Topical Issue Debate

Tobacco Control Measures

Each morning as I pass the Coombe Women & Infants University Hospital on my way to the Dáil, I see pregnant women standing outside taking a smoke break before they return to their hospital beds. These women are often heavily pregnant and one cannot help but feel concern given the risk to their unborn babies and themselves.

The medical community is in no doubt about the dangers. According to the Irish Cancer Society, "smoking during pregnancy can lead to miscarriage, stillbirth and illness in early infancy". In fact, so sensitive is the unborn baby to the effects of smoke that the Irish Cancer Society says that smoking in the presence of a pregnant woman may also endanger the health of the foetus. Aside from these very serious risks of miscarriage and stillbirth, a recent study shows in stark detail the infection risks associated with smoking during pregnancy. The findings, published on 6 November in the US journal, Paediatric Infectious Diseases, show that babies born to mothers who have smoked during pregnancy are at increased risk of developing a wide range of infections. They are 50% more likely to be hospitalised or die as a result of these infections, compared with babies born to mothers who did not smoke during pregnancy.

We must do something to address this problem, but we must first know its extent. The Economic and Social Research Institute, ESRI's, 2012 Perinatal Statistics Report calls for better tracking and recording of smoking during pregnancy in Ireland "given its importance as a risk factor for adverse perinatal outcomes". We simply do not know the extent to which Irish women continue to smoke throughout their pregnancies. It is important that we know the scale of the problem before we begin to address it.

I applaud the Minister for the stance he has taken on the general problem of smoking in this country. The proposed plan to introduce plain packaging is a welcome start. It must be noted, however, that any such initiatives must be brought forward in conjunction with measures to tackle the illegal trade in cigarettes, which is making life very difficult for retailers in this country. Recent figures from the retail industry show that one in four tobacco sales are illegal, according to ShelfLife, the retail magazine.

While I welcome the Minister's initiatives on smoking, I ask him to address the particular problem of smoking in pregnancy. In terms of finding solutions, education must be key, not only in the hospitals but also in our schools. For example, the risks of smoking during pregnancy must be outlined as a standard measure during antenatal classes and in other places attended by pregnant women. General practitioners, GPs, midwives and obstetricians must also receive special training in how to relay this critical information to pregnant women. We must be conscious that to give up smoking is a huge challenge for many people, and it is not made easier by the stresses and strains of the early stages of pregnancy. Young women, in particular, need our understanding and assistance in this matter, not a lecture.

We must equip our medical professionals to provide the advice and information in a compassionate way, but also in a way that leaves no doubt as to the dangers of smoking during pregnancy.

I thank the Deputy for raising this important issue. As she is aware, the Minister for Health and our Department have been public in our aims and objectives regarding smoking in Ireland. Last month, he launched Tobacco Free Ireland, which sets an ambitious target of Ireland being tobacco free by 2025. In public health terms, this means having fewer than 5% of people smoking by the year 2025.

Approximately 5,200 Irish people die every year from smoking related diseases. One in every two smokers will die of a tobacco related disease. These diseases are frequently protracted and unpleasant, not to mention distressing to the persons suffering and their families and friends, and all made even more upsetting by the fact that they are preventable. Unfortunately, 22% of our adult population are smokers. It is estimated that between 18% and 21% of Irish women smoke in pregnancy. Most smokers start smoking very young. Research shows that 78% of smokers started smoking before the age of 18 years. It also shows that Irish people start smoking younger than those in any other EU country.

Tobacco Free Ireland sets out the tasks that need to be undertaken to help people to stop smoking and to prevent our children from starting the habit. Currently, smoking cessation services are available nationwide, including the national smokers quitline. Tobacco Free Ireland has a recommendation that the State should target its smoking prevention and cessation interventions at specific groups. Pregnant and post partum women comprise one of those groups. This is important. Research has shown that age and socioeconomic factors are key determinants of smoking in pregnancy. Given this, it is equally important that children and young women, particularly those in lower socio-economic groups, are targeted with prevention interventions.

Tobacco Free Ireland contains a number of measures that, when combined, will go a long way towards denormalising smoking in our society. The denormalisation of smoking and the protection of children are the two key themes in the report. As the Deputy stated, pregnant women who smoke are specifically mentioned in Tobacco Free Ireland as a group requiring targeted interventions. It is the combination of all of the measures in the report that will bring about a significant reduction in the numbers of women who smoke generally and also those who smoke during pregnancy.

Tobacco control measures are working. The number of children and adults smoking is declining. It is the Minister's aim to make a significant further reduction in those. One of the measures that will assist in this is the introduction of standardised packaging for tobacco. Research indicates that standardised packaging can reduce the appeal of tobacco products and increase the effectiveness of health warnings. It also reduces the ability of branded tobacco packaging to mislead people about the harmful effects of smoking. Another measure being undertaken is the development of legislation to prohibit smoking in cars where children are present.

The Irish public has already shown a healthy appetite for and commitment to the introduction of tobacco measures, not least by fully embracing the workplace smoking ban, which was introduced some years ago. This is despite numerous pessimistic predictions and spurious arguments as to how and why people would not comply. This positive approach gives me confidence that the public will engage and support the Government and the HSE in the important journey ahead.

We all know that smoking in pregnancy is associated with significant health risks to the baby as well as low birth weights and premature births. There is an obligation on all of us as policy-makers, health workers and members of society to take the steps necessary to assist those who smoke during pregnancy in stopping and to prevent future mothers from starting.

I thank the Minister of State for answering in such great detail. It is shocking to see the figure of how many people die yearly from smoking. I am concerned, as I have seen many children smoking on their way home from primary school. The Minister of State has given me some figures with which to work. For example, approximately 21% of pregnant women smoke.

It is a matter of education, which begins at home. If children see their parents smoking while women are pregnant, they will reflect that behaviour as they grow up. The Minister of State is correct in that certain social backgrounds lead to younger smoking, for whatever reasons.

Will the Minister of State consider making a medical intervention such as is found in other European countries, for example, England, where nicotine patches are made freely available to pregnant women as a matter of course? This could be the first step in making a difference in the lives of a mother and her unborn baby. Giving the unborn a chance to survive when a mother smokes would be the legacy of the Minister for Health and the Government.

I thank the Minister of State for his reply and I will revert to him on some of those figures.

I will certainly discuss the Deputy's suggestion with the Minister. I thank her again for her insights and for the compelling additional points she has made. The value of Tobacco Free Ireland is that a policy statement and set of actions are in place to give guidance to those policy decisions that need to be made. In a sense, it can be added to in future, as new suggestions, such as those raised by the Deputy and others, can be incorporated into this policy compendium. That can only help us in the objective that we all share.

Special Educational Needs Services Provision

I thank the Minister of State for attending to discuss this issue, which has been raised in my constituency and in respect of which I am finding it difficult to get clarity. I understand that personal assistance for preschool children is covered by the HSE and usually delivered in communities by service providers. Children are assessed based on their physical needs as opposed to their intellectual needs.

In September, three children in my constituency started preschool at four years of age. One has Down's syndrome and major physical disabilities and another has delayed development and is unable to use a bathroom, needs to be in a play school, etc., but neither can get a personal assistant. A third child has cystic fibrosis and, following a stroke, has no use of one arm. St. Joseph's is our service provider in Charleville and the surrounding area of Cork North-West.

I would not raise a situation in the Chamber lightly. I have been in contact with the HSE in Cork at all management levels. I have been told that it is for St. Joseph's to perform the assessment and provide care. St. Joseph's has told me that it has been instructed not to provide further personal assistants for preschool children. The HSE has asserted that it has no vehicle to do this.

While I understand the issues facing providers in terms of budget cuts and audits to ensure that they are efficient and making appropriate provisions, this support will be no good to the three children in question next year. They need it now. It is not acceptable that, if they lived in a different part of the country, they would get it.

Despite questions about who has an entitlement, it is clear from my research that physical needs are a factor in these three cases. As such, they are legally entitled to support. However, the State does not seem to be providing it. HSE management claims that this is a matter for the service provider, but the service provider has shown me information to the effect that it was told not to provide support. This is because a personal assistant is not provided where a person has an intellectual disability, only where he or she has a physical disability. The three cases clearly involve physical disabilities. This is frustrating.

We discuss child care and early child intervention a great deal. These are important issues. We should be there before three years of age, never mind four or five years of age. The parents are distraught. Any parent of a child with a disability faces challenges. It is tough enough on those parents without having to fight this bureaucratic battle or to contact me, the HSE and St. Joseph's.

It seems to depend on where one lives. There is no problem in getting this service in some places. In other places, it is a major problem.

We do not have a standardised service, so I would like to hear the Minister of State's thoughts on the matter.

I thank Deputy Collins for raising this matter, which I am dealing with on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch.

I have no doubt that everyone in the House is aware of the pressures on the health system to maintain services within the parameters of its budget. Notwithstanding these financial pressures, I would like to assure the Deputy at the outset that the Government is fully committed to the ongoing delivery of vital services and supports to children with disabilities to the greatest extent possible within available resources.

In recent years, the health sector has invested significant resources in services for children with disabilities. Within the preschool sector specifically, the Health Service Executive provides some limited grant aid to community preschools, as well as funding some special preschools that cater specifically for preschool children with disabilities. In certain parts of the country, the HSE funds a preschool support service. This service provides a support worker to enable a child to participate and integrate into a preschool setting. The HSE has no statutory obligation to provide this kind of service. There is no standardised scheme in the HSE for funding these preschool support services, which have been developed at local level. One such service supported by the HSE is provided by St. Joseph's Foundation in Charleville, where 23 children are supported to access mainstream preschool. It is important to note that this is not a personal assistant service. Personal assistant services are generally provided to adults with a physical or sensory disability with support needs, who then self-direct their own services.

Significantly, the HSE is also currently engaged in a national programme of reconfiguring therapy resources for children with disabilities from birth to 18 years. This programme aims to achieve a national unified approach to delivering disability health services, so that there is greater equity of access to services based on need, clearer referral pathways to these services and improved intersectoral collaboration. The nub of the issue the Deputy has raised is the necessity for a standardised system across the country. It is not an area with which I am directly familiar but this matter has arisen in other areas of the health service where there are differential levels of service in various parts of the country. It is perhaps a legacy of the earlier organisation of the health services but it is very frustrating.

The Deputy makes the point eloquently that first, there should be clarity about what services are available and what the entitlements are. It seems that many of the services are not provided statutorily but have grown up over the years based on what people have tried to do locally, albeit in good faith. The Deputy is correct to say that an entitlement to access these services should be standard across the country. I can only agree with her that access should be uniform where possible.

The participation of children with a disability in preschool is a cross-cutting issue involving a number of stakeholders. These include the Department of Children and Youth Affairs, the Department of Health, the Department of Education and Skills, and the HSE. The health, education and children and youth affairs sectors co-operate on a regular basis concerning children's disability issues. To strengthen this co-operation the children, adolescents and young people with complex disabilities unit in the Department of Health, led by a principal officer, has been established. This important development aims to foster greater collaboration between the Department of Health, the Department of Education and Skills, and the Department of Children and Youth Affairs on children's disability issues and to build on the cross-sectoral working arrangements that are in place. A dedicated cross-sectoral team, comprising representatives of the Department of Health, the HSE, the Department of Education and Skills, and the Department of Children and Youth Affairs plays a key role in this regard.

A subgroup of this team has been set up to examine the issues around integration of children with disabilities into mainstream preschool settings, building on previous analysis in this area. Representatives of the various Departments I have mentioned, as well as the HSE and the city and county child care committees, are members of this group which is chaired by the Department of Health. It is envisaged the work of this subgroup will be completed by the end of this year, at which point it will report to the cross-sectoral team.

I appreciate the Minister of State's comments and I fully understand the budgetary pressures the HSE is under. However, these service providers seem to be getting a lump sum payment, although it should be attached to the services they provide and the number of people concerned. In this case, they were providing the service but were told by the HSE that they should not do so, as it was not covered under the service level agreement. When I asked about this, I was told that they were entitled to the service based on a physical disability but not on an intellectual disability.

In one such case, the HSE originally funded the service through the Irish Wheelchair Association. Then the HSE said the person concerned was more suited to St. Joseph's, even though the HSE knew that St. Joseph's could not do anything for them. Another child has been granted three hours per week through St. Joseph's but the service cannot be provided because they are awaiting Garda clearance on somebody. It is now mid-November but if this delay continues for much longer the school year will be over. It is great that children with disabilities are integrated into mainstream schools, both for themselves, other children, the social environment and social cohesion. It is not good enough, however, that these three children to whom I referred cannot be supported when a child in a neighbouring constituency can obtain the service.

I fully accept the pressures that the HSE is under and I am also aware of all the constraints on Ministers and Ministers of State. However, the setback for these children at this early stage, due to the lack of a small amount of direction, seems to be enormous. Intervention is needed to try to resolve the issue immediately. I would appreciate the Minister of State's comments in this regard.

I am not in a position to add much more to what I have already said. However, I will undertake to raise this matter with the Minister of State, Deputy Kathleen Lynch, at the earliest opportunity. I will certainly have an opportunity to discuss it with her next week. If Deputy Collins reverts to me or directly to the Minister of State, Deputy Kathleen Lynch, we can see how to address the issue concerning the differential in levels of service between various areas, including neighbouring counties. The Deputy is entitled to have this matter addressed and I will do everything I can to ensure that it is dealt with.

Rare Diseases Strategy Implementation

Ehlers-Danlos syndrome or EDS is classified in European Union terms as a rare disease because it affects fewer than one in every 5,000 of the population. EDS is mainly thought if as being a genetic disorder but some literature suggests that it can occur spontaneously. It has been termed as the "invisible illness" because while there are no visible symptoms, sufferers may be in great pain and discomfort.

According to information I have received from members of EDS Awareness Ireland, and in a response to a parliamentary question I recently received from the Minister for Health, Deputy James Reilly, it is thought that around 200 people in Ireland are suffering from EDS. In the past, there were ten classifications of the disease but this was revised downwards to six main classifications, namely, hypermobility, classical, vascular, kyphoscoliosis, arthrochalasia and dermotosparaxis.

There is a wide variety of symptoms of EDS depending on the type of the disease but, in the main, it is recognised as a defect in the synthesis of collagen. Some of the main characteristics of EDS symptoms include joint hypermobility whereby sufferers' bones are dislocating constantly; skin extensibility and tissue fragility; chronic early onset debilitating musculoskeletal pain; arterial, intestinal or uterine fragility or rupture; scoliosis at birth; scleral fragility; poor muscle tone; and gum disease. That is a serious range of conditions within this EDS classification. According to the HSE, most EDS sufferers in Ireland fall into the EDS-3 hypermobility group.

I thank the Minister of State for attending the House for this debate. I wish to convey to him the key issues of concern for EDS sufferers and to which EDS Awareness Ireland wants answers. First, there is no specialist clinician to treat EDS sufferers in this State. Many EDS sufferers have been advised to seek treatment in the UK, but when they make an application for such treatment under the HSE's treatment abroad scheme, their applications are being refused. One such application was refused recently for a constituent of mine.

Another serious cause for concern for EDS sufferers is the lack of research undertaken about the disorder and its prevalence. In fact, the HSE has advised me that no research of any kind has been undertaken on the range of EDS illnesses by the Department of Health. In addition, an interdisciplinary approach to EDS is lacking. A key issue concerning EDS is its timely diagnosis and intervention. Children with the disease are not being diagnosed early enough.

Again, EDS Awareness Ireland believes that because of this many sufferers face a life of grave illness and serious difficulties. Due to the rarity of the disorder and its varying classifications, diagnosis can take some time. This is exacerbated by the lack of a specialist clinician in Ireland with knowledge of EDS. There was a clinical facility for the treatment of this illness in Tallaght hospital about a decade ago but this was subsequently withdrawn by way of various cutbacks.

The Minister of State will be aware that a European Union Council recommendation on an action in the field of rare diseases provides for the putting in place by EU member states of a framework of obligations in the area of rare diseases by the end of this year. What progress has been made in this regard, which also deeply affects EDS sufferers? Members of EDS Awareness Ireland are anxious that the provisions of the Council recommendation would be put in place. Their primary concern is to improve treatment and supports for sufferers in Ireland. They also request that applications to the treatment abroad scheme to receive treatment in the UK would be dealt with more favourably because of the wealth of experience of some physicians such as Professor Rodney Grahame or Professor Mathias in London. EDS sufferers, who meet regularly in Cork and Dublin, will continue to campaign for more supports and recognition of this very serious disorder. I hope that the Minister of State, despite the straitened times in which we find ourselves and in the spirit of the more hopeful news we heard earlier today, can offer EDS sufferers more hope this evening.

I am pleased to have this opportunity to outline the position in relation to the matter raised by Deputy Broughan today.

As outlined by the Deputy, a rare disease is defined in the EU as a disease or disorder affecting fewer than five in 10,000 of the European population. Although each disease is individually rare, there are a great many rare diseases. Collectively, rare diseases affect a large number of people. It has been estimated that European populations have a 6% to 8% lifetime prevalence of having a rare disease. More recent estimates suggest that 2% to 3% of the population at any one time have a rare disease. Rare diseases are significant contributors to a number of population health outcomes in terms of their high associated mortality, morbidity and disability. They are also significant as a cause in sensory, physical and intellectual disabilities as well as in the population health burden of chronic disease.

As also outlined by the Deputy, Ehlers-Danlos syndrome, EDS, is not one condition but a group of several clinically distinct conditions. The vast majority of patients would fall into the EDS category, which has a relatively high prevalence of one in 5,000. Many of these patients attend rheumatology clinics and may often be seen by physiotherapists without needing consultant assessment. I understand from the HSE that inpatient and day care rehabilitation facilities at Our Lady's Hospice and Care Services are available and suitable for adult patients with Ehlers-Danlos syndrome. Children services are available at Our Lady's Hospital for Sick Children, Crumlin. Patients can be referred to these facilities by a general practitioner or medical consultant if they are attending a service in the acute hospital system. Patients outside the Dublin area can also be referred to these units for assessment and treatment if appropriate.

Due to the nature of the syndrome, most patients attend rheumatology clinics and, as stated, often may be seen by physiotherapists without needing consultant assessment. Patients with more severe forms of EDS attend the rheumatic and musculoskeletal disease unit, RMDU, based at Our Lady's Hospice and Care Services in Harold's Cross for periods of structured multidisciplinary rehabilitation.

I am pleased to have an opportunity today to advise the House that work is well under way on the national plan for rare diseases which, once finalised, will be subsequently published. One of the key elements of the plan relates to centres of expertise. Effectively, it envisages that national centres of expertise in Ireland will participate in European reference networks on rare diseases. Expertise in terms of guidelines, treatment protocols, e-health diagnostic and training tools, will be disseminated through these networks building up the expertise of national clinicians and enabling patients to be treated closer to home. Where necessary these networks will constitute health care pathways along which patients can be referred for treatment abroad.

It is envisaged that a national rare diseases programme would, over time, collate and assist with developing national treatment guidelines, standard operating procedures and care pathways for many rare disorders, in collaboration with the designated reference centres. It would also develop care pathways with European reference centres for those ultra rare disorders in respect of which there may not be sufficient expertise in Ireland.

There is no specific research on the prevalence of any form of Ehlers-Danlos syndrome in Ireland. However, the issue of research into rare diseases such as this will be addressed in the context of the National Plan for Rare Diseases.

Is the Minister of State saying that a dedicated clinician will be appointed in Dublin or Cork or, in both cities, to treat sufferers of EDS, which is the nub of the problem for sufferers? I would like to quote from a letter which I received from a wonderful young constituent who is due to sit the leaving certificate examination next year. She says:

I need your help. I am living with Ehlers-Danlos syndrome. It is a genetic condition of my collagen that affects so much of my physical and mental health every day. I wake up afraid of what the day will bring while I deal with hospitalisations, constant pain, medical complications, frustration, fatigue, fear and physical challenges. I am terrified I am living in survival mode.

This would be the typical view of young people who suffer from this terrible condition.

I understand that the EU Council recommendation of 2009 states that the report referred to must be finalised by the end of this year. Will it include a full plan and strategy and will it define rare diseases prevalent in this country? The Minister of State indicated that it is proposed to establish centres of excellence in this country. Will this happen soon? Also, will research be undertaken in Ireland into the prevalence of EDS and its cause and appropriate treatments? What is being done in terms of the development of a database of all EDS sufferers in this country?

I have tabled a series of questions on this matter to the Minister, Deputy Reilly and Minister of State, Deputy White, in respect of which I am still awaiting a reply, in which I have set out many of the concerns I have raised this evening. The Minister of State did not respond to my point about whether the centre of excellence in Tallaght hospital relating to the range of EDS conditions has ceased operation. Sufferers of EDS can become frustrated if required to have an MRI scan because, as there is no stand-up facility, they are required to lie down for the scan and, in particular, by the need to have to travel abroad for treatment. I urge the Minister to address this situation urgently.

The Deputy has been very assiduous in raising this issue. Some of the specific questions raised by him are likely to be only fully addressed in the context of the national plan for rare diseases, on which I have indicated to the House work is well under way. Once finalised, the plan will be published. I do not have any direct involvement in that area but I am aware, because I work in other areas with the officials working on it, that that work is progressing. I am conscious that this work is progressing in the Department.

I had the privilege of opening and addressing a conference on the subject of rare diseases earlier this year. Many of the issues raised by the Deputy were raised at that conference so I have some understanding of them. There are some very committed and strong advocacy groups involved in this area, of which I know the Deputy is aware. He has taken up their case very well this evening and on previous occasions. I am not in a position to address any individual aspects of the plan until such time as it has been finalised and published. This process provides a great opportunity to pull together all of the different priorities which the Deputy rightly says exist, be that in the area of research or the appropriateness of appointing or assigning particular clinicians to this area. All of the aspects of a proper plan, which is clearly needed in this country, will be dealt with in that context. I hope that the plan will be published in the very near future.

Rent Supplement Scheme Administration

I discussed this issue earlier with the Minister for Social Protection as I was aware she would not be here this evening. This issue falls between two Departments, namely, the Departments of Social Protection and the Environment, Community and Local Government in terms of the provision of social housing. It is appropriate that this matter is being responded to by a Minister from the Department of Health because the problems arising are putting a great deal of stress on individuals in particular locations where this issue is presenting as a crisis. I use the word "crisis" advisedly.

We are now seeing families being made homeless due to the shortage of houses. There are just under 100,000 individuals or families on the housing waiting list across the country and about €403 million last year was spent allocating rent assistance to 82,000 separate cases. That is intended to be a short-term solution to a longer-term problem. We both know why houses are not being built at the moment. In some locations, the rent caps introduced by the Department of Social Protection are far below the market rents. In my own area, there has been a noticeable increase, even in the last six months, in rents that can be obtained on the open market. Increasingly we are seeing people saying "no rent assistance". If they do take rent assistance, it is far below what is on offer. People are trying to top it up themselves under the counter. Everybody is doing it, and not just in my area. This is hitting people who are not getting rent assistance, such as people who are trying to pay on a low wage. People who cannot work or who have not got a job can enter a poverty trap in trying to get back to work. I know this is supposed to be resolved with the HAP legislation if that does not produce the problems that I think it might.

I do not want to see large amounts of money going into landlords' pockets; I want to see a solution to people's housing problem. The environment committee met with some of the housing associations recently, and if we want to look at a longer term issue, the lack of capacity within the housing associations and the lack of a regulatory process means that we cannot leverage European funds that are not Exchequer funds to build social housing. Even if we could do so, that will be some time in the future.

The Department of Social Protection officials must meet officials from the Department of the Environment, Community and Local Government as a matter of urgency on the issue of the absolute crisis that we are seeing in locations. I know that local authority officials in Kildare contact the Department of the Environment, Community and Local Government on a weekly basis to tell them about the experiences they are having in not being able to source accommodation through the RAS scheme or through people being unable to get housing themselves, with the rent caps that are in place. There is a real crisis out there.

About 100,000 individuals or families are on the waiting list. It is not the same experience around the country. Six local authority areas account for 43% of the entire waiting list. Three of them are in Dublin - South Dublin, Fingal and Dublin City - two are in Cork and one is in Kildare. Six other local authorities account for 3% of that waiting list, where there is not the same pressure because in the first six areas, house prices have started to bottom out, housing stock is in short supply and rents are starting to rise. The success stories, such as the few thousand people employed on the Intel site in Leixlip, mop up much of the availability of rental accommodation for people who are subject to the rent caps. While that is a good news story on one side, it produces a real crisis on the other side and managing that crisis is the key issue here.

I am looking for a dialogue between officials from the Department of the Environment, Community and Local Government and the Minister for Social Protection on how this can be managed, so that the people we are seeing in crisis at the moment may find some alleviation.

I thank the Deputy for raising this issue, which I am dealing with on behalf of the Minister for Social Protection. The purpose of the rent supplement scheme is to provide short-term support to eligible people living in private rented accommodation whose means are insufficient to meet their accommodation costs, and who do not have accommodation available to them from any other source. The overall aim is to provide short-term assistance and not to act as an alternative to the other social housing schemes operated by the Exchequer.

There are currently approximately 81,000 persons in receipt of rent supplement, for which the Government has provided €403 million in 2013. Revised rent limits under the rent supplement scheme have come into force with effect from Monday, 17 June 2013, and will be in place until 31 December 2014. The new rent limits have been determined following an extensive review of the private rental market, based on the most up-to-date data available. The Department currently funds approximately 30% of the private rented sector so it is essential that the rent limits are kept under review. The new rent limits have been set using the 35th percentile, ensuring that sufficient housing is available for recipients of the scheme. There have been increases in the maximum rent limits in Dublin and Galway, while there have been some reductions across a number of rural counties, reflecting the conditions in the rental markets in those counties. Separate to the county limits, higher rent limits have been provided for in the north Kildare and Bray areas. Special provisions are made in exceptional circumstances, including, for example, people with disabilities in specially adapted accommodation or homeless persons. The overall cost of the rent limit review for 2013 is around €7 million, which can be met from within the existing provision for the scheme.

Analysis shows that there are properties available within the maximum rent limits for rent supplement recipients, including in County Kildare. However, the number of rental properties available in north Kildare including Leixlip, Maynooth, Kilcock and Celbridge, is significantly lower than the numbers available in the rest of the county and, therefore, has an impact on the number of accommodation units available for rent supplement. Latest figures show that there are over 1,000 rent supplement recipients in the north Kildare area, indicating that it is possible to secure accommodation in these locations within the rent limits.

Department officials dealing with rent supplement tenants will continue to ensure that their accommodation needs are met and that the residence is reasonably suited to their residential and other needs. The Department, through its work in the homeless persons unit, provides assistance to people in sourcing the most appropriate accommodation available. In addition, prison and hospital in-reach services are provided to explore accommodation options and, where necessary, liaise with local authorities to identify and source the most appropriate accommodation available for those who are homeless or at risk of homelessness. This ensures that where possible, people are diverted away from homeless services and towards community-based supports. Department officials will continue to monitor the impact of the revised rent limits.

This is by a long way the number one issue about which people come to me at the moment. It has really become a crisis. I probably could have written that response myself. It has been talked about as a short-term support. I know people who are seven and eight years on that support. There are 7,000 people on the waiting list, so one would want to be a 2003 to 2004 applicant to have a chance of the odd house that might come up.

The rent limits were revised on 17 June and they made a little bit of difference, but it is chaos now and we cannot wait until 31 December 2014 for the next review, as outlined in the reply. I am onto the officer for homeless persons on a daily basis. The crisis is really of that order. I know families who have had to take children out of school. I know a family with a number of people with disabilities who are currently in bed and breakfast accommodation, and the homeless officer is dealing with that.

It is all very well to talk about data on averages - we got that earlier this week - but there is somebody living in Leixlip who is indigenous to the area and somebody living in Athy and indigenous to that area. We simply cannot shift a family from one area to the other. There are all sorts of things that go on with a family other than housing.

I do not know anybody of the 1,000 people who are able to secure accommodation in north Kildare who is not topping up. They are using their social welfare payments or their child benefit payments to pay the difference between what is being declared and what they are paying for accommodation.

This is happening to everyone. A person can only live on beans and toast for so long. That is what is happening. These people are turning up at the Money Advice & Budgeting Service, MABS, because something does not get paid.

I acknowledge the work of the homeless officers in the council. They are doing as much as they can in a tough environment. However, when we see the magnitude of the problem, which is turning up as the number one issue consistently, then there really is a problem that needs to be managed in a different way.

I do not imagine I have much I can add to the response I have given on behalf of the Minister for Social Protection. Clearly, there is an acute problem, as described by the Deputy. As a Deputy, I am aware of the problem myself. I do not have any particular knowledge or insight other than what I have relayed to the House on behalf of the Minister. I gather the Deputy had an opportunity to raise the matter with the Minister, Deputy Burton, earlier but certainly I will relay to the Minister what has been said by the Deputy this evening. She has put the case clearly and I will ensure the message is relayed to the Minister for Social Protection.

The Dáil adjourned at 6 p.m. until 2 p.m. on Tuesday, 19 November 2013.