Adjournment Debate

Health Services

Deputy Joe Behan

I thank the Ceann Comhairle for giving me the opportunity to raise this important matter on the Adjournment today. As Members know, dementia is an umbrella term for a group of conditions which cause brain cells to die. Alzheimer's disease is the most commonly known form of dementia and is a condition which has a potentially devastating impact on the cognitive, emotional and physical life of the affected person and poses enormous challenges for their families. Dementia is progressive in its nature, but thankfully in some cases the progression can be slow and because of this the person can often live independently and with dignity in his or her local community with a range of supports. It is also important to note that while dementia is usually a condition of older age it is not part of the normal aging process.

The Alzheimer Society of Ireland reported recently in its pre-budget submission that there are currently 44,000 people with dementia in this country and they predict that this will rise to more than 100,000 over the next 25 years. There are estimated to be approximately 50,000 carers of people with symptoms of dementia at present but when one adds in the number of other family members who assist and whose lives are affected by this condition, it represents one of the most serious challenges to the health care system in this country and is worthy of detailed consideration and prioritisation by the Members of Dáil Éireann and the Government.

I attended the launch of the Alzheimer Society of Ireland pre-budget submission some time ago and I was struck particularly by the testimony of the daughter of a person with dementia. She described in heartrending detail the progression of the illness which her mother endured and how it came to affect her own health in a serious way as well. That presentation prompted me to request this debate today.

The Government should give serious consideration in the forthcoming budget to the following four key points made by the Alzheimer Society of Ireland. First, protection should be given to the current funding level of €14.61 million for the community services provided by the Alzheimer Society of Ireland nationally. This would help to sustain the basic level provision of day care service, carer support groups, social clubs for carers and persons with dementia, and the Alzheimer's disease national helpline to current service users. Second, the current levels of service should be extended to the 1,000 people on waiting lists throughout the country at an additional cost of € 4.6 million. Third, the 4,400 younger people with dementia who currently have little or no support structure or services should have a regional case management service to assist, post-diagnosis, in accessing entitlements, services and information. This would cost €350,000. Fourth, a public campaign promoting risk reduction and prevention of dementia in the general public should be organised and supported. This would cost €250,000.

I believe that there are compelling reasons to designate dementia as a national health priority. A national dementia strategy would enable the formulation of a strategic and fully co-ordinated response to meet the needs of people with dementia and their carers. It is an extremely worthwhile objective and I ask that the Government consider this matter carefully and sympathetically when framing budget 2011.

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

Dementia is a most distressing condition, both for those suffering from it and their families. It presents a significant and growing challenge to health and social services.

Alzheimer's disease represents about 70% of the cases of dementia. People are living longer and, as a consequence, are more likely to develop some form of dementia. While dementia is not solely related to age, the prevalence is higher in older people and increases with age. It is estimated that approximately 5% of people over 65 years of age have some form of dementia, with this figure rising to 20% for people over 80 years of age. Research and published work on dementia have outlined the complexity and range of issues involved in its effective management. This work also emphasises the need for co-ordinated, multi-layered and well-resourced services which respond to the individual needs of people with dementia, and of those who care for them.

There is an intimate link in Government policy between the care of older people and that of people with dementia. It stresses the need to provide support in dignity and independence, through the provision of appropriate services to the people concerned and their carers. Recent years have seen dramatic changes in both the concept and practice of services for older people. Enormous strides have been made in developing a comprehensive, community-based service. This will continue to focus on helping people to remain in their own homes and communities.

There has been an unprecedented level of investment in this sector. The Government has provided over €200 million in additional funding for new service developments in recent years. This year, therefore, the Health Service Executive will invest in the region of €211 million for mainstream home help services and approximately €130 million for home care packages. This commits the executive to providing almost 12 million home help hours to over 54,000 people; to deliver home care packages to over 9,500 people at any one time or to some 13,000 clients over the course of the year; and to maintain over 21,000 day care or respite places, benefiting an estimated 80,000 people.

On 1 July 2009, the new regulatory regime for residential care settings for older people came into force. On that day the Health Information and Quality Authority, HIQA, commenced an independent system of registration and inspection of all nursing homes. The Health Act 2007 (Care and Welfare of Residents in Designated Centres) Regulations 2009 underpin the National Quality Standards for Residential Care Settings for Older People in Ireland.The standards include supplementary criteria for dementia specific residential care units which should be read in conjunction with the general standards. Since the commencement of the regulations the authority has inspected all designated centres for older people, some 600 centres and published approximately 550 inspection reports.

The demographic make-up of Irish society is changing. Our population is ageing. The number and proportion of people diagnosed with dementia can be expected to increase, and with it demand for services. In recognition of this, the Department of Health and Children has started the process of developing a policy on dementia that will support the delivery of long-term care services. The policy will be developed on the basis of the best evidence available from national and international sources.

One of the first issues to be addressed is the need for comprehensive data on the prevalence of dementia in Ireland, on dementia specific services and on demographic trends. Officials from the Department held discussions with relevant stakeholder groups and the Health Service Executive earlier this year on the first stage of the process. Arising out of these discussions an advisory committee was formed to oversee a project to provide a comprehensive research evidence base to inform the development of the policy. I expect this project to be completed and submitted in 2011. Following this, formal work on the national policy will commence.

In addition, the HSE is currently exploring the potential for changes in care pathways for people with dementia, and will make recommendations for the future provision of dementia care across all health and social services. An audit is under way within the HSE of the current specialist dementia care services available both in residential or hospital settings and community services and it is hoped to have it completed by the end of this year. This work will also feed into the overall dementia policy formulation.

Road Network

Deputy Martin Ferris

I welcome the opportunity to raise this issue. Last Monday night, I attended a meeting in the Devon Inn Hotel in Templeglantine which was attended by more than 200 local people. The meeting was in response to a number of fatalities that have occurred on the stretch of road down the hill at Barna. Only two weeks ago, a young 20 year old student, Liva Eglite, was killed on the road and in September three local men who were travelling in a taxi were also killed. Another person was killed since May this year, which comprises five fatalities on this stretch of road.

With regard to the alignment of the road, it is over 21 years since a section of the road which goes down the hill was upgraded. The road led into a bridge and the bridge was removed. There is now a double lane of traffic going up and down the hill. However, it leads into a bottleneck and it is at this section that all these fatalities occurred. There is grave concern about the safety of the N21 at Barna. The public meeting highlighted that concern and the fears of local people with regard to the lack of activity and commitment to addressing that safety hazard.

Representatives of the National Roads Authority, NRA, and Limerick County Council were invited to the meeting but did not attend. These public servants did not attend to answer the public's concerns. I corresponded by e-mail with the National Roads Authority about this. The reply I received thanked me for the invitation but respectfully informed me that its representatives would not be attending my meeting. In fact, the meeting was arranged by the general public and I was asked to attend, like every other public representative in the area.

I understand Limerick County Council has submitted a plan for a re-alignment scheme for the road to the NRA. I call on the NRA to ensure this is made a priority. I also ask the Minister to use his influence to ensure the proposals are acted on before any more deaths or serious injuries occur on that road. The NRA has responded to the council's proposal by stating that it will only be considered as part of works to be carried out in 2011 and that it would be subject to the overall budgetary constraints under which the authority must operate.

While I am fully aware of the budgetary situation we face, this issue must be a priority. It is a matter of life and death and has caused terrible tragedies for families both from the area and outside it. I do not say that lightly, but in the interests of safety. The re-alignment and upgrade of this stretch of road must be made a priority. Otherwise, we will be discussing this again in 12 months with more fatalities having occurred. That road has claimed lives each year. The local law abiding, decent people were so concerned that they have initiated a public campaign about it. I hope the Minister will give it the attention and concern it deserves and that the NRA will respond to the political direction of the Minister and the Government.

Deputy Áine Brady

I am taking this matter for the Minister for Transport, Deputy Dempsey, and thank Deputy Ferris for raising it.

The Minister for Transport has responsibility for overall policy and the provision of Exchequer funding for the national roads programme element of Transport 21. Section 17 of the Roads Act 1993, as amended states the National Roads Authority, NRA, has a general duty to secure the provision of a safe and efficient network of national roads. Section 19, which is even more specific, provides for the NRA to prepare or arrange for the preparation of construction of improvement works on these roads and to allocate funding to such works. The Minister, therefore, has no direct role or function in the matter of providing funding or issuing directions to the NRA to work on specific sections of our national road network.

The NRA has an ongoing annual programme of safety improvements to the national roads network based on accident statistic data. It funds an extensive programme of engineering works with the aim of improving road safety and dealing with known collision clusters, formerly known as black spots, on national roads.

Over the past five years, an annual average of 120 locations have been the subject of remedial measures. It is proposed to complete over 150 schemes this year. Prioritisation of safety related works is determined on a national basis by the NRA; again, the Minister for Transport has no role or function in the specifics of this work.

Since 1997 the Government has provided in excess of €15 billion to develop the national road network. In that time, the NRA has made considerable progress in bringing the network up to standard. The NRA is reviewing its investment plans for the national roads network. The review is being carried out based on a commitment in the renewed programme for Government and taking into account available capital resources. As the House will appreciate, progress on particular road schemes will be dependent on the availability of funds within a significantly reduced capital budget.

Road safety is a key priority for the Government and this commitment is underpinned by the road safety strategy, 2007 to 2012. The strategy's primary aim is to reduce road deaths to no greater than 60 fatalities per million of population by the end of 2012, which equates to an average of 21 road deaths per month or 252 deaths per year. In 2009, there was a total of 241 fatalities, an average of 20 per month. The emphasis now is on taking steps to ensure the good progress is continued for each of the remaining years of the strategy.

Responsibility for oversight of the implementation of the strategy rests with the Road Safety Authority, RSA, and involves participation from several Departments, the Garda Síochána and other agencies. Under the Road Safety Authority Act 2006 (Conferral of Functions) Order 2006, responsibility for the collection of information on road collisions lies with the RSA. Based on its statistics, the authority states road collisions are rarely caused by any one single factor. In most cases, collisions are caused by several factors, including human error in dealing with the driving conditions around which the collision occurred. According to the RSA road collision facts 2008, driver error is responsible for 90% of collisions, pedestrian error accounts for 6%, and road conditions account for 3%. It is obvious the personal responsibility of drivers plays a major role in road traffic collisions.

The RSA and the Garda Síochána recently rolled out the privatised safety cameras initiative to target speeding on all roads at all times of the day and night. The Minister for Transport understands the section of the N21 in question will be receiving ongoing attention from the new cameras at the direction of the Garda Síochána.

There is, of course, no acceptable number of road fatalities. The strategy, however, appears to be working. Road deaths dropped by nearly half between 1999 and 2009, inclusive. According to the third report of the European road safety performance index programme, run by the European Transport Safety Council, Ireland is now ranked sixth out of 27 EU member states in road deaths per million population. This compares well to our eighth position in 2001.

Unfortunately, there will be times when, no matter how good the roads are and no matter how strict the enforcement, the behaviour of the driver will be the determining factor as to whether an accident occurs and how serious it will be. As we get nearer to Christmas, and at a point where our accident statistics indicate we have reduced fatalities by a further 6% as against this time last year, I ask all drivers to slow down, take care and help to prevent further needless tragic loss of life.

Horse Racing Ireland

Deputy Chris Andrews

I thank the Ceann Comhairle for the opportunity to speak on this matter. I originally tabled it last week. Since then various statements have been released by Horse Racing Ireland, HRI, KPMG and the Irish Bookmakers Association, IBA, each asserting different positions on the report on HRI's expenditure. For this reason, I will not focus on this but rather wider issues concerning HRI and betting tax generally which should be addressed.

HRI has refused to release information requested from it under the Freedom of Information Act. As stated in a response to a parliamentary question I tabled, HRI is subject to all the provisions of the freedom of information legislation. I know HRI rejected the original application for information stating the amount of information requested was deemed to be too large. I would like to see an effort made to attempt to facilitate the revised request from the IBA. Any disputes about spending figures etc. would be resolved by the release of this information.

Reports in the media today detailed suggestions for betting tax to be increased from 1% to 2% so the revenues raised can be used to fund the two activities, horse racing and breeding. The author of this report was Colm McCarthy, author of the bord snip nua report in which he recommended reducing funding the horse and greyhound fund by €16.4 million to €51.7 million. He stated this was still a substantial amount of Exchequer funding for the sector. Is there a possible conflict between these two stances?

I appreciate the value of the racing and breeding industry to Ireland and our economy. However, now is a time when organisations such as HRI must be able to prove a return for State financing. The Irish Sports Council which supports over 62 sports receives 24% less funding from the taxpayer than the horse and greyhound racing industries. Prize money in Irish horse racing is 60% higher, on average, than that offered in England. While I understand the arguments placed by both sides, we must have a clear picture of how State grants are spent by HRI.

We must ensure best value for money is achieved rather than indiscriminately granting greater funds though proposed tax increases, without ensuring this funding is being used to its best advantage. For example, many of the country's horse racing tracks appear to have not benefited from State funding. The all-weather racing track in Dundalk remains closed for half of the year.

HRI claims substantial prize money must be offered for Ireland to remain an attractive place for top-tier breeders to enter competitions. However, is HRI achieving best value for money? Could savings be made in areas such as salaries and administration, which could then be passed on to the prize money fund, rather than throwing money indiscriminately at HRI?

It is inherently unfair that a person who bets on soccer, rugby or boxing makes a contribution to HRI but not to the sports in question. This practice discriminates against other sports, much in need of funding.

Deputy Áine Brady

HRI is a commercial State company established under the Horse and Greyhound Act 2001, with a board appointed in accordance with the Horse Racing (Membership) Act 2001 whose duty it is to direct the affairs of the company.

Horse racing and breeding is a significant industry in rural areas, supporting approximately 16,000 private sector jobs, often in areas where alternative employment opportunities are limited. The industry has a regional spread with 26 racecourses, over 770 trainers and some 9,500 breeders spread across the country. Each of these generates direct employment and supports a diverse network of local suppliers including vets, farriers, feed merchants, transporters, grooms, jockeys etc.

Last year, almost 1.25 million people attended Irish race meetings; racing accounts for approximately 80,000 tourist visits every year. The Punchestown and Galway festivals are worth €45 million and €60 million each to their respective local economies. Ireland is the third largest producer of thoroughbreds in the world with exports of thoroughbred horses to over 35 countries worth €175 million in foreign earnings.

The industry's value to the economy is estimated at €1.1 billion per annum and the industry generates significant foreign direct investment.

Government support for the horse and greyhound industries is provided under the Horse and Greyhound Racing Fund, which was established under section 12 of the Horse and Greyhound Act 2001. The Act provides that 80% and 20% of the moneys paid into the fund each year are distributed between Horse Racing Ireland and Bord na gCon, respectively.

Since 2008, there has been a significant reduction in the amount of public funds allocated to the horse and greyhound fund, falling from €76.3 million in 2008 to €68.1 million in 2009 and €59.3 million this year — a 23% reduction in two years.

An independent review of the fund was completed in 2009 and concluded that, while not all aspects of the total contribution of the sector can be definitively quantified, there is adequate direct and indirect evidence to support a strong argument that the horse and greyhound racing industries contribute a major source of direct and indirect employment, give rise to considerable domestic and exports earnings and constitute a key driver of substantial economic activity, especially in rural areas.

Funding of both Horse Racing Ireland and Bord na gCon supports two important productive industries and helps to sustain the important role of horse and greyhound breeding and training enterprises in the development of the rural economy. These industries generate substantial economic activity and make a vital contribution to the rural economy, including farm incomes. Furthermore, bloodstock breeding is a sustainable and environmentally sound activity.

Some recent commentary has focused on the value of prize money at Irish race meetings. In that regard, it is worth making the point that the value of Irish prize money has been declining in the past two years, from a peak of €60.4 million in 2008 to an anticipated €47.7 million this year — a fall of 21% in two years. Prize money in 2010 will fall back to below the 2004 figure. It is also worth noting that for the five flat race classics this year, Horse Racing Ireland's contribution to the total prize fund of €2.5 million was only €20,000 with the balance funded entirely by owners and sponsors.

Prize money is regarded as the lifeblood of racing. A report commissioned by the Irish Thoroughbred Breeders Association identified that in 2008, €289 million was spent on training fees to win available prize money of €60 million and in the decade between 1999 and 2009, expenditure on training fees and stable staff employment averaged about five times the total prize money available. The policies pursued in relation to prize money in Ireland over the last decade are regarded as having ensured that some of the best horses in the world have been kept in training in this country.

Horse Racing Ireland is subject to annual audit by the Comptroller and Auditor General and at no time since its establishment has its efficiency or effectiveness been called into question. In addition, it has outsourced its internal audit function, which operates in accordance with the framework of codes of best practice, as set out in the code of practice on the governance of State bodies and which reports directly to the company's audit committee.

In response to recent allegations made about it by the Irish Bookmakers Association, HRI strongly rejected the claims made. Having met to consider those claims earlier this week, the board of HRI found them to be "wholly inaccurate and based on a flawed understanding of the racing industry and, in particular, the restructuring which took place following the enactment of the Horse and Greyhound Act in 2001." Indeed, the authors of the report on which the Irish Bookmakers Association's claims were based, acknowledged that their analysis "did not, nor was it required to, take account of the restructuring of the horse racing industry in 2001, resulting in the transfer of certain administrative functions of the Turf Club to the newly formed HRI".

Contrary to the IBA's claims that Horse Racing Ireland's costs are out of control, HRI makes the point that its costs increased by 35% between its first full year of operation in 2002 and 2009. Over that same period, there was a 28% increase in the number of race meetings. HRI also makes the point that, since 2008, its administrative costs have reduced by 28% and the number of permanent employees in the HRI group — including the Tote, the four race courses it owns, and Irish Thoroughbred Marketing — has been cut from 176 to 143 in the same period, which is a reduction of 19%.

In a recent letter to the Minister for Agriculture, Fisheries and Food, the chairman of HRI assured the Minister, Deputy Brendan Smith, that the "board takes its responsibilities in relation to governance and cost control very seriously".

Sugar Beet Industry

Deputy David Stanton

I wish to thank the Ceann Comhairle for allowing me to raise this matter on the Adjournment. At a time of high unemployment and emigration we should examine every single possibly of increasing employment. The closure of the sugar beet industry occurred a number of years ago and there were reasons for that. Last week, however, the European Court of Auditors issued a report which, to say the least, raised questions about how the decisions were taken. Ireland ended up as the only member state with just one factory to close and consequently our 80-year-old industry was shut down.

A number of people have approached me recently to suggest that we should examine the possibility of re-establishing the sugar beet industry here. This time, they suggest, that such a plant could be linked to the production of ethanol, electricity and a district heating system.

The European Court of Auditors' report was highly critical of the initial decision, saying that the information was out of date. The report also said that overall sugar production has become less competitive as a result of the reforms and that price cuts have not been passed on to consumers. The Minister of State may be interested to note that the Siúcra brand is now owned by a German company.

The price of sugar on world markets has never been higher, as there is a global shortage. This presents an opportunity for Ireland given the current huge unemployment and mass emigration. Let us therefore examine this proposal and discuss it to see what the potential is. For instance, the EU biofuels directive advocates that member states replace petrol and diesel transportation with biofuels. To that end we should produce more ethanol. There is a major opportunity to do this if we linked ethanol production with sugar production.

The report of the European Court of Auditors also said that the Greencore plant was large, modern and potentially efficient. The ECA report also maintained that sugar production is now controlled by a very small group, with some 75% of EU production currently accounted for by six industrial groups. There are all sorts of reasons Ireland should reopen this debate on sugar beet production. This is especially so if we can prove that the original closure decision was flawed. The ECA report maintains that it was based on outdated information.

The ECA report said that there was no follow up on the impact of the closures of this industry on local communities. There are many recommendations in the report that should be followed up. The Government should establish a study group on this matter and invite experts to make submissions to it. Let us have an open discussion on this suggestion to ascertain its feasibility.

Other things could flow from this proposal also and the last debate on horse racing was relevant in this respect. The importation of pulp for animal feed is all important now, although there was a time when we were self-sufficient in that regard. That is another reason we should reopen the debate on sugar beet production. There are many other reasons we should examine this plan, so I will be interested to hear what the Minister of State has to say about it.

Last year, we imported €99 million worth of sugar, and in 2008 we imported €77 million worth. Surely that is a reversal of what we should be doing. Up to a few years ago, we used to export a small quantity of sugar and were self-sufficient in supplies. Meanwhile, the ECA report stated that no reductions in bulk sugar prices have not been passed on to consumers. Nobody has benefited therefore and the country has lost out hugely. Farmers have lost out, as have contractors, former sugar plant workers, consumers and the economy generally. There is an opportunity here for us to resume sugar production.

We currently import ethanol from Brazil, so any plan to resume domestic production would be a win-win situation. The Government should examine this matter. It should go back to Europe and explain that this decision was flawed initially. For the good of the nation, let us revisit the decision and see if a resumption of sugar production is feasible. I am not calling for it to be done immediately, but I want a study to be undertaken to see if it would be feasible for the sugar beet industry to be reopened and remodelled to include ethanol, electricity and pulp production, as well as possibly providing a district heating system through surplus heat from such a plant.

Deputy Áine Brady

I am responding on behalf of the Minister for Agriculture, Fisheries and Food. I am pleased to address the House on this matter. As part of the reform of the EU sugar regime in 2006, a temporary restructuring scheme was introduced by the EU Commission with the aim of reducing EU sugar production in order to comply with WTO and other international obligations. The scheme provided an incentive for sugar processors to renounce sugar quota and dismantle the associated sugar processing plant and it provided compensation for affected stakeholders. Greencore plc, the sole Irish sugar processor and holder of the entire Irish quota allocation, decided to avail of this restructuring scheme. Accordingly, the company renounced the quota and dismantled the last remaining Irish sugar factory at Mallow in compliance with the conditions of the scheme.

This brought the Irish sugar industry to an end. As a result of the restructuring scheme, the overall EU sugar quota was reduced by almost 6 million tonnes, of which the Irish quota contributed some 200,000 tonnes. At the time of the reform negotiations, the Government made strenuous efforts to have the Commission's reform proposals modified in such a way that an efficient sugar industry could have been retained in Ireland. In the end, there was insufficient political support among our EU partners for the Irish position and our efforts had to be directed at achieving the best possible compensation package.

The sugar reform package was secured as a whole. Restructuring aid, diversification aids and the single payment was worth approximately €226 million to Irish beet growers and contractors. The restructuring and diversification aids were paid to stakeholders concerned in 2007 and 2008. Greencore plc received €127 million, giving a grand total of €353 million of aid to Ireland under this package.

Following the restructuring of the EU sugar industry, sugar production is now concentrated in 18 member states, as opposed to 23 before the reform, which enjoy favourable agronomic conditions and over 75% of production is accounted for by seven of these member states, namely France, Germany, Poland, UK, Netherlands, Belgium and Italy. There is no mechanism under the current regulations that allow for the re-instatement of the sugar quota for the growing of sugar beet in Ireland for the sugar industry. Any proposal to review the EU sugar quota regime is a matter for the EU Commission in the first instance and any proposal to re-establish a sugar factory in Ireland would, subject to the availability of quota, be a matter for commercial decision by interested parties. At the time of the closure of Mallow, Greencore plc was approached about the possibility of producing ethanol there but it was not considered to be a viable proposition.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 23 November 2010.

Dáil Éireann debate - Thursday, 18 Nov 2010