Dáil Éireann debate -
Tuesday, 25 Nov 2014

Vol. 859 No. 1

Topical Issue Debate

Hospice Services Provision

Deputy Ciara Conway

I am glad to have the opportunity to raise this matter, which I have raised previously at the Joint Committee on Health and Children. Currently, Waterford is without a hospice and it is not only Waterford that is affected but the whole region of Waterford, Wexford, Carlow, Kilkenny and Tipperary, taking in a population of 0.5 million. As we approach 2015, we are still in the shameful situation where the south east of Ireland does not have a dedicated hospice building.

Work is underway to address this, thanks to the hard work of the local hospice movements across the south east, in particular in Waterford. A design team was appointed this summer and meetings have been getting underway with the architects. It is hoped the planning application for the unit will be lodged in March 2015 and that the building will start in the summer of 2016, to be finished by the end of 2017. That is all well and good, and we look forward to seeing the work progressing, but it is currently costing Waterford hospice approximately €600,000 annually to provide home care services. Most of this amount - 67% - has been raised through donations from coffee mornings, sunflower days and local fund-raising by very loyal supporters.

The HSE provides 33% of the remaining funding required. There is a great deal of money being raised and spent locally on the hospice home care packages. From my work with the hospice board, led by the chairperson, Danette Connolly, I know that it has always said that the HSE locally has been very supportive and helpful.

While the HSE is helpful, money talks. I have a rather alarming document, the response to a recent parliamentary question from me requesting a detailed breakdown of the funds. It makes for stark reading. In 2014, Milford Care Centre in Limerick received €11.5 million; Galway Hospice, €3.36 million; North West Hospice in Sligo, €2.59 million; Our Lady’s Hospice in Harold’s Cross, €13.23 million; Marymount Hospice in Cork, €6.5 million; and St. Francis Hospice in Raheny, €7.1 million. These hospices receive between €3 million and €13 million each year to fund services for people at the end of their lives.

The picture in the south east, however, is not pleasant. Until September 2014, the Waterford hospice movement received the miserly sum of €140,000; the Carlow-Kilkenny home care team, €160,000; the Wexford team, €150,000; and the local hospice movement in south Tipperary, €170,000. The combined hospice service in the south east received €620,000 from the HSE until September of this year.

We do not begrudge the money to Limerick or Sligo or anywhere else for those caring for people who are very unwell, managing pain and at the end of their lives. The south east hospice normally gets approximately €800,000 per annum, still the lowest amount for any region in the country. It is hard to read these figures in the awareness that not only are the people across Waterford, Wexford, Carlow, Kilkenny and south Tipperary being asked to fundraise for home care services but also to raise €6 million towards the palliative care unit. Anyone can see from these figures that the south east is missing out on a very big piece of the pie.

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

I thank the Deputy for raising this issue because palliative care is an integral part of the delivery of health services. We should be conscious that it is not always given at the end of life but ensures that people who have a condition that will end their lives can have a quality of life for a prolonged period which allows them live the best life possible. I take on board everything the Deputy has said but I know that the fundraising committee in Marymount in Cork, which is the one I am most familiar with, raised €28 million to put in place the fine hospice in Cork. I accept that there is a huge area of the country that does not have a hospice.

Direct budget allocation for palliative care is €73 million in 2014, but this does not include expenditure on the specialist palliative care provided in 38 acute hospitals, approximately 170 palliative care support beds and designated home care packages. Most of the HSE's palliative care budget is provided to the main voluntary hospice organisations to provide palliative care services, including inpatient beds, home care and day care. The funding is provided under an annual service level arrangement with each organisation. Many agencies also provide additional services which are resourced through charitable fundraising, which, as the Deputy, said is an active part of what happens in Waterford.

I am aware that Waterford home care services relies on voluntary fundraising to supplement the funding it receives from the HSE. This is also the case for the other palliative care home care services in the south east. The HSE funds approximately 40% of the running costs for each of the four providers. All of these teams provide support for palliative care patients with malignant and non-malignant conditions, and all provide a seven-day service. These teams, and the fundraising efforts behind them, provide a vital service for people with a life-limiting condition and their families in the south east, and this Government greatly appreciates their efforts to ensure quality of life for patients with a life-limiting diagnosis.

I would like to see increased support for these services but despite better economic indications in recent times, funding is under pressure across the health sector and will remain so for quite some time, and it will continue to be very challenging to secure additional funds in these circumstances. I am also aware that Waterford home care services has agreed to raise €6 million to cover the capital cost of the new 20-bed specialist palliative care inpatient unit to be built as part of the redevelopment of Waterford Regional Hospital. The unit will act as a focal point for the provision of specialist inpatient beds, and community and day care services for patients and their families living in the south east.

There are six similar proposals for new hospice units at various stages of development throughout the country where the voluntary hospice groups propose to provide the capital funding on the basis that the HSE will take on the ongoing operational costs. This year 16 new beds have opened at Marymount in Cork and all 24 new hospice beds in St. Francis Hospice, Blanchardstown, will be open by the end of the year. The University Hospital Waterford project, including the palliative care unit, is included in the HSE's capital plan for 2014. It is expected that the planning application will be lodged in March 2015. Construction is planned to commence subject to funding approval in the second quarter of 2016 and to be completed in the third quarter of 2017. Following commissioning and equipping, the unit is planned to open in early 2018.

The provision of the structure sometimes brings additional funding and this will help in the provision of service in that area.

Deputy Ciara Conway

I thank the Minister of State. I am really delighted that the palliative care unit is in the capital plan for the HSE. Other governments reneged on their promises to the south east and Waterford in this respect. The fundraisers and activists behind this issue are glad to see a finishing line.

In respect of life-limiting illnesses, the Minister of State is absolutely right that this is not just a once-off but can be an ongoing service throughout a person's life to improve quality of life. It is in a patient's interest to be kept at home as long as possible. The home care team does incredible work, which I have seen at first hand. The local fundraisers have to subsidise the home care packages because we get so little funding vis-à-vis the rest of the country, but that money could be diverted into the bricks and mortar of the hospice building. The local HSE has been very good and has a really good working relationship with the hospice. The end result will not just be a hospice unit on the grounds of University Hospital Waterford but a five storey building integrated into the plan for the hospital which will be an incredible facility for the people of Waterford and the south east. In the interim, however, the home care services are very poorly funded vis-à-vis the rest of the country.

I would like the Minister of State to ask the Minister, Deputy Varadkar, why that is the case. This region has a population of approximately 500,000. Between 33% and 40% of the funding is being provided by the HSE. I understand that in other regions of the country, the salaries of the wonderful nurses who go into people's homes to provide such great care are paid for by the HSE, rather than from the buckets of fund-raisers.

Deputy Kathleen Lynch

I suppose I have a little personal knowledge of this matter. I would have an affinity with it. Of course it would be an objective to be able to increase the budget in this area. It is not something that is being forgotten. We are very familiar with what happens, especially with the home care teams. I would like to mention an interesting development. Many people are staying and being maintained at home for a long time. This means the only people who are going into inpatient hospice beds are those with significant levels of need. Their demands are so great that even the very established hospices are experiencing funding difficulties. The fair deal has to be part of it. I would like to mention another matter about which we need to be very conscious. The VHI needs to be conscious of this as well, and it is in terms of the beds. If someone has been paying VHI all of his or her life, it just cannot suddenly stop for that little piece at the end of his or her life. In many cases, they are very conscious of that and they do deliver. We need to have a conversation with them about how best we can do that as well. I think it is far more complex than people imagine. If one talks to most of the voluntary organisations that deal with palliative care, they will clearly tell one that the needs of people during that journey, which can sometimes be extensive, are far more complex than we thought. Of course it would be magnificent to be able to increase the budget. It is not something that will slip off the agenda. We are very conscious of it.

Disability Support Services Expenditure

Deputy Paul J. Connaughton

I thank the Minister of State for being here to take this debate today. We could not take it last Thursday. The funding provided to the Brothers of Charity and to Ability West in County Galway has been cut. I understand they received notification of this cut in October, even though it had been set out months previously. It seems that the cut stems from the Haddington Road agreement, under which savings were to be made, and from a value for money report that was carried out within these services. I would like to concentrate on the value for money report. The Minister of State might be able to give me some clarity on it. I understand that the details of this cut were set out to all the individual agencies involved a number of months previously. There seems to be some concern about the value for money report. The Minister of State might be able to let me know who carried it out. What were the terms and guidelines around that report? How is the cut of €5 million to be broken down between each of the individual agencies? It seems that €156,000 will come out of the budget of Ability West before the end of the year. How was it set out that Ability West would take such a cut? I think the cut being imposed on the Brothers of Charity is almost double that. How was the figure for that cut arrived at? There is some concern about how these cuts were arrived at and how they will be rolled out. I have been told that the HSE may have informed these agencies that the €5 million I have mentioned might be taken out of central Exchequer funding and would not be passed on down to the agencies at this stage. I know that half of the cut will come out before the end of this year and the full cut will come out in 2015. The Minister of State might be able to give me some clarity in that regard as well.

Since the decision to impose this cut was arrived at and the agencies were informed of it, I have been contacted by a number of families and parents who are concerned about the effect it might have on them. I know the HSE said on 2 October that the agencies should achieve these funding cuts without affecting front-line services. Is the Minister of State convinced that it is possible for these savings to be made without affecting front-line services? If it is proven that this cannot be done, will it be possible to reverse the cut? Is there any way to make sure these agencies are well funded? Much of the concern that is being expressed to me relates to respite care. Many families desperately need the respite care service to continue. They are concerned that if this cut goes ahead, they and their loved ones will not have an opportunity to get a break of a week or two weeks. Many people have contacted me today to express concern about reports that there has been an 11% increase in middle management in the HSE. This has led to some frustration because it has happened at a time when a cut to front-line services seems to be coming down the line. I ask the Minister of State to clarify the issues I have raised with regard to the value for money report and its impact on these agencies.

Deputy Kathleen Lynch

I seem to be going slightly over time on these matters. I genuinely do not mean to do so. I know we are stuck for time. The value for money report, which was carried out by the Department of Health, took approximately two years. It was very difficult to get the type of information that was necessary on the services that are being delivered and the cost per unit of those services. We needed to be very sensitive because one does not want to categorise people as "unit costs". Nevertheless, when an audit of this scale is being undertaken - we are talking about €1.4 billion here - there is a clear need for it to be broken down in such a way. The value for money implementation group is really getting under the bonnet in terms of the money that is spent and how it is delivered. It is also involved in the personalised planning that will have to accompany the capacity legislation. Such planning will deal with how to disentangle the people's preferred choices in terms of service, for example. I have never denied that various agencies and groups of people have delivered services that the State did not deliver. They are delivering those services on behalf of the people of Ireland. In the main, they are doing an extraordinarily good job. I include the two agencies mentioned by Deputy Connaughton in that.

I will read out the prepared answer. If the Deputy wants to have a wider discussion at a later stage, I will not have a problem with that. I thank the Deputy for raising this matter. I am pleased to take this opportunity to outline the current position regarding the funding provided by the Government for disability services this year. The vision for the HSE disability services programme is to contribute to the realisation of a society where people with disabilities are supported, as far as possible, to participate to their full potential in economic and social life and have access to a range of quality personal social supports and services to enhance their quality of life. The HSE national service plan for 2014 and the accompanying operational plan for the social care division outline the quantum of specialist disability services, the key reform initiatives and the additional investment in 2014. The HSE has assured us that these plans will give effect to this vision in 2015.

The HSE will spend €1.4 billion and employ approximately 15,000 whole-time equivalents to provide specified service levels in 2014. An additional investment of €14 million in 2014 has been made to address deficits in disability services, to deal with a reform programme that will transform services to a community-based model of person-centred supports and to focus on the implementation of the HIQA standards for residential services for people with disabilities. Value for money efficiency targets of €5 million were identified this year in the national service plan. In order to arrive at a fair and equitable allocation of these efficiency targets, the social care division of the HSE has been assessing the capability of the voluntary disability providers to implement the necessary measures. In recognition of the amount of time that is required to complete this work, I understand that just 50% of the 2014 requirement, or €2.5 million, is being assigned to agencies this year. We are doing that because we understand there will be difficulties in the transformation we need.

The matter raised by the Deputy - the provision of funding to Ability West and the Brothers of Charity services in Galway - is relevant to this overall efficiency target. Ability West is funded by the HSE under section 39 of the Health Act 2004 through a service arrangement. The 2014 budget allocated by the HSE amounted to €21.7 million. This year, Ability West will have its budget reduced by €156,600, partly in line with efficiency targets under value for money but also through savings achieved by implementation of the Haddington Road agreement, by which we must all abide. The Brothers of Charity services in Galway are funded by the HSE under section 38 of the Health Act 2004. Services are provided through a service arrangement which is signed on an annual basis and reviewed continually.

The agency was allocated funding of more than €44 million in 2014. This year, Brothers of Charity Galway will have its budget reduced by €88,000 - not double Ability West's, but just over half - in line with efficiency targets set out under the value for money report. I have been assured that the HSE will continue to work with both disability agencies to ensure that efficiencies are achieved without impacting on service provision.

Deputy Paul J. Connaughton

I thank the Minister of State for her reply. I will ask two questions. If the HSE cannot work with the agencies to make savings without hitting front-line services, what will be the next step in the process? Is there any possibility of a change in Ability West's €156,000 reduction? How will it be rolled out? People are concerned about the effects on front-line services. What effect has the €5 million reduction that was announced several months ago had on other agencies? I am sure the story is the same the length and breadth of the country. Have those agencies been in touch regarding that cut?

Deputy Kathleen Lynch

Up until last year, every year that I was in this job - it was not a long time - I was told that applying a 2% cut to every agency was deeply and grossly unfair, as it did not take account of agencies that were doing things differently or progressing our aims for disability services, for example, centralised and personalised planning. We have since adopted an agency-by-agency approach. It is a mammoth task, but we are getting under the bonnet and taking a serious look at the situation.

The agencies to which the Deputy referred were told well in advance what would be the reduction in their budgets. There was, and still is, an interaction over service improvements, which is a new theme in the HSE and social care. We speak with the agencies about how we want everything to work. It is a question of operating differently. I am not saying that what was done previously was wrong - obviously, it was not. However, there are different ways of doing things. This is what we want and what we constantly hear. According to the groups representing the agencies, it was unfair to have an across-the-board cut and that we needed to cut based on what each agency could do. That is what we are doing now.

I happen to know Ability West. It does an extraordinary job in a different way. Unfortunately, there is no turning back. If, as we have done, we discover that some agencies find it difficult to continue providing the service in its totality, one must re-engage and take a serious look at how best to continue providing that service.

Hospital Staff Recruitment

Acting Chairman (Deputy Derek Keating)

The next Topical Issue is in the names of Deputies Lawlor, Catherine Murphy and Heydon. The Deputies have two minutes each.

Deputy Anthony Lawlor

I thank the Ceann Comhairle's office for allowing us to raise this issue. I also thank the Minister of State for attending. A positive aspect of my locality is Naas hospital. It has tremendous staff and management and is probably one of the most efficient hospitals in the country in terms of what it sets out to achieve. It is in the process of seeking planning permission for an endoscopic unit, which I hope will be up and running in the coming years.

We must consider the demographical pressure on the hospital. County Kildare has the second largest population in Leinster and has a large number of over 65 year olds. Both trends will continue growing. There are also 17 nursing homes in the immediate vicinity of Naas General Hospital, which automatically places pressure on the hospital. I understand that some agency staff have been replaced by full-time nursing staff, given the difficulty involved in finding nursing staff. In fairness to the hospital's management, 46 beds are open that, strictly speaking, should not be, but this has placed additional pressures on its budget.

A couple of issues are causing this problem. The fair deal scheme has been delayed in respect of a number of elderly patients who, despite wanting to go to nursing homes, are still occupying beds in the hospital. The staff are under extreme pressure because of their workload and their numbers have decreased considerably. I ask that the hospital be allowed to work within its budget to open a number of extra beds on a permanent basis instead of ad hoc and without the HSE's approval.

Deputy Catherine Murphy

I will try not to go over the same territory. Approximately two weeks ago, nurses at Naas General Hospital took the unusual step of going out in protest during their lunch hours. Some of us joined them. The point they were trying to make was that they were presiding over an unsafe service. They took their decision with heavy hearts, as they are proud of their hospital. They were also concerned that working in the hospital's environment compromised their own registrations. I understand their point.

On average, 12 to 17 of the hospital's patients per week are on the fair deal scheme. In terms of size, this is the equivalent of 50 patients at Tallaght hospital. The large number of nursing homes creates pressure, particularly since many Dublin patients go to nursing homes in Kildare. There is pressure at both ends, given the area's young demographic.

Kildare has a population of 210,000 people. It is the fourth most populated county in the country. That its increasing population could lead to increased demands was never properly considered. The immediate recruitment of nurses is key. Some 24 nursing posts have been sanctioned. With 17 being filled on an agency basis, we are discussing seven or eight additional staff. Some of these posts have been funded by the hospital's management in an efficient way. The recruitment process has taken up to two years. There is a complicated system of recruitment. The staff are needed now.

Keeping a fair deal patient in a bed costs six to seven times what it does to keep someone in a nursing home bed. The latter would achieve a better outcome for the individual and an acute bed would be freed for people who actually needed it. The approach being taken does not make sense for the hospital financially or in terms of safety.

Deputy Martin Heydon

I thank the Minister of State for taking this important issue. Like my colleagues, I stood outside Naas General Hospital a number of weeks ago on a wet, cold Monday. I saw members of its nursing staff doing something that was not natural for them, that was, to be out in front of the hospital. They did not want to scare patients, but they needed to highlight their frustrations.

The hospital has sought 24 full-time positions. Given the delay in filling a number of these by agency staff, it makes sense to go from agency staffing to full-time or full-time equivalent staffing. Approval for these positions needs to be fast-tracked, the red tape needs to be cut and the posts need to be advertised and filled as soon as possible.

The 12 delayed discharges have had a knock-on impact within the hospital. The figure was higher a couple of weeks ago, but it needs to be cleared. There are great step-down facilities in, for example, St. Vincent's Hospital in Athy.

However, it is necessary to have those cases processed in order that they can be moved out of the system in Naas and to ensure that everyone who is in a bed in Naas hospital needs to be there and that every available bed in Naas is open and used fully. I support fully the management and staff at Naas General Hospital. When my constituents in Kildare South get sick, they depend on Naas General Hospital for that great level of care, both at emergency level and for longer stays. Members must support the staff, must make sure their working conditions allow them to do their job to the very best of their ability and must ensure there is a sufficient number of staff. Moreover, where it makes sense the movement of those staff members from being agency staff to being full-time equivalents should be fast-tracked and should happen as soon as possible.

Deputy Kathleen Lynch

I thank the Deputies for raising this issue and for giving me the opportunity, on behalf of the Minister for Health, to outline to the House the current position on the matter. The HSE has advised that Naas General Hospital has experienced additional pressures this year with a 14% increase in emergency admissions in the year to date. Moreover, it has advised that there has been a 45% increase in the number of patients on trolleys since this time last year at the hospital. Naas General Hospital has also been obliged a number of times during the year to implement the full capacity protocol, which involves placing additional patients on trolleys to ward areas. I have been assured by the HSE that when Naas General Hospital experiences overcrowding in its emergency department, every effort is made to admit patients to inpatient beds based on clinical needs as soon as possible. The hospital has in place appropriate escalation policies and monitors its activities continuously. A number of measures have been taken to address the demand. The hospital currently has 30 additional beds open, which have remained open all year, and has additional beds open in the acute medical assessment unit and day ward to meet the demand from the emergency department. Moreover, from what the Deputies have indicated, this demand clearly exists.

Notwithstanding current pressures, when compared with the baseline year of 2011, there have been 1,717 fewer patients on trolleys in the year to date in Naas in 2014. As for resources, the hospital's budget allocation for 2014 is €53.196 million with a staff of 637 whole-time equivalents. The hospital has appointed 26 staff nurses this year, 14 of whom were appointed as replacement posts and 12 as new posts. Furthermore, the HSE's national recruitment service currently is in the process of appointing a further eight nursing posts, of which six are replacement posts and two are new posts. I am assured by the HSE that the hospital will continue to engage with the HSE's national acute services and social care divisions to take advantage of additional capacity initiatives to relieve pressure on the hospital throughout the winter season.

The Deputies also will be aware that Naas General Hospital is part of the Dublin Midlands Hospital Group, which includes St. James's Hospital, Tallaght hospital, Midland Regional Hospital, Tullamore, Midlands Regional Hospital, Portlaoise and the Coombe Women & Infants University Hospital. I am confident there will be a structured integration of Naas hospital into the Dublin Midlands Hospital Group in 2015 and this will provide support for Naas hospital in managing demand and delivering high-quality and safe patient care in a cost-effective manner. However, I accept fully that when one has such numbers of replacement posts and additional posts as I read out, it is clear there has been great demand on this hospital and it did not have the requisite number of posts it needed to manage that demand. I hope the additional posts, both replacement and new, will alleviate some of this pressure because I know how beneficial it is to have a hospital within one's own area.

Deputy Anthony Lawlor

I think the Minister of State and welcome her response. As far as most people in Kildare are concerned, the point is to have a safe hospital and while this is the case, the members of staff there are under extreme pressure. One thing that can be degrading for those staff members is to hear each morning on the local radio station the number of people on trolleys. I am aware of how hard they are working and I understand what they are going through at present. While I welcome the additional staff, I note many of them are replacement staff and additional staff are needed. As I already pointed out, the area's demographics are changing as its population increases and there is additional pressure on the hospital itself. While the additional staff members are welcome, I will push constantly for additional funding and staff for the hospital because, as stated earlier, it is a focal point for the entire county. Naas General Hospital is associated with the entire county because it is situated right in the centre and I reiterate that the staff, who are working under considerable pressure at present, consider that additional staff members are required there.

Deputy Catherine Murphy

One thing one never used to encounter was the direction of people from the Leixlip-Celbridge area towards Naas as heretofore, they always were directed towards Blanchardstown and Tallaght hospitals. To an increasing extent, Naas is absorbing that major conurbation and consequently this is a kind of pressure the hospital had never experienced previously. I wish to echo the point about the staff and the kind of stress under which they operate. When one has replacement staff, obviously there is a training-in period and so on and part of the reason that staff members are being replaced is they are burned out, as one can only deal with stress for so long. It is useful to have the figure of a 14% increase in emergency admissions but unfortunately, it is historical and one must get to that point to prove there is pressure on the hospital. However, the very fact that such an increase is showing up demonstrates that demand is increasing because of the size of the county and the increased pressure from places that heretofore never depended on the hospital. In addition, the 2,000 people who are queueing to gain access to the fair deal scheme are putting enormous pressure on both Naas General Hospital and the Dublin and midlands hospitals to which it is connected. Consequently, there needs to be more than just the consideration of an historical model. Consideration must be given to planning to make sure this situation does not arise when there is clear and demonstrated demand that is an increased demand all of the time.

Deputy Martin Heydon

I thank the Minister of State for her response. The figures she has outlined of an increase of 14% in admissions and a 45% increase in the number of people on trolleys show the pressure under which Naas is at present and has the potential to be in the future. This is November, not January, and the peak time has not yet arrived. Absolute flexibility is needed in aiding the hospital to continue to provide safe care. Everything must be done to help the management and the staff of Naas General Hospital, in this time of increased pressure on demand on its services, to ensure it has the requisite flexibility. I welcome the Minister of State's comments on the new appointments this year, as well as the replacements, but I urge the Minister of State to go back to her officials, to cut through the red tape and to ensure that those agency nurses can be turned into full-time equivalents and that the additional positions can be put in place as soon as possible.

Deputy Kathleen Lynch

I take on board the point about that area and how that population base is increasing once again. This is a significant issue and although Naas General Hospital will become part of a bigger group, I do not believe this will deliver the type of solution that is needed. Perhaps consideration should be given to a broader solution in terms of extending the hospital. I always find that once a building comes in and begins to be developed, additional staff always follow. Clearly, however, there is a need to examine the population base and the rate of growth. This area always has been fast growing and while there was a little bit of a dip for a while, it is coming back. Perhaps this requires more than simply staff, even though staff members are of crucial importance. Perhaps it will be necessary to take a broader look at what is needed there.

Flood Risk Assessments

Deputy Michelle Mulherin

I regret that the Minister, Deputy Kelly, is not in a position to be present but I understand he is on other business. As winter approaches, the storms of last winter are etched into the minds of certain people, that is, those who have experienced flooding in their homes and businesses and of their land. A series of terrible storms was experienced that left terrible devastation in their wake. In my constituency and home town, approximately 100 houses have been identified as being at risk of flooding. In addition, there was flooding to housing in another area outside Ross, as well as in Westport, Crossmolina and other villages and towns nationwide. As winter approaches, people are fearful that this entire disaster might happen again if we experience, as we did previously, bad weather combined with high tides.

I welcome the work being done by the OPW in developing flood risk management plans. I understand it is studying 300 areas under the catchment flood risk assessment and management, CFRAM, programme and has prepared flood risk maps which identify areas at risk and list all the factors which contribute to flooding in order that we might obtain a true picture of the position. As a result of the OPW's work, options will be identified in the context of flood mitigation measures. As matters stand, however, the people to whom I refer remain in the same position as last year. In other words, they are facing into the same risks and problems. Rather than waiting for the various options to be identified, I am of the view that action should be taken. The Government committed €45 million in capital expenditure in respect of this matter for the period 2012 to 2016 and a number of minor works have been carried out by local authorities. However, there is a need to support people in order that they will not feel helpless in their homes.

I propose the establishment of a small grant scheme to be administered by the Department of the Environment, Community and Local Government under the auspices of the housing grants schemes currently operated by local authorities. They have the wherewithal to provide small housing grants. If grants were provided for matters relating to the risk of flooding, people would no longer feel helpless because they would be in a position to erect small flood barriers outside their homes as a short-term measure. In such circumstances they would be able to rest assured that they had done the best they can and that the Government has done all it can, despite the various time and financial constraints which obtain. Taking this type of action would be less costly to the State than being obliged to provide financial relief to people when their homes or properties have been destroyed.

It is worth bearing in mind - this adds weight to the case I am making - that in many cases the owners of houses which have already been flooded can no longer obtain insurance for them. As a result, they will from now on be obliged to fork out their own money or turn to the State if their homes are again flooded. The type of flood barriers or gates to which I refer can be fitted for approximately €1,500 and I would welcome it if the State were to make a contribution in this regard. In assessing eligibility for grant payments, it would be necessary to examine the position with regard to the areas identified in the mapping exercise carried out by the OPW under the CFRAM programme. These areas could then be targeted and the people who live there could be empowered and enabled to take the action required rather than being obliged to wait years for the arrival of more long-term, effective solutions such as the construction of sea or river barriers. If it is decided to pay grants, I request that these have retrospective effect for those who have already forked out in order to have barriers put in place at their homes. When one considers what would be the final cost of repairing the damage caused by flooding, the case I have put forward makes a great deal of sense. I have discussed this matter with the Minister for Public Expenditure and Reform, Deputy Howlin, who is not averse to the proposal I have just outlined. I am aware of the financial constraints that obtain but I am of the view that this would be a worthwhile exercise.

Deputy Kathleen Lynch

I thank the Deputy for raising this important matter. It was very good of her to allow the debate on it to proceed in light of the absence of the relevant Minister, Deputy Kelly.

The Office of Public Works is the lead State agency for flood risk management in Ireland. I understand the office is putting in place a range of measures to assist householders in flood-prone areas, based on its national programme of river catchment flood risk assessment and management, CFRAM, studies. This work is being undertaken in partnership with local authorities in order to meet national flood policy needs. The final outcome of the CFRAM programme is a comprehensive plan for areas at risk of flooding. This plan examines all possible options to address flood risk in particular areas and sets out a series of integrated measures of a structural and non-structural nature, as appropriate. I understand that draft CFRAM plans will be available by the end of 2015, with a view to their being finalised in 2016. These plans have already been completed in many areas.

It may be the case that in certain situations, structural or hard defence measures, such as walls or embankments, are not possible or appropriate to address the flood risk affecting a particular community or property. In such instances, the CFRAM plan may examine the viability of an option of individual property-protection measures as a way of addressing the flooding problem. This, however, would be considered in the context of the overall scheme to be implemented for the community in an area at risk of flooding as a whole, rather than as a type of grant scheme for individual property owners. As flood mitigation works issues do not fall within the area of responsibility of the Minister for the Environment, Community and Local Government, he has no plans for a housing grant scheme of the type suggested.

While the CFRAM programme will map out the State's strategy and priorities for flood defence investment for the period from 2016 onward, significant investment has already been, and will continue to be, made pending the programme's completion. From 1995 to date, almost €370 million was invested in flood risk management measures. These measures have protected 10,500 properties and have delivered benefits estimated at over €1 billion in terms of damage and losses avoided. The Government has prioritised investment in flood risk management by allocating a further €225 million for the period 2012 to 2017 as part of its infrastructure and capital investment framework. This is a very substantial financial commitment in the current difficult conditions and underlines the priority the Government attaches to this matter. There has also been significant investment in smaller scale, localised protection measures through the OPW's minor works scheme. Approximately €29.3 million has been approved for 422 projects since 2009, with approximately €25.1 million being expended on works which have been undertaken so far.

In March 2014 the Minister of State with responsibility for the Office of Public Works announced details of a memorandum of understanding between the OPW and Insurance Ireland, the representative body for insurance companies in Ireland, on the exchange of information on completed flood defence works. Under this, Insurance Ireland members have been taking into account all information provided by the OPW when assessing exposure to flood risk within these areas since 1 June last. To date, the Office of Public Works has provided to Insurance Ireland information on 12 completed flood relief schemes in an agreed format. It should be borne in mind that decisions on the provision of flood insurance cover and on the premiums to be charged will remain a commercial matter for individual insurance companies. However, it would be the expectation that the operation of the memorandum of understanding and the continuing investment by the State in major flood defence works will lead to the greater availability of flood insurance in areas benefitting from those works.

I again thank the Deputy for raising this issue.

Deputy Michelle Mulherin

I thank the Minister of State for her reply. I was immediately struck by a certain aspect of it as she read it into the record. I refer to the fact that - as was the case when flooding occurred last year - certain issues fall within the remit of the OPW, that the Department of the Environment, Community and Local Government is responsible for providing emergency responses, that other matters are proper to the Departments of Public Expenditure and Reform and Agriculture, Food and the Marine and that lands or property located within a special area of conservation, SAC, are overseen by the Department of Arts, Heritage and the Gaeltacht. There is a need for a cross-departmental approach on this matter. I accept that this need has been identified but I would like to see the actual approach implemented.

I raised this matter with the Minister for the Environment, Community and Local Government because I am quite satisfied as a result of my experience in dealing with householders trying to obtain assistance from the State that the OPW has nothing to offer in the way of short-term solutions. I welcome the plans to put in place longer-term, significant solutions. I hope that such solutions will take account of the future rise in sea levels to which global warming is going to give rise. The easiest way to assist people in putting in place short-term solutions would be through the Department of the Environment, Community and Local Government. As already stated, I have mentioned this matter to the Minister for Public Expenditure and Reform, Deputy Howlin. I am of the view that the Ministers at the various Departments to which I have already referred should work together on this matter. The Minister for the Environment, Community and Local Government is responsible for putting in place the response to any emergency which might arise.

Provision of the type of assistance I referred to in my initial contribution would very much ameliorate people's concerns. As is normally the case with housing grants, the Government would not be obliged to pay the full amount for the erection of the small flood barriers or gates I described earlier. Local authorities are excellent when it comes to disbursing small grants of the type to which I refer. I acknowledge that work is being done but there are many householders and business owners who have not and may not benefit from this.

People understand that and the financial constraints but just want some assistance. I ask that this measure be discussed by the Minister for Public Expenditure and Reform, Deputy Howlin, and the other appropriate Ministers because it is very worthwhile. It would result in savings for the State in the longer term because it costs the State more money to assist financially people who are flooded but who have no insurance.

Deputy Kathleen Lynch

I am sure the Deputy's remarks are being listened to by the officials in both the OPW and the Department of the Environment, Community and Local Government. I will ensure that the comments made by the Deputy on the record will be made known to the appropriate Ministers.