Dáil Éireann debate -
Thursday, 17 May 2018

Vol. 969 No. 3

Topical Issue Debate

Water and Sewerage Schemes

Deputy Tom Neville

My background is as a local councillor. I was first elected in 2004, having been co-opted in 2003. In my native county of Limerick, with the economy of that time, a number of sewerage schemes were bundled together, un-bundled and then re-bundled again. There was a lot of to-ing and fro-ing between the Department and the council in respect of developing wastewater and sewage systems in our towns and villages. Much of this was driven by the drive for development at the time but there was also a need to upgrade these schemes. Now we are moving into an economic climate of seeking more housing and development. I welcome the initiatives that have been started by the Government. I welcome that the number of commencement notices and planning permissions in the private sector have increased. We need to do more because the demand for housing is extremely high at the moment. Coupled with this, we need to be looking at towns and villages in rural Ireland.

I refer particularly to strategic towns and villages within rural Ireland and in County Limerick that are on infrastructural routes. One town on which I have been working and that has been mentioned quite a bit is Askeaton, County Limerick, and another is Hospital, County Limerick. These towns are at capacity and cannot expand further without upgrade of the sewerage schemes. Putting the onus back on the private developers could put them off taking the risk to further develop housing. It is a chicken-and-egg situation. The Askeaton sewerage scheme was built some time in the 1940s and was to cater for 550 people. The 2011 census showed a population of about 1,150 there, which is double what it was. That has put huge strain on the existing sewerage system.

The local councillors have been writing to me about the problems that are arising in that town through Limerick City and County Council, which was my municipal area as a councillor. This issue has come with me since my time on the council. This also comes from constituents at particular times of the year, particularly after a heavy deluge of rainfall. Whether it is global warming or something else, we have seen more moisture and precipitation than usual over the last years, particularly during the fodder crisis this year. That is putting extra pressure on the sewerage scheme.

The Askeaton local area plan produced by Limerick City and County Council in 2015 states that the existing wastewater plant is overloaded and has been for some time. The system is currently failing to meet obligations under the EU directives such as, for example, the urban wastewater directive. Background levels of phosphorus in the Deel continue to exceed the limits of the surface water regulations. Preliminary studies for the council have identified the need for a new treatment plant and upgrade of the sewer network. Plans for the construction of a new wastewater treatment plant were included in Irish Water's capital investment programme for 2014 to 2016. Askeaton's competitiveness as a place to invest, locate business and sustain a good quality of life for a growing population is dependent on high-quality infrastructure including wastewater disposal. The council states that it will work with Irish Water to improve the primary discharge into the River Deel. It stated that all future development would require separate foul and surface connections to the appropriate collection network in compliance with the Department.

I ask the Minister of State to prioritise Askeaton in respect of wastewater treatment work. I have some other clarification issues to raise, particularly around the prioritisation of this work now that we have moved on to Irish Water.

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

I thank the Deputy for raising the issue of the upgrading of rural town and village schemes to further housing development. The Deputy highlighted the importance of doing this, particularly in Askeaton in his native county of Limerick. This is something on which we must focus if we are going to achieve our housing targets and get construction going again in the parts of the country where it is needed. Under Project Ireland 2040 and looking ahead, we have to invest money in water and wastewater infrastructure if we are to achieve our regional targets and get the regional balance we want in housing development, as well as jobs and so on. It is important that Limerick would be a major part of that space as well.

Since 1 January 2014, Irish Water has statutory responsibility for all aspects of water services planning, delivery and operation at national, regional and local level. Irish Water as a single national utility is taking a strategic nationwide approach to asset planning and investment and meeting customer requirements. Investment in water services is a key factor in enabling proper planning and sustainable development in physical and economic terms and in national, regional and local contexts. Towns like Askeaton are a major part of that. Irish Water is proposing to invest in a range of programmes that will support growth at national, regional and local levels. Irish Water will also play a key role in implementing Project Ireland 2040, which incorporates the national planning framework and the national development plan.

Irish Water's water services strategic plan, WSSP, sets out the strategic objectives for its delivery of water services over 25 years up to 2040 to ensure the provision of clean safe drinking water, the effective management of wastewater, environmental protection and support for social and economic development. The Irish Water business plan, "Transforming Water Services in Ireland to 2021", sets out its short to medium-term planning in implementing the first phase of the water services strategic plan. While the Irish Water business plan sets out the planned level of operational and capital expenditure over this period, the actual allowed operational expenditure and capital investment is decided on by the economic regulator, the Commission for Regulation of Utilities, CRU. To this end, Irish Water submits a water charges plan based on the WSSP and a business plan for given regulatory periods to the CRU. Irish Water also developed an investment plan based on a five-year investment planning horizon from 2017 to 2021, which aligns to the WSSP and the seven-year business plan 2014-2021.

Irish Water must optimise investment decisions to ensure that it utilises scarce capital by making investments that deliver the best possible service improvements while maximising value for money and should undertake this in conjunction with the local authority in each area. In the case of Limerick, the link-up with Irish Water would be very important for key sites and areas of towns and villages that have to be developed. A substantial proportion of investment by the State through Irish Water over the next ten years will be focused on programmes to improve compliance with relevant public health and environmental standards. This will involve implementation of the measures contained within the river basin management plan for Ireland 2018 to 2021 and the achievement of the outcomes identified. Through Irish Water’s capital investment plan, it is implementing the capital investment programme, which prioritises investment decisions to ensure it utilises available funding most effectively by making investments that deliver the biggest benefit while maximising value for money.

One of Irish Water’s key goals is that the same standard of service for water and wastewater will apply no matter where someone lives in the country. Achieving this objective will take time in accordance with the varying condition of the assets. Certainly, in the case of Askeaton, where a system was put in place for 550 people and where there is now double the population, it is certainly an area that needs to be addressed. I will raise the specifics of the two towns the Deputy has mentioned directly with Irish Water to get a more detailed response for him.

Deputy Tom Neville

I thank the Minister of State and wish to share some more information with him. Irish Water stated to me in June 2017 that it completed a concept design study recommending a preferred solution for Askeaton sewerage scheme. The project had just received approval to proceed to the next stage, detailed design and planning, which was to be undertaken over the following 12 to 18 months. Could the Minister of State get some timelines from Irish Water in that regard? Is it going to make a decision within the 18 months? Is the design and planning phase going to be completed within 18 months? The language is quite ambiguous. Do we have to wait until the design phase is over before we can hunt for a budget for this project?

We have been told it is not part of the 2017-2021 priority list which I believe it should be, given the criteria outlined by what I have read from the local area plan from Limerick County Council before Irish Water took over in 2014. Askeaton will be a spur off the main Limerick to Foynes motorway which will be built and which will include the Adare bypass. This is a strategic town which sits along the Shannon estuary and where several multinational industries are located. Several days ago, the expansion of Foynes Port was announced. It is an EU tier one port which can take the larger container ships being built and can compete with many ports across the world. The motorway is being developed there and Askeaton sits just off that. One is looking at developing these towns which will facilitate the major natural resources of Foynes Port. There is synergy developing in Askeaton. We need to get the town’s water and sewerage schemes along with this.

Deputy Damien English

I thank Deputy Neville for the information he has provided on the importance of Askeaton and other areas in County Limerick. It is important when Irish Water is rolling out its investments, it does so in collaboration with local Oireachtas Members and councillors. It has to take cognisance of the national planning framework, the national development plan, the forthcoming regional and spatial economic strategies, as well as the ongoing reviews of the county and local area development plans. When we are trying to roll out long-term plans for housing, we try to match the services needed, such as health and education services, in a planned way.

There is much ambition for Limerick county and city to develop and take its fair share as a region. We want to rebalance development from the east coast. It is important Irish Water bears that in mind when deciding its investment strategies. The updated Limerick county and city plan will fit into that, along with the regional strategy. It is important local Oireachtas Members are consulted. I will ask the Irish Water team to deal with the Deputy specifically on this case. Neither I nor the Minister, Deputy Eoghan Murphy, actually picked the different places for investment. However, it is important Irish Water does that in collaboration with Deputies who know what is going on in the areas and matches up the plans. We meet people every day who want to provide public or private housing. We need to make sure the infrastructure is in place to make that happen. If we do not, we cannot reach our targets in Rebuilding Ireland or Ireland 2040. The Deputy made submissions to Ireland 2040. There is much ambition for both Limerick city and county in those plans. We can only achieve those plans if we provide water and wastewater infrastructure, along with other required services. I will make sure the Irish Water team gets in contact with the Deputy on timelines and future plans on this issue.

Services for People with Disabilities

Deputy Joan Collins

I am disappointed the Minister of State, Deputy Finian McGrath, is not here to take this Topical Issue matter. However, the St. John of God special school in Islandbridge, providing services for children with profound disabilities, is in the constituency of the Minister of State, Deputy Catherine Byrne. I know she will be interested in what has come out about it over the past few days.

On Monday, Emma O'Kelly gave a report on “Morning Ireland” about three parents and their children who attend the school. One mother, Christine, has an eight-year-old son who attends the school and who is both deaf and autistic. She is a lone parent who lives in Dolphin House. Her son is non-verbal, wears nappies and has received no services or therapies in the past two years. He needs supports for washing, dressing, toilet training, etc.

Sarah and Fabrice's son, Joseph, 17 years of age, has been four years in the school. He has received no services. He needs speech and language therapy, as well as occupational therapy. He was receiving them from the HSE but is not now. Once one goes into a service like St. John of God, the HSE expects the service to provide them. Sarah described the situation like a ping-pong ball. One service blames the other and no one seems be able to get to the nub of the problem, namely, that there are no services. They are currently paying €2,500 per year for speech and language therapy. Fabrice said he can afford to pay but the lack of service discriminates against those like Christine who cannot afford it. Why are their children's needs being outsourced to a private charity?

Catherine Lyons, secretary of the parents' committee, said no therapeutic services are provided. This year's school leavers have never received therapy. She says they are in limbo and are the lost children. That is a terrible description for a parent to have to use about her child.

When Emma O'Kelly asked St. John of God services how many speech and language therapists were available at the school, she was told none in the past two years. She said she has seen in writing that it has been for the past three years while parents say it has been for the past four years. On occupational therapists, St. John of God said it took a consultation approach to 11 of the 92 children. That is not a service. That is just paying lip service to it.

The parents' committee did a comparison of services provided by the school in Islandbridge and St. Augustine's school in Blackrock. It got this information from genuine sources. St. Augustine's has two speech and language therapists working exclusively in the school while Islandbridge has two speech and language therapists shared with 500 people in the south-west Dublin area. St. Augustine's has two social workers working exclusively in the school while Islandbridge has an emergency social work clinic for two hours a week. Blackrock has two psychologists working exclusively in the school while Islandbridge has one psychologist shared with St. John of God Menni Services. St. Augustine's has one school nurse while no such service is available in Islandbridge. St. Augustine's has 26 vocational instructors funded by the HSE through St. John of God community services. Pupils are supported for three years after leaving school in Blackrock. In Islandbridge, no such service is provided. Six modern houses providing residential services, Monday to Friday, funded by the HSE through St. John of God community services, are provided in Blackrock while there is no such service in Islandbridge. An after school independent living programme from 3 p.m. to 9 p.m., Monday to Friday, is provided in Blackrock while in Islandbridge, there is no such service. An extended school day for pupils in their final two years in Blackrock is provided while in Islandbridge, no such service is provided. That tells a stark story.

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

I thank Deputy Joan Collins for raising this issue. Unfortunately, the Minister of State, Deputy Finian McGrath, cannot attend.

St. John of God community services provides for a range of HSE-funded supports in the area of disability and mental health. It is committed to the provision and development of services and supports of the highest standards to children and adults with intellectual disability. There are two whole-time equivalent speech and language therapy posts currently funded by the HSE in St. John of God, Islandbridge. At present, one of these posts is vacant due to sick leave. However, I understand St. John of God community services has commenced a recruitment process to fill this vacant post.

As part of the wider St. John of God community Menni Services, some occupational therapy services are also provided to the users of Islandbridge. The Department of Education and Skills also provides significant levels of educational staffing to the school to support the educational needs of the pupils attending the school. This includes provision for a school principal, 16 teachers and 30 special needs assistants to support the care needs of the pupils attending the school.

A programme for reconfiguration of children’s disability services is under way in Dublin west and the south city as part of the Government’s progressing disability services for children and young people programme. The national programme is changing the way services are provided across the country to make access to services equitable and consistent for all. It also recognises that children with complex needs may present with needs across several areas and that services provided in isolation within one environment of a child’s life is not appropriate.

Therefore, support and intervention is provided in a variety of environments, including home, school, clinic and community settings. When the services are reconfigured all resources currently available in the area, voluntary and statutory, will be centralised and reconfigured into children's network disability teams. Children currently attending the St. John of God School, lslandbridge will be among the cohort of children affected by the reconfiguration of new teams in the community as part of the process. In the interim, children can be referred to the current school-age team in the community. The proposed reconfiguration of services is scheduled to take place in the fourth quarter of 2018. I will come back to Deputy Collins on some of the issues she has raised.

Deputy Joan Collins

I raised this issue with the Taoiseach last year during Leaders' Questions. It was thrown aside. I was told that what I had said was not the case and that it was not happening in St. John of God. I was told the children were getting the services. I followed up with parliamentary questions.

Emma O'Kelly did a detailed report into this. It has been shown that St. John of God, Islandbridge is the poor relation when it comes to services. The organisation does not have vocational structures. It has only one psychologist, who is shared with St. John of God Menni Services. It has an emergency social work clinic for two hours each week, while two speech and language therapists are shared with 500 people in the Dublin South-West area. This has to change.

On Tuesday, the Minister for Children and Youth Affairs, the Minister for Education and Skills and the Minister for Health launched a pilot scheme funded by the National Council for Special Education to bring services into mainstream schools. This school in Islandbridge is specifically supposed to provide these services for children but they are not getting the service. This is mad. The main message the Ministers tried to get across was that early intervention makes all the difference, yet these children have had no services for four years. Parents are going to private speech and therapy services for their children at a cost of €2,500 per year.

A scandal arose in St. John of God services only two years ago when pensions and so on were being paid to the people on the board according to their rights. What about the rights of the children? These children need services now. That launch was in the HSE community healthcare organisation 7 area, which includes Islandbridge. The parents are demanding that the National Council for Special Education or the HSE intervene and provide the services that St. John of God, Islandbridge is not providing.

Deputy Catherine Byrne

I thank the Deputy. I saw the report by Ms O'Kelly on the television. I was shocked by some of the statistics raised, including those raised by Deputy Collins, as well as by the information she has given me. Unfortunately, I cannot answer any of the accusations Deputy Collins has made on paper. If Deputy Collins gives me the information I will certainly bring it to the attention of the Minister of State with responsibility for this area, Deputy McGrath.

At present, the Government and the HSE are committed to supporting children with special needs. We have recognised that first-class early intervention is very important for all children with disabilities. It is paramount.

Deputy Joan Collins

The problem is that they are not getting it.

Deputy Catherine Byrne

I hear Deputy Collins loud and clear. We need to improve and organise more effectively the process under way at present nationwide. The key object is to bring about access to disability services consistently and to ensure services are delivered with a clear pathway for children with disabilities and their families.

I do not have the information available to Deputy Collins. I know St. John of God services well, as does Deputy Collins, because the organisation is in our constituency. I admire the work done down through the years in St. John of God services by all the people working there, including special needs assistants and those serving the community. I know many families whose children benefit from St. John of God services.

I will certainly bring the concerns of Deputy Collins and, to be honest, my concerns to the attention of the Minister of State with responsibility for this area, Deputy McGrath. If Deputy Collins gives me the information she has, I will certainly bring it to the attention of the Minister of State.

I am unsure whether St. John of God services is the poor relation, as suggested by Deputy Collins. However, if that is the case then something needs to be done rapidly to address the matter and I will support Deputy Collins in that regard. Until I have the full information before me, I cannot go back to the Minister of State. I will get the information from Deputy Collins and get the Minister of State, Deputy McGrath, to reply to her.

Deputy Joan Collins

Parents have full respect for the teachers and the SNAs working there. The people there are great.

Deputy Catherine Byrne

I know they are. I know most of the parents.

Mental Health Services Staff

Deputy James Browne

I welcome the opportunity to raise the issue of unqualified non-specialist doctors working as consultants in our mental health services. The President of the High Court, Mr. Justice Peter Kelly, has been extremely critical of this practice. He has described as scandalous the HSE practice of permitting non-specialist doctors to be appointed as consultants in hospitals and mental health services. He said that the HSE appears to be a law unto itself in this regard. These comments came from the President of the High Court. He also highlighted the disparity and distribution of sub-standard consultants, which is considerably higher in one CHO area and in regional hospitals. All 20 acute hospitals are affected. Mr. Justice Kelly was so perturbed that he directed that his judgment be sent to the Attorney General, the Minister for Health, the Secretary General of the Department of Health, the HSE chief executive, HIQA and the State Claims Agency. He made these worrisome criticisms in a decision to cancel the registration of an individual consultant who had made a series of medical errors.

The Medical Council, HIQA and the Irish Hospital Consultants Association are all reported as having expressed serious concerns about this practice. The College of Psychiatrists of Ireland recently stated that it holds that a doctor should not be a consultant if the doctor is not a specialist in the appropriate area of medical practice, yet unqualified doctors are being appointed as psychiatric consultants. These doctors have not undergone higher training, only basic training. They are not subject to the usual rules and oversight to which a qualified psychiatrist consultant is subject. They are not trained in leadership or management, but they are being paid the consultant rate. Indeed, if they are working for an agency, they may even be paid more. One week such a doctor may be a junior trainee and the next week he or she may be running the place. One week the senior registrar may be holding the hand of such a trainee and the next week the trainee may be giving senior registrar orders.

Let us consider for a moment what this means for patients. It means that someone who is not qualified is making orders to the effect that a person should be deprived of liberty or detained under the Mental Health Act against his or her will. Surely, this is a clear breach of human rights. It means that doctors are prescribing medications and courses of treatment without the appropriate training, continual upskilling or oversight. It means patient safety is being seriously compromised.

One of the regular excuses is that there is a shortage of consultants, but only some weeks ago the College of Psychiatrists of Ireland stated that it had enough quality candidates to increase the number of training places by at least 10%. Inexplicably, the HSE only approved a 5% increase in training places. Nothing adds up in this regard. It is clear that the practice of permitting non-specialist doctors to be appointed as consultants places the lives, health and welfare of patients at risk. This is a real patient safety issue. It is another example of the dysfunctionality at the heart of the HSE and it demands to be addressed immediately.

Will the scandalous practice of permitting non-specialist doctors from being appointed as consultants stop? Are people who have been the subject of medical errors by non-qualified consultants notified of these errors? Will the Minister undertake to increase the number of training places for those who actually want to be properly trained and who wish to properly qualify as psychiatric consultants?

Deputy Catherine Byrne

I thank Deputy Browne for raising this important matter. Unfortunately, the Minister of State with responsibility for this area, Deputy Daly, is not here but has asked me to address the matter on his behalf.

Mental health policy, including policies and services for the prevention of suicide, remains a priority for Government. This is reflected by the additional funding of €35 million provided in the last budget, bringing total HSE funding for mental health to in excess of €910 million this year. A Programme for a Partnership Government gives a clear commitment to increase mental health funding annually, as resources allow, to expand and modernise all aspects of services. The HSE currently employs 324 whole-time equivalent consultant psychiatrists to support community and specialist mental health services throughout the country.

There are 26 non-specialist consultant psychiatrists working in the Health Service Executive. The majority of these appointments are temporary, pending posts being filled permanently with a specialist consultant psychiatrist. These consultants carry out their work in the context of relevant HSE consultant contracts.

The HSE has advised that since 2008, it has worked to recruit only consultant psychiatrists in the public health system with appropriate specialist training and competence to enable individual consultants to attain and maintain specialist registration with the Irish Medical Council. The stated aim of the executive is to employ consultant psychiatrists with the highest possible level of training and expertise.

In March 2008, the HSE amended the qualifications specified for consultant posts in the public health service to require registration in the relevant specialist division of the register of medical practitioners at the Medical Council. The rationale for the change was to ensure that consultants employed in the public health system have the appropriate training, skills, competences and qualifications to deliver care as assessed by the Medical Council.

Internationally, there is a shortage of medical doctors, including appropriately trained consultant psychiatrists. Many countries in Europe and across the world are significantly challenged to recruit adequate numbers of appropriately trained doctors.

In recent years, the HSE has developed new services, as outlined in the national mental health policy, A Vision for Change. This requires increased numbers of specialist trained consultants. In the context of staff recruitment and retention challenges set against the expansion of consultant posts throughout the country, individual consultant posts are sometimes filled temporarily with consultants who may not be entered into the specialist registration of the Irish Medical Council. This occurs in circumstances where, following exhaustive searches, no specialist consultant has been available. It is done to ensure ongoing delivery and continuity of essential mental health services.

The majority of consultant psychiatrist recruitment challenges are experienced outside the large urban centres. A particular and acknowledged recruitment problem relates to staffing for the child and adolescent mental health service, CAMHS, which the HSE is addressing on a priority basis. It should be noted that strategic priorities for mental health in the agreed HSE service plan 2018 include delivering a timely, "clinically effective and standardised safe service" together with developing highly trained staff within a modern infrastructure. The HSE mental health service is working closely with the HSE national doctors training and planning office and College of Psychiatrists of Ireland to increase the number of specialist training posts for psychiatrists. The intention is to create a larger potential pool of specialist consultants who can be trained in Ireland.

Deputy James Browne

While I appreciate that the Minister of State, Deputy Jim Daly, could not attend this discussion, the appointment of non-qualified medical personnel as consultants is a matter for the Minister for Health, Deputy Simon Harris, notwithstanding that the focus of the discussion is on psychiatric consultants. The dangerous practice I have highlighted has been described as scandalous by the President of the High Court who has written to as many of the relevant stakeholders as possible about the matter. Patients are not being informed that some of the consultants attending to them are unqualified. Some non-qualified consultants are being struck off the medical register because of medical errors. Are patients being notified of these medical errors, as is their entitlement?

There is a perverse incentive built into the current system. A trainee psychiatrist faces two choices. First, he or she can choose to spend three or four years doing higher training on a lower salary and trying to make his or her way through the proper channels. He or she also has the option to skip this step, however, and go straight into a senior position with a higher salary and the status that comes with a consultant role. If he or she can hold this position for three years, the post will almost certainly be made permanent, which means a specialist role in psychiatry will be permanently filled by someone who is not qualified. In such circumstances, it is the patients who lose out.

This is a serious matter. The words of the President of the High Court did not receive the attention they deserve because other very serious matters have arisen in health in recent weeks. People are becoming more aware that they are being treated by unqualified consultants. This matter will not go away and must be addressed as a matter of urgency.

Deputy Catherine Byrne

I do not have anything to add to Deputy Browne's contribution. I took a note of his concern that some of the consultants in situ are not suitably qualified and I will convey his concern to the Minister of State, Deputy Daly, and the senior Minister. I will also inform them of the concerns the Deputy raised regarding matters that have arisen in recent weeks in the area of smear testing. I hope the Minister or Minister of State will respond to the Deputy on the issue.

Acting Chairman (Deputy Eugene Murphy)

I thank the Deputies and Ministers who contributed. We will suspend for a few moments to allow the Tánaiste and Minister for Foreign Affairs and Trade time to arrive for the Second Stage debate on the European Communities (Brexit) Bill 2017.

Sitting suspended at 5.37 p.m. and resumed at 5.42 p.m.