Topical Issue Debate

Planning Issues

Deputy Catherine Murphy

The immediate reaction to the Minister of State's decision to overturn decisions made by Kildare County Council on the Celbridge local area plan is, predictably, negative. People wonder what the point is in the public process that they are encouraged to engage in when it is a forgone conclusion. The decision is pretty much made in the Custom House. Utterly disheartened people have contacted me. Some say they are contemplating moving because of the mess that will be made of the town and the total disregard for the views of the public from which there have been thousands of submissions. People have questioned the point of electing councillors when the real power lies with the council CEO and the Custom House. This is not a rogue group of councillors. They have respected the process and listened and engaged with the public but that has counted for nothing. Democracy is sullied. The sheer scale and extent of the development now provided for, the location of some of the development and the absence of supporting infrastructure and services are matters that people have real concerns about. It is a pattern that people have got used to. It is not a planning system that avoids chaos but one that creates chaos and then responds to it. People in Celbridge are not opposed to new housing - far from it - but it is not enough on its own.

The directions the Minister of State made relate to two locations. The first is Donaghcumper, a location of significant historic importance adjacent to the internationally important Castletown House. An expert study commissioned by Kildare County Council in 2006, carried out by UCD's school of architecture, landscape and civil engineering, stated:

This study has clarified the extraordinary degree of design and planning evident in the composite design of three demesnes; those of Castletown, St. Wolstan's and Donaghcumper. With their key spinal town of Celbridge they form a remarkable instance of the quality and vision of eighteenth-century landscape design.

This is at the heart of Celbridge and is why it is a historic town. Following thousands of submissions from the public, people who value their heritage, the council rezoned the land in Donaghcumper demesne as strategic open space. The council CEO had proposed zoning for a town centre extension. The Minister of State has overruled the councillors and instead says that the Donaghcumper site is centrally located and is the most appropriate location for town centre zoning for future commercial retail and other related facilities. This site is small, at 6.5 ha. It is not a gigantic site but it is important.

If it was not of historic importance, this would be fine. There is a great irony in that the Minister of State's Department, on 22 July 2009, expressed concerns at the potential of a previously proposed development and how it might impact on the character and setting of Castletown House and its designed landscape and protected views. I quote from the correspondence from the Department at the time, which states the issues of particular concern would be the potential adverse effects on the built heritage and their settings which would include Castletown House, Donaghcumper House, the built heritage of the area, the built heritage of the town, protected structures and recorded monuments. There is history to this site. Some of the lands were zoned as residential and for town centre extension. Planning applications followed in 2001. They were approved by the council but there was a lengthy oral hearing when there was an appeal to An Bord Pleanála.

An Leas-Cheann Comhairle

The Deputy will have a further two minutes.

Deputy Catherine Murphy

I am just finishing. The board overturned the proposals on the principle of building on this historically important site and said that it was unfortunate it was zoned in the first place.

Minister of State at the Department of Housing, Planning and Local Government (Deputy Damien English)

I thank the Deputy for giving me the opportunity to address this important issue. I thank all our colleagues who engaged with me over the months about this site and this development plan, including many councillors who have engaged through the system. I also thank the residents, many hundreds of whom have emailed me personally or taken time to make submissions to the process. That is part of it. Everyone's submission was listened to, as was the council. I have visited the site and spent time in the area, as well as at Castletown House, to look at the views and see how this would affect the overall area. I take this part of my job very seriously.

I have a statutory function under the planning code whereby I monitor statutory plans to ensure that they are consistent with established national planning policies and comply with the relevant legislative requirements. Where this does not happen, the power to issue section 31 directions provides a safeguarding mechanism and is only used in a limited number of cases, relative to some 300 statutory development plans and local area plans across the State. In the case of Celbridge, I used those powers on Friday, 10 November 2017. The simple fact of the matter is that Celbridge is a strategically located town within that fast growing cluster of towns including Maynooth and Leixlip, and is earmarked to grow by about 10,000 people over the next five to ten years. We have to ask if we want Celbridge and towns like it just to be dormitory towns, full of commuters but with no commercial heart. Celbridge has a very weak, some say declining, but historic town centre. All I am trying to do is to uphold national policy in ensuring that the one small area it can grow into is not lost forever. If I did not do my job and allowed local planning policies to make these kinds of decisions, in the future those local communities would regret the situation they would find themselves in having to provide the shops and services they need at the edges of their towns and, worse than that, maybe not in those towns at all but in neighbouring towns. It will be important to get the balance right on the development of the centre of Celbridge. We will need to respect its historic urban and landscape character. I believe we would benefit from really well designed new housing right in the centre, to give new life to it and create new footfall for its struggling main street, the vitality of which should be the key focus. I emphasise that this is also to support that main centre. I have been on that street and many businesses there have seen a decline in business over the years because people cannot access it. This plan would put some housing right beside it and I support that.

There will also be a new public park and riverside amenity, which will be a major attractor for the town centre. We need to get working on putting this into practice. The land that was previously zoned a number of years ago has much less housing. There is also a portion of land that has been handed over which was owned by the local authority since 2012, which can be developed as a top-class amenity and park and protect the character of the landscape and the house and lands there. Great efforts have been made to do this right. I have seen previous planning applications and footage of what could have happened and the scale that could have happened. We are not allowing for that or envisaging that here at all. I look forward to working with Kildare County Council and others to make this vision happen and deliver it properly.

The site offers an ideal opportunity to revitalise and regenerate the core of Celbridge for new and existing residents alike and to integrate sensitively with the recognised assets of the River Liffey, Castletown demesne and the historic main street. The alternative would be the creation of more poor quality, car-based shopping and commercial developments that occupy peripheral locations and undermine the distinctive character and attraction of an important town like Celbridge. My Department is ready to work with Kildare County Council to ensure that those lands to the south of the main street at Donaghcumper are developed in a manner and at a pace that will protect the commercial vitality of the town centre, the heritage value of the adjacent Castletown demesne and will enable the creation of a new riverside public amenity as set out in the local area plan.

I have read all the submissions myself. We have engaged with the OPW, which owns the house in question, since everyone has been asking that. This is a zoning matter. It is not a matter of planning permission and anyone who wants to develop that has to bring forward plans that are sustainable, pass all the tests and that will address all the concerns of the residents in Celbridge.

Deputy Catherine Murphy

I acknowledge that I have spoken to the Minister of State on several occasions about this matter. Celbridge has some 6,500 houses at the moment. There are an additional 3,500 houses proposed over the next six years. This is a nearly 70% increase. The site we are discussing today is a very small site at the centre that is historical and critical to the heritage of the town. It is the reason Celbridge is a heritage town and I question whether the national planning framework is being undermined by some of what is being proposed. Kildare, for example, has a population of 220,000 people with 80,000 extra people proposed over the next six years. We are not talking about a minor increase. Like the Minister of State's own county, Kildare is one of the areas that has done the heavy lifting in respect of residential development over the years. People engage with this process in their thousands. They do it every time. They did it with planning applications in the past and they have engaged at every stage of this process. They have the right to make their views known, but they do not feel that their views were listened to and they feel that their councillors were disrespected in the view they took. This is not just any site; this is an historically important site with an 18th century designed landscaped that is a reference point for Castletown House, of which people are rightly very proud.

The Minister of State spoke of commercial viability. That door is well closed. There is a huge 24-hour Tesco, a Lidl, an Aldi and a big SuperValu all located outside the town core. As these stores developed, the town's core businesses started to deplete. That is well gone and is not going to come back. I really wonder what the Minister of State was looking at.

Deputy Damien English

We do not share Deputy Murphy's view that it is well gone and cannot be saved. We believe this is an opportunity to save the town centre and its core. This is why this land, as a key piece of town centre land, was zoned many years ago for much more increased development. That, however, is not what this is about. This is about trying to develop a plan that can support the town, the people who live around the town and new housing on the site. Other housing was proposed for the outskirts of the town, which we have moved. We are not inflicting more houses in Celbridge with the overall number of units. It is wrong to say that. We are looking for a better balance and we are looking to develop the core centre of the town.

I have seen areas where, as the Deputy said, retail units are on the edge of the town. That does not support the town centre. We are quite happy now, and I will write to Kildare County Council on this matter, to try to work with the council on developing this site on a proper, phased basis that will work with the existing commercial town centre to get the balance right. Some new custom will be developed for those businesses through the new housing right in the centre of the town where people want to live. People do not always want to drive a car constantly. They will have a choice, with the opportunity to live beside a town centre, and to avail of all the services including the fabulous lands around Castletown House and the new park that hopefully will be developed by Kildare County Council. The council owns the land and I urge the council to bring the development forward in a very sensitive way. There is an ideal opportunity to do this right. I have read the submissions of the owners of the Castletown House and I wish everyone else would read them also. We try to respond to all the needs here.

I accept that many of the residents have raised concerns and I believe that we have managed to address those issues. With regard to some of the issues they were concerned about, compared to some of the maps that show how bad it could have been years ago with previous owners, I believe this plan is appropriate and is right. It is my job to do that. The national planning guidelines are there not to be paid lip-service, but to be used and implemented where we believe it is right. I engage with local councils often, and they generally do a great job when it comes to planning. In some cases, they do not always get it right. In this case, we believe it was not aligned with national policies and we had to intervene to make changes. It is not a decision that is taken easily and that is the reason I spent a lot of time on this decision. I went there on numerous occasions and I walked the lands to be absolutely sure we were doing the right thing. I am happy to work with all parties to develop it, but I will be clear that this is a zoning application, not a planning application.

Traveller Accommodation

Deputy Eoin Ó Broin

The Minister of State is aware that two very important reports on the issue of Travellers and Traveller accommodation were published in the past four weeks. The first report was commissioned by the Housing Agency and the Minister of State's own Department was involved in it. It was conducted by independent researchers looking at the Traveller accommodation programmes since their inception. The second report was the Behaviour & Attitudes Traveller Community National Survey, commissioned by the national Traveller data steering group. This report provides a very useful insight into the views of those members of the Traveller community who were surveyed on a range of issues. I will address the housing related issues today.

Both reports make for pretty grim reading about the current state of accommodation provision for many people in the Traveller community. For example, the Housing Agency study shows that at the end of 2016, only 39% of the targets contained in the 2014-18 Traveller accommodation programmes across the State have been achieved. This is very below target, and is substantially below previous programmes. From the report and from our own experience, we know there are real problems in accessing land and securing Part VIII planning permission in local authorities. This is due to opposition from the political system, communities or others.

My own research shows the startling number of councils that were not drawing down any of their Traveller accommodation programme funding in 2015 and 2016. Other councils make up that shortfall by drawing down more than was originally allocated. There are counties that are simply refusing to draw down funding that is available to them for programmes they have actually agreed themselves. It is remarkable. I do not have more recent figures but as of July 2017 only 9% of Government funding allocated for Traveller accommodation this year has been drawn down - €800,000 of €9 million.

The Behaviour & Attitudes Traveller survey also produced some startling figures. One in three Travellers was forced to move in recent times. For those Travellers who are under 25 years of age, it is one in five people. This is a significant level of forced displacement. A total of 40% of people surveyed answered that they were no longer a Traveller in a nomadic way because they had, essentially, been stopped through legal or other mechanisms.

There is an increasing and unhappy reliance on the private rental sector, which is very insecure and for Travellers it presents additional forms of discrimination. The survey showed a clear desire for secure accommodation close to family networks and in a range of accommodation types to suit their needs.

I raise these points with the Minister of State today because, on the back of this information, we have a real opportunity - I know he shares this view - to come together as political parties. Over the next year or so, as a result of the work I am sure the Minister of State is about to outline in his initial response, we can start to design out of our housing, planning and local government system the structural barriers, and in some cases the structural discrimination, experienced by the Traveller community in accessing quality and culturally specific accommodation. If that is the Government's intention, it will have our full support and we will put aside any party political differences or any constituency interests to ensure we do the right thing by this important section of our community.

It is important not only to remove those barriers that clearly exist, and the studies I have outlined highlight this, but to deal also with some new challenges especially the population growth in the Traveller community, the changing nature of family formations and the need to give Travellers, as we try to do with for wider community, real choice in meeting their accommodation needs. For those Traveller families that want it, this means secure, appropriate and Traveller specific accommodation.

Deputy Damien English

I thank Deputy Ó Broin for raising this issue today and for all the discussion we have had around this topic. I know the commitment is genuine in trying to address the issue. I am happy to have the opportunity to update the House on the Traveller accommodation programme, TAP, and to review the next steps.

In accordance with the Housing (Traveller Accommodation) Act 1998, housing authorities have statutory responsibility for the assessment of the accommodation needs of Travellers and the preparation, adoption and implementation of multi-annual Traveller accommodation programmes in their areas. My Department’s role is to ensure that there are adequate structures and supports in place to assist the authorities in providing such accommodation, including a national framework of policy, legislation and funding. I am also trying to ensure the funding is spent.

A Programme for a Partnership Government commits to establishing a special working group to audit the current delivery and implementation of local authorities’ Traveller accommodation plans and to consult with stakeholders on key areas of concern. This commitment was underpinned in Rebuilding Ireland, which provided for the commissioning by the Housing Agency, on behalf of the Department, of an expert, independent review of capital and current funding for Traveller specific accommodation for the period 2000 to date, having regard to the targets contained in the local authority TAPs and the actual units delivered, the current status of the accommodation funded and the funding provided for accommodation maintenance and other supports.

Following a tender process, a research company was selected by the Housing Agency to conduct the review. The researchers gathered and analysed all TAPs to date and related data from the Department and other sources. Based on this analysis, a series of surveys, specifically tailored to each local authority, was created. Following analysis of outcomes from this survey phase, a number of key stakeholders were identified for consultation. In all, 11 Traveller representative groups and seven local authorities were engaged by the researchers to explore issues arising from the earlier phase of research in greater detail.

Where targets were not met, the review provided an analysis of the underlying reasons, in order to identify the particular challenges that need to be addressed to underpin future progress.

The report was finalised and submitted to the national Traveller accommodation consultative committee, NTACC, for consideration at its meeting on 28 August 2017. The NTACC is a statutorily-appointed committee comprising key stakeholders, including Traveller representative groups, to advise me on Traveller accommodation matters. On foot of its consideration of the report, the NTACC collectively agreed to advise me to establish an expert group to examine and make recommendations on issues regarding Traveller accommodation policy, strategy and implementation. This in keeping with the programme for partnership Government and, as such, I have agreed to proceed with the establishment of the group. I have also agreed that a review of the Housing (Traveller Accommodation) Act 1998 should be part of the work of the expert group. The composition, terms of reference and methodology of the group are currently being formulated with a view to it being put in place as soon as possible. I am happy to engage around that process.

I am aware of the national Traveller survey prepared by the philanthropic organisation, the Community Foundation for Ireland, the work of which I am familiar with in many other cases. The foundation does a great deal of good work and I am happy to engage with it on this also. The survey was not commissioned by my Department and is independent of the Government. However, my Department has taken note of the survey outcomes and, where appropriate, relevant elements of the survey will be taken into account by both my Department and the NTACC in its future Traveller accommodation policy and strategy work. I hope to have an opportunity myself to engage with the authors of the report.

To underline the Government's commitment to providing safe, Traveller-specific appropriate accommodation to members of the Traveller community, €9 million was announced for the delivery of Traveller-specific accommodation in 2017. This was an increase from €5.5 million in 2016. A further €4.22 million will also be paid to local authorities for specific accommodation-related supports under the current budget. These include salaries for social workers employed by housing authorities to engage with Travellers and their accommodation needs, caretaker salaries and site maintenance. Additional funding of €3 million was announced in the budget for Traveller-specific accommodation projects and developments in 2018, bringing the annual allocation to €12 million.

We hope to continue to increase the funding for this area in the years ahead, which is why I welcome the commitment from Deputy Ó Broin and his party to work with us to review the policy and make changes where necessary as well as to ensure that we achieve our targets. I accept that we are going to set higher targets as we allocate more money. I agree with Deputy Ó Broin on that. However, we have to be able to change the way this is delivered to ensure we get the results on the ground across all relevant local authorities. None of us is completely happy that every local authority is playing its part here. It will require all Members working on a cross-party basis to address this and solve the problem. We have a duty to do that. As we discussed earlier, the current element of the budget for this year will certainly be spent. We expect before the end of the year that the full capital spend will be drawn down. It is approximately 67 units out of 90, which means there is a bit of work to do. We hope to get it all spent and fully expect that will happen in the months ahead.

Deputy Eoin Ó Broin

I thank the Minister of State for his reply and acknowledge, again, the commitment we have given to work with the Government on this to ensure we get the right result. I welcome the establishment of the expert group and look forward to the announcement the Minister will make following the receipt of correspondence from the national Traveller accommodation consultative committee. I welcome also the consultation that will form part of the work of the expert group. The membership of the group is crucial in terms of expertise, independence and adequate buy-in from the Traveller community and its advocacy organisations. I know the Minister of State accepts that. I would like to see the Oireachtas housing committee involved in some formal way. We will discuss that at the committee and come back to the expert group and the Minister of State with some recommendations early in the new year.

It is very important that all of this work is done within 12 months. If the group is established before the end of the year and really starts to work next year, not only its report and recommendations but any potential legislative changes should be got through by the end of next year in order that everything is in place as the framework through which the new batch of city and county councillors elected in 2019 will be working. That does not mean we do not have to look very hard at planning permission and the issue of Part 8 provision, in particular for those local authorities which have a long history of failing to adhere to their own obligations. We need to look at greater involvement in decision-making by the Traveller community because they sometimes feel consultation is more of a box-ticking exercise than a real form of decision-making. We must also look at the overall level of funding and move back towards the 2008 level of €40 million.

I welcome the Minister of State's comments on the 2017 spend. I suspect, however, that there will still be local authorities which have not spent any or very little of their allocations while others will have taken up the shortfall. We must get into the business of naming and shaming those local authorities publicly, which is why I have requested the information. Those who are doing a good job should be commended but those who repeatedly fail should be named and shamed so that the public knows who is responsible.

Deputy Damien English

Deputy Ó Broin asked me at the end of his initial contribution about giving the Traveller community full choice, which is something I agree with completely. The Government is committed to enabling all households to access good quality housing appropriate to household circumstances in their communities of choice. It is open to Travellers to opt for any form of State-supported accommodation. Traveller accommodation needs are addressed to a significant extent through mechanisms other than Traveller-specific projects, for example general social housing or the private rental sector with supports such as the housing assistance payment. I accept, however, that while that is allowed for, it does not always happen or is not always easy. We need to improve that choice. It is there but it does not always happen. We need to work on that, which is something about which I also agree with the Deputy. Like members of any community, people want to have a choice, which is what we are trying to achieve through our Action Plan for Housing and Homelessness across all the sectors. People should feel they have a choice no matter what their record, their community, or their age, including people of older years. They have different circumstances and different choices. We all know that choice is very limited for many groups of people due to the pressures on the housing sector. We want to improve on that as well.

The recently completed review of the Traveller accommodation programme gives us the factual information and will be a key platform for the special expert group to progress its work effectively. I agree with Deputy Ó Broin that it is important to get the expert group right. I will take on board any advice in that regard. The process is there at the moment such that names will come back to us. We can then tease through that to ensure we have all the expertise. There is a desire to get this right and find ways to spend our money and increase resources to deliver choice for people effectively and in such a way as to secure value for money for the taxpayer. Every local authority must play its part. That is key. I share that view with the Deputy. I see no reason this cannot happen within 12 months. It is a very long timeframe. We should be able to do it sooner if we can. That will be our target. It would be ideal to have this report and be up and running as soon as we can.

Hospital Waiting Lists

Deputy Billy Kelleher

I raise this issue on foot of the grave disquiet earlier in the year when the "Prime Time" programme, "Living on the List" unearthed the fact that the information on which we depend to know about the varying degrees of lists, the number of people on them and for how long they are waiting is not always collated correctly, efficiently or accurately. I have always said that we are especially good at waiting lists. We have 685,000 people on some list or other in our health services. This cohort is from one half of the population, as the other half has private health insurance. In effect, it is 685,000 people out of approximately 2.3 million or 2.4 million people who depend on the public health system. Clearly, there is a huge difficulty in dealing with patients on waiting lists in a timely, effective and clinically sound manner. On top of that, we are not collating the information correctly.

On foot of the "RTÉ Investigates" programme, the National Treatment Purchase Fund was requested to audit waiting lists and come up with recommendations. The key findings of the audit were exceptional and extraordinary. The hospitals audited did not comply with national protocols on date capture. The audit team found evidence of a combination of non-compliance and inconsistent practices in how date captures were being recorded across all hospitals for outpatient, inpatient, day-case and planned procedure pathways. In some cases, the audit team found evidence of long delays in wait-listing patients, as well as retrospective wait-listing of patients. As a consequence, there were implications for overall waiting list management, including incomplete tracking of patient journeys and incorrect waiting times. All of this resulted in inaccurate reporting of patient waiting times at local and national level.

The audit team observed a number of patients across all hospitals who had been directly listed on an inpatient or day-case waiting lists. The findings are extraordinary in view of the fact that we at least assumed the information we were getting in the Dáil was always accurate as to the number of people on waiting lists and how long they were waiting. It was also assumed that information as to when they were transferred from one consultant to another was accurate. Interestingly, the audit team found evidence that direct listed patients were either referred to the listing consultant by another hospital consultant or community physician, for example a community ophthalmologist, or seen by the listing consultant in another hospital. The audit team observed variation in the management of referrals to ophthalmology services, in particular for cataract surgery.

"Some referrals from community ophthalmologists were accepted onto an inpatient and day case waiting list, by-passing the outpatient service, whilst other patients referred from community ophthalmologists were placed on an outpatient waiting list to be seen prior to listing for their surgery." In that case it was wholly inaccurate:

The Audit Team found evidence of significant variance in the 'date placed on waiting list' as a result of the length of time between receipt of referral and the clinical decision to 'direct' list patients for cardiology and ophthalmology. As a result, there were inconsistencies in how patient wait times were recorded.

This is highlighting the problems. We need to ensure that the recommendations of the audit and quality assurance report presented to the Minister at the end of September, and carried out on behalf of the National Treatment Purchase Fund, NTPF, are implemented and that we can now depend on wholly accurate information when we raise these issues in the Dáil.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I will be taking this matter on behalf of the Minister for Health, Deputy Harris. The "RTÉ Investigates" programme in February highlighted the deeply moving personal stories of people waiting for treatment in public hospitals. Following the programme the Minister was determined that the health service must learn from those patients' experiences. Patients deserve timely, effective and safe treatment from a compassionate and caring health service.

For these reasons, the Minister asked the NTPF to examine waiting list practices in the hospitals highlighted in the programme. The NTPF has now reported to me on its findings and last week the Minister published the findings of the special audit. The NTPF's report has a number of actions to be implemented by the individual hospitals and across the public hospital system as a whole, to drive better performance in how waiting lists are managed in our hospitals. Arising from the audit, the HSE has taken immediate steps to put in place a plan at national level that will focus on driving system-wide implementation of performance and process improvement in waiting list management.

As part of this plan, the HSE will assess, review and oversee implementation of performance and process improvement to address the special audit findings across all hospitals. Addressing the special audit report's recommendations will also be a priority for the HSE for the remainder of the year and will form a core pillar of the waiting list action plans for 2018 as well as the HSE's national service plan. In addition, the Minister has asked the NTPF to develop a plan to extend the special audit process in 2018 to other public acute hospitals.

The Government's commitment to addressing waiting times is clear. Funding of €20 million was allocated to the NTPF in 2017 for waiting list measures and for three months in a row we have seen reductions in the total numbers of patients on the inpatient-day case waiting lists. To continue this strong focus on waiting lists, €55 million will be allocated to the NTPF in 2018 for waiting list measures and a further €10 million will be made available to the HSE for waiting lists, including scoliosis and paediatric orthopaedics.

Addressing waiting lists is, however, not only a question of funding. Since the "Living on a List" programme, several initiatives have been under way to reform and improve how our health service manages hospital waiting lists. These initiatives seek to drive sustainable, multifaceted and innovative approaches in waiting list management. These include a range of initiatives including a study ongoing by the NTPF working with Trinity College to examine international best practice in how waiting list information is collected and reported, and progressing towards more integrated approaches in waiting list management at hospital group level as part of the feasibility study recently carried on by the NTPF. In addition, the HSE is undertaking a national waiting list validation project run by the HSE, to improve the quality of our waiting lists and get an up to date picture of how many patients are actually waiting for care so that the hospitals can plan better and manage waiting lists more efficiently. Initiatives are also ongoing to develop capability in our hospital system in waiting list management best practice and to utilise technology to best effect to support more responsive, effective and efficient waiting list management. The Minister is committed to the idea that the health service learns from the NTPF special audit and the experiences of the patients concerned in order to improve services for all patients.

Deputy Billy Kelleher

The key recommendations are the important points in this report. Having unearthed what it did we need to address that. The heading "Date captures along the patient journey" is critically important. Under "Direct referral/direct listing of patients onto an inpatient and day case waiting list" it states: "The current pathways for managing patients who are 'direct' listed either as a result of a 'direct' referral from another hospital consultant, community physician or having been seen by the 'listing' consultant elsewhere should be reviewed by all hospitals." That must be carried out immediately. As a Deputy the Minister of State knows that when clinicians write "urgent" on a list it is meaningless. I know of people being marked "urgent" for a hip or knee replacement who have to drag themselves around their kitchens and put rails in their houses so they can move around them. There have been amazing instances of people being referred as "urgent" by their physician or their general practitioner which the system parks on a waiting list like any other. We are debasing the word "urgent". More important, we are debasing the patients who need this urgent treatment or diagnosis. "Clinical Prioritisation" is recommendation No. 3: "All hospitals should review their systems tracking capability to ensure that revisions to clinical priority are clearly documented and are visible from a waiting list management perspective." That is a fundamentally important recommendation in this report, that they be clearly visible so the system will highlight clinical priorities which are deemed urgent, and that clinically urgent requirements do not get lost in a black hole. I urge that this recommendation be prioritised.

Deputy Catherine Byrne

I agree with Deputy Kelleher that when information comes to the Dáil it must be correct because we can only act on correct information. He is right to highlight the fact that some of the information we received in the past was not as clear as it should have been. Many of those who work in the health service, clerical staff, doctors and nurses, do their jobs very well but only when proper management and chief executive officers are in place can any hospital function properly. It is up to the board and management of the hospital to make sure that things are in order. The audit and the RTÉ programme truly identify the need for all hospitals to provide correct information.

I appreciate Deputy Kelleher's knowledge and his recommendations based on the audit. I spent some time with him on the Oireachtas health committee and he was always very straight in bringing issues to the fore. We all know there are many cases around the country where personal stories have been highlighted and have in many ways clarified for those of us in government and in other parties how important it is to act on emergencies. I have taken note of Deputy Kelleher's concerns and will highlight them for the Minister who may give the Deputy a response to some of them.

Health Services Provision

Deputy Danny Healy-Rae

I thank the Leas-Cheann Comhairle for allowing me to highlight Parkinson's disease and the need for services for those who have developed this disease and especially for the carers and family members who have to help them. Parkinson's is a progressive neurological disorder caused by the shortage of the chemical dopamine in the brain. The diagnosis of a serious movement disorder can be very challenging. It presents those affected with numerous emotions and obstacles and a combination of solutions are required, including care, support and information. The management of common chronic diseases, such as Parkinson's, is now one of the most significant challenges our health care system faces. It requires us to find ways of providing health care services to help patients and their families.

I hope that events such as this help to highlight the need for funding and services to be provided so that the patients can be partners in the management of their condition and cope better with it. We know of almost 12,000 patients in the country, and approximately 600 of these are in Kerry. In 2016, Dr. Richard Walsh, a consultant neurologist in Tallaght hospital, published a landmark Irish study on Parkinson's disease in partnership with the Parkinson's Association of Ireland. The study showed that the number of people living with the disease in Ireland is predicted to double over the next 20 years but treatment in Ireland is shamefully well below international standards.

Older people are some of the most vulnerable people in our society. We have a large population moving into advancing years and living longer, which would give rise to a surge in Parkinson's diagnoses over the next 20 to 30 years. It is critical that those of us in public life do our utmost to address the deficit in services for those with Parkinson's.

A significant issue facing those with Parkinson's disease is the number of Parkinson's nurse specialists in Ireland. We have five but the recommended number is between 27 and 30. I remind the Minister of State that three of those nurse specialists are in Dublin and the other two are for the remainder of the country. I ask the Minister of State to provide nursing specialists distributed fairly throughout the country. We should have two in Kerry but we are well entitled to have one.

Another issue is to secure an all-Ireland deep brain stimulation service. Deep brain stimulation is a device-aided therapy involving an implant into the brain. The Oireachtas Joint Committee on Health reviewed this and recommended a link with Northern Ireland to provide the surgery, with the Mater hospital in Dublin providing aftercare. This would mean we would need more buses like those for people going for eye and cataract treatment in the North but so be it. Will the Minister of State provide these therapies which we need?

Deputy Catherine Byrne

I thank Deputy Healy-Rae for raising this very important issue of support for sufferers of Parkinson's disease. It is estimated that 700,000 persons in Ireland are affected by neurological disease, 6,000 of whom have been diagnosed with Parkinson's disease.

Working in collaboration with consultants, nurses, health and social care professionals, patient support groups, patients and carers, the national clinical programme for neurology has developed a model of care to address the need for the strategic development of neurology services. The model of care, which was published in 2016, details a number of care pathways, one of which is the pathway for patients with Parkinson's disease.

The patient pathway for Parkinson's outlines that the nature and severity of the symptoms of Parkinson's disease and the rate at which it progresses will be individual. Symptoms may take years to progress to a point where they cause major problems. Drugs are the main treatment to help control the symptoms of Parkinson's disease. These treatments are most effective when supported by access to multidisciplinary input from health and social care professions.

With regard to nursing, the patient pathway also sets out the role of the clinical nurse specialist in the management of patients with Parkinson's disease. This includes assessing the person with Parkinson's disease and identifying their needs, developing care plans and monitoring symptoms as well as providing lifestyle support. As with all service developments, the implementation of the neurology model of care, including the Parkinson's patient pathway, will be addressed in the context of competing priorities for the limited service development funding.

The Health Service Executive funds a range of community services and supports to enable each individual with a disability, including persons with Parkinson's disease, to achieve their full potential and maximise independence, including living as independently as possible. Services are provided in a variety of community and residential settings in partnership with service users, their families and carers and a range of statutory, non-statutory, voluntary and community groups. Services are provided either directly by the HSE or through a range of voluntary service providers. The range of services provided includes assisted living services such as personal assistant and home support services.

The Government is committed to protecting the level of personal assistant and home support services available to people with disabilities. In 2017, the HSE's priority is to provide 1.4 million hours of personal assistance to more than 2,000 people with disabilities, which is an increase of 100,000 hours over the 2016 target. In 2017, the HSE will also provide 2.75 million hours of home support to adults and children with disabilities, an increase of 150,000 hours over the 2016 target.

Therapy services for adults and children are generally delivered through primary care teams or community therapy services through specialist disability providers. People with disabilities may also be eligible for medical or surgical aids and assistive devices that facilitate and maintain mobility and functional independence. People with Parkinson's disease can benefit from therapeutic assistance, including physiotherapy, occupational therapy and speech and language therapy as well as a range of medical interventions.

I assure the Deputy that we are aware of the challenges facing people with Parkinson's disease and the Department of Health continues to work with the HSE to ensure the delivery of services to meet the needs of these patients. I will come back to the Deputy on some of the questions he has raised.

Deputy Danny Healy-Rae

Only 3% of Irish Parkinson's patients have access to deep brain stimulation, which is established as a standard treatment for patients with medication frequency issues. Therefore, the implementation of the neurorehabilitation strategy is critical to people with Parkinson's. This strategy was published in 2011 but there is still no implementation plan in place. There is a commitment in the programme for Government to publish an implementation plan, but investment will be critical and we need investment in this area. Ireland has less than half the number of rehabilitation beds that we need for our population. We have the lowest number of consultants in rehabilitation medicine in Europe. This is completely unacceptable.

With regard to Parkinson's nurse specialists, there are only five in the country and three of these are in Dublin. I ask the Minister of State to think about this. There is one in Limerick, one in Galway and three in Dublin. I ask the Minister of State to provide this service for all of the patients throughout the country on a fair basis. I am asking especially for Kerry. It is up to every Deputy to stand up for his or her own community. I am standing up for the people of Kerry and I thank those in the local branch of the Parkinson's association in Kerry. Its president is Grace McCrae, and Connie Dillon and Brenda Edmonds are also involved. Dr. Helena Moore, a neurologist in Tralee, does tremendous work for all of the Kerry patients who come to her.

This is a serious problem. These are people in trouble. It is not a reversible disease. Once someone presents with it, it progresses and get worse and worse day by day. I ask the Minister of State please to take this to the Government and work to ensure we get fair play for people who present with this disorder.

Deputy Catherine Byrne

I thank the Deputy. With respect to the Deputy and his devotion to the people of Kerry, he is always in the Chamber speaking about his constituents. We all have constituents. I know how when people have Parkinson's it affects not only the individuals, but their families. In saying this, I am sorry some of the statistics do not cover Kerry in particular, about which the Deputy is speaking, and I will ask that further details can be given to the Deputy. I have taken note of the fact he has said there are only five nurse specialists in the country, with three of them in Dublin and two in the rest of the country. This is something that needs to be addressed.

With regard to deep brain stimulation, I was a member of the health committee for a long time. I remember being at two or three meetings where individuals who had undergone the procedure came before the committee.

I was really struck by the fact that many of these people came on so well after they had deep brain stimulation procedures. I will raise this matter with the Minister and ask him to come back to the Deputy on it. I have taken a number of other notes that I will decipher when I go back upstairs. I thank the Deputy again. I will raise all the issues he has brought to my attention with the Minister.

Dáil Éireann debate - Wednesday, 15 Nov 2017