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Dáil Éireann debate -
Wednesday, 27 Sep 2017

Vol. 959 No. 4

Topical Issue Debate

School Transport

I welcome the Minister. The primary school on Sherkin Island closed last June. Children now attend school on the mainland, which means using the ferry to get there. There is no supervisor on the ferry or on the mainland once the ferry docks. The children must then walk to the school bus, which is some distance away. This poses a significant health and safety risk to the children, some of whom are as young as four years of age while others are 12. I call on the Minister to address this as a matter of urgency.

I will set the scene. Sherkin Island is one of the most southerly points in Ireland, an island approximately one mile off the west Cork coast. Three miles long and one wide, it has a beauty and a variety of landscapes. It epitomises all that is good about island living.

As the Minister is aware, Sherkin Island national school closed its doors for the last time at the end of the most recent school year. This saw the end of 124 years of primary education on the island. From the time that the island community was notified that the school was closing, it did its utmost to work with parents, the patron and the Government to ensure that the children on the island had continued access to education. Those children are now attending school on the mainland and, obviously, must use the ferry to get there.

The Department of Culture, Heritage and the Gaeltacht has provided an extra ferry to ensure that the children can get off the island in the morning. The residents are grateful for this. However, there is an urgent need for a chaperone on the ferry and to escort the children from the pier to the bus in Baltimore on the mainland.

The Department of Education and Skills stopped the grant aid for the school and left the island people with no provision to access education. The island community, working with the patron and the school, requested meetings with the Department and submitted a proposal to ensure continued access to education.

The Department of Education and Skills advises that ferry services operating from offshore islands do not come under the education transport scheme and while the island community has successfully negotiated a deal whereby the Department of Culture, Heritage and the Gaeltacht would subsidise an additional ferry for morning travel, it does not go far enough. At present, parents of children between the ages of four and 12 are operating a rota system to chaperone their children on the ferry and thereafter from the ferry to the bus on the mainland. This is a four-hour daily commute for parents wishing to educate their children by the only means open to them. It is unfair. They are working parents who cannot afford to take time off. In essence, this system is not sustainable in the long term. The Department of Education and Skills has a responsibility for the safety of these children. There is a social and community benefit to the State supporting these children to attend school on the mainland and still live on the island. I therefore call on the Minister to recognise this oversight and provide a chaperone in order that these children may access education as is their right, in line with their peers on the mainland. If we want to keep our island communities vibrant and sustainable, we need to allow young families to keep living on the island. It is time for a bit of common sense and long-term thinking when it comes to supporting our islands. Will the Minister please provide a chaperone for these children for the ferry?

I thank Deputy Murphy O'Mahony for raising this issue. I am happy to reply on behalf of the Minister of State, Deputy Halligan. The Department and Government are very aware of the importance of small schools in rural communities. That is why it is in the programme for Government that small schools will not be closed without the consent of parents. The initiative for closing a school may come from a variety of sources, such as parents, staff, boards of management, the patron or the Department. Any proposal to close a school must involve consultation with all of the relevant stakeholders and follow decisions taken at local level. I understand that procedure was followed in this case.

The position with regard to school transport is that it is a huge operation. There are 116,000 children, including almost 12,000 children with special educational needs, who are transported every day in approximately 4,500 vehicles. Such a large programme requires that eligibility criteria are applied nationally on a uniform basis. The scheme only provides support for escorts to accompany children with special educational needs. Escorts are not a feature of the mainstream primary or post-primary school transport services. Many children use ordinary scheduled services which provide that access. Bus Éireann is responsible for the planning and time-tabling of school transport routes. It endeavours, within available resources, to ensure that each eligible child has a reasonable level of school transport service in the context of the scheme nationally. Routes are planned so that, as far as possible, no eligible child will have more than 2.4 km to travel to a pick-up point. Children living off the main route of a service are generally expected to make their own way or to be brought to convenient pick-up points along the main route.

In the case of Sherkin Island there is no charge for the children on the ferry. Bus Éireann has advised that there are two children who are in fourth and sixth class who attend Rathmore national school with an address on Sherkin Island. As these children are collected at the pier where they get off the ferry, a long walk is not involved. Unfortunately the scheme that applies has to apply uniformly and we do not provide chaperones in the sort of circumstances the Deputy describes. They are confined to children with special needs. There are other children who have to adapt to the scheme. There are continual demands for expansion and extension of this scheme. We have had to operate in a situation where rules are applied uniformly in order that we can stand over them on a consistent basis and where every child is treated on the same basis.

I thank the Minister. I acknowledge the parents were consulted about the closure but I also acknowledge that they co-operated and held up their hands and accepted this was an inevitable thing to happen. They were also given the understanding at the time that easy access to the mainland would be provided and a chaperone is part of that. The Minister called out the statistics but one size does not fit all. It is a unique situation. It can be very easily solved. A chaperone is not a huge cost. It beggars belief that the Minister is not in a position to provide something that could be so easily and cheaply solved. The islanders have asked for a meeting with the Minister and the Minister of State, Deputy McHugh. I ask the Minister to say he will at least meet them and listen to their points. He is also very welcome at any stage to visit Sherkin Island for a weekend and we will look after him very well there.

I will end with a quote from President Michael D. Higgins who said:

Nothing is inevitable. The loss of sustainable island life is not inevitable. The recent decline in many of our islands’ populations is a challenge to be addressed.

I am asking the Minister to address this challenge and provide a chaperone for the people of Sherkin Island.

I understand the Deputy's request but chaperones are a very significant cost. We provide chaperones for 12,000 children with special educational needs and they are a very significant cost. Those are a growing area of need.

There is the remote area grant.

In applying a national scheme, the Department has to decide if it will extend chaperones to children below a certain age in any circumstances where children might be using such services.

It is water; it is different.

Such an extension of the scheme would be a significant extension; it would not be a minor extension of the scheme. That is the dilemma faced. As I understand it, which the Deputy acknowledged, arrangement was made for support for the ferry so children would be carried free on the ferry and Bus Éireann has arranged that the bus picks the children up at the pier where they land. It is a good accommodation. Within the rules of the scheme, every effort is made to accommodate children.

The 2.4 km that some children are expected to walk does not apply here. A more convenient collection point has been arranged. Unfortunately, with a scheme of this scale, where there are so many children with different ages and needs involved, the Department has to apply a consistent approach and that has been the approach applied in this case.

Local Improvement Scheme

I thank the Ceann Comhairle for allowing me to raise this issue today. I welcome the allocation of €411,000 for Limerick City and County Council for the local improvement scheme. It demonstrates the Minister's and Government's commitment to the continuing development and improvement of rural Ireland. It was one of the major issues during the crash. Under the previous Fianna Fáil-Green Party Government, discretionary spending on rural and tertiary roads was all wiped. We did not have the money. Now that the economy is in a state of recovery and we are looking to spread that recovery, it should be recognised. I want to put on the record of the House that I recognise the Minister's commitment to it. Given his background, he will excel in the job and he is extremely committed to it. The €411,000 for the local improvement scheme is welcome. It is a rural scheme for the improvement of private roads on which there are two or more landowners. They can avail of the scheme to surface-dress the road as opposed to fully reconstructing it. The landowners try to maintain it as best they can but the roads can deteriorate over time and it is a period of time before they are resurfaced. There are a number in Limerick City and County Council at the moment. There are 54 on the list. Given the current costs, this €411,000 will do a further 12 roads, up to 20% extra, which is extremely welcome.

They have escalated the issue to me and suggested that the deadline for the uptake of the money might be extended because it can be challenging to surface-dress these roads in the winter months. They are not being reconstructed and are predominantly being surface-dressed. They request extending the deadline for drawing down the money to allow surface-dressing to take place in spring or summer as that is when I have been told the discretionary spending on the local improvement scheme takes place in Limerick. We cannot guarantee the weather, which may be good in November. However, they seek an extension of time to allow the surface-dressing take place in 2018.

As a Deputy for County Limerick, I welcome the allocation of €411,000 for Limerick. It shows a further commitment to the development of rural areas. I look forward to the Minister's reply.

I thank the Deputy for raising the issue and I also thank him for his kind comments. He is quite correct in saying that the local improvement scheme, LIS, is a very important scheme for rural areas. As the Deputy will be aware, the Taoiseach and I announced the provision of €10 million for a local improvement scheme for 2017 at the National Ploughing Championships last week. The scheme supports improvement works on private and non-public roads. Often these roads lead to multiple residences, parcels of land that support agricultural activity, or public amenities such as lakes, rivers or beaches.

My Department wrote to local authorities in August to establish the level of demand for a local improvement scheme this year. The local authorities were clearly advised that any requests for funds would be subject to their capacity to complete any proposed works in 2017 and funding availability.

The scheme was launched on 21 September on the basis of the information received back from the local authorities. It was not possible to support fully the level of demand which the local authorities stated they could deliver in 2017, but all eligible local authorities received a minimum of €250,000, with the exception of the three authorities that requested less than that amount. It is now a matter for the local authorities to determine which roads they wish to prioritise from the funding allocated to them.

As Minister for Rural and Community Development, I am very much aware of the importance of the local improvement scheme. The roads covered by the scheme give access to homes, farmyards, agricultural land and business premises, and are often heavily used. However, because they fall outside direct local authority control, many need upgrading. For emergency services too, bad road surfaces can lead to delays in accessing sites and tending to people in need.

We have not been in a position to fund the local improvement scheme adequately in recent years, but we have now honoured the commitment in A Programme for a Partnership Government and in the Action Plan for Rural Development to reinstate the scheme.

Given the consultation which my Department engaged in with the local authorities in determining what they could deliver in 2017, I urge local authorities to implement the programme and spend the money allocated to them without delay.

The priority is to fund projects which can be completed during 2017 and I am not in a position to extend the deadline for the drawdown of moneys if we are to achieve this objective. The timeline was highlighted to the local authorities prior to their submission of expressions of interest.

I thank the Minister for his reply which provides clarification on the issue. I outlined a suggestion that came through and I take on board the Minister's comments. The message that needs to go out from here today is that the local improvement scheme is back. We are now hitting that list again and 20% of it will be knocked off in County Limerick. We need to build on that and make a case for funding to address tertiary roads in coming years, as was done in the past.

I understand the challenges the Government has regarding funding. There is a commitment to rural areas through the Department of Rural and Community Development. We recently saw what Culture Night did to invigorate certain areas, including Bruree, Rathkeale, Newcastle West, Abbeyfeale and Kildimo in County Limerick. I know the town and village renewal scheme will be coming up. Rathkeale, which has a unique socioeconomic background, would be greatly enhanced by such schemes. I look forward to its roll-out. As late as this week we heard that eir is continuing to roll out rural broadband to 300,000 houses, including in County Limerick. We know we are down to two bidders for the roll-out of the State broadband of the remaining 500,000. The Government is acting on what it is saying. It is putting things in place because the economy is now able to afford it. That is the bottom line. The heavy lifting that was done by the Government and by the people is now starting to make this happen.

I again thank the Deputy for raising this very important issue for rural areas. He is correct in saying the LIS is very important for people in rural areas. People pay their taxes, including property tax. In some cases these people provide their own water and pay for it themselves, and they are entitled to have a scheme such as this. I am delighted that this scheme was opened this year. The programme for Government made a commitment to open the scheme. We have honoured that commitment and we will continue with that scheme next year.

We talked to the local authorities. They requested that they could spend the money this year and I hope they will. County Limerick got €411,000; it had sought €1.716 million. I know the local authority will spend that money by the end of the year to address badly needed road repairs. As I said in my reply, these are roads people, in some cases ambulance drivers, doctors and nurses, use on a daily basis. Therefore these schemes are very important and this particular LIS is a very important scheme.

In the past year we have opened up the CLÁR programme. The town and village scheme is up and running as is the rural recreation scheme. Many schemes that assist rural areas are now operating. Next year we will be into a new year. I hope the local authorities will actually spend whatever funding they got this year. Councillors and others are crying out for funding for rural areas; when they get it they should spend it.

Mental Health Services Provision

We are here specifically to discuss the report on Roscommon. The big question, apart from the need to address specifically the localised issues in this report, is to determine just how localised they are. Is Roscommon an exception or the rule, especially when it comes to funding? Some €18 million was returned from mental health funding from 2012 to 2014. We have heard a lot from the Government about its strides in increasing mental health funding from the low base that it was at for many years, but how much of that money is being spent on an annual basis and how much is being returned? A total of €16 million for just one area is huge, particularly when that area is not providing quality care according to the report or at the least is failing in a number of regards.

In response to a recent parliamentary question, the HSE advised that all money for 2017 was allocated and would be used. Can we be sure of that until next year, given the findings here? Are other CHOs returning moneys on this level on a regular basis? Is the Government aware of the problem and, if so, what has been done or is it benefiting from announcing spending figures which do not materialise and recycling that money? Last year the Government announced a measly €15 million increase in mental health funding. Was this decided on the basis that the underspend from 2016 was providing for it?

I am very conscious that many service users in Roscommon and their families have experienced huge problems in accessing services and in the level of service they get.

Generally, the reason given, or the excuse, for all of that, as the Minister of State is well aware, is that we do not have the resources or the funds. Now we find that significant funding was sent back. There were also scandals in some of the services in the area. People are wondering what on earth is going on. For many years the mental health service has been the poor relation in the health service. It has a bit of stigma attached to it and people do not ask too many questions or probe too much. It is time to end that and to probe into the issue to find out exactly what is going on because there is clearly a serious problem given the amount of money that is being returned. As my colleague, Deputy Pat Buckley, asked, is it a reflection of what is happening in other areas around the country? If it is, there are serious questions to be answered in respect of this issue.

I reiterate the points made by my two Oireachtas colleagues this afternoon. I come here with a very heavy heart. As Deputy Martin Kenny is aware, I lost a very close friend. This morning, the Taoiseach said on Leaders' Questions that many people have been affected by suicide. As the two previous Deputies have said, this report is damning in every respect. A total of €17.67 million was returned, €4.57 million in 2012, some €6.91 million in 2013 and €6.19 million in 2014. This report was carried out by three very eminent people from the Northern Ireland health care sector, namely, Mr. Brendan Mullen, Dr. Nial Quigley and Mr. Don Bradley. I am sure the Minister of State has read the report. The language in it is appalling. There are 27 recommendations. I know the Minister of State is a genuine man. The big worry and concern now is whether those recommendations will be implemented. They must be, as it is absolutely necessary that they are. I will have an opportunity to say a few more words in due course.

I thank the Deputies who have raised the matter and continue to keep the focus on this important issue in what is a very disturbing period for all of us.

The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion. In 2015, the mental health division of the executive determined that it was necessary to conduct an independent review of the quality, safety and governance of Roscommon mental health services to support achieving the goals set out in A Vision for Change and other relevant national policies.

Within a short period of being commissioned, it became evident that the initial timeframe proposed to conduct the review was insufficient and the review team requested, and received, extra time to complete its work. I welcome the recently published comprehensive report, which makes 27 recommendations for local service improvement. The report indicates that the review team was impressed by the majority of staff it met or interviewed, and was struck by their commitment to see services improve for service users in Roscommon. The overriding concern of the majority of those interviewed - staff, service users and carers - was that patients and families in Roscommon were not receiving services in line with current best practice that would meet required quality and safety of care standards.

Multidisciplinary team working - the linchpin of modern mental health services - was severely eroded in Roscommon, with fractured relationships within the area management team, within the Roscommon teams and between a number of professionals and key consultant medical staff. Throughout, there were poor line management arrangements. Leadership at a number of levels appeared to be ineffective. The majority of nursing staff interviewed believed, and the team agrees, that the senior nursing leadership critical to representing the professional views of nurses at the executive level was missing. It is the team's view that, in some instances, relationships appear to have broken down irreparably.

Managers in any organisation have a difficult balancing role and they should be allowed to manage without undue interference. However, that can only occur in a working environment that is conducive to mutual respect and understanding. There was clear evidence that this was absent in this instance. The review team pointed to the need for effective application of change management principles as a new entity attempts to merge disparate parts of hitherto separate organisations. The team believes that preparatory work to support the area management team should have been in place, as it embarked on creating a new culture. The team concluded also that there was disproportionate focus, even at a time of straitened financial circumstances, on achieving budget savings at the cost of an adequately staffed and safe service.

The report highlights that approximately €17.6 million of mental health funding for the years 2012 to 2014 was returned by the Galway-Roscommon area, and it details the context surrounding that. The report makes a specific recommendation on the issue, to the effect that the HSE should have greater delegation of budgetary authority to promote greater accountability, better management and more effective service delivery at local level. The HSE has confirmed that funds unspent in a particular area may be reallocated elsewhere within mental health services, and that is the case here.

A team has been formed by the HSE to implement the recommendations of the report. The executive has statutory responsibility for the planning and delivery of health care services at local level, including mental health in Roscommon. Nonetheless, the Deputies can rest assured that I, and the Department of Health, will closely monitor the progress of the HSE implementation team to ensure that all the recommendations are delivered as quickly as possible to address at local or national level, as appropriate, all concerns raised by this important report.

I thank the Minister of State for his response. In the very first paragraph it stated: "The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion." One of the two key points I raised with An Taoiseach yesterday, which are in the report, is that there was more focus on achieving savings than providing safe and effective services. The second point concerns allegations of conspiracy. I cannot see anything in the report to suggest mental health services are being "delivered in a consistent and timely fashion". The report refers to corruption, secrecy and acceptance of poor standards. As Deputy Eugene Murphy and my party colleague, Deputy Martin Kenny, said, this is a 43-page document and it is absolutely pathetic in this day and age that we as public representatives have to come in here and fight to represent the people that are trying to use this service when everything in the system is corrupt. Some of the people concerned would not even engage in the review. That is how bad it is. The mental health services in this country upset me so much. My daughter is going to a funeral today of a 15 year old friend because of the failure of the mental health services.

Deputy Eugene Murphy mentioned a case and I am also aware of a young woman who died while in receipt of help from the mental health service in Roscommon. At the time, there was very little come-back from the service for the family or when others tried to find out what was going on and what happened. It is really because of that case that I began to ask what was going on when I saw the report. It flags it to the high heavens that something can happen to a young woman with a family who wanted to get a service and was rejected and pushed away, and ended up in the circumstances that transpired.

The Minister of State has given a response and he said he will do his best but there is a cultural problem there that needs to be addressed. My understanding is that there are people who do not do their job and when they are challenged about it, they have a hissy fit and say they are being bullied and pressurised. We all know it is a difficult balance in the workplace, no matter where one is, but especially in that type of workplace where one is dealing with very vulnerable people. Those who are charged with providing the service need to do it in a much more adequate way than has been the case to date. I accept the Minister of State is new to the job and I wish him God speed to get this issue sorted out because it needs to be sorted out in Roscommon and across the country.

Every time I look at the young family of that woman my heart aches. The family is from down the road. It is no secret. There is also a family that is known to Deputy Martin Kenny as well. In this case the woman was turned away from several hospitals over a five-week period. Her family had done everything to help her, as Deputy Martin Kenny could also confirm in the case he outlined. There was absolute and utter failure within the system. In this review, more than 60 staff were interviewed and a lot of them were very committed, dedicated people. Quite a number of them had expressed concerns to me and to other politicians over a period about what was going on.

I acknowledge the sincerity of the Minister of State. There are 27 recommendations. I do not want to be back here in six months, nine months or 12 months talking about more tragedies and trouble within the system. We need extra money and the money that was taken away from the system. I meet people every day, as do the other Deputies, who really need the services and, as things stand at the moment, the service is not there in Roscommon and we need to rebuild it. There are great staff in many sections but we must ensure we have a top class service for people.

All I can do is provide the Deputies with an assurance that I am well aware of the issue. I have spoken to a number of their colleagues in the other House and to Deputies who are not in the Chamber today. To their credit, I think every Oireachtas Member has reached out to me on the issue of Roscommon. I am travelling there on Monday and intend to meet with Tony Canavan, the chief medical officer there. I intend to get my head around what went wrong. I understand the Deputies are not looking to assign responsibility for the past but for the future, to make sure that the recommendations are adhered to. I accept that responsibility in full. As Minister of State, I have responsibility to oversee the implementation of the recommendations. That is not much but it is the very least we owe to the victims of the wrongdoings that took place. I will take that responsibility as seriously as I can to ensure there are no repetitions. I will also keep an eye to the national picture to ensure issues like this are not going under the radar in other community health care organisations or counties.

Disease Incidence

I welcome the people who came from around the country today to protest at the Dáil. They had a presentation in the AV room, which was excellent. It was heartbreaking to hear their experiences, particularly those of one farmer whose life was turned upside down when both he and his young sons got Lyme disease. The one point I want to raise is the lack of early diagnosis. People have to get diagnosed themselves. They have to leave Ireland and go to Germany or America, and must raise a fortune if they do not have the money themselves. They have to beg, steal or borrow it. When they get the diagnosis, they come back to Ireland and it is not recognised here. That is wrong. It should be recognised here. The HSE should be doing more for early detection of this problem and should be recognising it.

The figures that are being given out by the HSE are totally wrong. We know they are wrong because for the numbers they are saying that have Lyme disease, we have that many in Kerry already, not to mind the rest of the country. We have people from Rathmore, Killarney, Killorglin, Castleisland, Cordal, Duagh and many other parts of Kerry who are affected with this terrible disease. A young girl, who gave all her years to qualifying in college, is in Germany being treated for Lyme disease. As Deputy Michael Healy-Rae said, they have blood tests here and the tests come back saying they do not have Lyme disease. Every other kind of disease is attributed to these patients rather than Lyme disease. When they go to Germany, it is recognised and accepted that they have Lyme disease. Many of them have to stay in Germany or go to America.

This disease should be recognised. If they have to go for treatment to these countries, let the HSE pay for it. Other diseases are paid for and this disease has to be recognised and treated accordingly.

Lyme disease is currently the fastest-spreading tick infection in the world. Some 50% of Lyme disease cases in Ireland are detected in the south west. What is also very disturbing, as my two colleagues have said, is that there is a lack of standardisation regarding detection. The Government and the State have not adopted the same urgency that Germany has, which is foremost in the world in respect of detection. People have to go to Germany and get their tests done and get the treatment that should be done in this country. They can also go to Portadown in the Six Counties and get it done that way.

I am asking the Minister of State to agree on a form of standardisation within the EU as regards the treatment and detection of Lyme disease. If that is agreed and done, it will be a way of resolving the problem for so many of the people who travelled here today to try to get this issue addressed.

I thank the Deputies from Kerry for giving me the opportunity to update the House on this matter. Lyme disease is an infection caused by a spiral-shaped bacterium called borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The health protection surveillance centre of the HSE has extensive information concerning Lyme disease on its website. The infection is generally mild affecting only the skin, but can occasionally be more severe and highly debilitating. Many infected people have no symptoms at all. The most common noticeable evidence of infection is a rash called erythema migrans - a red, raised skin rash, often called a bulls-eye rash. People can also complain of flu-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue.

Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person’s body in response to the infection. In general, it is accepted clinical practice in Ireland, the UK, Europe and North America that laboratory confirmation is unnecessary for a confidently made, clinical diagnosis of erythema migrans.

In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease published by the Infectious Diseases Society of America in 2006. Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.

Misinformation concerning the long-term effects of Lyme disease is causing real harm to people who may seek inappropriate treatments. There is no evidence that viable borrelia burgdorferi persists in patients following confirmed Lyme disease. I am aware of people travelling to other countries and spending large amounts of money on treatment for so called "chronic Lyme disease". Chronic Lyme disease lacks an accepted clinical definition, and in practice the term has been applied to a wide variety of patients. These symptoms are very common in the general population, and the evidence does not show that they occur any more commonly in patients with a history of Lyme disease. The diverse natures of these symptoms, which can have both physical and psychological causes, are shared by many conditions. The majority of patients referred for chronic Lyme disease have no objective evidence of the infection, and most often have an alternative medical diagnosis or a functional syndrome such as fibromyalgia or chronic fatigue syndrome. As diagnosis and treatment of Lyme disease are available in most of the larger hospitals in Ireland, there is no need for anyone to travel abroad to access them. I advise anyone suffering from these symptoms to seek advice from their family doctor and referral for appropriate evidence-based treatment.

What I am going to say is in no way a personal attack on the Minister of State, but I am outraged at that response. Telling people who have gone abroad for treatment to Germany - who cannot get a diagnosis here and who are seriously ill - that they have fibromyalgia is outrageous. I thank the people who travelled here today from around the country and particularly my own friends and colleagues who came from County Kerry. If they were in the Chamber to hear the Minister of State say what he just said, they would be outraged beyond belief. His statement is telling these people they are not really sick.

We heard from patients who were told by their doctors that maybe it was a bit of a problem upstairs they actually had. They then went away and got a diagnosis of Lyme disease. They were treated for Lyme disease. The good gentleman farmer we met today, a lovely man who broke all our hearts when we heard his story, thankfully is on the road to being cured. His child's fingernails had fallen out and his hair was falling out. Now he is cured. If the Minister of State were to tell those people that they had fibromyalgia, they would be outraged.

I am not directing this at the Minister of State personally. I know there would have been people in the HSE who had to okay this and it is their wrong, not that of the man who uttered it today. It is not his fault but this is balderdash. This is nonsense. This is not the answer to the debate that myself and Deputies Danny Healy-Rae and Martin Ferris wanted to bring to the attention of the Minister of State. It is not the answer.

The problem is with the person or people who wrote this reply for the Minister of State. The former Taoiseach, Deputy Enda Kenny, in a reply to me, recognised that something had to be done to improve the service, medicine or whatever for these people.

It was wrong to suggest there was something wrong in people's minds but this is what many of them were told. It has to be changed. How is it that they can be cured in America and Germany but we cannot cure them here, or even diagnose them? We cannot even accept the results of blood tests from Germany. What is wrong with the HSE and the health service? Why do we have to fight like this to get rights for these people?

It is well known where the ticks are coming from. They are coming from deer and the country is overrun with them. Anyone who has any contact with the national parks or forests are picking them up there and something needs to be done in that regard too. People need to be warned that they may be liable to pick these ticks up if they go into these areas. The HSE needs to wake up.

I thank the Minister of State for a non-response. I do not mean this in a personal way as the response was clearly written by a civil servant to protect the inadequacies of the HSE and the injustices perpetrated by it and the State. Everybody we spoke to today has had a family member with the illness or has had it themselves. Everybody we spoke to told us that the German model is the most efficient and the best to follow to deal with the illness. I did not realise it was so simple but intervention with a treatment of antibiotics at an early stage is a solution. We need to set up specialist centres to deal with it and it is within the power of the Government to do that. The rubbish we have been given by way of a response today, and which the Minister of State was given to come into the House and read out, does not in any way address the issues. It is hiding behind the HSE and a profession that has been discredited by what has happened to the people we met today.

I ask the Minister of State to go back into the system, starting with the setting up of a specialist centre to identify the cause, and work with the German model, which is the most successful in Europe and probably the world, to resolve the issue.

I accept that no Deputies are being personal in this matter. I have heard their concerns and know that all three are very genuine. I am not going to get involved in the clinical argument as that is not my role or function. However, I will take the concerns, raised on the floor of the House, back to the Department and discuss them with the senior Minister, Deputy Harris, to see if I can get further explanatory notes for the Deputies. I will take on board their concerns and I acknowledge they are talking about real people. It is their duty to represent them inside this House and I will do my job to ensure their representation goes all the way back to the Department, where it matters.

Sitting suspended at 4.25 p.m. and resumed at 5.05 p.m.