people when these redundancies are completed and it has committed its future in the Castlebar plant.

I assure the Deputy that the IDA and Enterprise Ireland, together with Mayo County Enterprise Board and Mayo County Council are working to facilitate and support enterprise development in Mayo. Key to the IDA strategy for Mayo within the western region is to progress the development of a knowledge-based economy so that Mayo, and, in particular, the linked hubs of Castlebar and Ballina, with Westport as a priority location, can compete both nationally and internationally for foreign direct investment. IDA's strategy for its western region is to support the growth and development of the region's existing clients by working with them to increase their strategic importance through additional functions and activities, to market the western region to overseas clients in order to secure new greenfield investment, to strengthen the region's product by working with relevant partners, including local authorities, third level institutions and service providers to enhance the region's ecosystem and to provide property solutions with supporting infrastructure to attract foreign direct investment. In this regard the IDA has invested and continues to invest significantly in the provision of plant and focus property solutions in the west, specifically in County Mayo with the development of business and technology parks in Westport and Castlebar and the purchase of 11.5 hectares of industrial-zoned land on the Sligo road in Ballina.

There are 18 IDA-supported companies in County Mayo employing more than 2,900 people in permanent jobs with a further 500 temporary positions and contract employment. Enterprise Ireland activities focus on the creation of new jobs through supporting entrepreneurs who set up new high-potential start-up companies, the retention and creation of new jobs in existing companies and enhancing the innovation capability of Ireland at national and regional level through supporting research companies in third level institutions. Enterprise Ireland-supported companies in County Mayo in 2009 included Construction Management Software Limited, INTIME Group Limited and the Ovegen Group. Enterprise Ireland also supports community enterprise centres in eight locations, including Ballina, Ballyhaunis, Brickens, Castlebar, Claremorris, Foxford, Killala and Kiltimagh, and funding for the community council has recently been reactivated.

I accept Deputy O'Mahony's concerns in regard to infrastructure. As he stated, we organised a meeting recently with the Taoiseach, specifically in regard to the bypasses he mentioned at Ballaghaderreen and Longford and the completion of the N5. We continue to make the case for those projects. I noted the comments he gave made by a chief executive officer but draw his attention to comments from another CEO who complimented Government enterprise policy in regard to decisions his company came to in announcing the expansion of its existing facilities. I also noted commentary in local newspapers by Castlebar Town Council about its willingness to work on new solutions with the IDA. I would be happy to facilitate that and will facilitate Deputy O'Mahony in any initiative to encourage enterprise in the county and specifically to encourage a response to the situation in Baxter Healthcare. Our thoughts are with the workers affected and I am happy to assure the House that the agencies involved will be on hand to support them in any way they can.

The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 4 November 2010.

Dáil Éireann debate - Wednesday, 3 Nov 2010