Dáil Éireann debate -
Wednesday, 18 May 2016

Vol. 909 No. 2

Adjournment Debate

Homeless Accommodation Provision

Deputy Eoin Ó Broin

Brú Aimsir is an emergency hostel in the city of Dublin with 101 beds. It opened in October of last year on a temporary basis and is run by Crosscare, the homeless service provider. It provides emergency accommodation on a night-by-night basis and works to place people in more secure emergency accommodation and in permanent housing.

Brú Aimsir has proved incredibly successful, and since it opened, more than 200 people have been successfully moved on to better quality and better supported emergency accommodation, and in a number of cases to permanent housing. The lease between Dublin City Council and the Digital Hub was temporary and the hostel was due to close in April of this year. It is important to emphasise that this is a publicly owned premises, ultimately under the auspices of the Department of Communications, Energy and Natural Resources. I understand that the Digital Hub would like to sell this premises as there is no immediate alternative use for it.

Unfortunately, since Brú Aimsir opened, the homeless crisis throughout the State and here in Dublin city has worsened. The Dublin Region Homeless Executive did a rough sleeper count on 24 April and on that particular night found 102 people sleeping rough in the city, a 10% increase on the previous count. On the same night, an additional 70 people were in the Merchant's Quay night café and all emergency beds in the city that night were occupied, including those in Brú Aimsir. Since the end of April, Brú Aimsir is being wound down. It was first restricted to 80 beds, and since 9 May, the freefone service which places people in Brú Aimsir has been instructed not to make any more placements. This means Brú Aimsir is essentially reduced to 43 beds a night.

At the same time, the average number of people turned away from emergency accommodation by the central placement service on any given night is between 50 and 60 people. These are people who ring up in search of day-to-day or night-to-night emergency accommodation, but they are told there is no accommodation for them. I have spoken to a number of people who work in the homeless sector in the city today and they tell us there has been an increase in the number of people sleeping rough as a direct result of the reduction in the number of beds in Brú Aimsir. Even if Brú Aimsir were operating at full capacity, the city would need more emergency beds.

Does the Minister believe it is acceptable for Brú Aimsir to close if the result is more people being forced to sleep rough in the city? Has the Minister raised this matter directly with his counterpart, the Minister for Communications, Energy and Natural Resources, Deputy Denis Naughten, who has responsibility for the facility in terms of the ownership of the premises? Has he raised it with Dublin City Council, with the Dublin Region Homeless Executive or with Brú Aimsir itself? If the Minister has not done any of this, he needs to pick up the phone to the Minister, Deputy Naughten, and seek his direct intervention with the board of the Digital Hub to ensure this facility is not closed, as is currently planned, at the end of this month.

I also respectfully suggest that the Minister should talk directly to the city manager, Owen Keegan. Not only is he the city manager, he is also on the board of the Digital Hub and has a key role to play in this regard. There is a simple message all of the players on this issue need to hear, which is that the 100 beds that will effectively be removed from the Dublin emergency accommodation system if Brú Aimsir is closed should not be lost to the system. We need more, not fewer, beds. Nobody should be sleeping rough in Dublin when tonight there are 60 vacant beds in Brú Aimsir.

Minister for the Environment, Community and Local Government (Deputy Simon Coveney)

The Deputy will receive a copy of the official response, but I will begin by answering some of his questions directly. I have been speaking to a number of people who are sleeping rough in Dublin who are looking for hostel accommodation and Brú Aimsir is a popular choice. It is seen as safe and as of one of the higher standard hostels available for people looking for sheltered accommodation who otherwise would be forced to sleep rough.

I do not have direct responsibility for the allocation of beds in Dublin.

The Deputy knows how that system works and does not need me to tell him. I have a policy responsibility and I have spoken to Dublin City Council and to Owen Keegan about this issue, as has my Secretary General in the past couple of days. The chief executive of Dublin City Council has written to the board, or the management, of the Digital Hub agency to see whether we can extend the availability of Brú Aimsir as a facility for sheltered accommodation. It is important, however, to understand what had happened and how Brú Aimsir came into the system. It was a winter response to rough sleeping and, because it was so successful, it became a very popular choice. There have been attempts to wind down facilities, as would be normal after a winter period, and to move people out of sheltered accommodation after the winter months. The latest count of the numbers rough sleeping was 102, a much reduced figure on last year but still a very significant figure. Given those numbers, and the fact that there is another hostel being taken out of operation, a Focus Ireland hostel which is being forced out of operation for other reasons, my judgment is that if we were to take Brú Aimsir out of hostel accommodation it would result in people being forced to sleep on the streets who otherwise would not be there. I have asked the chief executive of Dublin City Council to try to ensure it can stay open. My understanding is that he has written to seek an extension of the lease for 12 months as well as to seek to make it operate at full capacity, which is 100 people as opposed to the 40 it has been facilitating in recent weeks during the attempt to wind it down.

The Deputy is not the only person who has raised this matter with me. Most important, the clients of Brú Aimsir have raised it directly with me. We had a regrettable incident last week, which I hope will not happen again or in other hostels that are part of an agreed wind-down. There were protests and staff were intimidated by protestors and that is not what we want. It has not contributed to this decision and in some ways it has made it more difficult.

I cannot confirm Brú Aimsir will be available for another 12 months yet but I can confirm that the request has gone in. I will speak to the Minister for Communications, Energy and Natural Resources, Deputy Denis Naughten, about it to ensure we do what we can to extend the facility for 12 months. In that period of time there will be a very significant effort from me and from Government to make a big impact on rough sleeping in Dublin. It is not acceptable that we have the numbers we have forced to sleep on the street. There are very complex reasons for people finding themselves on the street, such as addiction, mental health, family breakdown and other things and it is not simply a lack of availability of housing. I am determined to make a positive impact in this area. While we do that, keeping this hostel open will make a positive contribution towards the emergency response that is needed. Hopefully we will be successful in securing the extension of the lease.

Hospital Services

Deputy Lisa Chambers

My adjournment issue relates to Mayo University Hospital and the consistent overcrowding at its emergency department. It was only a number of weeks ago that the emergency department issued a public statement to the wider community surrounding Castlebar and County Mayo for people not to present unless it was absolutely necessary, because they were so overwhelmed with demand. It is a crazy situation for an emergency department to ask people not to attend. It is a recurring situation and is an issue I have been highlighting for many years in my community. I know staff who work in the hospital and on that day trolleys overflowed into the café beside the emergency department. That is how bad it was. It is getting to the stage when staff morale is at an all-time low. People are afraid to go into the emergency department. No patient should be left on a trolley for a considerable period but some elderly and extremely ill people are being left on trolleys for very long times. It is an issue that needs to be addressed forthwith.

The accident and emergency unit in Roscommon was closed a number of years ago and that has led to an increase in demand at Mayo University Hospital. It is not the only reason but it is a contributing factor. Patients are also presenting from Galway because, believe it or not, the hospital situation in Galway is actually worse. People are hedging their bets and presenting at Mayo University Hospital hoping that they will be seen more quickly.

We have an ageing population, which is the case throughout the country but is especially the case in the west, and this is leading to increased admissions too. Another very serious issue relating to this problem is that hospitals are now finding themselves under increased scrutiny, particularly by the Irish Nurses and Midwives Organisation, INMO, which runs the trolley watch service. This scrutiny puts increasing pressure on staff and hospital management to keep the figures as low as possible. It is my belief that there are patients being moved at night to the medical assessment unit and the day services unit, which are vacant at night because they operate for day procedures. Those patients are being moved from the corridors into those units to give the appearance of fewer trolleys in the corridors. It is my understanding that they are brought back during the day so that day services operations can resume. Those patients are not picked up by trolley watch as being there from the previous day and are counted as new figures. This is information the Minister can get if he so wishes.

This is not in any way a criticism of hospital management or the staff. They are under such severe pressure from the public and are doing everything they can to make the hospital work as well as possible but they cannot cope with the demand. Capacity is the key issue, a lack of beds and staff to man those beds, as well as a lack of step-down facilities for patients who do not need to take up hospital beds and could be moved on somewhere else.

There is also an issue regarding rheumatology services at Mayo University Hospital. A full service was promised to the hospital but there was a row-back on that promise. The consultant was actually appointed to Leitrim and the intention is that the consultant will service Mayo University Hospital on a visiting basis, with what will be 11 hours' service per week for the entire county. Rheumatology affects many thousands of people so 11 hours per week, while welcome as it is an increase on zero, is not close to being enough to look after the patients with such conditions. These conditions are quite debilitating and the people affected require disability payments but they are being asked to travel large distances to Merlin Park in Galway or Manorhamilton in Leitrim for services.

Mobility is an issue and finances are an issue in terms of getting around. Many patients cannot drive themselves to an appointment and rely on friends and family members to transport them to services that have a huge impact on their daily lives, so it is crucial that these patients are provided with services in the local community and I ask the Minister to review the 11 hours being provided to Mayo University Hospital with a view to increasing that service. I am sure there are huge demands on resources but, with a county the geographic size of Mayo and the number of patients with that illness, a full-time service is required.

Minister for Health (Deputy Simon Harris)

I thank Deputy Chambers for the opportunity to address the House on this important issue and for bringing these matters to my attention. I am very conscious of the impact that long wait times in emergency departments can have on patients and their families. Emergency department overcrowding is not just a problem for emergency departments to resolve. There has to be a system-wide health response and the programme for a partnership Government recognises this, as does Deputy Chambers.

Emergency department attendances have been significantly higher this year. The HSE has reported an average increase of 6.4% compared with the same period last year. This indicates the pressures that our hospital services are experiencing. Pressure on emergency departments has been rising as the population is growing and ageing and investment was constrained during the recessionary period. However, the 2015 and 2016 budgets have seen increases in the health budget, investments in capital expansion and the implementation of measures designed to tackle overcrowding in emergency departments, though, clearly, there is much more to do.

In June 2015, additional funding of €18 million was made available to the HSE under the winter additional capacity initiative to facilitate the opening of new hospital beds and the reopening of previously closed beds. With these beds, emergency department performance has remained steady, despite a sustained increase in patient attendances.

The performance of Mayo University Hospital emergency department has been improving in 2016. Despite a 12% increase in attendances in quarter one of 2016, fewer patients have waited on trolleys at the hospital compared to 2015. I take seriously the point Deputy Chambers has brought to my attention about trolleys and concerns about people being moved. I will ask the hospital group chief executive to respond directly to that point.

With regard to measures to tackle emergency department pressures, the programme for Government has committed to progressing a new emergency department facility for University Hospital Galway which will reduce pressure on emergency departments across the Saolta group, including at Mayo University Hospital. A review of bed capacity in our health service, coupled with the review of the hours of service of medical assessment units, are key commitments in the programme that are intended to alleviate emergency department overcrowding. We must look at alternative options to emergency departments and examine whether medical assessment units and an extension of the opening hours of such units can assist. That is an issue I will prioritise. The review of bed capacity will be evidence-based and will inform decisions made regarding the bed complement of all our hospitals, including Mayo University Hospital.

In our first year of this Government, we will carry out a full review of the hours of service of medical assessment and similar units, with a view to extending their hours where justified by patient usage. Maximising the potential of these units, including the unit at Mayo hospital, will help alleviate emergency department pressures due to the growing demand for emergency care.

In January 2016, the primary care centre in Castlebar commenced participation in the primary care ultrasound project, which will increase access to diagnostic facilities in the Mayo region. These programme commitments will all contribute to reducing patient waiting times in our emergency departments.

As the Deputy will be aware, an emergency department task force implementation group has been set up. This group is co-chaired by the INMO and the director general of the HSE. The group continues to meet on a regular basis. I will meet the group by the end of this month to consider the actions it intends to take, bringing in all the relevant stakeholders to tackle issues in emergency departments and ensure co-ordination across acute hospitals and primary and social care to address emergency department overcrowding. I look forward to meeting the task force shortly.

Following on from this debate and the important issues Deputy Chambers has raised, I intend to send a transcript of this debate to the hospital group chief executive and ask for a direct response to Deputy Chambers and to me on the important matters she has raised. I will ask to have the issue of the rheumatology service examined and I will report back directly to the Deputy.

Home Help Service Provision

Deputy Jim Daly

I thank the Acting Chairman for the opportunity to raise the issue of home help. By way of illustration, I present the Minister with a case that is on my desk since early December 2015. Margaret is just out of hospital following major open heart surgery. She has had a number of strokes and has a tumour on the brain. She cannot work the nebuliser she needs to ease her asthma. Her husband, Pat, who has had two strokes, has cancer and many open wounds which need dressing three times a week. The only person who cares for this couple is Margaret's sister, who is 74 years of age.

I made representations to the HSE for home help hours for this couple in early December. I received a letter on 29 January stating that the request had been assessed by a professional who agreed that the couple required home help and recommended one hour five days a week. However, at the end of the letter I was advised that due to a lack of resources the couple would be wait-listed, which is the new buzzword for any application for home help, until resources became available. I heard back from the HSE on 21 April to say they had finally been allocated the home help. From 3 December 2015, when I got involved, until the end of April, the couple got home help of one hour, five days a week. This raises the question of why home help is not a service that is available seven days a week in the first instance. In pursuing some research recently, I asked the HSE the number of people not only in west Cork but in the whole country who are currently wait-listed for home help. I understand that 1,700 people are wait-listed for home help at this point. I also asked the HSE what it would cost to allocate the home help hours needed for these 1,700 people, and it informed me on 11 May that it would cost approximately €10 million to eliminate the current waiting list for home help hours. The sum of €10 million in the context of the overall budget of the HSE is the equivalent of having €14,000 in my hand and somebody asking me for €10 out of that €14,000. For those who are mathematically minded, 0.07% of the budget would eliminate the current waiting list.

The people we represent are very frustrated by this anomaly in the system. People who pay their taxes, go about their daily lives and do their work are frustrated that the HSE is cutting corners in home help, given that it would take people out of hospital, keep other people out of hospital, and relieve many problems associated with the build-up of patients in acute emergency departments and the trolley crisis. Yet this €10 million, which is a paltry sum in the greater scheme of things, is the budget that the HSE has targeted for reduction. It should not be a budget exercise; it should be demand-led. I hope the HSE management and the Minister will understand this and go forward in this knowledge.

In the previous Dáil, the Ministers, whether by design or choice, became Ministers for hospitals. I ask the Minister to take on ministering for primary and social care and home help issues. I would go so far as to say that the hospitals are working perfectly well. I am very proud of our hospitals in Ireland and the way they work. Anybody who is lucky to get into a hospital will say they get a great service. However, I understand from medical managers that about 50% of people in hospitals should not be there. They are taking up acute hospital beds. A little-known but important statistic is that in Cork University Hospital, 3% of medical patients occupy around 30% of the bed days. In other words, over a third of the entire hospital capacity is being taken up by 3% of patients, many of whom do not need to be there. The number of patients in hospital for more than 30 days is quite staggering. Some 50% of the capacity of St. Vincent's Hospital in Dublin is taken up by people who are there more than 30 days. It is important to address and eliminate this pressure point in hospitals. The hospitals work well for the people who get in. We need to free up capacity. We must start by having a Minister who will focus on primary care and home help and encourage people to stay at home by giving them this facility. I ask the Minister, for God's sake, to please ensure that home help is available seven days a week. The elderly, the vulnerable and the sick, about whom we all care deeply, are not sick and vulnerable five days a week; they are in need of care seven days a week. I hope the Minister will get that point across to the HSE and ask for the €10 million to address this anomaly, which would free up much capacity and eliminate many of the knock-on effects of overcrowding in the emergency departments.

Deputy Simon Harris

I thank the Deputy Daly for raising this important issue and for giving me the opportunity to respond to some of the points he has raised in regard to the importance of home help provision in our community. I begin by agreeing with the point he makes that the role of the Minister for Health is not just to be a Minister for acute hospitals but to be a Minister who examines the continuum of care from primary care to acute care to social care, because one leads to the other. The worst thing that can happen in the HSE and the Department of Health is the creation of a silo mentality, or an attitude in which it is one part of the health service versus the other, because, as the Deputy has outlined very articulately, one leads to another.

Older people have consistently said to all of us in the House and to many others that they want to stay in their own homes and communities for as long as possible. The Government is committed to facilitating this. Home care services are key to achieving this and the strengthening of home care services is an absolute objective to which this new Government is committed. The HSE provides significant levels of home support and will spend in the region of €324 million this year on these services.

The HSE's national service plan for 2016 provides for a target of 10.4 million home help hours to support approximately 47,800 people. It also provides for 15,450 home care packages and 130 intensive home care packages for clients with complex needs. A further 60 clients with dementia will be supported with co-funding from The Atlantic Philanthropies under the national dementia strategy. The service levels of 2015 are being maintained this year. I make this point because I have heard misleading comments, not from the Deputy but from others, on home help cuts. Service levels are being maintained this year and there has been no reduction in the resources available for home supports in 2016 compared to 2015. However, prudent management of available resources is needed as demand for services increases. The HSE is working to apply available resources to target most effectively those with the greatest need and to provide the best possible contribution to the service as a whole. Services are being stretched by demands from more people and for more hours at times outside core hours in the evenings and at weekends, as outlined by the Deputy, all of which cost more. Decisions on resource allocations are made and reviewed by front-line staff who are familiar with a client's individual needs and circumstances. All relevant factors are carefully balanced in order that as many people as possible can viably stay at home and enjoy the best possible quality of life. Those who cannot be provided with a service immediately are risk-assessed and placed on a waiting list for resources as they become available. The latest information available to me is that the current waiting time is between two and four weeks.

Notwithstanding the significant improvements in the overall economic position that we have seen in recent years, pressures continue to apply across the health service. There is no doubt that home care services need more resources than are available. For this reason the programme for Government commits to increasing funding for home help and home care packages, year on year, in the coming period. This is a commitment I wish to fulfil in ensuring additional resources for home help and home care packages in the next budget. In the meantime, I assure the Deputy that I am maintaining close liaison with the HSE on home care services and the implications for them. This is an issue which will continue to receive attention from me.

Public Transport Initiatives

Deputy James Lawless

Before I get into the substantive matter, I congratulate the Minister for Transport, Tourism and Sport, Deputy Shane Ross, on his appointment. I was a constituent of his in his previous role as a Trinity Senator when he did us proud. I wish him well.

I commute from Kildare and represent commuters from north Kildare and wider commuter belt constituencies. It was with concern, shock and dismay that I greeted the recent announcement of the greater Dublin area 30 year transport strategy. I appreciate that the Minister was not in his new position at the time and cannot be blamed for the details of the plan. However, the Government must accept responsibility for its announcement and the programme was not debated in the Dáil. I acknowledge that there was a hiatus at the time, but this is a substantial transport investment programme to be implemented over 30 years. Of greatest concern is that it appears to contain little reference to what previously would have been considered the linchpin of the entire strategy - the interconnector tunnel. This is the missing link in the greater Dublin area transport system and the nation's transport system because it would be our circle line, the line that would connect the north, west, south and east. It would connect Pearse, Connolly and Heuston railway stations. For several years there was much ado about the two Luas lines not connecting. However, far less has been said about the two central railway lines into the city not connecting and which have been operated for over a century. This is of major concern.

The transport strategy, as published, contains within the 60-page document one clause in parentheses referencing the possibility of a tunnel. There is a map included in the appendix. If one traces carefully enough with a magnifying glass, one can make out what may or may not be a tunnel. I am seriously concerned about whether the tunnel has been scrapped, dropped from the plan or whether it is still included. Being such a central piece of the strategy, the question must be asked why it has not been included.

I shall put into context the need for the tunnel to connect the two railway lines. Commuters using the Kildare lines - I use them on an almost daily basis - as well as commuters from further south and the south west, from Portlaoise, Kilkenny and Waterford, and the large volume of commuter traffic from Newbridge, Sallins, Naas, Celbridge and Hazelhatch and on all the lines and stations in between must disembark at Heuston Station. They must then travel onwards on foot to connect with the Luas. The Luas has been a welcome development, but it is still another mode of transport. Commuters must then travel on the Luas line in the direction of Connolly Station and get off and walk or cycle to make their onward journeys via other modes of transport. At the very least, commuters must use three connections to get to wherever they want to go. The majority wish to travel to the city centre or to the southside of the city which is where most employment centres are located. For anybody travelling across country, in making national or regional journeys, the problem, again, especially for elderly people and those with luggage, etc., is that they must make criss-cross journeys using the train and the Luas.

The tunnel was previously the linchpin of the Transport 21 strategy. Some €40 million was spent on research and feasibility studies, all of which confirmed that this would be a worthwhile project. The cost-benefit return would very significant, despite the large cost of the project. This was without factoring in the capital and economic stimulus during construction. The ratio was 4.23:1, or to keep it simple 4:1, using the traditional cost-benefit analysis. It is amazing to see an infrastructural project of such importance to the capital city, the greater Dublin area and commuters on the Kildare and other lines, apparently, being dropped from the plan.

Perhaps I am pre-empting the Minister's response, but I am aware that the Phoenix Park tunnel is to be opened later this year. It is a welcome development but by no means is it a substitute for the interconnector DART underground service. The Phoenix Park tunnel will connect the Kildare line with Connolly Station and possibly Pearse Station, but it will not fill the gap in terms of the provision of a circle line. Most other capital cities in Europe and around the world, in countries apparently less developed than Ireland, have such a circle line. It is a normal part of public transport infrastructure. I seriously impress on the Minister the need to re-evaluate this project. If it is not contained within the transport plan - it is not apparent from the document that it is - I ask him to please include it. It is a critical project, not just within the commuter belt but for the nation as a whole. It would probably be the most important public infrastructural project in the next decade, if not the next century. I prevail on the Minister to reconsider it and place it at the centre of public transport planning in the next Dáil term.

Minister for Transport, Tourism and Sport (Deputy Shane Ross)

I thank Deputy Lawless for his kind words and I wish to reciprocate them. I hope he has a long and happy period in this House. As he has been a constituent of mine, I would also say that, while I have never been a constituent of his, most of my family came from Kildare and there are many constituents left there who may or may not be able to do him a favour in the future. I am not sure I can do a great deal for him today, but I can certainly give him a reply to the question he has put.

The new programme for Government includes a commitment to invest €3.6 billion across the lifetime of the capital plan for the period 2016 to 2022 in order to enable a number of major transport projects to proceed and to fund additional capacity to meet existing and future commuter needs. The capital plan provides for the commencement of a multi-phase DART expansion programme, as recommended under the, National Transport Authority's recently published Transport Strategy for the Greater Dublin Area. The wider DART expansion programme, which incorporates the DART underground project, is envisaged under the NTA's greater Dublin area strategy. The programme will see the DART system expanded to Drogheda on the northern line, Celbridge-Hazelhatch on the Kildare line and Maynooth on the Sligo line. The DART underground project, as currently designed, will not proceed. Instead, it will be redesigned to provide for a more cost-effective tunnel, which is the nub of the matter raised by the Deputy.

The NTA, the statutory remit of which covers the planning of public transport in the greater Dublin area, was requested in 2014 to review the DART underground project in conjunction with the preparation of the transport strategy for the greater Dublin area. In July 2015, and based on the outcome of the updated business case, the NTA recommended that the project, which remains a key element of integrated transport for the greater Dublin area, be redesigned to provide a lower-cost technical solution, while retaining the required rail connectivity. A project of such magnitude - in the order of €3 billion - has to be designed and delivered in a way that ensures value for money for the taxpayer. The overall DART expansion programme has been assessed by the NTA as a positive project from an economic perspective and its advice is that the programme is essential for efficient transport in the greater Dublin area and nationally.

The programme has a key role to play in delivering an efficient transport system and key elements of the overall DART expansion programme will be progressed under the capital plan. However, it has been identified that it is possible to redesign the tunnel part of the project to substantially reduce the capital cost involved. The NTA's recommendations that the tunnel element can be delivered at a reduced cost to the taxpayer cannot be ignored. I can confirm that funding has been allocated in the new capital plan to progress redesign and planning for the revised project.

The Deputy will also be interested to learn that the Government's capital plan specifically provides for enhanced rail connectivity to the city centre for commuters on the Kildare rail line by upgrading the Phoenix Park tunnel line for passenger services. The project, which is funded by my Department through the NTA, will see commuters on the Kildare to Dublin Heuston line have the option of direct trains to Connolly, Tara Street, Pearse and Grand Canal Dock stations. Services on the Kildare commuter line will be a mix of Kildare to Dublin Heuston and Kildare to Grand Canal Dock services, offering new connections to commuters. These services will commence in quarter 4 of 2016.

The capital plan provides for investment in transport infrastructure to reduce congestion and cater for future demand. The DART underground remains a key element of the integrated transport strategy but I am anxious to ensure that the most economically advantageous and affordable solution can be identified for the benefit of the taxpayer. In the meantime, other elements of the DART expansion programme will proceed under the current capital plan.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Thursday, 19 May 2016.