Dáil Éireann debate -
Thursday, 12 Mar 2015

Vol. 871 No. 3

Topical Issue Debate

Health Services Staff

Deputy Eamonn Maloney

As a member of the Oireachtas Joint Committee on Health and Children, I endeavour to take an extra interest in such issues. I refer specifically to the research published today in the online journal, Human Resources for Health, and which was overseen by NUI Galway. Some might describe the evidence presented in the study as alarming and some as shocking. A total of 2,273 medical students were surveyed, of whom 1,519, or 67%, were classified as Irish medical students, having completed secondary school in Ireland. The remaining 33% were non-Irish. What is of concern are the figures showing that 90% of the medical students "may" leave this jurisdiction having completed their medical education. Like all politicians, I have some scepticism in that, if we were to rule our lives on the basis of such studies, we would not move too far. Notwithstanding that, if the figure is anything near to 90%, by any yardstick, it would be a matter of concern for us all, including the Minister, Deputy Varadkar.

I am reminded that the taxpayer paid approximately €75 million last year for those engaged in medical education. In the lifetime of a medical course, the cost to the taxpayer is €125,000 per student. I am not suggesting in any way that we should intern them or nail them down but, given the difficulties in the health system and the lack of funding as a result of the country being destroyed, we must examine this issue.

Is the situation as bad as is portrayed in the study or is it more optimistic? If it is not, what is the Minister's advice for rectifying the situation? When I heard the Minister speak recently in the House, he told us about the lack of anaesthetists and the difficulties over pay, and the fact they will not stay because their experience is more extensive than just being qualified as a doctor. Is the situation as bad as is portrayed in the study?

Minister for Health (Deputy Leo Varadkar)

I thank the Deputy for raising this important issue. The recruitment and retention of doctors at all levels, from medical student to specialist, is important for me as Minister for Health and I am committed to the implementation of the recommendations of the strategic review of medical training and career structure, which was chaired by Professor Brian Mac Craith. Through its various reports, the strategic review working group has offered solutions and recommendations, which, if we see them through, will ensure that we build a sustainable workforce for the future.

I recently received the first progress report on the implementation of the recommendations. I am pleased to say there has been a range of developments which will, I believe, help us recruit and retain doctors, including newly qualified doctors, in our health service.

As the Deputy will be aware, on foot of the working group's recommendations regarding consultant career structures, associated proposals for new salary scales for new consultants were recently supported in a ballot by IMO members. Since then, the HSE has moved quickly to advertise positions with new pay scales and there has been considerable interest. I expect that these new scales and improved salaries will help us to keep more of our graduates at home and persuade consultants who are working overseas to return to Ireland.

With regard to the quality of the training experience, there have been a number of developments which I am confident will have a positive impact on the day-to-day working lives and experiences of our trainee doctors. For example, an agreement was reached last summer among health service management, staff associations and the training bodies on protecting training time for trainees. The HSE has issued guidance on implementing this agreement to clinical sites, and I expect that all sites will adhere fully to the agreed annual limits for interns, specialist trainees and other non-consultant hospital doctors on professional competence schemes. In future, trainees will also have greater predictability regarding their rotations at the outset of their training schemes.

Most of those commencing basic specialist training this summer will know their rotations for the next two years, and I understand that the HSE and the training bodies are working closely to introduce pre-defined rotations for higher specialist training this July, where they are not already in place. I also see the national implementation of the lead NCHD initiative as a very important step. This initiative was piloted in five hospitals in 2014 and has been expanded to a further 26 hospitals for 2015. The lead NCHD role provides an important link at management level between NCHDs and hospital management. While these are all positive and welcome developments, more remains to be done to implement the full range of recommendations. To support implementation, my Department has established a monitoring group comprising key stakeholders, including trainee doctors. This will help us to drive implementation across the system and embed the recommendations in the day-to-day business practice of the health service.

The first six-monthly progress report was published on my Department's website on 5 March, and I look forward to receiving the next report at the end of June. The report will also be published online so that all stakeholders, particularly trainee doctors, can assess the progress we are making. Finally, it is important to point out that, notwithstanding problems we are having with recruitment and retention, the number of consultants and NCHDs employed by the HSE is at an all-time high and the number of GPs contracts in the HSE is close to an all-time high.

Deputy Eamonn Maloney

I thank the Minister for the more optimistic conclusion of his contribution than is indicated in the study. One of the difficulties is that historically there has been a transfer of people who qualify in medicine in Ireland. It is an historic problem and is not terribly new. I know from my previsions involvement with a committee in my local hospital in Tallaght that different medics have different views on why people leave the jurisdiction. Some say it is because of remuneration, while others say they go to certain places such as America and Australia. One also meets people, as I did in my local hospital, who came back after a very short period of time and are working in the Irish medical system, which is encouraging.

Deputy Leo Varadkar

I am disinclined to comment in detail on the study because I have not had a chance to read it; I have only seen online coverage today. I would speculate that if one did a similar survey on many other professions one might get a very similar result. It has always been the case that people migrate, something which is truer now than ever before. We have a long history of doctors migrating to Ireland and from Ireland to other parts of the world, sometimes to get experience with a view to coming back. Others want to work in international centres such as the Mayo Clinic or the Memorial Sloan Kettering Cancer Center, which will never exist in Ireland.

It is important that we achieve an equilibrium so that similar numbers come in and leave. That requires remuneration, and we now have agreement on consultant pay with the IMO, with new salaries being offered. A left-led Government could propose to impose high taxes on people earning over €100,000. That, along with the risk of pay being capped at €100,000 or a 60% tax rate above €100,000, is a potential threat to our health service and would certainly leave patients at risk.

We need to improve the experience of working in our health service. It is a difficult place to work for many people - not just doctors but other health staff. The fact that doctors will know their rotations two years in advance is very important. They will know where they will live in six months' time. It is a simple thing which is now being done. The fact that they will have dedicated protected training time when they are off-bleep is very important. A lot more can be done in those spaces.

An Leas-Cheann Comhairle

Is the Minister taking any other Topical Issues?

Deputy Leo Varadkar

I am taking three.

Deputy Clare Daly

There is no Minister to take our Topical Issue. We have agreed with the Department of Foreign Affairs and Trade that it will be taken on 24 March.

Special Educational Needs Service Provision

Deputy Anthony Lawlor

I welcome the opportunity to speak. I have submitted this matter several times over about five weeks, but it seems that when the House is due to close down for a week one has a better chance of being selected. The Minister is not here, but I will welcome the reply of the Minister for Health, Deputy Varadkar.

I am speaking on behalf of parents in north-west Kildare, but this is a national issue. We have made tremendous strides in the primary school sector, and there are units for pupils with autism spectrum disorder, ASD, in virtually every school in the country. Any new schools being developed will have an ASD unit. While we planned well at that level, we have not planned for post-primary level. The parents of many children who finish primary school would love to see them attend mainstream secondary schools, but they might not be suitable. There are few ASD units in post-primary schools. A number of parents in north-west Kildare contacted me. At least three children there are finishing primary school and cannot access the local secondary school. They have been offered places in Portarlington, which is 65 km away. Asking children with ASD to travel for an hour and a half each way and adding three hours onto their school day is not acceptable for any child, especially those with special needs. The arrangement is also costly; parents have said it will cost the Department in the region of €95,000 per year per child, including the cost of a bus escort. That is simply not a sustainable solution in view of the fact that such money would go a long way towards building additional ASD classes in the area. There has to be some alternative solution.

The local feeder school in Edenderry, Oaklands Community College, currently has one class with six students attending. There is no room to take in another class, and to date up to ten families have looked for places for September 2015. Clearly, it would make much more sense to put the money into building an extension to this school which would include additional ASD classes to meet the future needs of the area. The principal of the school and the parish priest support the building of an extension to provide the much-needed classrooms. The NCSE said it does not want to put too many children with ASD into the one area, which was the reason for not pushing for a unit in Oaklands. However, there are 12 ASD primary classes within a seven-mile radius of Edenderry and these children must be provided for at post-primary level.

The Minister may wonder why I referred to Edenderry, which is in County Offaly, but it caters for post-primary education for the whole of north-west Kildare. There are currently up to 50 children attending primary ASD classes within a five-mile radius of Oaklands Community College in Edenderry who will need post-primary places in the near future. One would hope that many of those children would go into mainstream classes, but a number will need to go into ASD classes. Based on these figures, the Department needs to act now.

As I said, this is an issue affecting not just north-west Kildare but the rest of the country. The Department has planned for primary level but not post-primary level. It is important that we plan for the future of those children who are leaving primary school.

Deputy Leo Varadkar

I am taking this debate on behalf on behalf of my colleague, the Minister for Education and Skills, Deputy Jan O'Sullivan. I thank the Deputy for raising this issue as it gives the Government an opportunity to outline the process of monitoring demand for school placements for children with special needs, including those with autism, and providing placements accordingly.

The Deputy is aware that this Government is committed to ensuring that all children with special educational needs, including those with autism, can have access to an education appropriate to their needs, preferably in school settings through primary and post-primary school networks. Such placements facilitate access to individualised education programmes which may draw from a range of appropriate educational interventions, delivered by fully qualified professional teachers, with the support of special needs assistants and the appropriate school curriculum.

Young people with autism transitioning from primary school placements have a number of alternative options, including mainstream placement in post-primary school with support, placement in a special class in a mainstream school or placement in a special class in a special school. The Deputy will also be aware that the National Council for Special Education, NCSE, is responsible, through its network of local special educational needs organisers, SENOs, for allocating resource teachers and special needs assistants to schools to support students with special educational needs, including autism. It is also the role of the NCSE to make appropriate arrangements to establish special classes in schools in various geographical areas as required.

SENOs engage with schools annually in order to plan for and to open new special classes each year in order to ensure there are sufficient special class placements available at primary and post-primary school level to meet demand in a given area. Special classes within mainstream schools are intended for children who, by virtue of their level of special educational needs, cannot reasonably be educated in a mainstream class setting but who can still attend their local school in a special class with a lower pupil-teacher ratio and special needs assistant support. The total number of special classes for children with autism in mainstream schools throughout the country at the end of 2014 was 626, of which 152 were in post-primary schools.

The NCSE has advised the Department of Education and Skills that it is currently planning, through its local network of SENOs, for a number of new special classes for the coming school year. SENOs have been working with local schools on a national basis over the past number of months to plan and establish special classes for children with special educational needs who require such placements for 2015 and 2016. This work is ongoing in some counties and SENOs continue to liaise and work with schools in order to meet the demand for such placements at local level.

Deputy Anthony Lawlor

I welcome the reply and there is a little bit of positivity in it. I hope SENOs will be given much more authority in future planning for post-primary school placements for some of these kids. There are 626 special classes but only 152 are in the post-primary setting, so sometimes the numbers do not add up. I have highlighted a case where kids will potentially be travelling 65 km. Even if somebody is going to a university or third level school in Dublin, one would not travel from Roscrea every day. That is akin to what we are discussing, with some kids having to travel from south Kildare to Dublin city on a daily basis. That does not seem fair at all.

We have put in place an excellent service at primary level but we have not thought through the whole process. I understand there is a variety of post-primary options but many parents want to see their kids at least attend post-primary education. There are certain schools willing to cater for such students and they want to expand to allow more kids to attend. They are being held by the Department not allocating funding for classrooms to be built. I will continue to press with the Minister that we must continue to plan for the future in this regard. There is no point in us doing a half-assed job when we must fully examine where the kids coming from these primary schools will end up.

We should consider the issue on a long-term basis and the benefits will be felt throughout the whole of society. There is always potential for a kid with autism to develop in a different manner than prescribed. I welcome the Minister's comments but I will continue to press the issue, particularly in Edenderry, which has so many primary school kids coming out on the autism spectrum disorder. The area does not have the facilities to cater for these kids who want to attend post-primary school.

Deputy Leo Varadkar

I thank Deputy Lawlor for raising this important issue and I know he takes a great deal of interest in the matter. I will certainly inform the Minister for Education and Skills, Deputy O'Sullivan, of today's debate.

Mobile Telephony Use

Deputy Brendan Smith

I thank the Leas-Cheann Comhairle for the decision to allow me to raise this issue. I am glad the Minister of State, Deputy Joe McHugh, is here as he should have great empathy for consumers in the Border areas, which are once again the victim of bad decision making in Europe. It is extremely regrettable that EU Ministers have agreed to delay the abolition of mobile phone roaming charges from this year to at least 2018. The decision demonstrates a blatant disregard for consumers and prioritises large multinational mobile phone companies and their interests at the expense of the interests of customers throughout the 28 European Union member states.

We are all very well aware of the punitive charges associated with roaming calls. Those of us who live in the Border area, such as the Minister of State and me, know that when we go on a journey along the Border, we may at times be on our own networks of 3 or Vodafone but suddenly a British network can be used, leaving us with exorbitant charges for transacting business and making or receiving calls. Sometimes mobile phone roaming charges are associated with people going on holidays but this issue affects a large cohort of people in this country who live in the Border area or who have good reasons to travel North and South to transact business daily. All of us living in the Border area have at many times received exorbitant mobile phones bills as a result.

It is absolutely deplorable that the communications Ministers of the European Union agreed to defer a decision made in 2014 and which was to be implemented by December 2015. My understanding is there will be an "assessment" by mid-2018. This is kicking a can down the road; a decision was made a year ago but the issue is now to be assessed more than three years into the future. What proposals were put forward on behalf of the Irish people at the recent meeting when this decision was made? People are bitterly disappointed. There was a palaver when it was agreed to abolish roaming charges, as the indication was that costs would be reduced for consumers throughout the European Union. Naturally, we are concerned about our own country first. There has been little or no comment from the Government or the Minister about this deplorable decision, which was taken approximately a week ago.

I hope the Minister of State can convey through the Minister, Deputy White, to the relevant authorities in the European Commission and the relevant Commissioner that this is not acceptable. A decision was made a year ago but now we hear nonsense to the effect that it will take time for companies to adjust. I have never heard of a delay in implementing new or increased charges but there is always a delay if there is a need to reduce charges. This is typical of European Union bureaucracy, giving in to the interests of the large multinational companies. What was a very positive decision is now being reversed after 12 months and we are being told the issue will be assessed again three years from now. That is absolutely reprehensible behaviour and I hope our representatives are making this argument at ministerial and other levels to the European Commission and the relevant Commissioner.

Deputy Peter Mathews

Hear, hear.

Minister of State at the Department of Communications, Energy and Natural Resources (Deputy Joe McHugh)

I thank the Deputy for raising this issue. He is correct in that I have much empathy for what he describes as I have driven through the Border twice every time I have come to these Houses since 2002, or for 13 years. It has been an issue.

I welcome this opportunity to clarify for the House the steps taken by the EU institutions to control, reduce and ultimately to eliminate roaming charges within the European Union.

I am aware of the recent media reports which suggested the Council or the Commission does not support actions to eliminate roaming charges, or is seeking to delay the removal of roaming charges, contrary to the consumers' interest. This is not an accurate representation of the true position. The Minister fully supports harmonised EU actions to eliminate roaming charges, but this shared objective has to be achieved in a manner that avoids long-term adverse impacts on users of mobile phone services generally, including those who do not avail of roaming services.

The EU has made substantial progress in reducing the maximum permitted roaming charges. Three EU regulations, adopted since 2007, have progressively reduced roaming charges by an estimated 80%. This includes voice calls, SMS, texting, and data-Internet access. These substantial reductions in retail roaming prices are also sustainable due to the imposition of proportionate reductions in wholesale charges.

The European Commission brought forward proposals for a future EU regulation to incentivise mobile service providers to remove roaming charges voluntarily. The European Parliament adopted an amendment to the European Commission proposal which would prohibit retail roaming charges within the EU from December 2015. The European Parliament's proposal does not prohibit the imposition of wholesale charges. If service providers are prohibited from recovering those wholesale costs directly from retail users, it is inevitable they will seek to recover the costs from other users or reduce volume limits in bundled minutes and data package limits to control costs. These outcomes would not serve the long-term interests of users.

The shared position within Council is to give the Latvian Presidency a mandate to enter into negotiations with the European Parliament to reduce retail roaming charges further towards zero. The revised charges, if agreed by Parliament, will deliver significant further reductions in regulated retail roaming charges and allow service providers to recover the wholesale costs incurred in providing the service. The proposal provides for a further review of the regulation by June 2018 which will include a further review of both wholesale and retail roaming charges.

I am glad to have had this opportunity to clarify for the House the significant progress which has been made possible by EU regulations to control and reduce retail roaming charges and to confirm that the Government's ultimate objective is to eliminate retail roaming prices in a manner which does not generate predictable adverse impacts for users.

Deputy Brendan Smith

I thank the Minister of State for his reply. The response from the European Commission, which the departmental officials have accepted, is not acceptable. The Minister of State said “If service providers are prohibited from recovering those wholesale costs directly from retail users, it is inevitable they will seek to recover the costs from other users or reduce volume limits”. That is code for saying we are going to protect the profits of the multinational companies. It is not acceptable that once again the interests of the international mobile phone companies come ahead of the consumer.

In 2013, Commissioner Kroes told her peers in the Commission and the European Parliament that she wanted them to be able to return to their constituents and say they had been able to end mobile phone roaming costs. That has not happened and is not happening. No matter how it is presented, roaming charges will stay with us in a different format. If the annual profits of these international mobile phone companies operating throughout the European Union were analysed, we would be startled by the returns they make for their shareholders. There is the added difficulty of poor mobile coverage. Those companies have got away without investing in infrastructure. If one is on a phone call for more than two or three minutes, particularly travelling northwards from the city, as the Minister of State and I know, every call drops out. It is scandalous how little investment the mobile phone companies have put into the infrastructure to ensure there is a quality service. Phone traffic has increased annually but there has been no worthwhile investment to ensure the consumer who is paying for the service gets a proper service. The reply is most disappointing from the point of view that the European Union is saying it must tell the telephone companies how it will make up for their losses if it reduces mobile phone roaming charges. It is not acceptable. It is time the interests of the consumers were put first.

Deputy Joe McHugh

When I was in opposition, I did a lot of shouting about roaming charges. If one was going from O2 Ireland to O2 UK, crossing the Border, one was charged. That changed when various companies, such as O2, said if one was locked into O2 North and South, one did not have to pay roaming but if one happened to move into another frequency, one would be charged.

Deputy Brendan Smith

I have had that experience. On the network I use I am not supposed to be charged, but every time I go North of the Border and every Friday going to do clinics in Monaghan, I have that extra phone bill. We are all being codded by the science and terminology these companies bring out.

Deputy Joe McHugh

Yes. There are still charges if one roams into a different network, such as Orange or Vodafone UK. There are data charges on top of that.

Compared with 2007, the cost of outgoing voice calls has fallen by over 60% to 19 cent per minute. I agree that we have to work towards zero. Incoming voice calls have fallen 80% to 5 cent per minute. Outgoing texts have fallen from 11 cent in 2009 to 5 cent. Per megabyte data charges have fallen from 70 cent in 2012, when the regulation on data price was introduced, to 20 cent today.

It is significant that the Latvian Presidency has been given responsibility to ensure we work towards proposals that would allow mobile service providers to charge a premium above domestic charges only to recover the regulated wholesale charges. My colleague, Brian Hayes, MEP, raised this publicly during the week at the European Parliament. I will speak to him about how we can move this forward. The date 2018 was given but that seems a long time to work towards eliminating charges altogether. I agree about the mobile coverage at the moment. Everything is not hunky-dory; in fact it has deteriorated. I met some weeks ago with the head of ComReg. The new motorways were not built in a joined-up way with mobile phone antennae placed along the motorways. We are playing catch-up. Calls are dropping out. We need more information on the infrastructural upgrades. We need to know how much money is being spent.

When I go to Cavan tonight, my calls will be dropping out the whole way and then I will probably go through Enniskillen. The coverage in the North is very poor. I hear, however, the mobile phone companies in Northern Ireland are making a substantial investment in their infrastructure. They should make the same level of investment in the South. We need an open, transparent conversation about mobile phone operators. Local companies declare their profits publicly, but we need to ensure the end user is not the one left to do the heavy lifting. That has been the case. There are different attractive packages and bundling of minutes and so on and phone costs have come down, if one is smart. If one brings one’s iPhone to Belfast, the data charges are astronomical. We are part of the European Union which must become a non-roaming charge environment for phone access. I will have a long conversation with Brian Hayes, MEP, to see how this Government, including the Minister for Communications, Energy and Natural Resources, who is also keen to work towards zero cost, can work with the European Parliament to push this important matter forward.