Dáil Éireann debate -
Wednesday, 12 Nov 2014

Vol. 857 No. 4

Topical Issue Debate

Garda Station Refurbishment

Deputy Patrick O'Donovan

I thank the Ceann Comhairle for selecting this issue which is topical in the context of the reforms which the Minister for Justice and Equality is seeking to introduce in the structure and management of An Garda Síochána. I believe the rank and file members of An Garda Síochána do exemplary work.

I raise this issue on the basis of the many changes introduced by way of the amalgamation of districts. In my county, the districts of Askeaton and Newcastle West have been amalgamated into an area which geographically is larger than County Monaghan. The Minister will be aware that the Newcastle West district stretches from the town of Bruff to Tarbert and from Charleville to Mountcollins which, geographically, is a very large area. The situation in many other districts is no different.

I would like in raising this issue to start a conversation in relation to the manner in which Garda stations are selected for refurbishment and extension and in regard to the construction of new Garda stations. For example, the manner in which school building projects are prioritised could be considered in this context. The school building unit of the Department of Education and Skills prioritises projects based on need. In many cases, projects are achieved by way of public private partnership and other models rather than in the conventional way.

In Newcastle West Garda station, which was constructed in the 1970s and has never been extended, except by way of a prefab gifted to the town following the visit of former US President, George W. Bush, to Dromoland Castle, there are 66 gardaí, 11 sergeants, one inspector, one superintendent and ten civilians. As a result of a lack of investment in this station for more than 30 years the building is no longer fit for purpose, with prisoners often congregating in the same area as civilians and civilian staff, thus making the work of the gardaí in that station very difficult. Lest any of my friends in the fourth estate would say I have a vested interest in this, I should declare that I live next-door to Newcastle West Garda station and that when a young child I was responsible for breaking a window in that station. I suppose that constitutes a vested interest.

Deputy Eamonn Maloney

Was the Deputy arrested?

Deputy Patrick O'Donovan

No, I was not. Some members of the media might accuse me of cronyism if I did not declare that we owned the property next door to the Garda Station. That being said, there is a dire need for investment in the property concerned. I have discussed this issue with the Minister of State in the Office of Public Works. As I said earlier, we need to examine new ways of approaching this issue. I am aware that the OPW is responsible for the maintenance of Garda stations and for other projects up to a certain level. After that, such matters are for appraisal by the Garda housing unit.

The fact the OPW owns and manages Garda stations and that the Department of Justice and Equality in the context of its role with the Garda authorities also has some responsibility in this area makes unclear the procedures that need to be followed to get stations off the ground in the first instance. Is it adequate that there would be only one shower and one toilet for the number of personnel I cited earlier? No, it is not. Is it appropriate that prisoners are being brought from court in Newcastle West into an inadequate holding environment? No, it is not. Is it appropriate that they are being brought through the public foyer where people are waiting to have passport forms signed? No, it is not.

I would be delighted if the Minister, Deputy Fitzgerald, would take the opportunity during any future visit to Limerick to visit Newcastle West, which is an amalgam of two districts. At the time of the proposed amalgamation a commitment was given that the station would be refurbished to accommodate the additional gardaí but that has not happened.

Minister for Justice and Equality (Deputy Frances Fitzgerald)

I thank Deputy O'Donovan for raising this matter. The question of the supports An Garda Síochána receives and the need for modernisation and change systems are very much on the agenda today. What the Deputy raised, namely, the question of the allocation of resources for new Garda stations is an issue that applies and needs to be dealt with in many parts of the country. The Deputy spoke in particular about Newcastle West.

The Deputy made a number of points about new methods and more transparency in decision-making. He made the comparison with school building programmes, which was a good comparison. If there are lessons to be learned there about how building projects are managed, they should, and can, be learned.

The programme of refurbishment and replacement of Garda accommodation throughout the country is determined on the basis of accommodation priorities, which are, in the first instance, established by An Garda Síochána. Of course, this must be put into the context of the recession and the difficulties in regard to capital funding in recent years. I am glad to say that with the improving economic situation there is greater capital funding available than hitherto for these various projects.

As the Deputy said, the provision of Garda accommodation, including refurbishment works, site purchases, the provision of new buildings and the examination of potential sites for the location of Garda stations, comes under the remit of the Office of Public Works, which has responsibility for capital expenditure on Garda accommodation. Garda accommodation projects are progressed in the context of the availability of funding within the OPW Vote and in the light of the priority attached to each project by the Garda authorities. I am very keen to see a clear list of priorities from the Garda Síochána, which is determined by it and is publicly available so that we know where a project is placed on the list. As capital becomes available, a project will receive attention.

I am advised that proposals for refurbishment works at Garda stations throughout the State, including Newcastle West Garda station, are examined on an ongoing basis. As I said, they are progressed in the context of An Garda Síochána's identified accommodation priorities and the availability of funding. There are three parts. I have been told by the Garda authorities that the allocation of all Garda resources, including accommodation, transport and personnel, is subject to ongoing analysis and review to ensure that the best possible use is made of available resources. In that context, the Deputy will be aware that in this year's budget, I announced a further capital investment of €42 million in 2015 to provide for the construction of a number of new Garda divisional headquarters. I know that is not what the Deputy asked about but I make the point that capital is going into the Garda Vote for the development of new divisional headquarters in Galway, Wexford and Kevin Street in Dublin, which is important. That is being done using the methodology I described, namely, a combination of work between An Garda Síochána and the Office of Public Works. That procurement process is at an advanced stage. This is a very significant development in Garda infrastructure, as the Deputy will know. An additional €10 million has been provided for Garda transport in the year 2014-15, which shows the commitment of this Government to improve the facilities.

The Deputy made a very persuasive case in regard to Newcastle West. I will forward the details of what he said to the OPW and An Garda Síochána and will determine precisely where Newcastle West is on the list of priorities in regard to the refurbishment of accommodation.

Deputy Patrick O'Donovan

I thank the Minister for her reply. I agree that the priority list needs to be very clear. In that context, public representatives like myself should be able to have an input into it in the same way we can make a case for a school in our constituencies which, as constituency representatives, we do all the time.

However, I go back to the central point in regard to the current system of allocating resources while welcoming the fact capital has been made available and the Minister and her predecessor have recommenced Garda recruitment, which had not happened for eight years and which needs to be acknowledged. Several districts around the country were amalgamated and there was an understanding at the time in regard to accommodation needs. In this case, 89 people are working in a building which is essentially a bungalow built in the 1970s and not fit for purpose. I am sure that is replicated throughout the country. I know there are budgetary constraints and it is in that context that the Minister might see if a new model could be considered through public private partnership. I attended the opening of a school in Doon, County Limerick, last week. It was a public private partnership and was opened by the Minister's colleague, the Minister of Education and Skills. It was one of a bundle of schools built, operated and maintained by the private sector for use by the public sector, so this can be done more cost efficiently.

I know Garda divisional headquarters has been refurbished, including Henry Street in Limerick city, which the Minister visited recently. Her visit was very welcome in the context of what the gardaí in Limerick have done over many years. I again invite the Minister to visit the Garda station in Newcastle West when she gets the opportunity to see the conditions with which the men and women, civilian and Garda personnel, as well as the public must contend in 2014. They deserve something better in a district headquarters which covers an area larger than most counties. As I said, it is larger than County Monaghan. I ask the Minister to visit at the first available opportunity to see the station for herself because there is no doubt the conditions are not conducive to a proper working environment for the gardaí, the civilian staff and the public in 2014.

Deputy Frances Fitzgerald

On the next occasion I am in Limerick, I will visit Newcastle West to see the station, as the Deputy described it. I would like to make the point on the day when there is a very heavy critique under way in regard to many aspects of the organisation of An Garda Síochána that when I visited Limerick, one of the reports I listened to was about how it had dealt with crime in Limerick and how in 21 out of 24 murders somebody had been convicted, which is some record. In the middle of so much difficulty, it is a record of which to be very proud and one which we should acknowledge.

The Deputy made the point that where districts have amalgamated perhaps we should look, in particular, at those districts having a priority in terms of refurbishment of stations and premises. I will certainly consider that point. I intend to meet my colleague, the Minister of State with responsibility for the OPW, to discuss what the ongoing approach should be to investment in the refurbishment of Garda stations throughout the country. As I said, I will revert to the Deputy in regard to the situation he described and on where Newcastle West is on the list.

Domestic Violence Refuges

Deputy Eamonn Maloney

I thank the Ceann Comhairle's office for selecting this Topical Issue matter. For years the Respond! Housing Association has carried out very valuable and important work in regard to housing. As part of its work, it has operated a refuge for women and children in my constituency for almost three years. Over that period of time, it has accommodated 55 mothers and more than 80 children who have been the victims of mental abuse, physical abuse, sexual abuse, emotional abuse and, in some cases, financial abuse.

This refuge provides a safe haven for victims who, unfortunately, are victims of domestic violence. Currently, it is under some threat due to a lack of funding and that is why I highlight the issue and again bring it to the Minister of State's attention, as I know he is already aware of it. The value of this refuge cannot be underestimated. It is regrettable that in this day and age we still need this sort of facility for women and children and that they must go through this kind of experience.

People like us, as legislators, have a responsibility to offer safety to these citizens. There is an existing application for part funding for the centre which is operated by Respond! but it operates under the name Cuan Álainn. It has applied to the Child and Family Agency. I hope that when the matter is being deliberated on there will be due consideration of and sympathy for Respond!’s predicament in trying to provide this service.

Minister of State at the Department of Justice and Equality (Deputy Aodhán Ó Ríordáin)

I am taking this topical issue debate on behalf of the Minister for Children and Youth Affairs, Deputy James Reilly, who is in Armagh attending a North-South Ministerial Council meeting with his counterpart from Northern Ireland.

Cuan Álainn, situated in Tallaght, is a refuge for women and children who are fleeing domestic violence. Since the centre opened in 2012, a total of 55 women and 82 children have accessed its services. Respond! has provided €350,000 in funding to the centre. The Child and Family Agency does not fund Respond!'s Cuan Álainn refuge through its domestic sexual and gender-based violence services programme. The agency has advised that a meeting is planned with Respond! next week to discuss the services provided.

It might be helpful for members of the House if I share some background to the arrangements for dealing with this issue at a strategic level. Due to the complex nature of the issues involved in domestic and sexual violence, and the need for a co-ordinated and effective response to these issues, the National Office for the Prevention of Domestic Sexual and Gender-Based Violence, Cosc, was established as an executive office in the Department of Justice and Equality in 2007 and that Department currently has overall policy responsibility in this area.

Cosc formulated a comprehensive cross-Government strategy, which combines the efforts of a very broad range of organisations and individuals, to combat all forms of domestic, sexual and gender based violence. This strategy runs to 2014. Cosc is in the process of preparing a new cross-sectoral strategy from 2015 onwards. With regard to service delivery, the new Child and Family Agency has since its establishment on 1 January this year, taken on responsibility for the provision of domestic, sexual and gender-based violence services previously funded by the Health Service Executive, HSE. Specialist domestic, sexual and gender-based violence services are primarily provided through a large number of non-governmental organisations.

In 2014, some €19 million in funding is being provided by the Child and Family Agency by way of grant aid to 62 specialist domestic violence and sexual violence services. These include 16 rape crisis centres and sexual violence services; 44 domestic violence services, including 20 refuges; two national networks, the Rape Crisis Network Ireland, RCNI, and Safe Ireland. For the first time, this area is under national direction. We now have a single line of accountability and a consolidated national budget which is reserved for allocation to these particular services. Domestic, sexual and gender-based violence services can now be delivered within a broad child and family support framework and this represents a significant change to the previous service delivery model.

In recognition of the policy priority which the agency is attaching to this issue, a dedicated position of programme manager for domestic, sexual and gender-based violence was created within the agency and the post holder took up the position earlier this year. This will help to bring greater cohesion to service delivery. A review of domestic sexual and gender-based violence services has been under way in recent months to get an in-depth understanding of current service provision and identify priorities for developments in these services. The findings of this review will be used in planning for future developments in service provision. A roadmap setting out strategic priorities for domestic sexual and gender-based violence service provision over the next three years is due to be completed shortly.

While the emphasis is on front-line services, issues such as training support, quality assurance and preventative measures are also being considered. Through this process the Child and Family Agency is engaged in ongoing consultation with domestic violence and sexual violence services about planned developments. I am pleased to say that the consultative process has been very positive. The discussions will have regard to key aspects of planned developments and a commissioning approach for 2015 service provision will be established. The new Child and Family Agency is committed to working in partnership with domestic violence services and other services providing support to women and children experiencing domestic abuse and the Minister for Children and Youth Affairs is awaiting the outcome of the agency's discussions with Respond!

Deputy Eamonn Maloney

I thank the Minister of State for the detailed response to the issue. I am aware of the review process which I hope will go a long way to providing a better understanding of the issue and will provide a proper framework for funding the sort of work that Cuan Álainn does. I hope the meeting next week will be positive. Respond! will welcome that too. Violence against women and children is not confined to particular locations. It is a nationwide problem and these essential services that offer a safe haven for children and mothers who are abused. I welcome whatever progress can be made on this issue.

Deputy Aodhán Ó Ríordáin

I thank the Deputy for raising this issue and will raise his concerns again with the Minister upon his return. The Child and Family Agency is a major reform and has been welcomed across this House. The issue in the Deputy's constituency will be the subject of a meeting next week and we will follow up with discussions after that.

Health Services Provision

Deputy Billy Kelleher

Yesterday, at the Irish Cancer Society's annual Charles Cully Lecture the worryingly high rate of cancer incidence and death in poor communities across Ireland was highlighted in a discussion on health and wealth, the cancer gap. Death rates in some areas, notably some of the poorest parts of the Dublin region, are more than twice as high as rates in more affluent areas. Cancer death rates in Dublin between 2009 and 2011 combined varied from 381 per 100,000 in Blakestown north west; 310 per 100,000 in Blanchardstown north; 265 per 100,000 in Ballymun east; 141 per 100,000 in Foxrock and Cabinteely south west; 138 per 100,000 in Malahide east; and 128 per 100,000 in Castleknock south east. It is clear that the more deprived the area, the higher the risk of a person developing cancer and dying from the disease. People in areas of most disadvantage are twice as likely to die from cancer as those in the most affluent areas.

As well as this, often the poorest in society have the greatest difficulties in accessing health care. As well as dying younger, they develop multiple illnesses at an earlier age. In some deprived Dublin areas, there are not enough primary care resources, for instance, in north Dublin there is one general practitioner, GP, for every 2,500 people. Nationally, this figure is 1:1600.

The cancer strategies implemented by governments over the past 20 years have been successful in many ways. I know that the Minister for Health, Deputy Leo Varadkar, has appointed a team of three international experts to evaluate Ireland's current national cancer strategy and to provide advice for the next one. In doing so, he said that the main challenges facing Ireland during the ten year period of a new strategy are likely to be minimising the increase in cancer numbers, bringing services for cancer treatment to a par with the top international performers and maximising holistic recovery among cancer patients.

I ask the Minister to bear in mind that the Irish Cancer Society has suggested that the next strategy should give specific priority to the need to combat cancer in the poorest sections of our society.

I represent the constituency of Cork North-Central, which has some areas of high socio-economic deprivation. The basic elements of housing, education and other support services are under stress and pressure and there is no point in saying otherwise. That is just an observation, as opposed to a political point. This aspect of the issue of health, which is a key concern of mine, has been highlighted by the Irish Cancer Society. Given his background and the constituency he represents, I know the Minister of State will be aware of this as well. Regardless of what we do in terms of resources, the least we should do is ensure the cancer strategy that is applied in the years ahead contains a strong commitment to social justice in the context of providing adequate health care in the areas under discussion. A strong strategy is needed to address the underlying causes of the poor health outcomes of many people in such areas.

Deputy Aodhán Ó Ríordáin

I genuinely appreciate the opportunity to discuss this crucial issue with the Deputy. In effect, the life expectancy of certain people in certain parts of Ireland is lessened. We need to take this serious issue on board. I will present the reply from the Department of Health to the House on behalf of the Minister and we can expand on it. As we have been making progress with cancer control over recent years, we have focused on improving the quality and equity of cancer services through reorganisation and expansion. We have moved from a fragmented system of care to one that consolidates cancer treatment in larger centres, with multidisciplinary care and decision-making.

The national cancer control programme has reorganised cancer surgery into eight designated cancer centres and ensured these centres have sufficient activity to provide and maintain ongoing surgical expertise. The programme has also established symptomatic breast disease clinics and rapid access clinics for lung and prostate cancer at the designated centres. These clinics are available to all patients, regardless of income. The HSE also provides free screening for breast, cervical and bowel cancer. The Government recently announced the extension of the BreastCheck screening programme, which offers women between the ages of 50 and 64 a free mammogram every two years, to women between the ages of 65 and 69.

The World Health Organization estimates that more than 30% of cancer deaths could be prevented by modifying or avoiding key risk factors. Tobacco use is considered to be the single most important risk factor for cancer. The Department of Health and the HSE are promoting healthier lifestyles to reduce the risk of many chronic diseases, including cancer. Policies include the achievement of a tobacco-free Ireland by 2025.

The National Cancer Registry, which publishes data on cancer incidence, treatment and survival in Ireland, has presented figures to demonstrate that regional variations in survival patterns are not statistically different. Long-term survival from cancer has greatly increased in the past decade. Survival at five years from diagnosis among men increased from 42% in the 1994-99 period to 60% in the 2005-09 period. The increase among women over the same period was from 52% to 62%. It is estimated that the five-year survival rate for people diagnosed with breast cancer between 2005 and 2009 was 84.9%, which represented an increase on the rate of 75.1% for people diagnosed between 1994 and 1999. It is expected that survival rates will increase further due to the combined approach of prevention screening, early detection and improved treatment.

The issue of health inequalities, as well as prevention, will be examined as part of the development next year of the next cancer strategy, which will run from 2016. Of course much of this is about the treatment of illnesses in certain areas. I feel quite strongly about the issue of life expectancy. The Government has adopted an area-based approach to tackling child poverty and disadvantage, using models like Young Ballymun, the Tallaght child development initiative and the Preparing for Life programme in Darndale. These models focus on parental empowerment, for example. Issues of maternal depression are becoming quite acute in certain disadvantaged areas. If mothers become isolated from the rest of the community, it can lead to destructive patterns of behaviour.

When one focuses on the geographical dimension to the blackspots of disadvantage in this State, it is clear that the potential exists for different agencies to work together collectively. Often in disadvantaged areas, many people who are doing fantastic work are not in communication with each other. Models like Young Ballymun, the Tallaght child development initiative and the Preparing for Life programme in Darndale have broken down many of those entrenched positions. We are rolling out more of those area-based approaches. They might form part of the solution to tackling the issue that has quite rightly been raised by Deputy Kelleher today.

Deputy Billy Kelleher

I thank the Minister of State, who is quite right when he says this issue should be broadened out. We should have a broader debate on health outcomes and supports for people in areas of socio-economic deprivation. There is no doubt that the location where a person lives is a determining factor in many health outcomes. Rates of obesity, dietary concerns and cancer, for example, vary by geographical area. The Minister of State referred to maternal depression. I do not believe it is beyond our capacity as a nation to recognise first and foremost that it is simply wrong for people's health outcomes to be predetermined by where they live. We should do everything in our power to address that issue. As the Minister of State suggested, when one scopes through this issue, one can identify the areas where resources should be put in place in the context of cancer and in the context of providing a platform whereby people have the supports and services around them.

Education is necessary to ensure people are aware of what is required to provide for their own health. There is no point in putting this in any other way. In many places in this country, basic skills like cooking, managing diets and handling household budgets are being lost. While we do not want to stereotype people, there is an inherent need for us to address these problems at a basic level. We need to ensure supports are in place to assist people who are vulnerable. They need to be helped to manage their own affairs and empowered to look after themselves and their families. While I hate burdening schools all the time by suggesting they are the answer, I think this issue starts in our schools. They need supports to allow people in communities to feel a sense of empowerment and look after their own destinies in areas like health and education. I refer to things that many of us take for granted on a daily basis. Yesterday's interesting Charles Cully lecture about the issues of health and well-being associated with the cancer gap is well worth reading. It highlights the huge inadequacies and inequalities that exist in our society.

Deputy Aodhán Ó Ríordáin

I appreciate the raising of this equality issue by the Deputy. I agree with what he has said about the schools system. Children do not live in schools. They are influenced by many things outside the school system. They start school at the age of four or five when so many things have already happened to them and influenced their lives. They key to this is empowering the parents in terms of diet and lifestyle in the home. If one comes from an area that is steeped in disillusionment, one can be sucked into a pattern of addiction in which one is attracted by vices like alcohol and substance abuse. Obviously, that has knock-on effects on the wider community. It is about empowerment and prevention. As the Deputy quite rightly said, it is also about providing services and resources to those who are suffering from cancer-related illnesses.

A wider societal approach is necessary here. As I have said previously, if we take an area-based approach, if we ask agencies to interlock with each other and - fundamentally - if we empower people, particularly young mothers, to think differently about diet, oral language and literacy skills and lifestyle and to take a fresh approach to parenting, it can be a starting point that leads to a long-term change in the life expectancy of people in certain disadvantaged areas. A report like this is a wake-up call for everybody. It is refreshing to have a discussion like this in the House because it is the real stuff of equality. It is an area in which policies and politicians can make a real difference. I appreciate the raising of this topic by the Deputy. I will personally raise it with the Minister when he returns. I think that, collectively, we can make some real differences in this area. It is not just a health issue. Many different strands are involved in it. Unfortunately, in government and in policy formation we sometimes tend to compartmentalise these areas far too much.

However, we are in broad agreement as to the strategy we should take. We should have a continuing discussion on this matter.

Ambulance Service Provision

Deputy Billy Timmins

I appreciate that the Minister for Health is not available, but I hope that the Minister of State will pass on my points. County Wicklow may be the only county that has never had a general hospital. As a result, the area has historically been served by hospitals in Naas, Tallaght, Loughlinstown and, in some cases, the general hospital in Wexford town. This has led to a fragmented service, one that may not always have had the confidence of the public.

In recent years and in conjunction with the former Tánaiste, the area's elected representatives and I have met the HSE and the National Ambulance Service with a view to reconfiguring the emergency services in north-east Wicklow, moving them from Loughlinstown to St. Vincent's University Hospital. Sometime last week or the previous week, clinical directive 03/2014 was issued by the National Ambulance Service to the effect that the emergency services at St. Vincent's would no longer be available for people suffering cardiac arrest in County Wicklow and that they would be required to go to the nearest primary percutaneous coronary intervention, PPCI, unit. My understanding is that there are only two such units in Dublin - St. James's Hospital and the Mater hospital. This would result in an additional journey of 20 or 30 minutes, depending on traffic.

That this directive was made caused consternation locally, as did the fact that it was impossible to establish who had made the decision or its basis. Once again, no one in the HSE was responsible. How was this clinical directive issued and what was its basis? According to the directive, the service was to cease indefinitely with effect from 16:00 hours on 7 November. After the pandemonium and the hullabaloo that were kicked up, an amending directive was made to the effect that the service would be restored from this Tuesday onwards.

How did all of this happen? In any future reconfiguration, the PPCI unit in St. Vincent's should remain open to cardiac arrest sufferers in south Dublin and north-east Wicklow.

Deputy Aodhán Ó Ríordáin

I thank Deputy Timmins for raising this important matter. The national clinical programme for acute coronary syndrome aims to increase the percentage of ST-elevation myocardial infarction, STEMI, patients who get PPCIs by ensuring that patients are being taken to the right place, their treatment is standardised and processes are in place to ensure prompt investigation of all acute coronary syndrome patients. Under this programme, St. Vincent's University Hospital, St. James's Hospital and the Mater Misericordiae University Hospital operate as designated PPCI centres for the greater Dublin area on a 24-hour, seven-day per week basis.

The HSE has advised the Department that, unfortunately, a premature decision was taken last week to withdraw St. Vincent's University Hospital as a 24-7 PPCI centre without the normal notifications to relevant stakeholders. This resulted in a temporary suspension over last weekend of ambulance transfers to St. Vincent's for patients suspected of having STEMI. From 4 p.m. last Friday until 8 a.m. on yesterday, ambulances were instructed to take confirmed STEMI patients in the greater Dublin area to either of the other two 24-7 PPCI centres - St. James's Hospital and Mater Misericordiae University Hospital. The HSE has confirmed that three patients suspected of having STEMI who would have been brought by ambulance to St. Vincent's over the weekend and Monday were transported by ambulance to St. James's Hospital for appropriate treatment. All patients who presented directly to St. Vincent's with suspected STEMI were able to avail of PPCI in St. Vincent's 24-7, if deemed clinically necessary. I am happy to report that St. Vincent's resumed its 24-7 PPCI service at 8 a.m. on Tuesday, 11 November.

A redesign of the PPCI programme, particularly the out-of-hours service, is under way within the HSE. The HSE acute hospitals division, in collaboration with the acute coronary syndrome programme and the National Ambulance Service, will enter into discussions with all Dublin hospitals currently delivering PPCI with a view to devising the most effective and sustainable model of care for PPCI in the region.

Deputy Billy Timmins

Wicklow has an organisation called the community first responders. It comprises approximately 400 or 500 volunteers based in various locations who assist the ambulance service. When a call is received concerning a cardiac arrest, an ambulance may be dispatched from Townsend Street, but a local volunteer who has been trained to an acceptable standard is also called to the patient's location via a central number. It is a fantastic scheme, it is chaired by Mr. John Fitzgerald and it has been running for almost ten years.

A previous health Minister committed to rolling out the scheme countrywide, but that has not happened. Instead, it has taken off sporadically in some places. It requires little or no funding from the HSE. Will the Minister of State ask the Minister for Health to examine Wicklow's scheme with a view to rolling it out to areas, especially isolated ones, where emergency services are not available? A scheme was set up in Bray, a large town fairly close to Loughlinstown and St. Vincent's, nine or ten months ago and has already received more than 100 call-outs and saved lives around the county.

The Minister of State mentioned that a premature decision had been taken. This is where the difficulty arises. How was an individual able to make a decision to cease the service without going through the appropriate channels? The service would have been ceased indefinitely if not for the issue being raised. A system of accountability for establishing who is responsible for certain decisions does not seem to be in place in the HSE. This is unacceptable. While I accept that Deputy Ó Ríordáin is not the Minister, his reply was unsatisfactory. How are we to know that this situation will not recur if his reply did not outline the shortcomings in the first instance?

Deputy Aodhán Ó Ríordáin

The Deputy raises a valid point. I will be sure to relay to the Minister his concerns as well as Deputy Kelleher's two points about health issues in his constituency and those disadvantaged areas nationally with a higher proportion of people who suffer cancer. Deputy Timmins has raised issues and deserves a comprehensive response from the Minister concerned. I will endeavour to ensure that he receives it.