Topical Issue Debate

Ambulance Service

Deputy Seán Haughey

Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the national ambulance service of the HSE. The Dublin Fire Brigade has a proud tradition of providing this fire-based ambulance service in the capital.

International best practice indicates that combining fire rescue and emergency services greatly improves the response to a crisis. A total of 830 Dublin Fire Brigade firefighters are also trained paramedics. They are available to provide immediate emergency medical assistance and the benefits of this integrated service should not be underestimated.

The Dublin Fire Brigade has been providing the ambulance service in the Dublin area since 1898. Since that time, it has dealt with major emergencies in an efficient and professional manner including at the time of the North Strand bombings in 1941, the Dublin bombings in 1974, the Stardust fire in 1981 and the fatal bus accident on Wellington Quay in 2004. Dubliners are rightly proud of their fire brigade and ambulance service and hold the service in great affection.

There are indications that SIPTU and IMPACT will ballot Dublin Fire Brigade members for strike action over a failure to secure four additional and necessary ambulances for the service. The chief executive of Dublin City Council, Owen Keegan, has stated that he wishes to see a transfer of all call taking and dispatching for ambulances to the national central control centre in Tallaght. He has also stated that this has been agreed by the chief executives of the other Dublin local authorities and by the HSE.

In recent years, three comprehensive reviews have been carried out relating to the ambulance service. The HIQA report, published in December 2014, highlighted public safety issues arising from the fact that two ambulance services were operating in the same area.

The report raised concerns about the existence of two separate control and dispatch processes and identified the need for greater clinical governance of both services. It called for an enhanced integration of service provision in the greater Dublin area. A joint review by the HSE and Dublin City Council of the Dublin ambulance service has also been completed. The independent Lightfoot review of the National Ambulance Service capacity was published. It is clear from all three reports that co-ordination and integration between the Dublin Fire Brigade and the National Ambulance Service is required. In addition, there are deficits in ambulance capacity which require significant investment.

Then Minister for Health, Deputy Leo Varadkar, informed the Seanad on 10 March 2015 that staff in the Dublin Fire Brigade would be fully consulted before any changes are implemented. Clearly, such consultation has not taken place. Dublin City Council recently passed a motion to the effect that the elected members in all the Dublin local authorities and on the regional assembly should be consulted about any proposed changes. During the same debate on 10 March 2015, the Minister, Deputy Varadkar, also clarified the position on statutory responsibility for the Dublin ambulance service.

The expert panel on the pre-hospital emergency care services in Dublin published its report in December 2015. The findings of this expert panel should be implemented as a matter of urgency as this report provides a mechanism to address operational inefficiencies and the issue of a fully integrated ambulance service in the Dublin area. The Minister should commence immediately, by way of the new governance arrangements set out by the expert panel, a process to eliminate the shortfall in the available capacity of the Dublin Fire Brigade to meet demand in order that the use of fire appliances to respond to ambulance calls is reserved for those calls that are clinically appropriate.

Funding should be provided directly by the Department and Dublin City Council for the operation of the ambulance service provided by the Dublin Fire Brigade and this funding should be increased to reflect the current costs of the service. The National Ambulance Service and the Dublin Fire Brigade should be given equal status and equal treatment regarding the operation of ambulance services in Dublin. The current dispatch functions should be retained by the Dublin Fire Brigade and the Dublin Fire Brigade should maintain control over its own clinical governance.

I understand that in the coming weeks the Department of Health and the Department of Housing, Planning, Community and Local Government will continue to engage with the HSE and Dublin City Council on any changes in service provision which may be proposed. The findings of the expert panel on the pre-hospital emergency care services in Dublin published in December 2015 provide a clear path to deal with problems identified in the various reviews carried out to date. The chief executive of Dublin City Council, Mr. Owen Keegan, and the HSE must not be allowed to make changes unilaterally to the existing arrangements and they most certainly should consult the staff and the unions involved. I fully support the retention of the delivery of Dublin’s ambulance service from the Dublin Fire Brigade call centre. This is in the best interests of the clients and patients and has the wholehearted support of Dubliners generally.

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy)

I thank Deputy Haughey for raising this matter. Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the HSE. The HSE National Ambulance Service provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport.

In recent years, three comprehensive reviews of our ambulance services have been undertaken: the Health Information and Quality Authority, HIQA, review, the independent Lightfoot review of National Ambulance Service capacity and the review of Dublin ambulance services, which was jointly commissioned by the HSE and Dublin City Council. The capacity review, published last year, examined overall ambulance resource levels and distribution against demand and activity. The review identified deficits in ambulance capacity, including in the Dublin area, which will require very significant investment to address. Implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. To this end, increased funding has been made available for ambulance services in the HSE national service plan 2017.

The HIQA report on ambulance services, which was published in December 2014, highlighted significant public safety issues arising from two ambulance services operating in the same domain. The report identified concerns around the existence of two separate control and dispatch processes, and also highlighted the need for greater clinical governance of both services. The HIQA report points very clearly to the need for enhanced integration of service provision in the greater Dublin area. In that context, the HSE is working closely with Dublin City Council, which is leading on this issue on behalf of the four Dublin local authorities to devise and agree the elements of a safe, sustainable, integrated and quality ambulance service for the citizens of Dublin.

The Minister for Health fully accepts that, in the interest of patient safety, we need the Dublin Fire Brigade and the National Ambulance Service to have a more co-ordinated and integrated approach to service delivery. To that end, discussions are taking place between officials of the Department of Health and the Department of Housing, Planning, Community and Local Government. The Departments have requested a joint action plan from the HSE and Dublin City Council on service and governance issues.

The Dublin ambulance services review, which was commissioned in 2014, is focused on identifying a service model for the optimal provision of emergency ambulance services and patient care in the Dublin region, including service quality, patient safety and value for money. The review’s primary objectives are to determine the optimal model of ambulance provision, which ensures patients receive the highest standard of emergency response, and to determine the most cost-effective model of provision in future which ensures optimal value for money for the public purse.

I assure the Deputy that when the Minister for Health receives the review, a formal proposal for any changes to the services will be required to be submitted to both the Minister for Health and the Minister for Housing, Planning, Community and Local Government for consideration and approval. I convey the apologies of the Minister for Health, Deputy Harris, as he cannot be here this afternoon.

Deputy Seán Haughey

I thank the Minister of State for her response. This situation is becoming urgent. As I mentioned, there are indications that ballots are about to take place regarding strike action because of the inadequate ambulance service in the Dublin area. It comes back to the question of who provides the ambulance service. I speak this evening in defence of the Dublin Fire Brigade. It has been providing an excellent service. Dubliners are very proud of that service. It has a great tradition and its staff have great skills. I believe that is under threat. The chief executive of Dublin City Council, Mr. Owen Keegan, says that he wants no more to do with the governance of the Dublin Fire Brigade. He wants to hand the whole thing over, lock, stock and barrel, to the HSE. That would be a disaster. If we asked Dubliners who should run the fire and ambulance services, they certainly would not say the HSE. There is not much confidence in the HSE generally. As the saying goes, "If it ain't broke, don't fix it." There are certainly problems that have to be addressed, but they can be addressed.

I want to come back to the issue of clinical governance. The previous Minister for Health, Deputy Varadkar, stated that it was the Department of the Environment, Community and Local Government, as it was then, that had responsibility for the Dublin ambulance service. Despite this, the Minister of State at the Department of Health is here this evening answering my questions and all my parliamentary questions were transferred to the Minister for Health. We need clarity on that. There are European court decisions in this regard which clearly state a role for the Department of Housing, Planning, Community and Local Government. I also want an assurance on consultation. No consultation took place between the staff and the unions on the HSE and Dublin City Council review. It is a recipe for disaster. There must be consultation with the elected members, the staff involved and the trade unions before any changes are contemplated, and not as a fait accompli. There must be consultation on this now.

Deputy Marcella Corcoran Kennedy

I assure the Deputy that I will certainly bring his pleas to the relevant parties on the consultation. Clearly, the people who are going to be most impacted by it need to be brought in as part of the consultation process. I do not think a top-down approach ever works, to be honest. I will most certainly bring that back to the Minister, Deputy Harris.

With regard to the considerations of the conclusions of the National Ambulance Service review, it is not yet possible to finalise the Dublin review until they are considered. Once the HSE and Dublin City Council have completed their consideration of the Dublin review, an action plan will be prepared to implement the recommendations of the three reviews of the ambulance service. The Deputy's key point on consultation is very well made and I will certainly convey that to the relevant parties.

General Practitioner Services Provision

Deputy Louise O'Reilly

I am not sure if the Minister of State is aware of the issue involving over-capacity difficulties regarding children under six for GP care. The reality would have been lost in a lot of the hoopla, backslapping and self-congratulation that went on around the granting of medical cards to children under the age of six. The unfortunate reality is that the failure to plan on the part of this Government and that which preceded it has now manifested itself. In north county Dublin, it is quite a feature but especially so in the town of Balbriggan. The latter has a very young population and we can expect to see a surge in the number of children under six in the next couple of years.

By way of illustration, I will speak about a woman I know called Louise - we have the same name. Louise is married and has three children, two of whom have special needs. She can practically see a doctor's surgery from her home but her children and her family are registered with a doctor in Malahide. Should her young children require the services of a GP, they must travel from Balbriggan to Malahide. As they do so, they drive past dozens of doctors' surgeries. The surgeries in Balbriggan are full to capacity. It is not possible for a large number of parents such as Louise to be able to access those services because they are full to capacity. Louise, therefore, has a choice. When one of her young kids has an ear infection or something that would require a visit to the GP's office she can bundle her family into the car and face in to the inevitable traffic, and all that goes with it, to see the GP in Malahide or she can put her hands in her pocket to find €45, go across the road and try to see the local doctor. If she is lucky, she will get an appointment after two or three days. Louise is not unique in this regard. This is an everyday occurrence. Parents cannot find a doctor willing to take them and, therefore, they cannot register. Their children do not have access then to the GP services that the Minister of State and the people who sit on that side of the House were busy high-fiving each other about and congratulating each other on granting. It is utterly useless to people in Balbriggan who cannot register with their GP and who are left without these vital services.

Families are being forced to spend money they do not have for a service of which the Minister of State is busy telling them they can avail. They cannot avail of it. I want to know what will be done to alleviate the pressure because it is not going to go away. If anything, it is actually going to get worse.

Deputy Marcella Corcoran Kennedy

I thank Deputy O'Reilly for raising this issue. At the outset, I assure the House that the Government is committed to ensuring that patients across the State continue to have access to GP services. There have been significant developments in the general practice service recently, with more services being made available to our citizens and additional support provided by the Health Service Executive, HSE. The first two phases of universal GP care without fees were successfully introduced in 2015, first, for children under the age of six years and, second, for all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees and without having to undergo a means test. The introduction free GP care for children under six represents a major step forward in improving access, quality and affordability of health care in Ireland. The service contract for GP care without fees for those who are under six, which includes age-based preventive checks focused on health and well-being and a cycle of care for children with asthma, underlines the Government’s commitment to enhancing primary care and keeping people well in their own communities.

I take this opportunity, on my behalf and that of the Minister for Health, to acknowledge the contribution of GPs to meeting the heavy demand on our health service during the peak winter period. The management by GPs of seasonal pressures, which include many patients presenting with exacerbation of chronic conditions is an example of how primary care plays a critical role in our health care system. I am also conscious that general practice does not take an extended holiday over the Christmas and New Year period and that GPs were dealing with a substantial workload while many other people were able to enjoy some time off. It is important to recognise the commitment of GPs to ensuring a responsive, accessible and high-quality service to patients on a year-round basis.

The Government is committed to the continued development of GP capacity and in 2017 the training intake will increase for the second successive year, from 172 to 187 places. Engagement is also commencing this month with GP representatives in the development of a new and modernised set of contractual arrangements for general medical services, GMS, and other public GP services. To date, approximately 94% of GMS GPs have entered into agreements with the HSE for the provision of services to children under six. Currently, almost 364,000 children under six have access to GP care without fees through a medical card or GP visit card.

I will now turn to the Deputy's area, about which I know she is concerned. There are currently eight GPs who hold GMS contracts in the Balbriggan area, of whom six also hold contracts for the provision of services to children under six years of age under terms agreed with the Irish Medical Organisation, IMO, in 2015. It would be preferable if all GPs who hold GMS contracts also agreed to hold contracts for GP care without fees for children under the age of six. Nationally, the HSE has recently written to those GMS GPs who have not yet signed up to the under-six contract, and have provided them with a copy of the contract and the form of agreement for their consideration. I hope that those GPs who have not yet signed up to offer this improved and expanded primary care service will do so and ensure that all children aged under six are easily able to access GP services without, as the Deputy stated, their parents or guardians having to pay a fee or travel long distances to access care.

The HSE is not aware of any instances where GPs in the Balbriggan area have declined to accept under six year olds onto their panels. GMS GPs, however, manage their own panels and may, on occasion, close them to new patients if they consider that they have reached the limit of their practice’s capacity. I would add that no GP in the area has reached the maximum permitted number of patients on his or her panel. Where a GMS patient experiences difficulty in finding a GP to accept him or her as a patient, and has unsuccessfully applied to at least three GPs in the area who are contracted to provide services under the GMS, then the HSE will assign that person to a GP's GMS patient list. I hope this is of help to the Deputy.

Deputy Louise O'Reilly

The short answer is that it has not really helped. It does not solve the problem this morning, this afternoon, this evening or tonight when people are going to need to see their GPs. It is all very well to say there are X number of children in the system who are eligible for access to this scheme but it is actually completely useless to those people who simply cannot access it. I wonder if the Department of Health would give some consideration to reimbursing those parents who, through no fault of their own, cannot access the medical card for under sixes and are forced to pay because the service is not available in their areas? The Minister of State said that the HSE is not aware of instances in Balbriggan but in the next breath she asks how the HSE could be aware of the position, particularly as GPs manage their own panels. I have made the Minister of State aware of the facts.

If the Department of Health is aware, then I - and the people in Balbriggan who are waiting - would like to know what exactly the Minister of State can do to alleviate this problem in the short term. It is not acceptable that there are chronic waits. Quite apart from the fact that people cannot get these medical cards, they also cannot get appointments to see GPs in Balbriggan for two, three or four days. The GPs are already overburdened. I absolutely join the Minister of State in lauding the commitment of GPs. They do a fantastic job but they are only human. They are up to the limit of their capacity. We need to incentivise general practitioners to go to the areas they are needed and we must have salaried GPs if that is what is necessary. In the short term, we need to reimburse people who, through no fault of their own, are forced to attend and pay for GP services for children under six.

Deputy Marcella Corcoran Kennedy

Deputy O'Reilly suggested that doctors' surgeries in Balbriggan are full to capacity.

The HSE primary care unit is not formally made aware of instances where a GMS-registered GP is refusing to attend to any children aged six and under due to over-capacity. I accept the Deputy's bona fides in this matter and will convey her concerns to the primary care unit. For people who are finding it difficult to get on a GP's GMS patient list, they should contact the primary care unit and give details of the GP who is saying he or she is full to capacity. The unit will assign that individual to a specific GP. There is a route there to access care. I am advised by the HSE that two GPs in Balbriggan have not signed the under sixes contract. I will convey the Deputy's concerns on this matter.

Hospital Facilities

Deputy Tony McLoughlin

I thank the Ceann Comhairle for selecting this important matter for discussion. I am seeking clarification of the Health Service Executive's plans to deliver a fixed cardiac catheterisation laboratory at Sligo University Hospital in 2017. I have had previous discussions and correspondence with the Minister on this matter, which is of the utmost importance to people in the north west, including those I represent in the constituency of Sligo-Leitrim. A quick glance at a map of Ireland illuminates how people living in the north west are being left behind in terms of access to this life-saving cardiac service. The major question at issue when a person presents at a hospital with an urgent cardiac arrest or other emergency cardiac illness is whether transport to a primary percutaneous coronary intervention, PCI, centre is available within the recommended 90 minutes. For patients in the north west, there is not a simple "Yes" or "No" answer to this question, as is often the case in our region. The answer, unfortunately, varies from day to day and on a case-by-case basis, depending on whether or not the emergency helicopter transport service is available from Sligo at the time. If it is not available or is out on a call, often the only option available is to give the cardiac arrest patient thrombolytic treatment followed by an urgent ambulance transfer by road to either Galway or Dublin for emergency treatment.

Having spoken to the senior consultant cardiologist at Sligo University Hospital, Dr. Donal Murray, this is unquestionably having an effect on the levels of cardiac mortality in the region. This tragic reality of the situation must be addressed this year as a matter of urgency. It is estimated that more than 50 patients per year are presenting at Sligo University Hospital in need of urgent attention for an ST-segment elevation myocardial infarction, STEMI, which is the most dangerous type of cardiac arrest. At this time, 50 cardiac patients at Sligo face that uncertainty. A further 150 patients present at the hospital with non-urgent STEMI heart attacks which require treatment outside the region. More than 1,000 patients every year need angiography services which cannot be provided at the hospital.

One of the key challenges in accessing primary PCI care in the north-west region is that the road network is not of the same standard as it is on the east coast or in the south. For example, it takes a minimum of two hours to travel from Sligo University Hospital to Dublin by ambulance. It takes the same length of time to get to Galway by road, but the journey by helicopter is 80 minutes. Therefore, the only option for patients in the region is via air travel to Galway. On that basis, Sligo needs a fixed cardiac catheterisation laboratory with three consultant cardiologists. People living in Sligo, Leitrim, north Roscommon, south Donegal, north Mayo and west Cavan have as much right to access this service as do the people of Galway, Cork, Dublin and Waterford. We have a combined population of more than 240,000 people, who must, as it stands, leave the region for care. Sligo University Hospital is the perfect location for the service given its position between the other primary PCI centres in Galway and Derry. Sligo has a proven track record in innovation, staff recruitment and clinical governance in this field and was the first hospital in the country to establish a mobile catheterisation laboratory service. That is no longer adequate and it is time to upgrade to a fixed service, which will require a minimal capital investment. Doing so would mitigate the impact of the lack of primary PCI care in the region. If the service is not delivered this year, 2,000 patients will have to leave the region for cardiac procedures, which will undoubtedly lead to increased cardiac mortality.

Deputy Marcella Corcoran Kennedy

I thank the Deputy for raising this matter, which has been of concern to him for a long time. He has been consistent in raising it with the Department and the HSE on behalf of his constituents.

Sligo University Hospital is currently served by a mobile cardiac catheterisation laboratory which provides services on one day per week for elective procedures. In terms of cardiac services in the north-west region, a cross-Border cardiology service was established in early May 2016, which provides emergency primary PCI services for the treatment of patients from County Donegal with a diagnosed heart attack at Altnagelvin Area Hospital in Derry. From May through to 20 December 2016, 23 patients from County Donegal received treatment under the scheme. Following admission and emergency treatment in Altnagelvin Area Hospital, patients are repatriated to Letterkenny University Hospital or Sligo University Hospital, depending on which is closer to their homes. The new service runs very efficiently and is of major benefit to very sick patients living in the north-west region. Any proposal for the further development of cardiac catheterisation laboratory services at Sligo University Hospital must first be considered from a hospital group perspective and in the context of planning for the cardiology needs of the population cared for by the Saolta University Healthcare Group. During 2017, each hospital group will he required to develop a strategic plan setting out how it proposes to organise services to provide optimal care to the population it serves and how it will achieve maximum integration and synergy across local health services, including primary and community care. The Department of Health has developed a draft document, Guidance on Developing Hospital Group Strategic Plans, which will he circulated to hospital groups in due course. In addition, any further development of cardiac catheterisation services at Sligo University Hospital must be considered in a national context and in the light of the competing demands for scarce resources. The Government is committed to prioritising waiting lists in 2017. Acknowledging the challenges in scheduled care provision, budget 2017 makes specific provision for the treatment of longest-waiting patients. An allocation of €20 million is set aside for the National Treatment Purchase Fund, NTPF, in 2017, rising to €55 million in 2018. In December, my colleague, the Minister for Health, granted approval to the NTPF for the first tranche of funding, in the region of €5 million, for an initiative focusing on day case procedures. The Minister has asked the HSE to develop an inpatient and day case waiting list action plan in conjunction with, and supported by, the NTPF's proposal for utilisation of the remaining €10 million of 2017 funding for patient treatment. Further, the Minister wrote to the director general of the HSE earlier this week in regard to waiting lists, with a specific request that priority be given to the development of a cardiology waiting list initiative in 2017. In the coming weeks, the Minister expects to receive a waiting list action plan from the HSE, which will include a cardiology waiting list initiative. That initiative will address cardiology waiting lists in a number of hospitals, including Sligo University Hospital.

Deputy Tony McLoughlin

The Minister of State's response does not address my concerns. There is a clear case for Sligo University Hospital having the required population for the service to be viable, and it makes sense in terms of geography, medical need and finances. Over a ten-year period, there would be a net saving of €3.6 million if the service were introduced. I have the facts and statistics to back that up.

When one looks at the map of this country to see the areas that are covered - the Minister of State mentioned Altnagelvin in Derry - some of the patients, certainly, in south Donegal, are coming to Sligo but north Donegal is covered by the Derry service. Then the service is in accordance with a line from Dublin to Galway, and from that down to Limerick, into Tralee, Cork and Waterford. These are the areas. This is the map that I am subjected to on a weekly basis. There is no service north of a line from Dublin to Galway where there is a population of 245,000. That is not acceptable in this day and age.

The last letter I received from Ms Ann Cosgrove on my correspondence on the cath lab in Sligo University Hospital states that she has recently become involved in this project and outlines that there is further work to be completed by HSE procurement in advance of going to tender for this project. Ms Cosgrove wrote that she could not give me an exact date as to when it will go to tender other than to say that it will be the last quarter of 2016 at the earliest. We are now into the first quarter of 2017 and this is the information that I am getting.

I am not happy and I am not accepting the information that I have got here. With all due respect to the Minister of State, when one looks at the facts and sees what I have in front of me and what I am being subjected to on a regular basis from constituents in my area who must travel on a daily basis to Galway not knowing whether or not they will make it in the back of an ambulance if they do not get the helicopter, it is high time. We have seen in other areas of the country where promises have been made in relation to cath labs, second cath labs and various other services in the past couple of weeks. It is not acceptable at this stage that we, in the north west, have had to be subjected to that.

Deputy Marcella Corcoran Kennedy

I thank Deputy McLoughlin. I ask the Deputy to give me a copy of that letter. If there are commitments in it, I would certainly want to ensure that the relevant persons are aware of it.

It might be helpful to talk about what is being provided at Sligo University Hospital. Angiographies are performed there using the mobile cath lab one day per week and they can do ten angiography procedures per day. The average number performed in Sligo is 455 per annum, broken down by inpatient and day-case activity.

Saolta has advised that there are 75 patients on the cardiac catheterisation waiting list for angiographies and this waiting list is reflective of patients from the Sligo catchment area only. In addition to the numbers treated in Sligo, the hospital refers approximately 300 per annum to St. James's Hospital and to the Mater Private.

I will certainly convey the Deputy's concerns. I would appreciate if the Deputy would give me a copy of the letter that he has to hand.

Air Corps

Acting Chairman (Deputy Declan Breathnach)

I remind Deputies Lisa Chambers, Mick Barry and Ó Snodaigh that they have one minute each to make an initial statement and the Minister of State, Deputy Kehoe, has four minutes to reply. Then they each will get a one-minute supplementary.

Deputy Lisa Chambers

I thought it was two minutes each to make a submission. That is cutting us short by a minute overall.

Acting Chairman (Deputy Declan Breathnach)

We are on the last issue. I will try and be as lenient as possible.

Deputy Lisa Chambers

We will fire ahead.

Worrying reports have emerged of serious and ongoing health and safety concerns at Casement Aerodrome, Baldonnel. There are reports of severely negligent practices concerning the handling of hazardous materials and there are a number of issues that we must address in this matter.

We have three whistleblowers who wrote to the Taoiseach and the then Minister for Defence, the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, between November 2015 and January 2016 to warn them about the conditions at the Air Corps headquarters in Casement Aerodrome, Baldonnel, relating to health and safety of soldiers and their handling of hazardous chemicals. The whistleblowers identified serious breaches in health and safety at the base, no provision of occupational health surveillance, lack of personal protective equipment and a lack of training on how to handle dangerous chemicals. One whistleblower is quoted as saying, "What has happened in the past and what is still happening regarding chemical health and safety in the Irish Army Air Corps is a grave scandal which I believe has seriously injured the health of a number of personnel."

If one goes back to 2013, the Air Corps safety management system carried out a safety review at the base and made certain recommendations. We have heard nothing since on that review, what recommendations were made and what implementation was carried out.

PDFORRA, the representative association for enlisted personnel, wrote to the Defence Forces separately in November 2015 outlining similar concerns at the base and stating that if the HSA was to inspect the base, the report would likely be damning. The HSA inspected the base in 2016. It made a number of recommendations which, it stated, required action.

It is my understanding that a former civil servant was appointed by the Department in September last to review the whistleblowers' claims but that the person has not contacted the whistleblowers themselves. My questions to the Minister of State are as follows. Has he made contact with the whistleblowers? If not, why? Have the Defence Forces implemented the HSA report and has it implemented the Air Corps safety management system report?

Acting Chairman (Deputy Declan Breathnach)

Deputy Lisa Chambers will get back in.

Deputy Lisa Chambers

If that has not been done, what has been done in this regard?

Deputy Mick Barry

The issue here is serious concerns regarding health and safety at the repair and maintenance workshops at the Air Corps headquarters at Casement Aerodrome in Baldonnel.

One of the issues here is the breaking of the law. The law states that there must be occupational health surveillance in a circumstance such as this where one is dealing with dangerous chemicals. That is according to the Safety, Health and Welfare at Work Act 2005, which replaced an old piece of legislation dating back to 1989. There is mandatory screening required under that law.

The Department - the Minister of State, Deputy Kehoe, is a Minister responsible - and the Taoiseach are responsible here. The former American President, the late Harry Truman, had a sign on his desk stating, "The buck stops here." The buck stops with the Minister of State, Deputy Kehoe, and the Taoiseach. The Taoiseach is Head of Government and head of the Department, in which Deputy Kehoe is a Minister. What says the Minister of State to the facts that the law has been flouted here?

Deputy Aengus Ó Snodaigh

The outline of the cases being taken are scary, if they are upheld. We will not go into the detail of those cases.

My concern here is to ensure that Deputy Kehoe, as Minister of State, the senior Minister, the Taoiseach, and also the military authorities act immediately when first made aware of a health and safety issue and the unwarranted exposure to chemicals of Air Corps personnel, and especially since the damaging report of the HSA in October last.

Can the Minister of State assure the House that the 13 recommendations of the Health and Safety Authority have been completed, or when will they be completed? Can he assure us that there will be no more unwarranted exposure to both carcinogenic and mutagenic chemicals? Furthermore, can the Minister of State assure us that the Air Corps personnel now have the basic protection equipment required in handling such chemicals - gloves, eye protection and respirators?

It has been going on for years. Obviously, the Minister of State cannot undo the past. He can accept the responsibility of his remit. The military authorities should accept the responsibility for the years in which they are aware of this. Can the Minister of State let us know how long are the military authorities aware of an issue to do with the handling of chemicals in Baldonnel Aerodrome?

Minister of State at the Department of Defence (Deputy Paul Kehoe)

Let me assure the Deputies that, as Minister of State with responsibility for Defence, the health and welfare of the men and women of the Defence Forces are a high priority for me and the Defence Forces.

The State Claims Agency is currently managing six claims taken by former and current members of the Air Corps for personal injuries alleging exposure to chemical and toxic substances while working in the Air Corps in the period 1991 to 2006. As litigation is ongoing, the Deputies will appreciate that I am limited in what I can discuss.

It is the policy of the Defence Forces to manage health and safety risks to all of its members proactively. This is done in line with national health and safety regulations. The Defence Forces risk management system is designed to an internationally recognised standard. The Defence Forces are committed to continuous risk mitigation and encourage inputs from personnel at all levels to ensure the work environment is as safe as possible. Areas where members of the Defence Forces are handling toxic materials in the context of their work are subject to stringent risk mitigation and continuous review by health and safety practitioners.

I am informed that during 2016 the Health and Safety Authority, HSA, conducted inspections at the Air Corps premises at Casement Aerodrome, Baldonnel, on three occasions - 4 February, 5 April and 28 September. During these visits the Air Corps outlined the most recent developments regarding its health and safety practice and procedures, which were being developed in consultation with risk management experts. I understand that the HSA met with Air Corps personnel, safety representatives and other employees and observed some workplaces and work practices. On 21 October 2016, the HSA issued its report of inspection to the Air Corps. This report listed a number of advisory items for follow-up. They included the areas of risk assessment, health surveillance, monitoring of employees' actual exposure to particular hazardous substances and the provision and use of personal protective equipment. The Air Corps was very appreciative of the advice and support of the HSA.

On 20 December, the Air Corps wrote to the HSA outlining its proposed improvement plan and indicating that the Air Corps is fully committed to implementing the improved safety measures that protect workers from potential exposures to chemicals and will ensure risks are as low as reasonably practicable. The Air Corps has confirmed that it is implementing an improvement plan which is being conducted over eight phases. The first phase commenced in September 2016 with planned phased completion dates to December 2017. I am advised that seven out of the eight phases are planned to be completed by May 2017. The eight-phase implementation plan is focused on a number of areas, for example, activity-based risk assessments. Additional risk assessment of particular chemicals, policy review and health surveillance and biological monitoring also will be considered.

I will now outline the actions I have taken to date regarding protected disclosures relating to the Air Corps, which were received in November and December 2015 and January 2016. The Deputies will appreciate that in so doing, I must have regard to the fact that there is ongoing litigation relating to certain disclosures. I must also have regard to the obligation in the Act to protect the identity of those making such disclosures. I assure the Deputies that I take disclosures very seriously and the actions I have taken will illustrate this.

Legal advice was sought on how best to progress certain disclosures, as elements related to matters that are the subject of ongoing litigation. The Department was also aware that the HSA had visited the Air Corps with regard to the use and management of chemicals. It was decided that an external reviewer should be appointed. With some difficulty, an individual was sourced and I appointed him in July 2016 to carry out a review of the disclosures. However, in the event, he ultimately was not in a position to carry out the review. In September 2016, I appointed an alternative independent third party to review the allegations made in the outstanding disclosures, and those making the disclosures were informed of this fact. I believe that in this instance, it is important that I get a clear and independent view of the issues raised by those who have made these disclosures.

Acting Chairman (Deputy Declan Breathnach)

The Minister must conclude.

Deputy Paul Kehoe

Can I ask the permission of the House to continue to the conclusion? It is very important.

Acting Chairman (Deputy Declan Breathnach)

Do the Members agree to let the Minister of State conclude?

Deputy Lisa Chambers

We will take the same leniency too.

Acting Chairman (Deputy Declan Breathnach)

I have a little latitude. The Minister of State may continue.

Deputy Paul Kehoe

In late November 2016, the interim recommendations and observations from the independent third party were submitted to me and, in December, I asked that these be passed to the military authorities for immediate action and response. On 7 January 2017, the Department received a response from the military authorities outlining the actions under way and this has been forwarded to the independent reviewer for consideration. The reviewer will consider this material and determine the next steps required to finalise his review.

I will ensure that all recommendations, whether arising from the work of the HSA or the ongoing protected disclosures review, will be acted upon to ensure the safety of the men and women of the Air Corps.

Deputy Lisa Chambers

We have received quite worrying reports of practices and, to use one of the terms mentioned, "practical jokes". Something known as "tubbing" was reported, for example, which is where new recruits were tossed into baths full of unknown chemicals as a joke and an initiation process. There is a culture in that regard. There is a lack of appreciation of the ongoing dangers associated with these chemicals. Also worrying is the fact that many people are reporting now that they presented with symptoms and health issues to medical doctors but were not given the assistance or help they needed. The connection was not made, or perhaps they did not wish to make it, between their work with the hazardous materials and chemicals and the health issues they faced. Some of them continue to experience severe health problems. This speaks to the wider issue of adequately resourcing essential capabilities in the Defence Forces and resources in the Air Corps.

The Minister of State did not answer the questions. Has he or the Department contacted the whistleblowers? Has the independent third party contacted the whistleblowers? The Minister of State also did not answer my question about the safety management system review that was conducted in 2013. Were the recommendations made in that review implemented? The Minister of State referred to the six cases pending before the courts. I appreciate that he cannot discuss the individual cases or their merits, but I must strongly point out that the State should only be defending cases where it believes it does not have a case to answer. If the State has committed a wrong, it should compensate the victims properly. The Minister of State should not put people through the trauma of a court process where they have a genuine claim. Every effort should be made to settle such cases out of court with the individuals involved. The only people served by defending the indefensible are the lawyers.

Deputy Mick Barry

The Minister of State said he takes disclosures very seriously. Why is it that more than a year after the complaints were made by the whistleblowers, direct contact has not been made with them regarding the issues they raised with the Minister? The Minister of State said that on 20 December, the Air Corps wrote to the HSA outlining its proposed improvement plan and indicating that it is fully committed to implementing improved safety measures. It is more than a month since then. Are protective gloves in use now and is there protection for the workers' eyes? Are respirators fully available? Last, but not least, many observers of this case would say there has been a certain high-handedness about it, particularly as regards health and safety and in view of the delays that have occurred. Will the Minister of State comment on that charge of high-handedness? It appears to be not untypical of the way rank and file men and women in the Defence Forces are treated over a range of issues at present.

Deputy Aengus Ó Snodaigh

Military discipline dictates different dynamics, so the officers and the military authorities have a greater responsibility for the protection of the health and safety of those under their command. It is interesting that the whistleblowers first came forward in November and December 2015. That suggests these issues were raised internally before that, which is the reason I asked when the military authorities were first made aware of the concerns of those who were handling carcinogenic chemicals. Does the Minister of State accept that a risk assessment should have been carried out immediately when this issue was first raised in November 2015 or before that? The work that is now starting should have started when the military authorities were aware of the Health and Safety Authority arriving to the aerodrome in February, or perhaps even in April or September. Instead of waiting until October when the report was produced, most of this work could have been half done or completed at this stage if they had acted.

Furthermore, is the Minister of State aware if other branches of the Defence Forces are now acting to consider risk assessments in respect of both chemicals and other dangerous equipment being handled by soldiers or Naval Service personnel to ensure there are no other areas in the Defence Forces which would raise similar health and safety concerns?

Deputy Paul Kehoe

When Deputy Lisa Chambers mentioned people being put into baths, I presume she was referring to bullying.

Deputy Lisa Chambers

Not exactly. It was more just a lack of regard for the seriousness-----

Deputy Paul Kehoe

For a number of years, the Defence Forces have worked assiduously to counteract any bullying that may happen. There must be some reason why the Deputy said a person was put into a bath. I am only reading what was in the media.

Deputy Lisa Chambers

No, the point I am making is about the lack of knowledge and training about the seriousness of the dangers of the chemicals.

Acting Chairman (Deputy Declan Breathnach)

No interjections. The Minister of State is making a statement. I have been more than lenient.

Deputy Paul Kehoe

My office has written to the people who made these complaints and I have informed them of the process I have begun and of the fact that we have appointed an independent person. From the time these complaints were made in late 2015, the HSA has come to the Air Corps on 4 February, 5 April and 28 September and has made a number of recommendations on which the Air Corps is acting. Through my Department's Secretary General, I have asked that whatever recommendations have been made be carried out. Although it will take time for all the recommendations to be carried out, the Air Corps has informed me that all the HSA's recommendations will be in place by December of this year. I would say that 95% to 99% of them will be implemented by May. I have asked that all members be issued with whatever gloves and respiratory equipment they need to ensure this does not happen again. The health and welfare of all members of Óglaigh na hÉireann is a priority for me.

Dáil Éireann debate - Wednesday, 25 Jan 2017