Saincheisteanna Tráthúla (Atógáil) - Topical Issue Debate (Resumed)

Garda Resources

I had a similar Topical Issue matter last week, where I concentrated on the Dublin South-Central area of the south west inner city. My appeal today concerns the Ballyfermot and Drimnagh areas of Dublin South-Central, of which the south west inner city is a part. Much work has been done by local communities, voluntary groups, Dublin City Council and others over the years to ensure that the disorder in Ballyfermot which had been associated with the Hallowe'en period in the distant past was never repeated. Hallowe'en has been a joyous time for young people and the elderly in Ballyfermot and Cherry Orchard in recent times, but we cannot be complacent as we try to ensure that continues.

Hallowe'en is not just one day. I am also dealing with the run up to it. We need adequate Garda resources - feet on the ground to back up Dublin City Council crews who are removing bonfire material in advance, Dublin City Council clean-up crews and Dublin Fire Brigade and other emergency services who end up tackling dangerous bonfires that often destroy public parks. Ambulances responding to injuries or illnesses have come under attack or have been prevented from going to where they need to be. We have stated repeatedly that we need adequate numbers of gardaí to be on duty to respond if a situation develops, as it did in the distant past in Ballyfermot and the recent past in Drimnagh.

We know from recent court cases that criminal elements can easily use Hallowe'en as a cover for something more sinister. I urge An Garda Síochána to be particularly mindful of that in Ballyfermot this year. My understanding is that a policing plan for Ballyfermot has been submitted to Garda management. This plan is obviously dependent on Garda overtime, which, up to last week, had not been authorised for these policing plans around Hallowe'en. I ask the Minister of State, Deputy Doyle, to ask the Minister for Justice and Equality to get the Minister for Finance to release adequate funding to ensure that the city but particularly the areas I identified this week and last week have sufficient gardaí on the beat to deal with Hallowe'en. I also want the message to go out to the Commissioner that he must authorise these policing plans to ensure that work is done. I want to ensure that this time, the concerns of residents in Ballyfermot and Cherry Orchard are listened to and responded to properly unlike in the past, where sometimes genuine concerns around criminality and antisocial behaviour were ignored in this House and within An Garda Síochána. We need to hear the Minister say loud and clear that our gardaí have adequate budgetary resources to keep communities safe this Hallowe'en.

I am making this statement on behalf of the Minister for Justice and Equality, who would like to thank the Deputy for raising this matter. In accordance with the Garda Síochána Act 2005, as amended, the Commissioner is responsible for managing and controlling the administration and business of An Garda Síochána. The allocation of Garda resources is also a matter for the Commissioner. The Minister has no role in these matters. The Minister is assured, however, that Garda management keeps the distribution of resources under continual review in the context of crime trends and policing priorities to ensure their optimum use.

The Minister would also point out that it is entirely appropriate for the Commissioner to be in a position to make the detailed judgments necessary about where he puts his resources. That is a policing matter and the judgment of the Commissioner and his management team is key to the delivery of the best possible service to communities nationwide, including the Dublin South Central area.

Although resourcing questions are, accordingly, not for the Minister, he would like to point out that An Garda Síochána is a growing organisation. There are now over 14,200 gardaí nationwide, which is the highest level in over a decade. Since the Garda Training College reopened in 2014, 2,800 new Garda members have attested and have been assigned to front-line policing duties. A further 200 probationers are due to attest next month bringing that total recruitment to around 3,000. Approximately 800 new gardaí were recruited in 2017 and 2018. This year, 600 new gardaí were recruited. For 2020, recruitment of up to 700 gardaí will be possible depending on the Commissioner's decision on how best to balance the number of gardaí and Garda staff.

It must also be borne in mind that this unprecedented volume of recruitment of Garda members has also been accompanied by increasing numbers of Garda civilian staff. Garda members are now supported by over 2,800 Garda staff. In fact, Garda staff numbers have increased by 26% since the end of 2017. This very significant increase is allowing many more highly trained gardaí to return to the front line from administrative duties. The process of civilianisation has already delivered a total of 750 Garda members back to the front line and visible policing duties and this number is also increasing. To take Dublin South Central as an example, there are currently 758 Garda members, which is an increase of 110 from 648 at the end of 2018, while Garda staff total 117, which is a 60% increase on 2018.

This increased recruitment is one of the benefits being brought about through the Government's unprecedented investment in An Garda Síochána. We increased the Garda budget to €1.76 billion for 2019 plus capital investment of €92 million this year, which was a 50% increase on 2018 capital funding. The allocation for 2020 is increasing by a further €122 million to an unprecedented total of €1.88 billion. The capital allocation to An Garda Síochána is also increasing by 26% to a total of €116.5 million. This ongoing investment is with a view to the provision of the best possible policing service to all our communities, rural and urban, including Dublin South Central. We are seeing positive results from these efforts. The Garda Public Attitudes Survey results for quarter two of 2019 published earlier this month showed a welcome continuing reduction in the fear of crime, an increased public awareness of proactive policing and a visible Garda presence in local areas. There is also a lot to welcome in the crime statistics published by the CSO for quarter two of this year. There has been a decrease of over 40% in the number of recorded homicide incidents in the second quarter of 2019 when compared to the same period in 2018 and a decrease of 9.8% in burglary and related offences at the end of quarter two of 2019 when compared to the same period last year.

As I said earlier, my call is for the overtime ban to be lifted. I reiterate my call for gardaí to be on the beat and for a full deployment of gardaí, including the increased number of gardaí that are now available locally. I also want specialist units to be available in Dublin South Central to respond if an incident arises. Hopefully, they will not be required to respond. I am not reassured thus far that the overtime ban has been lifted with regard to the policing plans that have been submitted by the local superintendents to deal with Hallowe'en in Ballyfermot or Drimnagh in particular but also in the south inner city because that has not been communicated to Dublin City Council officials who are trying to put their plan together to remove the material used in bonfires, be it tyres, chemicals or pallets. A total of 175 tonnes of material were removed by Dublin City Council staff in Dublin South Central alone. Hopefully, if the overtime ban is removed and the policing plans get the go ahead, we will see Dublin City Council officials carrying out that work again so they can try to safeguard communities as much as possible so that children, teenagers, adults and senior citizens can all enjoy Hallowe'en properly as it should be and there is no space in any shape or form for criminal elements to use the cover of Hallowe'en to engage in criminal acts against the community.

I will take home the message about the Garda overtime ban. As I said, it is a matter for the Commissioner and his team in the first instance but the Deputy has touched on a valid point about the co-ordination that is needed between the various different services, the local authority, the emergency crews and everyone else to prevent and mitigate against any possible outcomes.

On Garda visibility, at certain times the Garda can predict that without gardaí on the street something will happen. For this reason, they need to be in preventative mode rather than dealing with issues after the event. This approach works and speaks to the necessity of having more community-type policing rolled out. I have seen its effectiveness in youth diversion programmes around drug prevention and other temptations.

On the emergency response units, ERUs, while I am unable to clarify the position today, I assume these units are on alert during these periods, especially during the Hallowe'en season and similar times when they may be called into action. Hopefully, that will not be the case or their use will be kept to a bare minimum. I will convey the Deputy's request to the Minister and his officials.

Health Services Provision

I welcome the opportunity to raise this issue and that the Minister of State, Deputy Finian McGrath, is in the Chamber to take this debate.

I am always here for my Topical Issue matters.

We met representatives of Acquired Brain Injury Ireland, ABI Ireland, last week when they gave a presentation to Oireachtas Members and staff. The excellent presentation outlined the scale of what we are dealing with in Ireland and what is needed to provide a proper response. ABI Ireland estimates that 19,000 people acquire a brain injury each year. These injuries can be caused by strokes, accidents, tumours, assaults and illnesses. Approximately 100,000 people have brain injuries. I understand ABI Ireland is a section 39 organisation providing vital services to those living with a brain injury, a type of injury that has a major impact on people's lives and can leave some people completely disabled.

The National Rehabilitation Hospital, NRH, in Dún Laoghaire is doing excellent work. Many people who have gone through the unit have made excellent progress. We all know such people in our communities. Some of them have made almost a full recovery and returned to normal life. More capacity is needed in the system, however. ABI Ireland provides neuro-rehabilitation community services that complement and sometimes replace full-time residential care and rehabilitation. It ensures that people can make a seamless move home from a hospital or permanent setting, such as the NRH. This avoids lengthy stays in hospital and, importantly, maximises the chances of a good recovery.

ABI Ireland needs funding. Its current model is not secure or sufficient to meet the scale of its operations. It has to seek funding from the HSE every month to keep going. The organisation is pleading for money to stay afloat. That is not good enough. ABI Ireland requires further core funding of €1.5 million per annum to maintain its services and meet growing demand. The population is expanding, which places increased demand on ABI Ireland because the number of strokes and accidents is also increasing.

There are no specialist beds for acquired brain injuries outside Dublin and rehabilitation services in general are under-resourced. ABI Ireland wants to establish a regional neurological rehabilitation centre to provide inpatient and outpatient rehabilitation. This could be based in the midlands, for example, where it would be within easy reach of all parts of the country. ABI Ireland plans to build a 25-bed unit for which once-off development funding of €5 million would be needed to kick-start the project. People could then avail of this regional service instead of being moved from hospitals to nursing homes. ABI Ireland faces two key funding pressures. One is core funding to keep going and the other is securing the €5 million in seed capital it needs to kick-start the development of a regional centre providing important inpatient and outpatient rehabilitation services.

I thank Deputy Stanley for raising this important issue and offering me the opportunity to respond to the House today. The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for Partnership Government, which is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities. Acquired Brain Injury Ireland is, as Deputy Stanley stated, a section 39 voluntary organisation which was set up in June 2000 in response to the need for services for people with an acquired brain injury. ABI Ireland aims to enable people with an acquired brain injury to live an independent life in the community by providing and maintaining a supportive living environment. I strongly support its work and I work closely with it.

The HSE funds a range of services across the country for people with acquired brain injury. These services include acute hospital services, the National Rehabilitation Hospital and a range of multidisciplinary services at local level providing rehabilitation in the community to people with acquired brain injury. The HSE also funds a range of long-term assisted living supports, usually contracted by the health service from the non-statutory sector, and rehabilitative training services, which are also usually contracted by the health service from the non-statutory sector. ABI Ireland works in partnership with the HSE to provide a range of flexible and tailor-made services for people with acquired brain injury in direct response to local identified needs. Services provided by ABI Ireland nationwide include 14 assisted living services, home and community rehabilitation and outreach services, day resource services, family support services, home liaison, social work and psychological services and acquired brain injury awareness information training and education programmes.

Turning to the development of neuro-rehabilitation facilities, the national neuro-rehabilitation policy and strategy implementation framework 2019-21 was published by the HSE in February this year. This policy will guide the roll-out and implementation of the national neuro-rehabilitation strategy in the years to come. Discussions are ongoing on the identification of the funding required to implement the framework. That is what is happening at the moment.

While the implementation framework will support the delivery of services to persons with acquired brain injury, it does not concentrate on any one specific diagnosis and aims to reach all people with neuro-rehabilitation requirements. ABI Ireland is funded

under section 39 of the Health Act, as Deputy Stanley mentioned, and is subject to service arrangements. The organisation is scheduled to receive funding from the HSE of €12.6 million in 2019. The HSE and I recognise the value of ABI Ireland's services to people with acquired brain injury. However, further increases in funding can only be considered within the parameters and scope of funding available to the HSE. In the weeks since the budget, we negotiated a HSE service plan with funding of approximately €2 billion. Negotiations are ongoing and in that regard I will take on board the Deputy's proposals because I value the work of ABI Ireland.

I thank the Minister of State for his reply. I note his point in respect of co-operation and partnership between the HSE and ABI Ireland. I do not dispute that. The case being made by ABI Ireland is that its funding is stretched. Its budget is approximately €13 million and HSE funding for ongoing operational costs this year will amount to €12 million. ABI Ireland is a significant organisation. This country's record on rehabilitative care has been weak, regardless of the injury or illness involved. The Minister of State takes a special interest in these matters and he knows that when people get timely interventions after an accident or a serious medical issue, such as a stroke, the long-term benefits for the individual and his or her family and community are immense. In many cases, it enables the person to return to work. I know several people who had brain injuries and have returned to work.

In fact, both of those who gave the presentation here that day, Niamh from my constituency and Ian from Dublin, are working in jobs every day now and they had gone through significant trauma. That tells me the need for us to concentrate on this. It is money well spent.

Notwithstanding that funding is being provided and there is a partnership, I ask the Minister of State to ask the Minister for Health to look again at the organisation's core funding to see if anything can be done to help it out, and to give consideration to the concept of establishing a regional neurological rehabilitation centre and service that would provide both inpatient and outpatient services to those suffering from an acquired brain injury. I ask the Minister of State to take back those two messages and to liaise with Acquired Brain Injury Ireland on that.

As I set out earlier, the HSE recognises the value of the Acquired Brain Injury Ireland service to those with acquired brain injury, ABI. That is the first point. Further increases in funding can only be considered within the parameters and scope of funding available to the HSE. That debate is now going on. As the Deputy correctly said, ABII received €12.6 million in funding from the HSE. The Deputy put forward a number of proposals. I take his point and accept his argument on the stability of funding because I am aware, from working with ABII, that that is an issue.

I agree 100% with the Deputy's point on timely interventions. The quicker people can come through the fantastic service the organisation has and back into the workforce, the better. It is making a contribution to society. Those are the points that I will be making on the HSE service plan.

ABII is also represented on the neuro-rehabilitation national steering group through the executive director of the Neurological Alliance of Ireland. It also has a seat on the working group tasked with developing the implementation framework and on the managed clinical rehabilitation network demonstrator working group. It is in those key positions.

I am informed by the HSE that work is continuing on progressing a number of key areas that will underpin the success and evaluation of a managed clinical rehabilitation network. The executive's national service plan, which will set out the detail of the level of service and supports that will be provided in 2020, is currently being agreed.

I absolutely take on board the issue. If we come at it from both sides, the Deputy's side where they have representatives on the steering groups and my side, we can see if we can push out, so to speak, the valid request for an increase in neuro-rehabilitation. As far as I am concerned, ABI Ireland makes a significant contribution to the country. As Minister of State with responsibility for disabilities, I am convinced when I see many people who had a disability all of a sudden back in their work, using their ability, making a contribution and paying taxes such as PAYE. That is positive. It is also a good long-term health policy.

General Practitioner Services Provision

I am raising this issue because so many people, especially newer people in the Macroom area, are finding it increasingly difficult to get a local GP service. They are being refused because GPs are already overloaded. They will often have to stay with their existing GP who could be many miles away in Killarney, Mallow, Ballincollig or anywhere up the country if they have moved to Macroom. While that is a concern, it is when they need access to the GP that it hits home, for example, if they are working in Cork and there is a sick child in school who has to come out to Macroom and turn around and possibly go back into Cork or all the way up to Mallow to their GP, or even if they are sick themselves.

I have raised this issue before and at the time the expectation was that the new GP contract would address the situation, but it has not. New people are still struggling to get cover. Many of them are travelling longer distances. People are having to pay for blood tests. Outreach clinics are not available such that, for example, a person in Ballingeary whose GP is in Macroom has a 60 km return journey to get to that GP. Out-of-hours services are being provided out of Bandon, 30 km away, causing further distress to locals.

I recognise that there are GP issues throughout the country for different reasons, but there are local issues that are having an impact in this situation. Unique local issues are making it more difficult for residents and for the GPs themselves. There is a very onerous out-of-hours cover rota, at one in seven. This very much contrasts with the rota of one in 30 in the adjacent cell in Cork. It means that a Macroom GP is expected to be on call at night-time and weekends four times more often. He or she will provide cover once every seven days. That discourages new GPs from taking up a position there. There is no rural practice allowance allowed in Macroom despite the fact that the Macroom service covers a very large rural area, from the Lost Valley to Mullaghanish and around to Barrahaurin. This is happening at a time when the population of the town has grown but there is no increase in the number of GPs.

This came to a head again recently when there was a retirement, posts were advertised and only one person came forward for the first round. Following more recent advertising, no interest was expressed in it. It is quite possible that it could go on being advertised for some time before a GP will come forward. As the Minister of State can imagine, this is all putting pressure on locals. It is also putting considerable pressure on the GPs. I acknowledge the significant work that GPs are doing locally. In fairness, they are still capable of providing a same-day service. That is important to acknowledge. However, that can only last for so long. There is phenomenal pressure where people are having to travel further for a GP. People coming into the area are not getting access to a local GP.

A total of €40 million is being set aside in the current budget for enhancement of GP services. There are also commitments on supporting various GP services and supporting SouthDoc and the various organisations around it. In the interests of supporting communities such as Macroom, which are finding it ever more difficult to get GP cover, will the Minister of State raise the issue with the senior Minister and can we in some way or other advance the situation so that people can expect to get access to a doctor in their own locality?

I thank Deputy Moynihan for raising this important issue relating to Macroom. I assure the House that the Government is committed to the continued development of GP capacity to ensure that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas in the future. The Minister for Health is working to ensure that existing GP services are retained and that general practice remains an attractive career option for newly qualified GPs.

The number of GPs on the Medical Council's specialist register continues to increase, from 2,270 in 2010 to 3,857 as of mid-October. The number of GPs holding General Medical Service, GMS, contracts has also risen from 2,098 in 2008 to almost 2,500 in 2019.

The Government is aware of workforce issues facing general practice, including the influence of demographic factors, and in recent years has implemented a number of measures to improve recruitment and retention in general practice. These include changes to the entry provisions to the GMS scheme to accommodate more flexible shared GMS GP contracts, and to the retirement provisions for GPs under the GMS scheme, allowing GPs to hold GMS contracts until their 72nd birthday, as well as the introduction of enhanced supports for rural GP practices. GP training places have also increased from 120 in 2009 to 192 places filled in 2019, an increase of 60% over this ten year period. In addition, the recent agreement on GP contractual reform will benefit patients and GPs.

In return for co-operation with a range of service developments and reforms, the Government will increase investment in general practice by approximately 40% or €210 million over the next four years. There will be increased support for GPs working in rural practices and for those in disadvantaged urban areas. Improvements in the maternity and paternity leave arrangements have also been agreed, in recognition of the need to ensure that general practice is compatible with doctors' family-friendly commitments.

I am confident that these measures will help make general practice a more sustainable and attractive career option for doctors.

In respect of Macroom, and I understand the valid point the Deputy is making, I understand that the GPs and the out-of-hours co-operative are reporting a significant increase in demand for their services. In addition, the retirement of a single-handed GP in the town has added to the difficulties. I accept the Deputy's point in that regard. The panel has been advertised on two occasions but has not been filled. It is currently being advertised again, both in Ireland and internationally. A locum GP is in place since 16 September and is providing services to general medical services, GMS, scheme and private patients. All other practice staff - the nurse and the secretary - remain in place, funded by the HSE. A locum doctor will continue to be funded until the post is filled.

The GPs in Macroom also provide out-of-hours services. That is managed by SouthDoc, with which HSE Cork Kerry Community Healthcare has a funded service level agreement in place. Supports have been put in place to reduce the GP out-of-hours commitment by funding locum cover for Sunday shifts. Work is ongoing to reduce further the out-of-hours commitment of the Macroom GPs.

To follow up on the points made by the Deputy, it is essential that we all work closely together on this issue. I will raise the Deputy's concerns with the Minister, Deputy Harris, particularly in respect of Macroom because the case he made is genuine. We have a problem filling the vacancies. The HSE has advertised them nationally, and it may have to do so internationally, to get the GP in the town but the people of Macroom deserve the right to have a proper GP service.

I thank the Minister of State. There is quite a lot in the answer but I stress that people need to be able to expect to have a GP service locally and not have to crisscross all over the country.

The Deputy is right.

There are difficulties across the country but I need to be sure that the Minister of State recognises that local issues are making it more difficult for people to access GP services in Macroom than anywhere in else in the country. What we are looking for is to be able to compete on a level footing to fulfil that vacancy. The out-of-hours rota in the area, at one in seven, is over and above what would be expected anywhere in the country. It means that a Macroom doctor is expected to be on call four times more often at night and at weekends than a colleague in Cork, which is just down the road, who is on a rota of one in 31.

I refer to the absence of the rural practice allowance. The Minister of State referred to increased support for GPs working in rural practices and those in disadvantaged urban areas but that does not apply to Macroom. Macroom does not have that status despite the fact that it has a very large rural hinterland. There are unique local issues in Macroom that are relevant. The recent retirement merely illustrates the difficulty that has existed in recent years, which I have highlighted here on previous occasions.

What we are looking for in Macroom is a level playing field to ensure the obstacles that are unique to Macroom - the out-of-hours service and the absence of a rural practice - will be addressed. In that way, people advertising for a Macroom job would have an equal standing with every other area in the country. It would mean also that locals would have a real expectation that there would be a GP available to them and that they will not have to crisscross the country for such a service.

I will give the Minister of State an example of a lady who travels to and from Kildare every month where she had her GP service until now. That does not make sense. There are people from Cork, Tralee and across the country because they cannot get a service locally. It needs to be tackled.

Absolutely. I reiterate the Government's commitment to ensure that this happens. I take the Deputy's point about having to crisscross the country and also the unique local issues in Macroom. He mentioned the urban disadvantaged areas and rural areas. The issue of an out-of-hours cover rota of one in seven has to be dealt with also. I accept the Deputy's argument on the unique local issues in Macroom.

On the GP service in Macroom, I assure the Deputy that the Minister, the HSE and I are committed to working with the local GPs in the area to resolve the current difficulties to ensure that services can continue to be provided to the local community. I strongly believe in having local services in communities. The example given by the Deputy of one of his constituents having to travel to and from Kildare for a service is unacceptable. I am aware the Acting Chairman, Deputy Durkan, is a prominent TD in Kildare. I accept the Deputy's point that it is unacceptable that situation has arisen. The HSE is trying very hard to fill the positions. We have to make this a priority. I will raise the Deputy's concerns with the Minister, Deputy Harris, and the HSE.

The Dáil adjourned at 6.15 p.m. until 2 p.m. on Tuesday, 5 November 2019.