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Dáil Éireann debate -
Wednesday, 2 May 2018

Vol. 968 No. 4

Topical Issue Debate

Traffic Management

The Minister is welcome and I thank him for attending. I know he makes a point of attending for Topical Issue matters and it is very much appreciated.

The M50, the major ring road around Dublin carrying between 100,000 and 150,000 cars every day, is at a standstill at peak times. Accidents that happen cause complete logjams and backlogs and affect both sides of the road, feeder roads and motorway junctions, including those for the M5, the M6 and M1, and have a serious impact on the commuter belt as drivers come into Dublin. In a reply to a parliamentary question some time ago, the Minister said that congestion is estimated to cost this economy some €350 million per year and the figure is growing, not to mention the impact on people's mental and physical health of just sitting in a car or a commercial vehicle for long periods during the day, or the logjam it causes in residential areas which feed into the M50.

That is the problem. However, the answer to the question as to what is the Government's range of solutions is "zero" as of now. All the Government's projects are focused on Project 2040 and no projects are planned for 2018 or 2019 that would relieve traffic congestion on the M50. There is no project to relieve the standstill which people are experiencing. One of the things that was missing from Project 2040 is the eastern bypass, at which we must look again. I am not a major proponent of building huge roads again but that one is the last piece of the jigsaw around Dublin and it needs to be looked at in a serious way. I await the Minister's response.

The Minister is as well aware of this issue as anyone else as congestion on the M50 features regularly on radio and news bulletins. Rush hour on the M50 is now 7 a.m., not 8 a.m. or 9 a.m., such are the volumes of traffic. It is not just the M50 but the feeder roads and their interconnectivity which are affected. Last Friday a truck was involved in an accident on the N4 but it resulted in considerable tailbacks on the M50, as far as Ballymun in one direction and Tallaght on the other side. That is an indication of the scale of the problem and the reliability of transport on the M50.

The Minister has previously said that the increase in traffic volumes is as a result of the economy growing and I do not disagree with him on that. The NTA indicated that, in 2016 and 2017, the volume of traffic on the M50 rose by 16%, which is very substantial. By most analyses, the volume of traffic we are experiencing on the M50 today is at a level anticipated by 2023. The challenge is to introduce measures to alleviate the congestion people endure on a daily basis, both on the M50 and on the feeder roads onto and off it, which are all interconnected. It was interesting to see that even a minor issue such as a small breakdown, rather than a fatal or multi-car accident, can bring everything to a standstill.

I am not asking the Minister about the long-term plans he has published for 2040 but about steps we can take in the next year or two to address congestion on the M50 and have some short-term impacts.

I thank the Deputies for the opportunity to address this issue in the House today. It is not the first time it has been raised and I readily acknowledge that this is a constant problem that causes a great deal of difficulty for commuters. I fully recognise the pressures on transport infrastructure in the greater Dublin area, including the M50. Since completion of the major €1 billion upgrade of the M50 in late 2010, annual traffic growth on the route has increased at a typical rate of 6% per annum in line with increased economic growth.

More than 170,000 vehicles per day are now using the busiest sections and in excess of 420,000 vehicles use some part of the M50 daily. Transport Infrastructure Ireland, TII, along with other stakeholders, is continuing to implement a number of measures on the M50 to manage demand and optimise operational efficiency, including: changes to merge and diverge layouts at junctions; the introduction of permanently signed emergency routes; increased incident access points; increased provision of incident response units; and enhanced interagency co-ordination to improve incident management.

Traffic incidents which obstruct running lanes are a significant contributor to commuter delays, with 1,429 incidents occurring in 2017 on the M50, over half of which occurred during rush hour traffic. TII's incident response service resolves traffic incidents on the M50 as quickly as possible. The average response time for the M50 in 2017 was approximately 12 minutes. TII has also established a project team to manage the development of a programme for enhancing motorway operation services, which involves the implementation by 2020 of traffic control measures on the M50, including variable speed limits and dynamic lane closures. The aim of this programme is to improve operational efficiency by smoothing traffic flow, improving journey time reliability and reducing the number of secondary traffic collisions.

In so far as congestion issues in Dublin are concerned, the National Transport Authority, NTA, has overall responsibility for the implementation of its published transport strategy for the greater Dublin area, GDA. Congestion is not confined to a single corridor in the Dublin region and it cannot be solved by focusing on just one or two corridors. This GDA transport strategy provides a framework for the planning and delivery of transport infrastructure and services in the greater Dublin area over the next two decades. The strategy sets out a range of measures, including public transport investment and demand management measures, particularly in relation to the operation of the M50, which would reduce the time spent travelling on the network and alleviate congestion. The measures proposed in the strategy are linked to an analysis of current and projected levels of travel demand across the region. While the management of the M50 falls within the remit of Transport Infrastructure Ireland, an interagency approach which includes Tll, the NTA and the relevant local authorities is required to achieve this.

The national development plan, which was launched earlier this year by Government as part of Project Ireland 2040, identifies a number of key public transport priorities including the BusConnects programme, MetroLink and the DART expansion programme. These will be delivered by the NTA progressively and steadily over the short, medium and long term, to deliver a comprehensive public transport network to match transport demand, alleviate congestion, provide an alternative to private car use and deliver a range of benefits over the next decade. This will ensure that an integrated approach to the management of travel demand on the M50 corridor and connecting national roads, combined with the provision of alternative transport modes, is pursued such that the M50 is allowed to function for its primary intended purpose as a national road which caters for predominantly non-local trips of high economic value.

The Minister's response was focused on Project 2040 and big projects and he did not even mention the air and noise pollution impact on people who live along the corridors. There is no public transport using the M50 and it must be the only city motorway in the Europe that does not have public transport corridors or separated public transport corridors. There are no park and ride facilities on the major junctions along the M50 where people could park and avail of public transport, and no major employers have been issued with bus licences that could help ferry their employees to work and reduce their reliance on the M50. There are no measures for the next year or two.

I am alarmed to hear the Minister talk of "demand management measures". That is a reference to tolling. Is he saying the Government approves of and supports additional tolling along the M50? That would have a catastrophic impact on the residential and suburban areas which feed onto the M50.

The first issue in the Minister's response was traffic control measures in 2020. He said a team was engaged on this but we would like to see the detail of this because 2020 is not that far away. He also said the M50 needs to be allowed to function for its primary intended purpose as a national road which caters for predominantly non-local trips of high economic value.

We have missed that boat in the sense that Dublin has grown beyond the M50, significantly so. If that is the objective the Minister has in mind, an outer ring road needs to be developed because the M50 has become an integral part of city life in Dublin and can no longer serve that objective. As long as that remains the objective, we will have congestion on the M50 and the roads that connect to it. I urge the Minister to give consideration to the development of an outer ring road.

On the issue raised by Deputy John Curran, we do not intend to develop an outer orbital route. It is not in our plans and not feasible. The National Transport Authority's greater Dublin area strategy does not include such a project because it would be incredibly expensive. It also recommends protection of this corridor.

The suggestion made by Deputies John Lahart and John Curran that everything I mention is Project 2040 focused is somewhat unfair. It is the nature of government and opposition that the former will always look for long-term alleviation measures and the latter short-term alleviation measures. It would be absurd for me to say I have a short-term solution to the problem of congestion on the M50 because I do not. Congestion on the M50 will continue in the short term. We have introduced a number of measures to alleviate it which I have outlined and intend to introduce many more which are not Project 2040 orientated. For example, the Luas cross-city service, which is carrying an extra 10 million passengers per year, will alleviate traffic congestion to some extent. BusConnects, in which we are investing €750 million plus, will commence operations next year, while MetroLink, on which work will commence in 2021, will be operational in 2027 which is a long way from 2040. We have already extended the Luas service and propose to introduce further park and ride facilities. We have introduced a number of measures, but we also have plans up to 2027 to remove thousands of people per day from their cars. I am not suggesting there is a panacea to traffic congestion on the M50. We have to optimise its use, but we are dong what is necessary to get people out of their cars onto public transport, which would automatically lead to a reduction in congestion on the M50.

Does the Minister support tolling?

We are moving to the second matter in the name of Deputy Pearse Doherty.

Health Services Staff Recruitment

Gabhaim buíochas leis an gCeann Comhairle as ucht an deis labhairt ar an cheist thromchúiseach seo agus an ghéarchéim atá ann ó thaobh seirbhísí diaibéitis san iarthuaisceart a phlé sa Teach inniu.

I welcome the opportunity to refer to the ongoing crisis in diabetes care services in the north west. I use the term "crisis" in its truest sense because that is exactly what it is. The latest HSE data for patient care and waiting times in Letterkenny University Hospital show the true extent of the crisis. For example, adults with type 1 diabetes continue to wait for up to one year for routine appointments and up to two years for follow-up appointments, despite the HSE guidelines recommending that patients with type 1 diabetes be reviewed every six months. We all know that in comparison with the general population patients with diabetes are at a significantly greater risk of developing one or more severe health complications owing to their condition. Without a doubt, these figures make for harrowing reading. Cardiovascular disease, reduced kidney function, uropathy, eye damage and amputation are some of the many complications associated with the condition if symptoms go unchecked. Given that all of this is avoidable with appropriate and timely medical intervention, it is reasonable to assume that given the delays, patients in counties Donegal, Leitrim and Sligo face a heightened risk of suffering from such complications.

Serious resource and staffing problems continue to go unsolved throughout diabetes services in the north west, including in paediatric, transitional and adult diabetes care services. With reference to adult care services, a second additional full-time endocrinologist post remains unfilled, despite the fact that it has been sanctioned by the HSE advisory committee. Similarly, parents and advocacy groups have expressed disappointment that the vacant consultant post at Sligo University Hospital is unlikely to be filled by a consultant paediatric endocrinologist to complement the diabetes services provided in the hospital. At Letterkenny University Hospital, while long overdue efforts are being made to recruit additional dieticians, there is still no sign of a dedicated post for diabetes care. I take no pleasure in reminding the House that despite many commitments made by the Government and the Minister for Health, the Saolta University Health Care Group remains without a centre of excellence for diabetes care.

Why are patients in the north west less entitled to these services than their counterparts in the rest of the State? This is postcode healthcare. The people of County Donegal and the north-west region are supposed to feel grateful for the few services offered to them and happy with their lot, but they are not. They are not happy and are standing up and demanding that the Government take action and provide the centre of excellence, the additional full-time endocrinologist, the second post in Sligo University Hospital and that it ensure there will be investment in pump therapy and other areas of diabetes services required for patients in the north west.

This is about saving lives and improved healthcare outcomes. It is also about saving financial resources for the HSE. What action does the Minister propose to take? I demand that the Minister of State, Deputy Jim Daly, responds positively to the lack of diabetes services in my home county which has result in people waiting for two years for a follow-up appointment. It is unacceptable that they have to wait that length of time for an appointment.

I welcome the opportunity to address the House on this issue on behalf of the Minister for Health, Deputy Simon Harris. I am aware that Deputy Pearse Doherty has some concerns about the resourcing of diabetes care services in the north west. However, he can be assured that this is a matter the Department, the HSE and the Saolta University Health Care Group are addressing through recruitment and the provision of extra resources in the north west.

I understand there is a high demand for the services in the north west due to the elderly population. However, steps are being taken to address this requirement. In Letterkenny University Hospital additional registrar support has been assigned to support the monthly endocrinology clinic. In addition to this extra support, a number of diabetes related posts have been filled in Letterkenny University Hospital. A consultant endocrinologist and a team supported by a consultant physician, with extensive endocrinology experience, have been recruited. Full-time podiatry cover and a clinical nurse specialist have been appointed, in addition to an advanced nurse practitioner in training for the paediatric diabetes service.

Further enhancements are planned to address diabetes care services in the north west. Additional posts have been advertised to be filled in Letterkenny University Hospital. A dietician post is being processed by the national recruitment service for appointment, while recruitment of a consultant endocrinologist, a clinical nurse specialist for paediatric diabetes and to another position in the adult service is ongoing. Diabetes services are also being advanced at Sligo University Hospital. Having raised the issue with the Saolta University Health Care Group, the Department of Health has been informed that the procurement process for the diabetes day unit in Sligo University Hospital is under way and the HSE has advised that construction of the new diabetic centre will take place in 2019.

On diabetes care services for paediatric patients across the group; a paediatric insulin pump service was initiated in May 2015. This service is based in Sligo University Hospital, with outreach clinics in Letterkenny University Hospital. A locum paediatrician is providing the service in counties Sligo and Donegal, with the permanent post to be advertised in the coming months. In Galway University Hospital a paediatrician is due to take up a post shortly. Diabetes care services are not only provided in an acute care setting; GPs also provide a diabetes cycle of care in the north west. In October 2015 a structured diabetes cycle of care was introduced for adult medical card and GP visit card patients with type 2 diabetes. The cycle of care enables qualifying patients who are registered for the service to avail of two annual visits to their GP for a structured review of their condition.

This initiative aims to improve clinical outcomes for patients and reduce complications often experienced with this condition. To date, almost 100,000 patients have been registered nationally for the diabetes cycle of care by their GP.

I am aware of the current situation for diabetic care services in the north west and that the Department of Health is monitoring the situation. The Minister notes that the HSE and the Saolta University Healthcare Group are carrying out a broad range of measures in order to improve diabetic care services across the north west.

The Minister of State has informed me of what is happening, and some of that information when it is put together in two pages might sound grand, but let me inform him about what is happening on the ground. There is a one year wait for an initial appointment and a two year wait for a recall appointment. There is a reason why the HSE says that a diabetic patient should be recalled every six months. In a four year period this would be eight check-ups if one lives in Cork, Dublin, Waterford, Louth, Monaghan or any of the other counties outside of Donegal, Sligo and Leitrim. If one happens to live in our region of the country, in the same period a patient only gets two check-ups, if he or she is lucky. The list is getting worse and the length of time is getting worse. We all know. We can talk about health budgets and the amount of money that is spent on treating conditions resulting from diabetes, which is substantial. We know that prevention is better than cure. There are serious consequences, which I outlined to the Minister of State, and the Government is allowing patients to have worse health outcomes because they happen to be born in or live in Donegal and the Government has not sanctioned the necessary personnel in time to deal with their care.

There is nothing in what the Minister of State has said that gives me any type of reassurance that the people I deal with daily in Donegal will get recall appointments anytime sooner than two years. The second endocrinologist post was not even mentioned. The Minister of State, Deputy Daly, spoke of a position in Galway but the vacant position in Sligo was not mentioned in the Minister of State's response, nor was the centre of excellence, which the entire Saolta region does not have. When will the people of the north west, the people in my region, be respected by the HSE in providing these services? Imagine if this was my son, my daughter or my wife but because a person lives in a certain part of the State they would get worse care and, therefore, worse outcomes in managing a disease that is manageable if the personnel are available.

The advocacy groups met with the Minister. I was there along with other Deputies. We heard all the promises, all the good words and so on. It has not, however, materialised. We need action now. I ask that the Minister of State takes it away and speaks with his officials in the HSE, to ramp up the pressure so we can have real delivery and so we can see the waiting times that are currently going in the wrong direction reversed and put back in the right direction.

I thank the Deputy for his contribution. We are working against a backdrop of an increasing prevalence of diabetes in the community. The diabetes programme established the national diabetes working group with the joint involvement of health care providers in primary, secondary and tertiary care sectors to devise methodologies for caring for these patients. The HSE national clinical programme for diabetes, led by Professor Seán Dinneen, has also established a guideline development group, which is chaired by Dr. Kevin Moore and includes two patients' representatives. I appreciate that some of the national steps will take time to work their way into it, but I assure the Deputy there is recognition of the challenge being presented and there is acknowledgment of the difficulties that exist in the Deputy's area. These challenges are not unique to the Deputy's area but they certainly exist in his area. I will do what the Deputy has asked. I will return, through my Department, back to the HSE to increase the pressure on the management of that service to ensure it is getting the optimum attention from the highest levels within the HSE to address those waiting lists and to address the shortcomings that are in the service, especially around speeding up recruitment. I will certainly do that for the Deputy.

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