Dáil Éireann debate -
Thursday, 20 Sep 2018

Vol. 972 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Nursing Homes Support Scheme

Deputy John Brassil

I welcome the opportunity to raise this issue, which I have been pursuing for a number of months. It is very topical, given the issues regarding vacant properties, particularly around Dublin. Whereas I would in no way agree with the tactics of occupying properties illegally, it serves to highlight a very important issue, namely, that there are thousands of vacant properties and, to date, no scheme we have tried to address that has worked.

I have often heard the Minister of the day of either housing or health say one can have one's own opinion but one cannot have one's own facts. I will give the Minister of State some facts. In the last census, there were 245,000 vacant properties in the country, 62,000 of which were holiday homes. That leaves 183,000 vacant properties of which 140,000 were stand-alone units and 43,000 were apartments.

This Government has a huge opportunity to deal with the housing and homelessness crisis by utilising the existing stock. One element of that stock is houses vacated by people who are in nursing homes under the fair deal scheme. In figures I obtained from the Health Service Executive, HSE, currently there are 14,000 such properties in the country. Of those 14,000, as few as 600 are being re-let. I call on the Government to come up with an incentive to give the owners or the families of the people who own the houses an incentive to get those properties in use quickly. If it set even a minimum target of 10%, 1,300 houses would be in circulation within a six to 12-month period. Surely that is an incentive for the Government to try to deal with the 10,000 people who are homeless.

We talk about incentives. When people are long-term unemployed, we offer employers incentives to take them off the long-term register. If they keep them on for more than two years, they get €10,000 per year, and the person might maintain some of his or her benefits while getting back into full employment. I welcome that; it is a very good initiative. I propose that if we take people off the housing and homeless lists, an incentive would be given to the homeowner to do that. It does work but, to date, every initiative tried by the Government, including its repair and lease and buy and renew schemes, have not worked. I heard the Minister of State at the Department of Housing, Planning and Local Government, Deputy English, on a radio programme last Monday morning with Fr. Peter McVerry trying to justify the repair and lease scheme. Fewer than 100 properties have been taken up under that scheme. I am not blaming the Minister of State. It is just that when it is announced we think it will be attractive but it is not attractive and when it is not, the Government should accept it and move on to something new. I am very interested to hear the Minister of State's reply because this is something that is waiting for some initiative and forward thinking to get viable homes back into use, which will make a valuable contribution towards our housing and homeless crisis.

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

I am taking this issue on behalf of the Minister of State, Deputy Daly, who apologises for not being present. I thank Deputy Brassil for raising this matter.

The nursing homes support scheme, NHSS, also known as fair deal, is a statutory scheme providing financial assistance for affordable and accessible long-term residential care for those applicants who satisfied a care needs assessment.

This financial assistance scheme is means tested. Participants of the scheme contribute up to 80% of their income and up to 7.5% of the value of their assets towards the cost of care, and the State pays the balance.

Under NHSS, rental income is considered income for the purpose of the financial assessment, and is assessed at 80% less any allowable deductions. Allowable deductions include income tax and, therefore, any income tax arising from rental income should be deducted; other deductions include some health expenses, levies required by law to be paid, and interest on some loans in respect of a person’s principal private residence.

Action 17 of the strategy for the rental sector commits the Department of Housing, Planning and Local Government to examine the treatment, under the nursing homes support scheme’s financial assessment, of income from the rental of a person’s principal private residence where he or she moves into long-term residential care.

The Department of Health has received legal advice that changes to the treatment of rental income in the scheme would require changes to primary legislation. Possible changes to the scheme are being explored. However, significant further analysis and development of the options, including legal analysis and costings, is required before a decision can be made to bring forward any proposed changes to the NHSS. There is also a need to explore and consider operational consequences and any unintended consequences that might result from any proposed changes.

There are issues to be considered relating to renting out one’s principal private residence, for example, many older people in long-term care enjoy returning to their home temporarily as part of reminiscence programmes. They may also have all their personal belongings stored in their home, and bringing the home to market could possibly see the sale or discarding of their possessions. Many vacant homes would need significant improvements to be made to bring them to a rental market standard, and would therefore require significant investment. In addition, a change to the treatment of rental income could introduce inequality in the scheme, as pension income contributions will remain at 80%.

We should also consider whether someone requiring long-term residential care would be in a position to take on and manage the considerable financial and legal responsibilities that come with being a landlord.

Officials in the Department of Health are working with Department of Housing, Planning and Local Government officials in examining a number of possible options. The Minister of State, Deputy Daly, is not in a position, however, to provide detail on these as discussions are ongoing and any potential proposals have not been finalised.

Deputy John Brassil

I thank the Minister of State for taking the question. I am quite disappointed with the tenor of the answer. It seems the Department is looking for more reasons not to introduce a scheme than to introduce one. Even if it is looking to introduce one, there is no timeline or delivery date for when such a proposal would come into use and begin to have an effect.

There are issues around everything the Minister of State spoke about but there are 14,000 houses waiting for some initiative. As I said, even if the Minister set a target of 10%, he would be making a very valuable contribution to the housing and homelessness crisis.

As for issues such as storage and people not being able to deal with matters because they are elderly, they often give over power of attorney to family members, and the Minister of State should not underestimate the ability of an elderly person to deal with such an issue. Many elderly people are more than capable. Just because a younger person has the years on his or her side does not mean he or she is capable of understanding a financial transaction, either. I assure the Minister of State that if the incentive is attractive, it will be understood quickly. I ask her to go back to the Minister of State, Deputy Jim Daly, and to include the Minister of State at the Department of Housing, Planning and Local Government, Deputy English, in the conversation as well. She should ask them to actively consider the proposal I have made and instead of finding reasons not to do it, come up with reasons they should do it and bring in solutions around that.

Deputy Catherine Byrne

I do not underestimate any older person. My mother lived a long life to the age of 89, and she was well capable of making decisions herself. I do not underestimate that. I said in the reply clearly that local government officials and the Departments of Health and Housing, Planning and Local Government are examining a number of options that may be introduced in the future. However, the Minister is unfortunately not in a position to give me those briefings at the moment.

The Minister of State, Deputy Jim Daly, is mindful of the challenges of housing supply facing the Government and of how all Departments must work together to tackle the issues. In this regard, it is important that the Departments of Health and Housing, Planning and Local Government continue to work together. The Minister of State would like to assure older people that it is a matter of personal choice for any individual as to whether he or she wishes to rent or sell his or her home when taking up residency in a nursing home. Sometimes there are measures that we cannot take in government but we will continue to work to achieve some of the measures Deputy Brassil has proposed. The Minister of State is conscious of the fact that there are many dwellings owned by older people residing in nursing homes who unfortunately might not have family members to even participate in a process to rent out the property. I will pass on all the Deputy's concerns and the issues he has raised. I have taken note of them.

Child and Adolescent Mental Health Services

Deputy James Browne

My matter is focused on the general issues and the lack of services for child mental health throughout the country. For example, more than 6,500 children were waiting for a primary care psychology appointment at the end of May 2018. Some 1,700 of them had been waiting for more than a year to be seen.

Demand for child and adolescent mental health services, CAMHS, is increasing; almost 3,000 children are now waiting for a first appointment. In excess of 300 of them have been waiting more than a year for a first assessment. This is an intolerable wait for children to see a specialist. The psychology services and CAMHS, which is our acute mental health service, are sister services. Delays in community psychology services are leading to increased pressure on the acute services offered by CAMHS.

Unfortunately, it gets worse. The number of children who are being admitted to adult units increased by 20% in the past year. Children who should not be in those units are being admitted to them, which is contrary to Government policy. Doctors and families are left with a Hobson's choice of either getting the services in an appropriate setting or not getting them. That is totally inappropriate.

There are no multidisciplinary teams to support parents and children when they need help. In my county of Wexford, for example, there should be three consultant child psychiatrists but there is none. There are only two approved but there is none for an entire county of 150,000 people. There is a 34-month waiting list for child psychology services in County Wexford, and urgent cases cannot be taken. Last October, the Minister promised a new site to replace the inappropriate facilities that specialists are working out of currently The site was promised for this summer. Now it is September and what I am being told locally is that the building is being rented.

Deputy Pat Buckley

More than 700 children with mental health difficulties are on a waiting list for specialist treatment services in the Cork and Kerry region, including 200 who are waiting more than a year. Delays in accessing CAMHS worsened recently in Cork North Lee, which closed to new referrals last month following the departure of a consultant psychiatrist. The HSE said referral rates among under-18s in the Cork-Kerry area have risen by 26% since 2011, including a 10% increase between January and June this year versus the same period in 2017. As of March this year, 2,691 children and young adults were waiting for the HSE to provide them with an appointment. The HSE mental health services disclosed that 1,369 were waiting for up to three months, 470 up to six months, 241 up to nine months, 225 up to 12 months, a staggering 178 up to 15 months and 80 up to and over 18 months. It goes on and on.

We all know that CAMHS staffing is only at 56%. I do not mean to be disrespectful but we are probably going to get a lot of generic answers on this and we are well aware of it. Cork, Kerry, Wexford and Tipperary services are understaffed. We now have problems in Waterford and Sligo. I can tell the Minister of State how bad it is within 16 seconds. A 13 year old was in CAMHS but somebody in his or her wisdom decided that she may not have Asperger's, so she was discharged from CAMHS. She needed an assessment which still has not happened, and that child is doing her leaving certificate this year.

Deputy Catherine Byrne

On behalf of the Minister of State, Deputy Daly, I thank the Deputies for raising this matter. He apologises that he cannot be present.

One of the Government’s priorities is ensuring appropriate and accessible mental health services for children who need them. This is reflected by a budget 2018 allocation of an additional €35 million for new developments, bringing total HSE mental health funding this year to more than €910 million. The HSE service plan 2018 commits to further development of CAMHS against a background where the population of children is expected to increase and where the demand for CAMHS has seen a significant increase in recent years. Approximately 18,800 referrals are expected for HSE CAMHS this year, with 14,300 being seen by this specialist service. Additional resources and facilities means there are now 69 CAMHS teams and three paediatric liaison teams, supported by 68 operational CAMHS beds nationally, with further beds planned to come onstream in the near future. Since 2012, more than 1,300 health professionals have been recruited across mental health to modernise and improve services. However, there are widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, particularly consultant psychiatrists. The HSE acknowledges that the lack of consultant cover can impact on access to services locally. It is working to explore all avenues for the recruitment of qualified staff to fill vacancies, particularly in areas such as consultant, psychologist and nursing posts. The HSE is working to provide the best CAMHS service within available staffing resources.

A key approach to developing wider services for young people, and thereby reducing pressures on CAMHS, is the decision by Government to increase access to counselling services in primary care, with the appointment of 114 assistant psychologists and 20 psychologists nationally.

In addition, the Minister of State, Deputy Jim Daly, recently approved ten new posts for advanced nurse practitioners who will be specifically directed to CAMHS. Other CAMHS-specific measures included in the HSE service plan include increasing the number of CAMHS referrals to be seen this year by 27% compared with 2017, providing for a seven-day per week service for CAMHS to ensure supports for young people in line with the Connecting for Life strategy, improving CAMHS day hospital services and developing eating disorder specialist community teams for young people. The Minister of State has set as a priority with the HSE the development of a 24-hour helpline, as well as digital support services. These will enhance access to supports and, where appropriate, facilitate early and urgent interventions using innovative digital technologies.

The Cork Kerry Community Healthcare organisation has approximately 168,000 young people under the age of 18, in line with the national average of 25% of the population. A CAMHS enhancement project commenced in September 2017 given local and national concerns about the growing demand for CAMHS services in the area. As a priority, the initial focus has been on reducing waiting times in excess of 12 months in Cork and Kerry. However, in the longer term, the project aspires to address both system and culture practice changes to improve access to CAMHS.

Deputy James Browne

The Minister of State mentioned the number of CAMHS teams but the vast majority of these are understaffed. She spoke about the difficulty in recruiting psychiatrists. This year, the College of Psychiatrists of Ireland sought a 10% increase in the number of training places from the HSE but the executive would only approve a 5% increase. The Government refuses to extend the National Treatment Purchase Fund to cover mental health services and refuses to appoint a digital safety commissioner, who would be critical in addressing the concerns young people experience online. Due to infighting between Departments, Pathfinder, a crucial programme set up by the Government, is not being financed in order that it can implement necessary supports for young people. Dr. Kieran Moore, a consultant psychiatrist, left Wexford because Slaney House is not fit for purpose. He left after having been there for 13 years. We were promised a new building last October but it has still not been delivered. Children and parents are distraught and it is simply not acceptable. Not enough is being done.

Deputy Pat Buckley

I thank the Minister of State for her answer. I am not surprised that it is more of a generic one. I am happy that Cork was mentioned in the answer because normally when one asks about a pen in this House, it is not in the answer. It does not mention any solutions. It mentions 168,000 young people under the age of 18 who are waiting for this or that. There does not seem to be a plan. The plan was to reduce waiting times to under 12 months. A total of 631 people in Cork have been waiting for more than 12 months. The Minister of State mentioned 69 CAMHS teams, four of which are staffed. We will not be having a premier league of 60 or 70 teams. We cannot set up a premier league because we do not have fully staffed teams. It is disgraceful. Regarding the difficulties in recruitment, if we paid the staff, we might get them and this generic answer is desperate.

In the brief time available to me, I will talk about what is happening. I want the Minister of State to get to grips with this. I got permission from a mother just before I came in here to tell the following story. It is about a 15 year old teenager who has been bullied, has been moved from school to school and has struggled to stay in St. Michael's unit in Cork. She has attempted suicide and cut all her hair off. Her father has stage 4 cancer, the family is being pushed from pillar to post and the Minister of State is telling us that there is a big push on in Cork and Kerry. The Minister of State heard Deputy Browne talk about how Wexford is falling apart, as is Tipperary. I am fed up with coming in here and talking. It is verbal diarrhoea. These people are struggling. The Minister of State should visit that family and see the hurt on the mother's face. The Minister of State should not come in here with generic answers because it is an insult to the people we are supposed to represent in this House.

Deputy Catherine Byrne

I hear Deputy Buckley's frustration and concerns.

Deputy Pat Buckley

I am frustrated. It is not a personal attack.

Deputy Catherine Byrne

I know and I am not taking it as a personal attack. I have read the reply I have been given and, unfortunately, I cannot answer some of the specific questions asked by Deputies Buckley and Browne but I have taken note of them and, as always when I am asked to come into the Chamber, I will go directly to the Minister whose place I have taken. I will raise the concerns raised. In reading the reply, it is clear to me that there is a significant shortage, particularly in recruitment in CAMHS. Perhaps some of the reasons involve finance but some of them, which I have experienced as a local Deputy, involve the fact that child psychology is a very difficult place to be. People burn out very quickly and, unfortunately, some decide to move on for whatever reason. I can understand those reasons. The reply I was given is not an adequate reply to some of the questions that have been asked but I will revert to the Minister with both questions I was asked and will ask him to reply directly to the Deputies who raised the issues.

An Ceann Comhairle

By way of information for Members, there was a proposal at this morning's meeting of the business committee that time be found in the near future for a plenary session on adolescent mental health. Having heard the Deputies, it would appear that they should ask their party Whips-----

Deputy Pat Buckley

Solutions would be better.

An Ceann Comhairle

The Deputies should ask their party Whips to seek the prioritisation of such a debate where solutions could be identified.

National Planning Framework

An Ceann Comhairle

The third item is in the name of Deputy Lisa Chambers, who has sought its deferral, so we will move to the fourth item in the name of Deputy Tóibín, who wishes to discuss the impact of the population cap on County Meath. I assume it is not the one-child policy that is proposed for County Meath.

Deputy Peadar Tóibín

Well, it is nearly as bad. It is a serious issue. Over the past number of years, I have taken a well-worn path into this Chamber to discuss investment in County Meath. Many people are unaware of this issue but Meath is an outlier when it comes to investment and resources. Meath is unique because out of 28 local authorities in this State, it is at the very bottom of the investment lists per capita in most categories. Meath County Council is the lowest funded county council in the State. It has the lowest number of staff per capita and the lowest amount of expenditure per capita in the State. Meath gets about 61% of the national average investment per council. It gets 45% of the national average investment in housing and 43% of the national average with regards to amenities, etc. Meath has about 60% of the investment with regards to water development. Counties Meath and Louth are at the bottom with regard to mental health services and Meath has the lowest number of gardaí per capita in the State. This morning, more people in Meath left the county to go to work than work in the county. This happens nowhere else in the State yet Navan is the biggest town in the country without a rail line. The State wants us to be commuters but it will not give us the technology or infrastructure to do that. This has a radical effect on the everyday living standards of people in Meath.

We in Meath have started to live with the realisation that we do not get the clippings of tin off the Cabinet table with regard to investment but it now turns out that we have a Government and a system that actively work against us with regard to investment. The working draft of the national planning framework and the regional spatial and economic strategy for the eastern and midland region seek to cap the population of Meath. It is stated quite clearly that only 8,600 houses should be built for the entire county of Meath between now and 2026.

To put this in context, there are 5,600 existing planning permissions for units that are not yet built. Therefore, if the Government's plan goes ahead, only 2,600 new planning applications could be issued in that period.

We have a cap of 8,600 houses. On the other side of the equation, we have nearly 4,000 people on the housing waiting list and many more, unfortunately, will join them on that waiting list in the next ten years. It is possible that, for social housing alone, the capacity being offered by the plan could be exhausted. Houses in Meath are as rare as hen's teeth at the moment. The outcome of putting a cap on this will simply leave thousands of Meath families on the housing waiting list forever. Anybody who has studied any bit of economics at junior or leaving certificate level will know that if one puts a cap on supply while there is increasing demand in the county, it can only have one result, which will be the acceleration of rents and house prices in Meath over that period. To tell people who are currently put to the pin of their collar and paying maybe 60% of their disposable income on housing that we are going to accelerate house prices in Meath is shocking.

What I want the Government to say is that absolutely no cap or targets will be put in place with regard to population growth in Meath. I support spatial development and I have argued strongly in this Chamber for proper spatial development that is powered and energised by infrastructural development elsewhere and not by reducing the opportunities for counties such as my own.

Minister of State at the Department of Housing, Planning and Local Government (Deputy John Paul Phelan)

I thank Deputy Tóibín for raising the matter, which I am taking on behalf of the Minister, Deputy Murphy, and for providing me with the opportunity to discuss the population growth projections for County Meath as set out under the national planning framework.

The suggestion being put forward that there is a "cap" on housing delivery in County Meath is erroneous and misleading, but it is also disappointing given that, instead of a focus on more and more commuter-driven development, future planning for the county needs to take account of past mistakes. We are all familiar with recent and historic trends when the county saw very high levels of housing development without the matching growth in local employment opportunities and provision of essential amenities and community services for fast growing communities. It seems as if those putting about the notion of a "cap" are trying to use the current housing issues to create an opportunity to go back to old and failed models of "zone and build" that, while rewarding landowners and developers with high financial returns from speculative housing development, do not tackle the issues facing existing communities in Meath from previous suburban expansion, such as congested roads, pressure on schools, limited amenities and a general sense of housing being provided ahead of jobs and services, not the other way around.

The strategic planning policies outlined in Project Ireland 2040 are aimed at a different path to what we saw in the Celtic tiger era. That is clearly what people wanted, as evidenced during the public consultation: self-sustaining jobs and services-centred planning and development, not just housing growth for the sake of housing growth. Nevertheless, it is vital that we plan for future growth, so a very detailed examination of estimates of housing, employment and population changes in an overall national and regional context was undertaken by the ESRI for my Department. In addition, development of a draft regional spatial and economic strategy for the Dublin, midlands and east region is based on these projected national population growth targets, which were communicated by my Department to all local and regional authorities in early July.

The facts are that the current guide for planning for future population growth in County Meath out to 2026 is for an additional 26,000 people above 2016 levels, equivalent to adding the entire combined populations of Ashbourne, Kells and Trim to the county in a ten-year period. How this very high level of growth is to be planned for on the ground is rightly a matter for Meath County Council to determine as part of its county development plan, which must be reviewed after the regional spatial and economic strategy has been finalised. The county development plan review process must also ensure there is capacity for up to a further 25% of the projected population target to 2026, or an additional 6,500 people, as development does not simply stop in 2026. This means that the next Meath county development plan will need to set out how the county can accommodate an additional 32,500 people to 2026. In this context, far from any cap on growth, there is plenty of scope to ensure the continued growth and development of Meath but on a sustainable basis that is about a balanced work-life based approach, not just the commuter-based development that was so prevalent in Meath and other parts of the country in the past.

Deputy Peadar Tóibín

I take the Minister of State's point with regard to jobs. Meath is a commuter county and comparator counties are Louth, Kildare and Wicklow, all of which get far more jobs from the IDA per capita than Meath. I too would pair the population with jobs if I was in the Government's position.

Let us look at the population statistics. Between 2006 and 2016 the population of Navan increased by 5,322 persons, which is roughly 532 per year, despite the long period of stagnant growth during those years. The draft plan which the national framework document seems to be considering would only allow for some 376 more people to live in Navan every year. To do that, we are talking about de-zoning some 205 hectares of land that has been zoned for housing development in that area. This would be detrimental to every club, every school and every business in the area. Any enterprise of any size would never consider Meath again because it would realise it cannot get new workers to live in Meath because of this target or cap.

Investment has been withheld from Meath for generations, for example, investment in the rail line. We were promised by Fianna Fáil and Fine Gael for years that the rail line would be built yet it has never happened. The chances of getting the rail line in the future would be radically reduced if this target or cap were in place.

I note the Minister of State says these are targets. However, targets in a plan such as the national framework document are not fuzzy figures to be thrown around and discussed. People are employed to pursue targets. Their jobs are to implement targets. If the Minister of State talks to any of the officials in the authorities in this area, they will say they will pursue these targets because it is their job to do so. Indeed, it will be a failure in their eyes if they do not achieve these targets. Why have a national development plan with targets and then say the targets are not really that important to the whole process? If that is the case, the national development plan is a ball of smoke in the first place. Either the targets are real and the national development plan is real, or they are not.

Deputy John Paul Phelan

The point is that the targets are real but they are not caps. I believe there is not that much difference between what the Government is proposing and what the Deputy is seeking. From the 1990s the population of County Meath doubled and much of that was in the towns and villages, particularly in the east of the county, but in some measure throughout the county. It was that kind of "zone and build" policy which was national policy at the time.

The Government wants to ensure the development of Meath and other places into the future is underpinned by sustainability. What I mean by that is keeping people living close to their work, their education and other amenities they wish to avail of. That is why the central plank of the national planning framework is around rebalancing development into the next ten and even 30 years. The huge population increases we have seen in Dublin and the area centred on Dublin in the last 30 years are unsustainable for the future. Part of that is the national planning framework itself but I want to emphasise that, despite the figures mentioned, none of this is set in stone. There is an ongoing process between all local authorities, regional authorities and the Department as to how the national planning framework will actually play out in terms of development in every region across the country. However, the central point is to ensure that more than half of the development of the country in the next 30 years is outside of Dublin. There is no question, and I do not want anyone to think there is, of de-zoning tracts of land in Navan. That is not on anyone's agenda. I emphasise, before I finish, that my colleague, the Minister of State, Deputy English, hoped to make it to the debate, but he had a commitment to attend a housing meeting earlier. I was on the phone to him and he was not in a position to respond directly.