Topical Issue Debate

Social Welfare Code

Deputy Simon Harris

I welcome the opportunity to raise the important need for the Minister for Social Protection to address urgently the problems being encountered by parents of autistic children seeking to receive or retain the domiciliary care allowance. I thank the Minister for her presence in the Chamber. According to the Department of Social Protection document, Medical Eligibility Guidelines for Domiciliary Care Allowance, domiciliary care allowance is a payment made in respect of the extra care, attention and supervision needs of the child. It is a monthly payment of €309.50, paid until the age of 16 and is also linked to eligibility for respite care grants and carer's allowance. I know many families living with conditions on the autistic spectrum, as do all Members. These children require extra care, extra supervision, extra attention and, in many cases, dominate a family's life.

Conditions on the autistic spectrum manifest themselves in many ways. To the outside world, a child might seem almost typical but behind closed doors a family could be experiencing severe challenges in meeting the care needs of their son or daughter. When it comes to autism and assessing need, nothing is black or white. It varies from child to child, from family to family. Domiciliary care allowance does not remove the challenges and it does not provide a cure because there is no cure. However, it provides some recognition, some help and some acknowledgement that the parents of a child with autism spectrum disorders, ASD, are meeting those extra care needs. It is a small help in what can be a difficult family life.

It now seems that parents of children with autism are meeting more and more obstacles in their efforts to receive domiciliary care allowance or, for those already in receipt, to retain it. I will give an example in the words of a parent:

I was one of the first to be hit with the refusal letter after Christmas having been in receipt of DCA for a little over 2 years. Apparently the reason they gave for refusing to continue payment was, "your child doesn't require any more care than a child of the same age who doesn't have a diagnosis".

That is earth shattering and insulting to the family of a child with a special needs diagnosis. That child was diagnosed two and a half years ago with ASD.

The child has toileting and feeding issues and can be prone to meltdowns. They have a full-time SNA in school, yet the Department had the audacity to say that the child does not have additional care needs.

I do not expect the Minister for Social Protection or any other Minister to respond to individual cases in a debate - I would not raise any individual case - but I want to assure her that the comments of this parent are replicated by dozens of others who have contacted my office. Fear of the postman delivering a brown envelope with the State harp through the door, informing families with autism that their child does not have extra care needs, is a real worry for many. I implore the Minister to take the opportunity of this debate to talk with her officials in her Department and revert with an update on the issue. Why are so many children with autism being subjected to reviews all of a sudden when their needs have not changed? Why are so many families of children with autism being refused payments they and their doctors know they need - they supply medical evidence in support of them.

I will conclude with a comment from another parent: "I am at my wits end trying to put together enough paperwork to prove what is clearly obvious to anyone who spends time with my children. I cannot tell you how soul destroying this process is." The parents of children with autism have to constantly fight a bureaucratic war with paperwork to prove a need they and their doctors know exist and they do not have time to be fighting. I would be grateful to hear anything the Minister can do to help address the situation.

Minister for Social Protection (Deputy Joan Burton)

The domiciliary care allowance, DCA, is a monthly payment to the parent or guardian of a child with a disability so severe that the child requires care and attention and-or supervision substantially in excess of another child of the same age. This care and attention must be provided to allow the child to deal with the activities of daily living, and she or he must be likely to require this level of care and attention for at least 12 months. Responsibility for the administration of new claims to the allowance transferred to the Department from 1 April 2009, with the existing customer base transferring on 1 September 2009.

The allowance is currently paid to over 24,000 parents or guardians in respect of 26,000 children at a cost of approximately €100 million in 2011, with the accompanying respite care grant costing a further €45 million, a total of €145 million. The respite care grant is an annual payment of €1,700 automatically paid to DCA parents in respect of each qualified child, provided it is in payment at the beginning of June in the particular year.

The application process for the allowance is exactly the same for children with autism as for those with any other disability and involves the completion of a claim form which includes details of the medical condition of the child and the level of care and attention the child needs to deal with normal day to day activity. This information can be provided by the parent or guardian of the child, the child's general practitioner and any other professionals who have dealt with the child. There is a section on the application form which allows for the detail of referrals to any of nine professional services to be listed and reports relating to these referrals can be included with the application.

Applicants are also free to submit any other information they feel will inform the Department's deciding officer in making his or her decision. All the information submitted is assessed by designated departmental medical assessors. Decisions are made by doctors, not departmental administrative officials. Medical assessors are qualified and experienced people who meet regularly to ensure best practice and consistency of approach. As the medical diagnosis is not in dispute, it is considered that the medical assessor is in a position to perform the role of assessing the additional care required for the child by way of desk assessment using the detailed information supplied.

Based on the information available, the Department's medical assessors give their opinion to the deciding officer as to whether the child's disability is such, as Deputy Harris said, that it requires him or her to need continual or continuous care and attention substantially in excess of that required by a child of the same age. They also advise as to whether the disability is likely to last for at least 12 consecutive months.

The range of disabilities that could qualify a child for the allowance is not prescriptive and, as such, each case is decided on its merits, taking account of all the available information. The current application form allows for the applicant to submit as much information as he or she may wish and from as diverse a group of professionals as possible. This ensures that the medical assessor has all the relevant information available before giving his or her professional opinion in each case.

The decision as to whether a child satisfies the qualifying conditions for DCA is made by the deciding officer, having considered all the circumstances including the opinion of the Department's medical assessor. In this context, the Deputy should note that the percentage of children on the autism spectrum that are refused DCA is in line with the overall refusal rate. DCA cases are reviewed to ensure that the conditions for receipt of the payment continue to be met. Scheduled reviews, on the recommendation of the medical assessor, are based on the prognosis of the child's disability and how his or her condition may or may not improve over time.

Parents and guardians are involved in the review process as reviews are initiated with the completion a review of medical criteria form by the parent, which also requires medical input from the child's doctor. The parent returns this form, together with any additional recent reports of medical or therapeutic services the child may be receiving. This information is then sent for review by one of the Department's medical assessors who will provide an opinion to the deciding officer on whether the child still meets the medical criteria for receipt of the payment. DCA remains in payment during the review process until a revised decision is made.

Deputy Simon Harris

I thank the Minister for her comprehensive reply which sets out the technical nature of the DCA scheme. From dealing with the issue in my clinic and my involvement with autism charities - many Members of the House will concur - it is not being matched with the reality.

In an effort to be constructive I will highlight some issues. One is the 21 day period of appeal that families are given. In many cases families cannot access the support services they need to back up their appeals within 21 days. Families depending on access through the public service wait for a longer period of time. As I am sure do many other Members, I meet people who come to my clinic in a panic to return the form within 21 days but have not seen medical experts within that period to back up their complaints.

The Minister referred quite correctly to the disabilities the Department's medical experts examine and whether a disability will last longer than 12 months. In the case of a condition like autism, it is lifelong and there is no cure. Some of the reviews I have come across happen at the most bizarre times, such as when an autistic child turns 13 years of age, moves to secondary school or commences puberty. They are very sensitive stages in the life of a child with a disability and a family living with an autistic child. Such reviews can be insensitive.

The problem I and the families I talk to see is that autism is not, strictly speaking, a medical condition. It is a neurodevelopmental condition. It is not the same as being in a wheelchair, with the many challenges that poses. It is different and varies from child to child.

Representatives of autism support groups have met with Department officials and have expressed concern about the DCA operational guidelines for deciding officers. I understand the officials acknowledged there may be an issue and it might be an area the Minister can examine. The Minister might also provide us with up-to-date data on the period of time it takes to assess an appeal, particularly if it has been refused.

Deputy Joan Burton

I want to discuss what is happening in terms of numbers. Some 55% of the claims for children with autism-related conditions were allowed from 1 April 2009 to 31 March 2011. These statistics are based on a total of 920 DCA applications processed during that period, with a stated medical condition within the autism spectrum. Of these, 507 were deemed to satisfy the qualifying criteria, and 413, or 45%, were deemed ineligible. Approximately 46% of all claimants are awarded the allowance. The success rate does not vary significantly between claims relating to an intellectual disability and those relating to a physical disability. This must be emphasised in the context of the Deputy's concern that children with an autism spectrum problem may be dealt with differently from other children whose parents submit claims.

The Department took over the scheme in 2009, before which the eligibility criteria were set out in a circular from the Department of Health and Children. The medical criteria, as set out in the circular, referred to children with a severe disability requiring continual or continuous care and attention which is substantially in excess of that normally required by a child of the same age. The medical criteria in the Social Welfare Act are almost exactly the same. There were no agreed national guidelines for the scheme when it was under the Department of Health and Children and the HSE. An expert medical group was established when the scheme was being transferred to the Department of Social Protection. The primary purpose was to set out consistent and objective guidelines for use nationally in determining the eligibility of children for the scheme. The assessment structure developed from the recommendations of that group.

If at the time of a child's assessment there is a recommendation to award an domiciliary care allowance, a review date is often indicated by the medical examiner. I presume the review's appropriateness is based on his or her medical expertise related to the condition the child presents with. The structure is in place. While I appreciate what the Deputy is saying about families being concerned, we are not treating children with an autism spectrum disability differently from others. The circumstances of children who qualify at a certain age for the allowance may improve or change. The expert medical group gave advice on the structure.

Local Authority Contracts

Deputy Arthur Spring

I thank the Ceann Comhairle for choosing this topic because although we are creating work, we are not necessarily creating jobs. I will elaborate on that.

The Road Safety Marking Contractors Association, RSMCA, was established within the Construction Industry Federation in 1998. It comprises the leading road marking contractors in Ireland. They provide direct employment to an estimated 400 people. The association's members are typically family-owned companies carrying out their work as main contractors for all the local authorities and the National Roads Authority and as subcontractors to civil engineering and road-surfacing contractors. These companies make a valuable contribution to the safety of roads in some very hazardous environments and the quality of their work is only to be commended. This work is paramount on many fronts and it is contributing to the decrease in the number of deaths on the roads.

During recent years, the association has noted a marked increase in the number of non-resident contractors being awarded work by local authorities for both road marking and road surfacing and a lack of effort by all public procurement bodies to ensure that all contractors or subcontractors, irrespective of where they are based, are fully compliant in respect of working in the Republic.

I am concerned about non-compliant contractors tendering and carrying out work on behalf of local authorities. They are competing with Irish-owned companies but have a lower cost base than those companies. Under the public procurement procedures of the Department of Finance, all contractors, including subcontractors, carrying out work on behalf of all local authorities must comply with the registered employment agreements. This ensures there is a level playing field for all competing tenderers in public procurement in regard to rates of pay and compliance with construction workers' pension schemes and revenue regulations. Employers are contributing €28 per week for each employee to the CWPS, while employees are contributing €24.50 per week. Foreign-owned companies have a distinct advantage as they may not be obliged to meet such pension requirements.

Failure to comply with the requirements is an offence under section 32 of the Industrial Relations Act 1946 and section 10 of the Industrial Relations Act 1969. Therefore, there is an obligation on all procurement authorities to ensure there is in place a robust and transparent administrative procedure when awarding contracts. The policing of these procedures falls upon the NERA, the CIMA and the local authorities but this is either not being done or being done through self-certification. Self-certification means a company signs a document stating it is compliant but it does not have too furnish any proof of this. It is the burden of proof that ensures non-compliant contractors must comply with relevant legislation. In certain instances, the local authority checks only that the main contractor is compliant and dismisses any requirement to check that all subcontractors on site are compliant. Compliance with the arrangements imposes a considerable cost on companies tendering for public procurement contracts, and the lack of enforcement of the legislation gives an unfair advantage to non-complying contractors coming in from abroad.

The association met Mr. Deering of the NERA last year to discuss this issue. The NERA has no powers to act against out-of-State contractors. This means non-compliant contractors can work without fear of prosecution. An integral part of the procurement process is the use of framework contracts, whereby a number of contractors who are pre-qualified participate in a framework agreement. Framework agreements typically last two years. It can cost considerable time and effort to pre-qualify for a framework agreement but it is the experience of the association's members that an integral part of the pre-qualification process is an interview with each tenderer to ascertain that the information submitted on the pre-qualification document is factually correct. However, I have been informed that no member of the RSMCA has ever attended such an interview, yet some of its members are pre-qualified in respect of a number of framework agreements.

Minister of State at the Department of Finance (Deputy Brian Hayes)

I thank Deputy Spring for raising this important matter.

It is a condition of the public works contracts that contractors must comply with the relevant regulations governing employment conditions. The most recent legislation in this area includes the Registered Employment Agreement (Construction Industry Wages and Conditions of Employment) Variation Order, 2011, and the Registered Employment Agreement (Construction Industry Pensions Assurance and Sick Pay) Variation Order (No. 2), 2006. The one exception, as referred to by the Deputy, is in regard to the registered agreement for pensions where a firm registered in another member state and working in this country has employees temporarily posted from that other jurisdiction and who subscribe to a national pension scheme in their own country. In such circumstances, the firm, or its employees, does not have to subscribe to the Irish pension scheme.

The National Employment Rights Authority, NERA, which has responsibility for monitoring employment conditions through its inspection services and which can enforce employment rights compliance and seek redress, comes under the aegis of my colleague the Minister for Jobs, Enterprise and Innovation, who has responsibility therefor. Where there is evidence that firms may not be complying with regard to relevant statutory pay and conditions of employment, the matter can be referred to the NERA for investigation.

There are a number of provisions set out in the public works contracts to ensure compliance with the registered employment agreements and they are covered by a clause entitled "Pay and Conditions of Employment". The main contractor is obliged to display a copy of the relevant clause from the public works contract covering the pay and conditions of employment in a prominent place on the site for the benefit of all those employed on the project. The main contractor is also required to provide a certificate of compliance, entitled "Rates of Pay and Conditions of Employment Certificate", with each interim statement submitted, normally on a monthly basis. Failure to provide this compliance certificate will result in payment not being made by the contracting authority.

If a main contractor provides a certificate of compliance and it is subsequently found to be untrue or partly untrue, the contracting authority has the right to deduct the money relating to the work or part of the work covered by the certificate from any sums due to the main contractor. This money can be withheld until the pay and conditions of employment issue is made right. The ultimate sanction if a main contractor continues to be non-compliant is for the main contract to be terminated.

The public works contracts also oblige a contractor to maintain records of pay, timesheets and any deductions made for all those employed on the site. These records are subject to inspections by representatives of the contracting authority, as required. The conditions of the public works contracts, therefore, place an obligation on the main contractor to ensure compliance with the registered employment agreements for all those employed on the construction site, and this is not limited to their own employees but also applies to all sub-contractors who provide labour to the site. Contracting authorities are required to ensure that the "Rates of Pay and Conditions of Employment Certificate" is received with each payment application and, in the event of non-compliance, to withhold payment until the matter is rectified.

If there is evidence that contractors employed on public works contracts are not complying with the payment requirements of the registered employment agreements, this should, in the first instance, be brought to the attention of the contracting authority, which can investigate the matter fully under the mechanisms set out in the contract and outlined previously. Where members of the Road Safety Marking Contractors Association are making these claims, they should in the first instance make their complaints to the contracting authority, whether the roads authority, a local authority, or a group of local authorities, as in this case. I will take a close interest in the outcome of any resulting investigation. However, a complaint must be made in the first instance as, otherwise, there is no procedure through which we can investigate the matter and come to some determination. Where there is a case to be answered, the contracting authority may then take the remedies set out in the contract for a breach of the clause on pay and conditions of employment and refer the matter to the National Employments Rights Authority.

The Deputy has put very important information on the record of the House. The responsibility now rests on the Road Safety Marking Contractors Association to make complaints to the authorities. I will investigate those complaints closely.

Deputy Arthur Spring

I do not consider it is an issue of the association actually having evidence but, nonetheless, the rules under which its members are applying are not the same for non-Irish resident companies. The examples are the construction workers pension scheme, to which the Minister of State referred, the compliance with Revenue regulations and so on. The fact this is not auditable, is self-regulated and is written off without being examined means the level of integrity is just an assumption. It is more difficult for Irish firms to do business here at present than for non-Irish businesses.

I am asking for a level playing field. As I pointed out, enough work is being created and businesses are doing a good job on what is often hazardous work, for example, on motorways. However, we are creating work without benefitting from the jobs. Some of the evidence with which I have been provided - the Department can ascertain this - demonstrates that 70% of the larger construction contracts have been won by non-Irish companies in the past two years. That is a frightening statistic. We are looking for our workforce to go out and do the work. While I accept we have compliance issues, tendering processes and all the rest, I would point to the Spanish model where contracts have been broken down into smaller parts, with 25% for SMEs. These people fit that bill. I would like to see the subcontractors as well as the main contractors under the same level of scrutiny as Irish companies.

Deputy Brian Hayes

I have gained some experience in the area of procurement in the past eight months and these issues have been raised with me as the Minister of State with responsibility for procurement. Evidence is the key issue, however. Without evidence, we have no means of checking the facts and bringing these matters to a conclusion.

Of course, Irish businesses win contracts abroad as well as at home. International businesses domiciled in other countries win business in this country on a continuous basis. I recently pointed out at a conference at which I spoke that close to 70% of SMEs in this country are not even registered on eTenders. How can they possibly know about the contracts if they are not even registered to tender for contracts?

Procedurally, there are very clear international European guidelines as to how companies contract and win this business. It is a key objective of the Government to make sure Irish SMEs can pitch for and win this business. Under circular 10/10, issued by the Department of Finance two years ago, we encourage SMEs to come together to pitch for business. Any contract over €25,000 is now up on eTenders. I use this opportunity on the floor of the House to encourage those Irish businesses, first, to register for eTenders, second, to pitch for the business and, third, to work with other SMEs as a means of getting this business.

I pointed out that we have national framework agreements in place. This is to protect the taxpayer and to get the best possible price and quality. Nonetheless, I take the Deputy's point. Some of these cases involve international businesses which win contracts but actually have Irish sub-contractors in place. It is much more complicated than some associations like to present.

I take very seriously the Deputy's remark that 70% of the road marking business is going to businesses outside the country. I will investigate that matter thoroughly and come back to the Deputy on it. If the veracity of that stands up and it is a fact, as he suggests, and I do not doubt him for a moment, there is a huge question mark over why Irish businesses are not winning these contracts or pitching for these contracts in a manner which ensures they offer the best and most efficient price for the taxpayer. I thank the Deputy for raising the matter.

Hospital Services

Deputy Seamus Kirk

I thank the Ceann Comhairle for the opportunity to raise this important issue affecting the Louth-East Meath constituency. The threat to close St Joseph's Hospital, Ardee, and the Cottage Hospital, Drogheda, will have a profound and serious implication for the patients and staff of both institutions. Both hospitals have given magnificent service to patients for many years. Closure is unacceptable to the patients, staff and the communities they serve.

Given the economic context, while we must have austerity at this time, we need austerity with compassion, sympathy and consideration for the vulnerable sectors in our community. There is no more vulnerable sector than the elderly. Those who have worked hard and served our nation well in its formative years now find themselves in some instances needing nursing home accommodation. Unfortunately, as per the recent budget, they find themselves threatened with the closure of these homes.

The HSE service plan for 2012 states that a minimum of 550 public beds will close in the course of the year. However, if we examine the document more closely, we find the HSE reveals that the true number could be as high as 898 beds, which represents approximately an 11% cut in the number of beds in public residential care. This has profound implications throughout the country.

My particular concern today is St Joseph's Hospital, Ardee, the Cottage Hospital, Drogheda, and the rumoured reduction in the numbers of bed accommodation available in what is a state-of-the-art facility at St Oliver's, Dundalk, which was built as recently as the 1980s or early 1990s. I ask the Minister of State, Deputy Kathleen Lynch, to advise us whether there is any basis to the rumours and, if not, to put at rest the concerns of the patients and the staff at the hospital. If there is no basis to the rumours I ask her to put at rest the concerns of the patients and the staff in the hospital.

There is no justification for the closure of these hospitals and there will be no benefit to the HSE because under the Croke Park agreement staff will have to be allocated to other HSE facilities in the area. There is a high quality of care in the hospitals earmarked for closure and as far as I am aware HIQA has not reported any cause for concern in any of them.

The treatment of the elderly by the Government is totally unacceptable. The brunt of cuts will be borne by the sickest and poorest old people. They are on low fixed incomes, have health needs and are dependent on the State for essential services. This raises the fundamental question - how do we as a society treat our older people? Do we cast them aside and forget about them? Is the State dismissing care for the elderly as one of its core functions? If the planned closure of so many community hospitals and nursing homes throughout the country proceeds as is apparently intended there will be profound implications. Finding alternative accommodation in the private sector for those who, in many instances, have lived for years in those hospitals, will be extremely difficult. It begs the question in a county such as County Louth where there are an estimated 16,000 people aged over 65 years. I readily admit that the 16,000 will not all need institutional care but a percentage will at some stage. More and more people are living to a much older age. If I walk through any of the towns in my constituency I regularly meet people aged 90 and over. Inevitably, they will need accommodation.

I ask the Minister for State to put the concerns of elderly people in County Louth to rest by telling us she will not close the hospitals I mentioned.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank the Deputy. From my additional notes I see the estimated population of people aged over 65 years in his county is 12,636. There is a myth abroad which tells us that now we are living longer we will need additional nursing home beds. The percentage of those of us who will need nursing home beds in the future will remain the same. We are living longer and are healthier but this does not mean we will all end up in nursing home beds - nor will all the 90 year olds Deputy Kirk meets. The percentage who do is 4.5% and I believe we should be able to deal with that.

I have known the Deputy for some considerable time and it is not usually his form to make claims such as that people will have their nursing homes closed down. That is scaring very vulnerable people. As I know from my in-laws, people listen to and watch the proceedings in this House during the day. It is unfair to frighten them. I know the Deputy a long time but that is not his form.

St. Joseph's nursing home, Ardee, is a listed Georgian building that is over 150 years old. It provides accommodation on two floors for 23 people. There are currently 19 long-term residents and four respite beds at the home. I am sure the Deputy knows this better than I do. The Cottage Hospital, Drogheda, was founded in 1908 and was taken over as a nursing centre by the HSE in 1988. It provides 14 long-term care beds and 15 respite beds. St. Oliver's Hospital is situated in the grounds of the Louth County Hospital. It is a single-storey building that opened in 1987. Accommodation is available for 92 residents in four separate units. Two beds have been temporarily closed to conform to fire regulations. The remaining 90 beds comprise 87 long-term care beds, 16 of which are specifically for people with dementia. In addition, three beds provide a respite service to clients in the community.

The Health Service Executive is currently examining the future use and development of public nursing homes in County Louth, taking into account the potential of these units to comply with HIQA standards. In this regard a project group held its first meeting on Tuesday, 24 January. The group is starting work on an optimal appraisal for the most appropriate service delivery model for elderly residential care in County Louth. It has agreed a framework, with mid-March as the expected time for completion. During the process, the project team will be in regular communication with all stakeholders - patients, families, staff and the wider community.

The moratorium on recruitment and compliance with national quality standards are both impacting on the public nursing homes in Louth. These pressures are mirrored across the country and are well documented. I acknowledge there is a great deal of concern about the future of our community nursing units. There is no doubt we are facing challenges in this sector due to staffing, funding and the age and structure of the existing units. However, I can confirm that no decision will be made to close a public nursing home without a full consultation having taken place with all stakeholders.

It is clear that, on a business-as-usual basis, the HSE would have to close further beds across a range of public community nursing units in 2012. In the absence of reform, this would increase the cost of caring for older persons within the public system. Consequently, this would undermine the viability of public community nursing units and reduce the overall number of older persons who can be supported within the budget available for the fair deal scheme. This is not a sustainable way forward and would not meet the needs of older persons, local communities, the taxpayer or those working in the public service. Instead we need a more proactive approach to the provision of community nursing home units which seeks to protect the viability of as many units as possible within the funding and staffing resources available. That includes smaller units where challenges of scale may require more innovative approaches to service delivery. This is likely to require a combination of actions such as consolidation of services and changes in staffing, skill mix and work practices.

All developments have to be addressed in the light of the current economic and budgetary pressures and any decisions taken by the HSE must have regard to this and to the current moratorium. I trust the Deputy and those listening will agree that we need to ensure the highest standard of care will continue to be provided to all residents in a safe and secure environment. Providing quality and safe care will always remain at the heart of any considerations.

Deputy Seamus Kirk

I thank the Minister of State for her reply. I am not heightening the concerns of the patients in the hospitals.

Deputy Kathleen Lynch

I accept that.

Deputy Seamus Kirk

The reality is that in recent weeks in County Louth, on the streets of Drogheda and Ardee, thousands of people have marched. They have listened to Oireachtas Members and the various support and save committees, in both instances. They say "hands off" the Cottage Hospital in Drogheda which is an iconic institution in the town. Similarly with St. Joseph's in Ardee which at one stage had a much wider health care spectrum than it does nowadays. However, it is a real institution in the town of Ardee and there is considerable attachment to it. There is shock that consideration is being given to closing these hospitals. At any of these meetings and protestations patients on wheelchairs are coming out and stating they want this accommodation to be retained in the nursing home service in County Louth.

I ask the Minister of State to go back to the Department and report that the people and community of County Louth wish both nursing homes to be retained in the service.

Deputy Kathleen Lynch

I fully accept that. That was the point I was trying to make. I realise the Deputy is not doing this on his own, that it is a wider issue. Equally, however, if we are to care for the percentage of older people who will eventually need the type of long-term care we are now providing we must look at things in a completely different way. If one looks at any of the surveys, people will state they want to stay in their own community. They want to live not only their active life but the end of their life in their own community. There will always be people who will need the acute and ongoing care which exists at present in the hospitals the Deputy mentioned. However, we cannot continue providing this care in the same way we always did. We will have to look at alternatives. We have groups of people looking at how we will provide that care in the future in a different way.

This is probably the only area where we have not come up with a five-year plan for the future and we will need to do that. We should be able to forecast how many people will need long-term care in a hospital setting and come up with an appropriate plan for them. However, Deputy Kirk accepts when it comes to the country's finances we are in a very dark place. I accept the people in question are not responsible for this. That is where we are at, however, and we have to look at service provision differently. It can be done. People need to be reassured the provision of hospital services is being examined seriously and not let lapse in some kind of a vacuum.

Mental Health Services

Deputy Tom Hayes

I thank the Ceann Comhairle for allowing us to raise the important matter of the planned closure of the psychiatric unit at St. Michael's psychiatric unit, Clonmel. This matter, the subject of much debate over the past several years, is a great concern to the people of Clonmel and south Tipperary, the facility's patients, their families, staff and everyone else associated with it. The Minister of State is aware of these concerns and has dealt with them head on.

The reality, however, is that admissions to the facility will stop on 1 March 2012. The Minister of State, and her predecessor, gave the commitment that no closure would take place until new alternative community-based facilities were on the ground. The concern is these facilities are still not in place. From the note I have been supplied, there are also staff shortages of clinical psychologists, social workers and occupational therapists in the area, another grave concern. Only some weeks ago, I, along with Deputy Mattie McGrath, travelled with the Minister of State to Wexford to visit a community-based mental health facility with which people there were very satisfied. People in south Tipperary do not understand similar facilities will be in place in the area because they have not seen them rolled out yet.

I implore the Minister of State to defer the decision to close the St. Michael's unit until all replacement facilities are in place. Then people will be in a better position to make a judgment on these changes.

Deputy Mattie McGrath

I thank the Ceann Comhairle for allowing us to raise this matter this evening. The Minister of State, Deputy Kathleen Lynch, already knows my views on this matter. She has visited the St. Michael's unit at our request and we have had painless discussions on it.

I am not going to repeat what Deputy Tom Hayes has just said. However, I appeal to the Minister of State to honour her commitment that all community-based facilities are in place before the unit is closed. So far, it has not happened. In a recent article, a consultant in Clonmel described the closure of this unit as medical apartheid.

The Minister of State knows better than I do the number of public servants in the health services who applied for retirement today. Even before these retirements came into play, south Tipperary did not have the staff for community-based mental health services it requires. I recently visited the replacement facility for St. Senan's in Wexford which was so new the paint was still wet. While I thank the staff for facilitating our visit, the unit has not been up and running for several weeks and we have no experience of how it works. Communities in south Tipperary have no reassurance as to how such a community-based approach will work for them. We are in favour of A Vision for Change but not in the selective manner the Minister of State has introduced it.

In the last Topical Issue matter, the Minister of State accused Deputy Kirk of scaremongering. Will she rebut the claim she told the deputation of users and family carers from south Tipperary that the decision to close the unit was not set in stone but set in blood? I hope these remarks were taken out of context. To say it, however, to mental health service users and their carers would be inappropriate. I note the Minister of State's official did not deny she might have said it.

A new development now is that no patient will be admitted to St. Michael's after the end of February. Instead, they will be sent on to facilities in Kilkenny. This will diminish further the standing and staff of South Tipperary General Hospital. This is a significant issue which already has seen 14,000 people on the streets protesting. They will be on them again. Two taoisigh, Brian Cowen, and Deputy Kenny have met deputations on this matter. All we want is a reasonable amount of fair play and a full assurance that replacement facilities will be put in place.

Deputy Kathleen Lynch

On the last Topical Issue, I did not accuse Deputy Kirk of scaremongering.

Deputy Mattie McGrath

Yes, the Minister of State did.

Deputy Kathleen Lynch

I said he should not scaremonger and that he also was not the type to do that.

I thank the Deputies for raising this issue which gives me the opportunity to restate the Government's policy on mental health services. The closure of the old psychiatric hospitals and the transfer of patients to more appropriate community-based settings are central to this policy and is a priority for this Government. The evidence is overwhelming that a modern mental health service is best delivered in the community. Hospitalisation should only be used in exceptional cases, and even then, only as a last resort. The Government is, therefore, committed to developing community-based services. Despite financial constraints, I was pleased we were able to announce a special new allocation of €35 million in last December's budget to be used primarily to develop community mental health teams and services to ensure early access to more appropriate services along with improved integration with primary care.

The implementation of A Vision for Change requires the amalgamation of south Tipperary and Carlow-Kilkenny into one catchment area for mental health services. The inpatient bed requirement for the combined population of approximately 205,000 is 34 beds which will be provided in St. Luke's General Hospital, Kilkenny. Accordingly, there will no longer be a need for inpatient beds in St. Michael's in South Tipperary General Hospital and the unit will close.

The psychiatric unit at St. Luke's is modern and purpose built. Service users will be able to avail of a much higher standard of physical inpatient environment there. The unit has the capacity to support the wider extended catchment area and fully meets the requirements outlined in A Vision for Change. The provision of the acute service for the extended catchment area from a single site will release resources to fund more modern community focused services for south Tipperary.

As community mental health services are developed in south Tipperary, the service user will be offered alternative services more appropriate to their needs such as home treatment and community day services. In this regard, south Tipperary mental health services are implementing a comprehensive change programme which is transforming the existing service into a modern, fit-for-purpose service providing a service of excellence to the local population. The development of community mental health services in south Tipperary is underpinned by a comprehensive €20 million capital infrastructure programme. This will provide a 40-bed community nursing unit, an acute day hospital and community mental health team base; a 12-bed high support hostel, and an eight-bed respite house.

A Vision for Change represents the Government's mental health policy. The developments and plans for the mental health services in south Tipperary are fully in line with that policy and enjoy mine and the Government's full support. Service users in the region will reap the benefits from the significant improvement in quality and access to mental health services in south Tipperary. I have conveyed again my commitment to the HSE that St. Michael's should not close until the appropriate community-based services are in place for the area concerned. I trust this has clarified the issues for the Deputies.

Deputy Tom Hayes

While the Minister stated she conveyed her commitment on this issue to the HSE, she must convey it to those HSE people who are driving ahead with the closure of the unit.

Deputy Kathleen Lynch

I have.

Deputy Tom Hayes

The problem is we have correspondence from service users and people working in the services which states there will be no admissions to the unit after 1 March.

Deputy Kathleen Lynch

Is this from the people responsible for admissions?

An Ceann Comhairle

The Minister of State can reply when the Deputies have finished their supplementary questions.

Deputy Tom Hayes

These are the views of retired psychiatrists from the health service. The reality is that they are telling us the case on the ground and that was a week ago. That is where the breakdown of communications is occurring. I thank the Minister of State for giving her commitment but it needs to be brought to the people in south Tipperary who are extremely concerned about the matter. I ask her to do so.

Deputy Mattie McGrath

The Minister of State spoke about a 40 bed community unit, an acute day hospital, a community mental health team, a 12 bed high support hostel and an eight bed respite centre. Where are these facilities? Construction of the acute hospital is under way but the other facilities are not in place. Today is the first day of spring but it will be next winter before we see them. People are worried because admissions will cease from the first of next month.

I cannot get over the change in the Minister of State since she was in Opposition. She has swallowed her Department's mantra hook, line and sinker. I ask her to deny she told the unfortunate users that the date was set in blood. I am disgusted to think she might have said that.

Deputy Kathleen Lynch

It is amazing how easily people are offended. At Deputy Mattie McGrath's request I met service users, all but two of whom happened not to be service users.

Deputy Mattie McGrath

They were service users.

Deputy Seamus Healy

They were service users and carers. That was the request which the Minister of State accepted.

An Ceann Comhairle

I ask the Deputy to resume his seat.

Deputy Kathleen Lynch

They were decent and honourable people. Our conversation lasted approximately an hour and a half. We had a free ranging conversation because we should not have to be automatons or robots watching every word that comes out of our mouths. The people I met were courteous and I sympathised with their position because I have been in that position myself and I understand their concern about losing a service with which they are familiar. I tried to persuade them that the service we are going to provide, which Deputy Mattie McGrath saw in Wexford, will be as good if not better.

Deputy Mattie McGrath

They have not seen it.

Deputy Kathleen Lynch

When I was asked at the end of the free flowing, conversational meeting whether it is set in stone, I jokingly said, "No, it is set in blood".

Deputy Mattie McGrath

It was a queer joke in very bad taste.

Deputy Kathleen Lynch

Perhaps, and if it offended the people at the meeting - I strictly refer to the people at the meeting - I withdraw it and I apologise for saying it. I do not think it caused offence because nobody mentioned it at the time, which amazes me.

I have not changed my mind on A Vision for Change.

Deputy Mattie McGrath

Nor have we.

An Ceann Comhairle

Please allow the Minister of State to continue without interruption.

Deputy Kathleen Lynch

Nobody, whether in Opposition or Government, objected to A Vision of Change when it was introduced in this House in 2006 because we knew it is what we should do with mental health services. I told the facilitator who I appointed to bring this process forward that while 31 March is the preferred date, it is not set in stone. It will not be 31 March 2013 but there is flexibility and that message has been conveyed clearly. In case people are under any illusion, St. Michael's unit in Clonmel is going to close and we are going to implement A Vision for Change in south Tipperary, Kilkenny and Carlow. We will provide a similarly excellent service to that provided elsewhere in the country.

If I said something in a free-flowing conversation, I will be more careful in future to avoid that kind of conversation.

Dáil Éireann debate - Wednesday, 1 Feb 2012