Saincheisteanna Tráthúla - Topical Issue Debate

Insurance Costs

Small to medium-sized enterprise, SME, is critical to the health of the Irish economy. Foreign direct investment is important but it is seen by this Government as the glamorous side of enterprise policy while small to medium-sized businesses are worthy but are treated like the poor relation. Plenty of lipservice is given to them but all it really amounts to is platitudes with no real support or help. Indigenous SMEs are represented by a junior Minister without the necessary supports or policy initiatives. Ireland has made very little effort to create a Mittelstand-type of enterprise that is indigenous but is able to compete with international firms. SMEs in this country are struggling for a number of reasons. They are struggling because of creaky or non-existent infrastructure, because business rates do not take the profits of a business into consideration and because retail is migrating to the Internet and they are not getting the proper supports with regard to it.

One of the reasons most businesses tell me they are struggling is that input costs are going through the roof. One of those input costs is insurance. Frustration is building up in the SME sector because the Government has given up on insurance reform. I have some experience of this. I was involved in a car accident about two years ago. After the accident, a solicitor said to me "Why not put in a claim as I can you ten grand for everybody who was in the car?" That worked out at €60,000 and I would not even have had to turn up at whatever decision-making process was involved. That would be very tempting for any family in the country but that money does not come from thin air. It comes from somebody's pocket. It is the process that is putting drivers, particularly young drivers in rural areas, off the road and putting businesses out of business on a regular basis.

The Government has spent the past two years doing sweet damn all on this issue. Reform has stopped dead. It is not just me saying that. ISME, which is the representative organisation for SMEs, has stated that Government reform of insurance has stopped dead. I have been told by a number of representatives that businesses simply will not last to the end of the year and that thousands of jobs are in danger of being lost. The Minister of State has met one business owner, Linda Murray, a number of times. She is involved in the Alliance for Insurance Reform and owns a small business - a play centre - in County Meath. Her insurance costs have spiralled from €2,500 to about €16,000. She represents about 60 such play areas in the country, three of which have gone bust this year. She has stated that small businesses are simply being crucified by insurance costs. Many small businesses are not having their insurance renewed even though they have made no claims while equivalent companies in Great Britain see no difference in their insurance costs. Linda Murray has told me that she knows of a play centre that is paying €50,000 for insurance. One such business in this city is paying €135,000 per year. One insurance company has stated that any business that caters for children of a certain age will soon be obsolete. Another large insurance firm has stated that it will no longer insure dance classes and outdoor playgrounds and is considering not insuring sports. Why is the Minister of State not dealing with this crisis? Why is the Government sitting on its hands and not holding vested interests in this area to account?

I will say this as respectfully as possible but if the Deputy is telling me that this Government has given up on insurance reform, he does not know what he is talking about.

It is not me who is saying it.

The Deputy said it.

It is the industry saying it.

The Deputy said it. He does not know what he is talking about. I thank Members of the House who have facilitated me in terms of insurance legislation passed last year. It includes the Insurance (Amendment) Act to give effect to the Supreme Court decision regarding Setanta and the Central Bank (National Claims Information Database) Act. The Minister for Jobs, Enterprise and Innovation is responsible for the Personal Injuries Assessment Board (Amendment) Act, which was also passed. I compliment and thank all Deputies and Senators for getting that through.

Regarding the Deputy's comments about the hospitality sector and, in particular, play zones, I have met with many people in those sectors and there are issues. The issue is the levels of award. It is as simple as that. A bang, scratch or cut can get €10,000 or €15,000, which is outrageous. The companies are paying these sums rather than presenting in court because it is a good commercial decision on their part. If they go to court, they present in front of a judge, the case involves a child and the award is paid at that level plus costs. The insurance company has the commercial decision to make. Does it pay this, get it over with, take the pain early and get out the door? What does it then do? It passes on the increased premium to its customers. This is what it comes back to.

Two issues arise here. If the Deputy wants to be helpful and facilitate me, we must pass the Judicial Council Bill as soon as it is presented. I was not to know that this Bill would get stuck behind the Judicial Appointments Commission Bill in Seanad Éireann with a filibuster. I had hoped and anticipated that this legislation would been concluded in 2018 along with the Insurance (Amendment) Act, the Central Bank (National Claims Information Database) Act and the Personal Injuries Assessment Board (Amendment) Act. If the Deputy wants to be positive, he should come on board and support that Bill. What that Bill will do is present, in line with the Personal Injuries Commission, the opportunity for members of the Judiciary to put in place new guidelines for levels of awards. I am challenging the Deputy to come on board and facilitate that legislation.

Another Bill I want to get through the House as soon as possible is the Consumer Insurance Contracts Bill, which is a Sinn Féin Bill. The Deputy may be aware of it. I am not satisfied with the interaction between insurance companies and their customers. The customers of insurance companies buy their product and subsequently are being badly treated because, as I said earlier, there is nothing easier than to pay the award and upload the premium on the person buying insurance.

Insurance companies cannot have it every way. We have worked hard to put a better structure in place to ensure that companies are profitable and that we have a sustainable insurance sector but we are not getting fair play from the companies. They are increasing premiums and are now very profitable. Aviva had profits €113 million, FBD had profits of €15 million while RSA had profits of €35 million - over €200 million between them. That is not fair play at all when it comes to the customers of these companies.

For the record, it is not just me who is saying the Government is sitting on its hands with regard to insurance reform and that insurance reform is dead in this country. It is the representative organisations of small businesses which are paying these massive premiums and which are being put out of business that are saying this. It always interests me that Fine Gael likes to give the impression that it is the party of small business yet it stands over the distorted market that exists. It is interesting that the Minister of State said that it is not his fault but the fault of the insurance companies.

The insurance companies operate under the legislative environment the Minister of State creates. He is unwilling to take on the vested interests, and I will give him one example of this. He is unwilling the deal with the legal lobbies. One way in which he could do so would be to deal with the caps on damages. He mentioned how shocking it is that people with soft tissue injuries can get massive payouts on claims. In his own words, however, when talking to some of these representative groups, his view was that the average payout for soft tissue injuries should perhaps be reduced from €30,000 to €20,000. This is outrageous.

No. I never said that. That is wrong.

This shows that this is clearly not even in the right ballpark. It is incredible. I know of a situation in which a family with a young child who had a small cut, not a serious cut, in 2014 made a claim again in 2019. We know of situations in which claims for about €6,000 are going to court but are resulting in legal costs of €26,000. How can the Minister of State stand over a system such as this? How can he stand over a system in which the legal costs are so high that only about 6% of claims make it to court and in which the insurance company just settles in 94% of the cases because of the legal costs involved? What about regulating claims management companies? What about setting up a Garda insurance fraud squad? The Minister of State promised a Garda insurance fraud squad. Where is it?

I want something clarified very quickly. I ask Deputy Tóibín to withdraw the statement he made, that I said a claim for €30,000 should be reduced to €20,000.

Where should the cap be?

Excuse me. That is what the Deputy said I said. I would like to have that clarified, a Leas-Cheann Comhairle. I ask Deputy Tóibín to withdraw that statement, please.

The Minister of State would like me to clarify something.

I ask him to withdraw the statement, please.

I cannot clarify the matter. We will have to check the record.

I can clarify if I am-----

I call the Minister of State, without interruption.

I ask the Deputy to withdraw the statement he made, please.

How can I if the Leas-Cheann Comhairle will not let me-----

Withdraw it now.

What I am saying is-----

Hold on. We will have to check the blacks.

It is my understanding that the Minister of State's policy is that-----

-----payouts for soft tissue injuries should be reduced from €30,000-----

I ask Deputy Tóibín to let the Minister of State to conclude. Let me make it clear: I am chairing this debate. I am not aware of who said what or whether or not it is correct, but both the Minister of State and Deputy Tóibín are long-term parliamentarians and I am sure we can check the record and resolve the matter.

I would like my time back as well, please, a Leas-Cheann Comhairle.

It is only fair.

I will give the Minister of State a little leeway.

I thank the Leas-Cheann Comhairle.

I wish to be very clear about the award levels. There are three pieces of work concerning award levels for soft tissue claims: one by the Department of Finance, which found that awards here were five times those awarded in the UK; one by PIAB, which states they were five times higher; and one by the Personal Injuries Commission, which states that award levels in the Irish jurisdiction are 4.4 times what they are in the UK. I want to see the awards reduced in line with the PIAB report, the Department of Finance report and the Personal Injuries Commission report. Those are the levels. This is not about 10%, 20% or 30%. This is to bring the award levels down in line with other jurisdictions, namely, England and Wales.

I asked about the Garda insurance fraud squad.

Deputy, please. The Minister of State, without interruption.

The Garda insurance fraud squad is a matter for the Garda Commissioner. I presented what was presented to me prior to my coming into this position. The Garda Commissioner will not accept the establishment of payment to An Garda Síochána from outside of the national Exchequer.

That is done. What I have asked the Garda Commissioner to do is to establish within the Garda national economic crime bureau an insurance section to deal with these matters directly. However, Deputy Tóibín gives no credit to anyone, including people who are working particularly hard to bring down the cost of insurance for companies. I have one objective in this, that is, that the customers of the insurance companies are able to continue trading in order that they can provide services and have a vibrant sector. The Deputy can come on board and facilitate me in this with the two Bills that are required to be passed very quickly through this House and then he will be able to say he has done this State some service.

Medical Aids and Appliances Provision

I thank the Minister of State for coming to the House. Over a long number of years the delivery of incontinence wear has been hugely important to people in various parts of this country, including in very remote areas, where this service has been made available by the HSE. It has been invaluable, especially for families that are vulnerable or may have a vulnerable person in their house who needs the service.

Unfortunately, I and other politicians have been made aware of the service required not being as good in its delivery of incontinence wear to people in various parts of the country. One cannot just say one will come today or some other day with this service. Unfortunately, from what I understand, the satisfaction rate, which the HSE examined, is low at present. The Minister of State may be able to confirm this. I believe - and the Minister of State can also confirm whether or not this is the case - that two HSE management people have looked at the situation in recent days. There has been a kind of cloud over this for a while, with temporary contracts rolling over and over. With these temporary contracts, my understanding is that there is a large amount of money due from the HSE to a company. I also believe that under the contract, the manufacturer and the supplier were not to be paid directly but that payment was to be made to the person who got the contract. My understanding is that this has all changed now. Unfortunately, with all that is going on in this situation, it appears that the most vulnerable person, that is, the person who needs the incontinence wear, is the person losing out. I know from some communities and some people who telephone me that they do not know what is going on. Is there a fear in the HSE that there is a problem that needs to be sorted? I believe that the contract, even though it is a temporary one, has been changed twice in recent months. I do not know how this can be done, but that is what appears to have been done to try to solve problems. Where is the HSE in all this? Will this situation be sorted out? Regardless of who manufactures or delivers a product, it is the people at the end who need the product who are of the utmost importance, and it needs to be delivered on time. My understanding is that something like 18 boxes were to be delivered. It has been pointed out that the previous contract was wide open to interpretation. Where is the HSE in all this? Will the matter be sorted out shortly? As I said, down through the years this has been a very good service. We must ensure this matter is resolved once and for all.

I thank Deputy Fitzmaurice for the opportunity to address this issue in the House. The community funded schemes are a collective name for the many products, supports, supplies and aids and appliances provided through the HSE community services for eligible persons. The schemes' main purpose is to assist and support service users to live at home and to facilitate hospital avoidance and assist with early discharge from hospital. The products are prescribed by consultants, GPs, public health nurses, continence advisers, physiotherapists, occupational therapists, speech and language therapists and dieticians. The products include incontinence wear which is delivered to healthcare settings, such as long-stay residential services, and to persons in their own homes.

The HSE has a national contract for the supply of incontinence products. In addition to providing incontinence wear products to healthcare settings such as long-stay residential services, the HSE provides home deliveries to eligible persons in their own homes.

Following a tendering process, the HSE selected a new product supplier and a new product distributor in 2018. I understand from the HSE that the new contracts have involved a lot of changes in the range of products and their distribution. There have been some issues with the timely delivery of products under the new contract.

In 2018 the HSE put measures in place, including additional staff, an electronic management system and training of drivers to address initial difficulties. The HSE has informed my colleague, the Minister for Health, that it is continuing to work closely with the contracted delivery partners to ensure that the problems experienced by some service users in the community healthcare west region and other community healthcare organisation areas are addressed as a matter of priority.

A governance structure has been put in place to oversee the national contract for the supply and delivery of incontinence products in order to ensure the timely delivery of these products to eligible persons across all CHOs. This involves additional controls and monitoring measures in respect of the ordering and distribution of these products in each CHO. To support this process, additional administration staff have been put in place to carry out this work. The HSE is committed to ensuring these service improvements result in an enhanced and more efficient service for all.

I thank the Minister of State for his reply but we know that there is a new contract. The problem is that one long-term contract was being issued. Let us be clear that there has been a very good service for many years. We, as public representatives, did not hear anything to the contrary. In recent months, however, most Deputies have been getting phone calls on this issue. Will the Minister of State confirm that HSE personnel have been put in place in recent days to monitor the situation? Will he also confirm that the previous contract, under which one company was paid, has been split and that the company manufacturing the product must be paid directly? In addition, will he confirm that this matter will be resolved for those vulnerable people in the very near future? Will there be a long-term contract or what is going to happen? This short-term contract does not seem to be resolving matters. Is the Minister of State concerned that if a contract is changed twice, even a short-term one, there may be difficulties down the road?

I cannot give Deputy Fitzmaurice any further details on the contract or on the subdivision to which he referred. The HSE acknowledges that this is an issue and that there have been challenges in the context of delivery. As is our obligation, a number of public representative have brought these issues to the House and to other fora to have it addressed. When the HSE was asked to respond, it acknowledged that there has been an issue and outlined the steps taken to address it. These include electronic control management and putting additional administrative staff in place to try to deal with the logistical issues that have arisen.

I have been assured by the HSE that it is confident it can manage this problem and resolve the issues that have arisen. The HSE wants the service to be of the standard expected and is working towards reaching that goal. It has promised to keep my Department informed of progress. I am happy to share that information with the Deputy. If he has any further concerns, he should feel free to come back to me. I would be more than happy to help. At this stage, however, I have to take the word of the HSE that it is doing everything it can to address these issues and I have to give it the opportunity to do so.

Drug and Alcohol Task Forces

I wish to raise the issue of the Government examining and ensuring proper funding for the Targeting Resources at Youth, TRY, programme at St. Teresa's Gardens. The funding is needed to ensure work undertaken to date, as well as work to come in future, is placed on a sustainable footing. A funding proposal from the TRY programme has been sent to the relevant Minister. TRY is a very specific programme aimed at some of those directly involved in drug taking, drug dealing, in many instances, drug-related anti-social behaviour and violence in the area of St. Teresa's Gardens in Dublin's south inner city. The area in question is currently the subject of a regeneration programme. It has suffered greatly over decades because of the scourge of drugs. Many of the solutions now commonplace across the city came from this community in the south-west inner city. That happened because the community understood how to address issues it faced. It knew how to address the needs of some of the young people caught up in the drugs culture present in the past 20 years in many local authority housing complexes and in many of our cities. The programme determined how to address those needs and ensure that young people are not involved.

The TRY programme, and the Donore community drugs team, ran a pilot scheme that was very successful. This was proven by the evaluation of the programme. The problem is that funding for the programme has ended. Dublin City Council, in fairness, understood that what is needed is not just a regeneration of houses and apartments. Sometimes part of the community also has to be regenerated. It funded the programme on a once-off basis. The understanding was that the Department of Health, the Department of Education and Skills or the Government would address the need to fund this organisation. What is being proposed is an outreach programme. It deals with young people and their families. Those young people are sometimes in a situation where other drugs workers would not engage with them.

The outcome of the programme to date has been very encouraging. Of the last 18 young people who were part of the programme, nine have gone on to mainstream services. They were not engaging with those services previously. Those young people can now be further stabilised and encouraged to go back to education or into some type of employment. One young person on the programme previously has gone on to college. Another was engaged with one of the larger contractors in the area. There have, therefore, been successes and those are measurable because the people in question are identified. What is being sought, as far as I know, is €150,000 to allow the continuing employment of staff. There are only two part-time youth workers holding the fort at present. It is being requested that there be three full-time staff and that funding continue for two years. That would give some consistency to the programme and address one of the pockets of major anti-social behaviour and violence identified, not just by the community, but also by youth workers and An Garda Síochána.

Last week, my colleague, the Minister of State, Deputy Catherine Byrne, announced additional funding of €1 million for the implementation of the national drugs strategy. The funding will be provided on a recurring multi-annual basis will address the priorities set out in the strategy. Those will include early harm reduction responses, emerging trends in substance misuse, including polydrug use and crack cocaine and improving services for at-risk groups. Government policy in relation to drug and alcohol addiction services is set out in the national drugs strategy, Reducing Harm, Supporting Recovery: A Health-led Response to Drug and Alcohol Use in Ireland 2017-2025.

Drug and alcohol task forces play a key role in assessing the extent and nature of substance misuse in their areas, and in supporting community responses, as part of a co-ordinated approach involving all sectors at local and regional levels. A total of €27.645 million was allocated to the drug and alcohol task forces by the Department and the HSE in 2018. This level of funding has been maintained for the past number of years. This funding is used to support community drug projects to deliver services which meet local priorities. The Minister of State, Deputy Catherine Byrne, is very familiar with and greatly appreciates this valuable work in local communities.

The Department and the HSE allocate over €2 million to the south inner city local drug and alcohol task force each year to fund 23 projects in the area. The Donore community drug team receives in the region of €178,000 from the allocation to the south inner city's local drug and alcohol task force, LDTF. The HSE has monitoring and oversight responsibilities of drug and alcohol task forces under its section 39 governance framework. This is to ensure that service provision is meeting identified needs and there is accountability and transparency for public monies provided by the Department of Health. The HSE has advised that the task force co-ordinator for the south inner city task force, the LDTF, has had several meetings with the Donore community drug team in respect of the TRY programme. It is working with it on structural development and financial issues.

I also understand that the youth programme will be the subject of discussion at a meeting of HSE senior management next week. Measuring the overall effectiveness of the response to the drug problem is an important objective of drug policy. Resources are best directed towards interventions and strategies which are most likely to lead to a reduction in problem substance use and an improvement in public health, safety and well-being.

The Minister of State, Deputy Byrne, is committed to developing a performance measurement system by 2020 which will improve accountability and strengthen the task force model. The funding will complement enhancements in drug and alcohol treatment services related to mental health and homelessness under the 2019 HSE national service plan. The Minister of State will be consulting with the drug and alcohol task forces, including that of the south inner city, and the HSE on how best to target this new funding. The Minister of State has invited the task forces to a meeting in the Department of Health at the end of March to begin this process.

I was aware of the Minister's announcement last week of funding for several local drug and alcohol task forces. I raise this because the current funding runs out in July, which is in the middle of the summer. This urgently needs to be presented to the Minister of State and to those who are engaging with the Donore community drug and alcohol team. They must look properly at the previous pilot, the evaluation of that pilot and the work that has been done on a shoestring budget since then. If that does not happen, the community and the Donore community drug and alcohol team are afraid that some of the individuals the team has managed to identify in its outreach work will revert to type without intervention. The intervention is not always based on age. Sometimes people are slightly older than these youth workers would normally deal with. It is not based on vicinity. If some of the characters the team deals with move out of the vicinity, the team tracks them and tries to keep them engaged. It attempts to ensure that their behaviours and challenges are addressed and tries to guide them towards a more positive role. The team has been successful despite the fact that some questioned this initiative when it was first introduced. Those of us who were sceptical in the first place have been proved wrong, which is a great thing. That is why I champion it. In its own small way, it has managed to address some of the major anti-social behaviour problems in the vicinity. It is not a panacea for all the problems, but this is a regeneration area. Plans for houses have just gone ahead. We do not want this behaviour to reappear in the future.

I thank the Deputy for his contribution and for refocusing attention on this issue, which is always very welcome. This is an issue that affects many different communities and areas, and the Deputy is right to ensure that his area is at the centre of attention in the distribution of supports. I also recognise his acknowledgement of where his position was and where it is now, which was very gracious. I assure the Deputy I will convey his concerns directly to the Minister of State and the HSE to ensure the Donore community drug and alcohol team gets the support and funding it requires to continue the work it is doing, which I have no doubt is very good.

I thank the Minister of State.

Hospital Accommodation Provision

I raise the issue of Macroom Community Hospital in the interests of the 38 residents, their families, the staff and the wider community. I would like to see if we can progress things. The hospital offers great care. It is well recognised by the Health Information and Quality Authority, HIQA, the HSE and the locals. One can see that by the demand for places. However, there are issues with the building. They have been identified for many years now. There has been a repeated cycle of plans and commitments and non-delivery and of further plans and commitments and non-delivery, and this goes on. We need to see progress on this. We have seen other community hospitals in similar positions make progress but Macroom Community Hospital has slipped behind.

There is concern among residents, staff and the wider community. People are asking if the national children's hospital's demand for additional funding is going to have some impact on Macroom. As far back as 2008 and 2009, there were plans to carry out development. The HIQA report highlighted the great care, but it also pointed out issues with the building concerning privacy, storage space for residents and the need to move away from the open-ward model to more private rooms. The subsequent HIQA licences were granted on the condition of works being carried out or plans being advanced. That was in 2017 and 2018. I am delighted the Minister of State, Deputy Daly, is taking this Topical Issue matter because I know he has been there and has seen the situation on the ground and the wonderful care provided. He has also seen the need. According to media reports, the Minister of State said that planning permission would be advanced by October of last year.

October came and went, as did November, December, January and February. It is now March and there is still no plan. Members should bear in mind that there was planning permission as long ago as 2008 and 2009. That was allowed to lapse in 2013. We need to get to the stage where there planning application is secured, funding is committed, works are under way and real commitment is shown to Macroom Community Hospital. I discovered when talking with the HSE late last year that €5.8 million was needed for it. Even at that stage, the HSE was expecting planning permission in the first quarter of this year, that is, about March. We have reached that point and there has still been no planning application. We need something definite. We need works on the ground so that residents, their families and the wider community know there is a commitment to Macroom Community Hospital and that the residents are to have the greatest possible comfort. These are basic and fundamental issues, namely, storage space for residents' clothes, privacy and closing off the current open wards. These are practical matters of day-to-day dignity.

In 2016, when there was a demand for the commercial outfits to deliver, they had to deliver within a deadline. However, the hospitals were given an extra five years. That deadline is approaching and the work does not seem to have been done for Macroom Community Hospital, although it was in other cases.

Gabhaim buíochas leis an Teachta as ucht deis a thabhairt dom labhairt ar an ábhar seo sa Teach inniu.

The Government’s core stated objective is to promote care in the community so that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. This is clearly what older people want and what everybody in this House wants. We also have patients who are in genuine need of residential care, either on a long-stay or a short-stay basis, and their safety and well-being is of paramount concern. Residential care is provided through a mix of public, voluntary and private provision. It is worth highlighting that the budget for long-term residential care in 2019 is €985 million, and at any one time an average of more than 23,000 clients will be in receipt of financial support.

The HSE is responsible for the delivery of health and personal social services, including those at facilities such as Macroom Community Hospital. Operating a 24-hour care service seven days a week, the hospital provides support to the elderly population of Macroom town and neighbouring parishes in North Lee West. There is a multidisciplinary team which looks after the needs of the residents, providing long-stay care, convalescence, respite and palliative care. The maximum number of residents which can be accommodated is 38. The existing residential care setting provides multi-occupancy shared bedroom accommodation, where highly dependent residents who are in need of 24-hour high-support nursing care or are in transition from hospital to nursing home care are accommodated together.

As the Deputy is aware, community hospitals like Macroom are an essential part of our national infrastructure and we are determined to maintain our public stock. The standard of care delivered to residents in these units is generally very high, but we recognise that many public units are housed in buildings that are less than ideal in the modern context. Without these units, however, many older people would not have access to the care that they need.

On that basis, we need to upgrade our public bed stock and this is the aim of the five-year capital investment programme for community nursing units announced in 2016. The programme provides the framework to replace, upgrade and refurbish these care facilities, as appropriate.

Significant work was undertaken to determine the most optimum scheduling of projects within the phased provision of funding to achieve compliance and registration with the Health Information and Quality Authority, HIQA. This programme includes a number of facilities in Cork, including Macroom Community Hospital. The Deputy will appreciate that all healthcare infrastructure developments require a lead-in time to complete the various stages. These stages include appraisal, project brief, design feasibility, a review of costing estimates and finalisation of financing.

I have visited Macroom hospital and updated the staff and management to the effect that the project was at design stage and planning permission is due to be lodged shortly with a view to completion by 2021. There was considerable change in the project scope which required recommencing the approval process. The project will proceed under the capital investment programme, which is part of Project Ireland 2040. Further progress will be subject to the granting of planning permission and the availability of funding for capital projects.

The HSE capital plan for 2019 is being finalised and will be submitted for approval to the Minister for Health very shortly. This will propose the projects that can progress in 2019 and beyond, having regard to the total available capital funding. All health capital projects currently at various stages of development are considered as part of this process.

I thank the Minister of State for the update. While I appreciate that there is a long lead-in time for capital projects, Macroom Community Hospital has been identified as a need and planning permission was granted for the project almost ten years ago. How long is a long lead-in time for an extension to a hospital? Two and possibly three generations of people have moved through the hospital in that time. It is in the interests of the dignity and privacy of those who will next use the hospital that these essential works are carried out. I note the Minister of State visited the hospital and indicated that works would be carried out shortly. It was stated at that time that planning permission would be granted in October 2018. As such, there has been further slippage, even in the past year.

I note what the Minister of State said on funding. We understand that funding of some €5.8 million was allocated previously but staff and families are concerned that the demand for money for the national children's hospital will challenge that in some way. We need to address that issue as well. Those involved in Macroom Community Hospital do not feel the project is a priority. If it is a priority, however, the Minister of State should not be under pressure for funding. He should have first call on the money if it is a priority project.

In the interests of Macroom Community Hospital, we need the Minister of State to set out a roadmap for the project. What are the steps and timelines involved and when will it be delivered? We have heard many commitments and seen many slippages. We now need delivery.

Go raibh maith agat arís, a Theachta. I visited the hospital some time ago at the invitation of my colleague, the Minster for Agriculture, Food and the Marine, Deputy Creed, who asked me to meet the staff and management. I was accompanied by HSE management and we gave the assurances that were required on the day. My office remains in regular contact with the management in Macroom Community Hospital and I understand managers often speak to my office. The Minister, Deputy Creed, asks me almost every fortnight for an update on the project.

It still does not have planning permission.

I cannot grant planning permission. The Deputy is referring to-----

I refer to the planning application.

I have the floor. The Deputy has made charges and I am now allowed to respond. He referred to having planning permission in 2008. I have no control over what happened in 2008 or the reason the building project did not progress. We can make a good guess as to why it did not happen. Obviously, it was for reasons of finance. We are where we are and we want to get the project back on track. I have given a commitment that I will do that for the local community. I have assured the Minister, Deputy Creed, that the project will be delivered and it will be delivered. However, as I said, significant change was made to the scope of the project which required that it be resubmitted for approval.

The Deputy is referring to a delay of two or three months, which is not earth shattering for a capital project of the size of the one we are delivering for the people in Macroom. We are under a commitment nationally to have this delivered by 2021. We have an agreement with HIQA to have community hospitals in place across the length and breadth of the country. They are in the Leas-Cheann Comhairle's constituency and my constituency. All Deputies have community hospitals in their constituencies on which they want to see progress but there are steps that we have to take. I cannot click a finger and make it happen. Projects must go through a planning process as well as design, project brief and financing stages. That is part and parcel of the process. I cannot give an absolute commitment to a deadline of one day, one week or one month because if the deadline were then to move, the Deputy would be the first to start jumping up and down. I do not control the planning process and must await its outcome. I have given the Deputy a commitment that the project will go to planning shortly. The planning process is independent but I assume it will be successful.

He may not be able to control the granting of planning permission but the Minister of State can control the making of the application.