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Dáil Éireann debate -
Wednesday, 23 Jan 2019

Vol. 978 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Mental Health Services Provision

The mental health service is a vital part of our society, a point with which nobody in the Chamber would disagree. Families and communities throughout the country have been visited by heartbreak and tragedy because of mental health issues and County Meath is no different in that respect. Before Christmas we witnessed tragedy when seven men died by suicide within ten days, leaving communities in Kildalkey, Athboy, Trim, Kells and Duleek in shock and grief over the period. As a society we need to start asking ourselves really serious questions about what is happening.

In many cases mental health issues are very difficult to resolve and it is not necessarily in our gift within the Chamber to do so. Nevertheless, some issues can be tackled by us. As a State, we need to ensure we tackle the socio-economic reasons which lead to some people suffering from mental health issues and believing suicide is the only answer. We can affect the way the health service treats and supports people suffering from mental health problems. Every county has a reason to complain, but County Meath is at the bottom of the ladder when it comes to the provision of resources.

I discovered recently that before Christmas there were 32 staff vacancies in the mental health service in counties Louth and Meath. The chief officer of the community healthcare organisation, CHO, for counties Louth and Meath confirmed to me that the 32 vacancies were in a range of grades, including that of psychiatric nurse. It is an inordinately high number and extremely worrying that there is such a gap in the provision of key medical professionals in such an area of crisis. Last summer we found out that the child and adolescent mental health teams in counties Louth and Meath had just over half the staff they needed to fulfil their duties. In the midlands and counties Louth and Meath there are over 50 children waiting for over a year for their first appointment. The Minister of State must understand mental health matters are urgent and that those involved require support and treatment fast to ensure things will not deteriorate. This figure is the second highest in the State and has grown significantly in the past three years. This is not something the Government has inherited but rather a problem that has been created by its lack of ability, inaction and funding.

This is unacceptable and County Meath is an outlier of how bad things are in the country. Ireland is an outlier when it comes to how bad things are with respect to teenage suicides in the European Union. Ireland has the fourth highest rate. In September the HSE confirmed to me that the spend on mental health services in counties Louth and Meath was the second lowest per capita in the State, at €121.67. It is not hard to join the dots - when we invest so little and employ so few staff in an area, there will be high rates of suicide because of mental health problems. Every community has been affected by teenage suicide, but it is clear that the Government is either not equipped, unable or not sufficiently motivated to tackle the problem. Again, County Meath is at the bottom of the resources list. We need to ensure radical investment of resources and energy by the Government in order that it can start to tackle this problem in counties such as Meath.

I apologise on behalf of the Minister of State with responsibility for mental health issues, Deputy Jim Daly. I thank the Deputy for raising this very important and serious matter.

In the recent budget an additional €55 million was provided to progress new developments in mental health services this year. It brings overall Health Service Executive, HSE, mental health service funding to nearly €1 billion in 2019. This, in turn, will allow for continued improvements in all aspects of mental health care across the nine HSE community healthcare organisations, including CHO 8 which incorporates County Meath. Louth and Meath mental health services continue to strive to improve the level and quality of service being delivered and the environs in which it is delivered. The service supports clients in their recovery and rehabilitation as close to their home and community as possible. All of this is being done within the resources available. Referral to community psychiatric services is through general practitioners.

There is a range of care options provided by the mental health service for the population of County Meath. Acute inpatient beds for counties Louth and Meath are located in the department of psychiatry at Crosslanes in Drogheda. Referral for assessment is either through a GP or an emergency department. With regard to community adult outpatient services, three teams are based in An Táin and cover Navan, Kells and Trim, and one is in Ashbourne. The psychiatric day hospital service covers Navan hospital and Ashbourne primary care centre. Examples of services provided from the day hospital include stress management, cognitive behavioural therapy, family therapy, alcohol counselling and a Clozaril clinic. Therapeutic interventions in line with national clinical care programmes are also being delivered, including, for example, for first episode psychosis and eating disorders. A first episode psychosis team is being established.

The day hospital provides an enhanced package of care for clients in the community, all of which is in line with A Vision for Change. A community high support residence is based at Ráth na Riogh, Leighsbrook Lane, Navan. There is an assertive outreach team for County Meath which provides continuing support for clients in their own community. The team is moving to a seven-day service. In addition, a home-based treatment team provides support for acutely unwell patients in their own home. Other services available to the population of County Meath include the psychiatry of old age team based on Kennedy Road, Navan, while there is an advanced technology room for persons with dementia. The child and adolescent mental health service is located in Hazel House, Navan and Trim primary care centre.

The recently agreed HSE service plan for 2019 outlines the priorities and actions to enhance mental health care nationally this year. This relates also to CHO 8 and County Meath and encompasses a range of services covering acute or community-based child and adolescent mental health services, general adult services and psychiatry of late life. The service plan also acknowledges widely accepted challenges in developing services, including increasing demands and difficulties in staff recruitment and retention, but the objective for the Minister and the HSE is to deliver overall service improvements this year.

There is no doubt that there are good people doing good work in County Meath, for which we applaud them, but they are dealing with a tsunami of need. A Vision for Change is really important, but if we do not have the funds we meed for change, it is not worth the paper on which it is written. In County Meath we have three Ministers or Ministers of State in various guises, as well as two Fianna Fáil backbenchers, but we are not getting the funding we need. County Meath remains an outlier because of the number of vacancies in critical health care service grades. It is also an outlier because of the lack of funding.

Does the Minister of State not agree that it is really hard for these healthcare professionals to function and carry out their job regarding the level of need they face if they do not have the adequate resources to do so? Given the current state of the economy, the State has an opportunity to intervene in so many individuals' lives, to bring people back to good mental health and to ensure they do not end up thinking that suicide is some kind of solution to their situation. However, we can only do this if we have feet on the ground and the funds available for them to do their job. Despite the rhetoric we hear year after year, the figures are getting worse. I looked at the figures recently. The rate of self-harm in 2016 was 10% higher than it was in 2007, the year before the economic recession. The rate was highest among the young. One third of children's mental health beds in the country are closed at present due to staff shortages in child and adolescent mental health units. There are vacancies for psychiatric nurses while 52 children have been waiting more than a year for an assessment for child and adolescent mental health services. If we must tell a child not to come near us for 12 months before we will even talk to him or her regarding mental health services, we are failing those children radically.

The Minister of State, Deputy Jim Daly, wishes to reiterate that improving all aspects of policies and services for promoting positive mental health is a priority under the HSE service plan for 2019. The Deputy will be aware that the Minister of State has met him in the past regarding this issue. In addition, within the past few days, the Minister of State's office has been in touch about arranging another meeting with the Deputy in the near future. If the Deputy needs to bring all relevant local representatives to that meeting, that would be fine. This meeting would review mental health services in Meath. As the Minister of State asked me to tell the Deputy that this meeting will take place as quickly as possible, perhaps the Deputy could contact the Minister of State's office. The Minister of State continually liaises with the HSE to monitor all aspects of mental healthcare, including implementing new initiatives agreed under the executive's service plan. The recent budget provided an extra €55 million to progress new developments in mental health, which adds up to exceptional funding in 2019 at just over €1 billion. The construction of the national forensic mental health complex in Portrane is progressing with the facility due to open in 2020. All aspects of CAMHS nationally are being improved by the HSE to reduce waiting lists, although I know there are difficulties. The Deputy's points are well made and well taken. I met the Minister of State yesterday to discuss them and he told me that he would be glad to meet the Deputy and representatives, that is, whoever represents the mental health community in that area. That meeting will take place as soon as possible.

Urban Renewal Schemes

The north quays in Waterford is the site of a proposed €350 million regeneration project that will be what can only be described as a game changer for Waterford. This opportunity has presented itself to Waterford through the hard work and efforts of Waterford City and County Council under the leadership of its CEO, Michael Walsh. The proposed investment in Waterford city by the Alhokair Group from Saudi Arabia has provided a much-needed confidence boost for the city and indeed the whole south east. The proposed development at a cost of €350 million will be a game changer for Waterford. The south east needs a regional city of consequence and that city must be Waterford. Waterford must be enabled for propulsive growth. For regions to be strong, they need a strong city.

However, this project is so much more. It has the additional potential to place an emphasis on additional permanent services such as healthcare, education, and transport. The economic benefits will be significant. The proposed development will happen on approximately 17 acres of substantial and spectacular river frontage. The proposal includes development of a total of 60,000 sq. m to include retail units, leisure and office space, 200 apartments and a relocated train station, which will result in an integrated transport hub. This will have the effect of providing a sustainable transport corridor and improving access from north to south by creating a pedestrian bridge linking the north quays to the south quays and the remainder of the city centre. This development will act as a catalyst for other developments like the Ard Rí Hotel and the Michael Street shopping centre. The north quays development will provide an increase of 50% in Waterford's retail offering. It is envisaged that 2,300 direct jobs will be created on completion of the project.

Under the national planning framework, Waterford metropolitan area has been designated for population growth of up to 30,000. If Waterford is to realise this aspiration, there is no doubt that the development of the north quays is crucial. In 2017, Waterford City and County Council applied for funding of €20.1 million from the urban regeneration and development fund for the first phase of this development. It received €6 million, which is well short of what is required. This is incredibly disappointing. The Government hyped up its support for this project consistently and now the city community has once again been left short-changed by this Government. The Government must accept that life exists outside of the M50. Waterford can and must act as a release valve for the pressure that is building in the capital. The city and county council has done an amazing job in getting the project to the current stage with the support of politicians, Waterford Chamber of Commerce, the Alhokair Group and other stakeholders. We now need to see how seriously the Government views promoting regional economic development. What we need to see now is certainty and indeed commitment by the Government to progress this invaluable project. The key words here are certainty, commitment and a timeframe to progress this project. Certainty to enter into contracts is required relatively soon. The investors are committed, as are the local authority and the people of Waterford city and county. Now we need the absolute commitment from Government. At a time of economic growth and balanced budgets, commitment is needed from Government.

I thank the Deputy for raising the matter, which is very important. It gives me an opportunity to discuss the north quays project in Waterford and, in particular, Waterford City and County Council's successful bid for funding for the north quays under the urban regeneration and development fund. It is a project with which I am very familiar having met many of the stakeholders involved in it on a few occasions over the past couple of years. It is a very worthy project that has been outlined quite well by the Deputy. It is an essential part of the region, not just Waterford city and county. In Project Ireland 2040 and the national planning framework, we recognise the importance of having regional bases like Waterford to serve regions and help them grow. In Project Ireland 2040, we are taking a long-term view about how we plan the shifting of population growth in the future away from the east coast and Dublin and build up other cities in order that they can compete nationally and over time, have an international footing. The chief executive officer of Waterford City and County Council, Michael Walsh, has done a great job in working with everybody to make this happen and put it on the map. We all know it will take time for it to roll out but great work is being done that is being led by the local authority, which is the way development should happen. Again, it had the co-operation of various Departments over the years.

The north quays in Waterford were the subject of a strategic development zone, SDZ, order made by Government in 2016 recognising the social and economic importance of this flagship brownfield site to the State and designating the Waterford north quays for mixed-use development subject to preparation of an SDZ planning scheme, which has been done. I met Senator Coffey a couple of times. It was a very important issue when he was Minister of State in the Department of the Environment. It was important that this designation was made thus enabling all the plans for the future.

The national planning framework, NPF, launched early in 2018 as part of Project Ireland 2040 includes objectives to achieve both more compact urban growth within Ireland's cities and the significant further development of Waterford city. Further to the NPF, a ten-year urban regeneration and development fund, URDF, worth €2 billion to 2027 was established with €550 million of committed Exchequer grant funding available to 2022.

Bids were invited from public bodies throughout Ireland for funding under the URDF. Waterford City and County Council submitted a bid for €104.5 million of grant funding in September 2018, seeking a sum of €20 million for 2019. The Waterford north quays bid was made as a category A proposal, on the basis of development being ready to go in 2019 and to continue in the years immediately thereafter. It was well recognised that Waterford, as a city, was well prepared for funds like this but I also want to point out that it was moving these plans on before any fund was established. That is key. It was not the case that it needed a fund to make this happen; it was getting on with the plans and making this happen. It had big visions. I give my thanks to all involved including the investors who also put great work into making this happen.

In November 2018 my Department announced an initial tranche of €100 million which was awarded to a total of 88 projects throughout Ireland for 2019. The Waterford north quays project was awarded €6 million for 2019, which is the single largest award made to any bid under the URDF. In comparison, awards made in respect of multiple bid proposals from each of the cities of Cork, Limerick and Galway resulted in awards of €6 million to €7 million to each city for a combined total of 24 projects in 2019. Later in the first quarter of this year, there will be a further call for URDF bids for funding in 2020. This URDF grant to Waterford, as with all other successful bid proposals, is approved in principle subject to agreement with my Department and may be regarded as the starting point of ongoing support for a significant city centre urban renewal project. As a successful category A project, the award signals commitment to further funding in future years. The overall URDF will increase for 2020 and it is expected that large integrated multi-annual urban projects will comprise a greater element of future overall allocations, as these more complex proposals require sufficient time for design, planning, procurement and construction to be advanced properly.

I have more to say but I am conscious that I am eating into the Deputy's time.

The Minister of State will have another two minutes later.

It is very important to state that it is extremely unlikely that this project would get over the line without State funding. I welcome what the Minister of State has said, which is that the overall URDF will increase for 2020 and that it is expected that large integrated multi-annual urban projects will comprise a greater element of future overall allocations. However, we have to look at where we came from. As the Minister of State said, we were ahead of the pack on this. Mr. Michael Walsh and Waterford City and County Council had plans in place. When considering the amount of money that was allocated, one has to look at the overall picture and at the catalyst the north quays will be for the whole south-east region. We look at the likes of Cork, Limerick and Galway, which are already doing very well. This absolute game changer of a project has to be recognised.

Some €13 million is required in 2019 to start the process and a commitment of €30 million is required for each of the years 2020, 2021 and 2022. Much of the infrastructure development that will be involved in this project would have had to come in the future anyway. What this project is doing is accelerating that hugely important infrastructure and increasing the connectivity between the north and the south of the city. Sustainable transport infrastructure is the essence of this project and development of this site can and will act as a catalyst for the city and county of Waterford. The employment opportunities, housing opportunities, and health opportunities cannot be underestimated. We are constantly talking about cardiac care in Waterford and about a university for the south east. This north quays development will act as a catalyst for all these things because it will lead to population growth and to Waterford and the south east acting as a release valve for the overcrowding in Dublin. To reiterate, in order to sign contracts and move forward, we need a timeframe, certainty, and commitment.

Without a doubt, the north quays project will provide many opportunities for the city and region. It is a project of major significance. I compliment all involved in getting it this far. Together with the total amount of lifetime URDF grant funding sought, the proposal that came forward this time included four very significant elements of enabling infrastructure which are: relocation of the city’s railway station to the east to form a new public transport interchange, expected to cost approximately €35 million; a new bridge over the River Suir for pedestrians, cyclists, and public transport and an associated urban greenway, expected to cost more than €33 million; site access roads and road realignment, expected to cost €26.8 million; and off-site roads in the wider north bank of the Suir area in Kilkenny, which will cost approximately €10.3 million. I am constantly telling people in this room that there is also mention of Kilkenny in this plan. This project will serve the area very well. All of these infrastructural works will open up and make more accessible the north quays site, and will enable the special development zone planning scheme to be realised.

Further discussion with the local authority and other relevant agencies, such as the Department of Transport, Tourism and Sport and the National Transport Authority, is ongoing to conclude the grant agreement for 2019 in the context of a project lifetime commitment for future years, which has yet to be agreed, subject to necessary public spending code and state aid considerations. I can confirm that for approved category A projects, such as the Waterford north quays, subject to a grant agreement being entered into that will result in ongoing multi-annual contracts starting in 2019, there will be a commitment to the agreed Exchequer share of such contracts for future years. I also wish to confirm at this stage that there is priority commitment to funding in excess of €6 million for infrastructure to enable the mixed-use development of the Waterford north quays project.

Again I thank the Deputy for raising the issue of this project and I reiterate the Government's ongoing commitment to the future development of Waterford as one of Ireland's principal cities and as the regional growth driver for the south east. I cannot be any clearer on that. Today we are discussing one fund under Project Ireland 2040 but there are many other funds and many other ways of accessing money. It is important that the quays project looks at them all. I have no doubt that it will and that it will apply for funding in different areas. I am glad that we are able to kick-start the project with funding through this scheme, but there are many other ways to fund it including bringing private capital and money into the system. It is a great project and the Government is looking forward to working with the local authority on it. We are constantly engaging with Waterford City and County Council on this project.

Brexit Issues

We all know that we are just short of 70 days away from Brexit. It is to be hoped that it will not happen with a big crash-out. I believe that is the hope of everybody in this House and of the people at large. My question relates to energy supplies in the event of Brexit happening. I first raised this issue as far back as three years ago and I have raised it a number of times since including during an exchange with the Minister's predecessor, Deputy Naughten, on 9 May 2017 to which I will refer in a minute. The issues relate to the supply of gas, electricity and oil. For better or worse, at the present time we depend on these supplies for our energy. Large amounts of them come through Britain. I will deal with them one by one.

Some 55% of our gas supply comes through the island of Britain - England, Scotland and Wales. We have an all-Ireland single electricity market, which is very important. Important work has been done on that. Some 40% of the State's oil reserves are also held outside the State - 20% in England, 11% in Scotland, and 9% in the Six Counties which are still occupied by England, Scotland and Wales. This 9% is held close to Derry. Some 55% of our natural gas comes from Britain. If that is interrupted or stopped, perhaps in an emergency scenario, we would be in a serious situation in respect of the supply of domestic home heating gas but also in respect of power generating plants. If it was cut off or if there were interruptions in the event of a no-deal Brexit is there a possibility of World Trade Organization tariffs applying to this gas? Will we have higher gas bills in nine weeks' time? This would also affect electricity bills because the gas is used to generate electricity. We must bear in mind that we already have the fourth highest electricity prices in the European Union. What provisions are being made for those two scenarios?

With regard to electricity, we have a 32-county electricity market which has been functioning very well since 2007, although there is other infrastructural work to be done in that area. Can we guarantee that, in the event of a no-deal Brexit, there will be no tariffs applied to cross-Border electricity? The new all-Ireland integrated single electricity market, ISEM, design which started in October was meant to save householders and businesses up to €200 million. What will happen in that regard? We also have an electricity interconnector with Britain which goes directly across the Irish Sea. Will tariffs be applied to electricity coming through that interconnector in nine weeks' time?

With regard to oil reserves, earlier I referred to the fact that 40% of the State's oil reserves are held between the North of Ireland and Britain. Under EU rules, this will not be counted towards our EU obligations after Brexit. What discussions has the Minister and his Government had regarding what will happen to those oil reserves in nine weeks' time? Under EU rules we are required to have a nine weeks' supply as a minimum. As a member of the European Union we must continue to have that reserve, but not only for that reason.

We need those nine weeks of supply to be sure that we will have enough energy to keep the wheels turning on this island, for industry and transport and all of the other areas where it is used.

In reply to a question in May 2017 the Minister said that the State was refurbishing facilities at Poolbeg in Dublin and Great Island in County Wexford. Are they finished and ready? Can the State now cater for the level of oil reserves that are required to get us over the minimum nine-week period?

I thank Deputy Stanley for raising this important issue. As the Deputy has outlined, there has been great co-operation between Ireland, Northern Ireland and the UK in the energy market. It is certainly our desire that this will continue.

On the issue of the security of the supply of gas, Ireland has two main sources. One is from the Corrib facility, which is a very important supplier, as Deputy Stanley has indicated. The Corrib field delivers nearly half of our gas needs. The balance of our supply comes from two wholly Irish-owned interconnector pipelines between Ireland and Scotland. These pipelines are governed by intergovernmental agreements with the UK from 1993 and 2004. Gas Networks Ireland, GNI, and the Commission for Regulation of Utilities, CRU, have indicated that gas trade across the two interconnectors will not fundamentally change in the short to medium term as a result of a no-deal Brexit. Gas trading contingencies are being further examined as part of ongoing engagement with the Directorate General for Energy and the European Commission, as similar issues arise for member states such as Belgium, the Netherlands and Denmark. They are secure but an interruption to gas supply from an unpredictable event is always possible. Brexit, however, of itself does not make that more likely. Ireland has a considerable advantage in having the Corrib provision.

The practicalities of gas trading on the interconnectors are governed by a series of mutually reinforcing agreements, contracts and trading rules, variously between the Irish and UK Governments and between the transmission system operators in Ireland, Northern Ireland and Great Britain, with the latter overseen by their respective regulators. With regard to the World Trade Organization, WTO, I have been informed by the Department that electricity would continue to trade and a tariff would not apply. There may be a very small tariff on gas in the order of 1%. Even in a WTO context the impact on this sector would be relatively small.

The position on oil products, is that Ireland is dependent on imports that are predominantly supplied by UK refineries. There are no indications, however, that we should be concerned about the continued availability of these products, post UK withdrawal. In the event of any unexpected supply disruption occurring in the UK, the industry has indicated that alternative supplies can be sourced elsewhere, such as Rotterdam in the Netherlands. On the issue of emergency oil reserves, Ireland is required under EU legislation and International Energy Agency, lEA, rules to hold oil stocks equivalent to 90 days of net imports for use in an emergency. Currently 57% are held in Ireland, 22% within the other EU member states - all of which are readily accessible - and 21% of our emergency stocks are held in the UK, including Northern Ireland. Post UK withdrawal, these stocks will still be accessible.

I will get information for Deputy Stanley on the works that have been done but I know that NORA has stepped up its own capacity and has been onshoring the reserves that are being held. That has made-----

Will the Minister clarify what NORA stands for?

The National Oil Reserves Agency.

As for electricity, in October 2018, after more than six years of work by Departments, regulators, the transmission systems operators, market participants and stakeholders, the new wholesale electricity market has been established. Legislation underpinning this was amended in Ireland and Northern Ireland. The legislation is contained in sections 7 and 8 of the Energy Act 2016. The position of Northern Ireland, including with regard to the single electricity market, remains a priority for the EU, Ireland and the UK. We are working to maintain the beneficial structures of the all-island single electricity market whatever the outcome of Brexit.

As one of the elements in the whole-of-Government initiative, I will be introducing some powers to ensure that the CRU has sufficient powers to ensure Ireland's compliance with the EU energy market requirements in the event of a UK withdrawal.

I thank the Minister for his reply. Some information has been provided there but it comes across that there is still some work to be done.

On the gas situation, the Minister indicated there may be a small tariff. It is a concern that there may be a tariff on gas coming into Ireland from England, Scotland or Wales. This will be a concern to industry, to householders and to citizens up and down the country.

I have raised this matter on a number of occasions over the last years, including at a conference organised by the Government two years ago in Roscommon. The conference was organised by the current Minister's predecessor and it was very useful. I ask that further information be shared on the issue as it becomes available. We are aware that any type of tariff or charge can start off as a penny but can wind up as €1 million because it is the thin end of the wedge. A charge can increase over time. Does the Minister have any information as to whether that tariff could be increased and if Britain holds all the cards? Is it within Britain's gift - the mother of parliaments - to decide whether there is a tariff on gas coming into Ireland? Some clarity on this issue would be useful.

With regard to the oil reserves, and in answer to previous questions on the matter to the Minister's Department, he said that 20% is in England, 11% is in Scotland and 9% is held in the North of Ireland. Could we have some clarity on that? Obviously it would be better if it was on the island of Ireland from a logistical perspective. Perhaps the Minister could illuminate where we are at in developing the capacity for storage in this State. Will he also explain what is happening in Wexford and in the other facilities that were supposed to be developed and which are leased from the ESB?

I will get additional information for the Deputy. I am aware that work has been ongoing in increasing capacity in order to have the oil storage onshore. We have good contracts to ensure the stores are accessible wherever they are held.

On the potential crash-out and the WTO rules becoming the rules, this is a market where there are very low tariffs and these are within the WTO rules. These tariffs would not be decided at random. They would be the fallback and, as I have said, they are 0% in electricity and very small tariffs in gas. It is not like the agricultural sector, which would face very big obstacles to trade under WTO rules.

The main area in which we need to take action, which is included in the omnibus legislation that the Tánaiste will bring through, is in ensuring that Ireland continues to comply with all European Union regulations around the electricity market. This is where we need to take certain reserve capabilities for the CRU to ensure we can be compliant. That will be included in the legislation that is due to be published in the near future.