Ceisteanna Eile - Other Questions

National Children's Hospital

Pa Daly

Question:

35. Deputy Pa Daly asked the Minister for Health the reason for the delay in the construction of the new children’s hospital; the new estimated date of completion; if the total cost of the hospital will now exceed the figure of €1.73 billion from the independent review; the legal costs arising from the current legal challenge; and the total legal costs to date. [16604/20]

Alan Kelly

Question:

47. Deputy Alan Kelly asked the Minister for Health the status of the national children's hospital; the details on the level of spending to date in 2020 on legal fees; and if he will make a statement on the matter. [23651/20]

Tá sé soiléir on gceist gur cuireadh isteach é tamall maith ó shin. It is clear from the question that it was submitted some time ago but hopefully the answer will be no less relevant. What is the reason for the delay in the construction of the new children's hospital? What is the new estimated date for completion? Will the total cost of the hospital exceed the independent review figure of €1.73 billion? What legal costs have arisen to date?

I propose to take Questions Nos. 35 and 47 together.

Like many other sectors of the economy, the construction sector was impacted by the Covid-19 pandemic. This resulted in construction-related work on the site of the new children's hospital stopping on 31 March due to Covid-19 restrictions. On 18 May, the restrictions in respect of the construction sector were eased. From this date, the National Paediatric Hospital Development Board, NPHDB, engaged with the main contractor to ensure the earliest possible reopening of the sites. I am informed the main contractor of the new children's hospital project returned to the site on 13 July.

There will be delays associated with Covid-19, but it is too early to assess fully the impact of the pandemic on the new children's hospital project and the paediatric outpatient and urgent care centre at Tallaght Hospital. The NPHDB continues to engage with the contractor and is monitoring progress on site in the interests of completing the project as quickly and economically as possible.

On that note, I want to say I am acutely aware of how urgently the new children's hospital is needed and I want to see it delivered as quickly as possible on behalf of children, young people and their families. I have no doubt the Deputies share that view; we have waited far too long for this hospital. Under the contract, the new children's hospital is due to be completed by the end of 2022 and handed over to Children's Health Ireland to be opened in 2023 after a period of commissioning. I am advised that as of March 2020, when the site closed due to Covid-19, the NPHDB was of the view that the main contractor was behind schedule on the construction works.

The NPHDB is continuing to engage with the main contractor to obtain an updated programme of works that is in line with its contractual commitments. Any delivery outside of the timelines agreed under the contract could be a matter for dispute resolution, so I wish to be careful in respect of what I say here, but I reiterate that it is a priority of the Minister and the Government that the hospital be completed as quickly as possible.

The €1.73 billion figure mentioned by Deputy Daly is the total overall project cost advised to the previous Government in December 2018. That figure comprises €1.43 billion, which is the overall cost to complete the capital project, and also a broader programme of activity associated with the integration and transfer of the services of the three children's hospitals to the new site under development. This includes, for example, investment in ICT, an electronic health record system and the children's hospital integration programme, which is the merging of the three paediatric hospitals.

The PwC report makes clear that the guaranteed maximum price established through the two-stage tender process does not provide a contractual ceiling on cost, and that significant residual risks of further cost remain. The residual risks, for which there cannot be cost certainty, include items such as construction inflation, claims and certain uncontrollable risks, such as potential costs relating to Brexit. I am advised the main contractor has submitted a significant number of claims that it alleges are outside of the agreed scope. The NPHDB has a robust process in place for the assessment of claims by the contractor in accordance with the construction contract. This process is a commercially sensitive one between the contractor and the board.

An instruction to commence with phase B, above ground works, was issued to the main contractor in January 2019. In February 2019, the main contractor informed the NPHDB that it was disputing the validity of that instruction. As the matter is now before the courts, it would be inappropriate to comment further at this stage, even as regards the legal fees. I will, however, outline the legal fees in my follow-up response.

I thank the Minister of State for the comprehensive history of what has gone on but, unfortunately, neither of the two main questions was answered in the long response she gave. The budget is approaching and a proper one is needed, including for University Hospital Kerry. The hospital is at serious risk of being downgraded because it is underfunded, and the cost of the children's hospital will be a very significant factor in that. It is unfortunate that although this question was submitted three or possibly four months ago, and given the record number, the answer has come back only today. Still there is no answer to my two main questions.

To divert the issue slightly, there is a serious risk that Kerry General Hospital will be downgraded. There is no cardiology and little oncology. Rheumatology is gone. Pathology, nursing and radiography have all been outsourced. Ambulances often have to come from Dingle to Tralee if there has been an incident and somebody needs one. Research in infrastructure is gone and there is a fear among staff and the people of Kerry that the hospital will be downgraded. It needs to be fixed.

I thank all three Ministers of State for standing in beyond their briefs and wish the Minister the best.

There is no doubt that the children's hospital will not be built on time and that it will cost much more than expected. I was across this issue quite a bit in the previous Dáil, as many will be aware. What we need now is a projection of timelines and costs. Covid-19 will bring additional costs to everything, including all construction projects. We need to know the Government's position on this project.

It found €600 million to be announced on Thursday. From a capital point of view, many other projects are required throughout the country, including extensions because we need more space across a whole load of disciplines. Are we going to profile out further the children's hospital because we need the money? Let us answer that question. Many of the legal challenges taking place in court are for fairly small sums. Let us be honest and straight up with the people. There is no massive criticism of this Government on the issue; it is a legacy of the previous one. What are the timelines and the projected costs as of now?

The question that Deputy Daly initially asked related to the timeframe for the construction of the new children's hospital. I answered that by saying it would be completed at the end of 2022 and opened in 2023. Those are the dates I have been given.

The Deputy also asked about the legal fees. In respect of legal costs, the NPHDB has statutory responsibility for planning, designing, building and equipping the new children's hospital. I have been informed that its legal fees were €409,000 in 2017, €128,000 in 2018 and €691,000 in 2019.

To respond to Deputy Kelly, he made a very fair point about projections of the timeline and the costs. As we all know, Covid is delaying matters. The Deputy asked about reprofiling the project into the future, but I will have to defer to the Minister on that and seek a written reply for the Deputy, if that is acceptable.

On the legal costs, the Minister of State referred to the costs of the board. Are they the total legal costs, including those of anyone who is claiming against it? It is possible to fix the problems at Kerry General Hospital. In February, there were three ICU beds at University Hospital Kerry, whereas one month later, there were 17, thanks to the great efforts of the ICU staff and the additional resources that were put in place due to Covid. We were able to get some answers more or less straight away, but now I fear we are back to circumstances in which a PR firm has been engaged on behalf of the hospital. The reply to this question came faster than it would have come from the PR firm. I thank the Minister of State, therefore, for the efforts she made in her contributions.

There are so many competing issues going on. For instance, we all know we need budgets throughout the country for hospital prevention measures. The HSE has been excellent in my country, producing an elderly care unit in Thurles, which is fantastic and fair play to them, to analyse those who are elderly and to prevent them ending up in hospital in the first place. I encourage more of that throughout Ireland. For mental services, in fairness, the Minister of State is battling for a capital budget to renovate the unit in Clonmel or to secure another location. That is the type of information we need to know straight up. If the children's hospital needs to be reprofiled, given the massive budget there will be, let us just say it. Sometimes the Government just has to make decisions and sometimes we in opposition have to be honest and accept that. Let us just say out straight that budgets will need to be diverted, if needs be.

I thank both Deputies for their constructive replies.

Deputy Daly has issues in regard to County Kerry. I regret I am unable to answer them. There is probably not a Deputy in the country who does not have issues in regard to their constituency. I agree with Deputy Alan Kelly that the pilot programme rolled out in Tipperary is fantastic. There is a similar programme in Waterford, Waterford Integrated Care for Older People. It is about keeping older people in their communities with geriatrician care. Reablement in the community is important. Going forward, we need to strive to keep our older people safely and securely in the comfort of their own homes with the correct wraparound supports.

I will take up the matters raised by the Deputies with the Minister and I will seek a written reply for both in that regard.

Covid-19 Tests

Alan Kelly

Question:

36. Deputy Alan Kelly asked the Minister for Health if he is considering introducing a self-referral system for Covid-19 testing; and if he will make a statement on the matter. [23654/20]

Given all of the issues we now know about in regard to testing, I am very supportive of the HSE and its endeavours to sort out this issue but it needs support from Government. The deployment of occupational therapists and physiotherapists to testing has to stop. Is there a plan potentially or will we have to move some form of limited self-referral for testing?

I thank the Deputy for raising the issue. A robust testing referral pathway for GPs was put in place in the early days of the pandemic and it has proved a vital component of our overall testing pathway. Enhancements to the referral process have been made throughout the pandemic, including the extension to out-of-hours GP services and new IT systems were developed or modified. The GP community has been a key partner in our efforts to quickly identify and test suspect cases of Covid-19 and I would like to acknowledge the vital role it continues to play in the management of this disease.

The HSE is finalising a future service model for testing and tracing. This service model will aim to deliver a patient-centred, accessible, consistent and flexible service, and will take into account the evolving needs and future potential service demands in the context of Covid-19 surges in disease transmission. The process to develop this future service model is examining all aspects of the testing pathway.

As part of this process, the HSE is examining approaches adopted internationally and is considering a variety of options that can best deliver on the above aims of increasing accessibility, consistency and flexibility. As part of this work, I understand that the HSE is considering the merits of complementary referral pathways to those already in place in general practice and out-of-hours services to provide additional capacity within referral services. It is important to stress that these pathways would be additional to what is already in place and would not replace in any way the important service currently provided by general practice.

I understand that significant work has already been undertaken on the design of the future service model and engagement with key stakeholders is ongoing. It will be important that any complementary pathways are fully considered, including in relation to appropriate clinical governance arrangements. The Minister hopes to receive a final proposal from the HSE over the coming weeks.

I thank the Minister of State for the information. I really appreciate it. The issue is that general practitioners are inundated and we all know it. Increasingly, they are being swamped. For one particular general practitioner in Cork, the number of people presenting has been impossible to deal with. What does the Government propose to do to free up or create a more streamlined process in order that general practitioners during a bad winter or whatever lies ahead - it is going to be bad one way or the other but hopefully not too bad - can do their normal work and not be totally taken up with Covid? We have to look to alternatives. The report mentioned will be welcome. General practitioners also will be administering the influenza vaccination. They will be inundated in terms of that service, although I welcome that.

We have to look to alternatives. The device I am holding up is a Covid test. It takes ten minutes but it is not 100% accurate. I am no expert but I am told it is between 90% and 95% accurate. The test took ten minutes. How is it proposed to do population testing? Is it proposed to roll out all other forms of technologies as well, obviously regulated and so on?

I agree with what Deputy Alan Kelly said. If the Minister, Deputy Donnelly, was here I am sure he too would agree with him. We have to consider the advantages and disadvantages of a self-referral or alternative referral system. A self-referral system has the potential to broaden access to testing, thereby providing greater out-of-hours access and would likely reduce turnaround times. It could also provide additional capacity as general practitioner surgeries move into the winter. It is important to remember that the referral system became overwhelmed in the early days of the pandemic and it is currently experiencing significant pressures.

I have researched the device the Deputy held up. I note it has been introduced in the UK. I understand it is 99.8% accurate, if one were to believe the data. It is the model we need to be moving to. It is worthy of consideration. The costing is as outlined by the Minister of State, Deputy Butler. When the Minister returns, the Deputy and he should have a conversation around the issue.

Interestingly, I offered to speak to the Minister about it but I have not heard back from him since. It is an open invitation. I have no problem referring people who provide it. There are a number of variations of the device. As a country, we need to consider it. If it is good enough for other jurisdictions, we should look at it as well, particularly as winter approaches. I am not saying it is fool-safe or perfect but it is a contribution, particularly in terms of airport testing. We will have to review airport testing as well.

The big issue is the resourcing of our medical scientists. We need to ensure that we have enough of them and to do whatever we can to push more of them into this area. We also need to ensure there is adequate laboratory space to enable us to do what we need to do. We need to prioritise those who need testing, be that through self-referral or a more streamlined referral system and tally that with this type of population general testing around the country, particularly at airports, and then we will have a more robust regime. I would 100% support a proposal in that next over the next few weeks or months.

Questions Nos. 37 and 38 replied to with Written Answers.

May I deal with Question No. 39 on behalf of Deputy Funchion?

Is that agreed? Agreed.

Autism Support Services

Kathleen Funchion

Question:

39. Deputy Kathleen Funchion asked the Minister for Health when the autism committee will be established (details supplied). [22337/20]

When will the autism committee be established as per the commitment given in the last term of the previous Dáil?

I thank the Deputy for raising the question. As outlined in the recently published programme for Government, the Government is committed to improving services and supports for people with disabilities, including those with autism.  

The HSE has established a national autism spectrum disorder programme board with the key responsibility of leading the implementation of the recommendations of the 2018 review of the Irish health services for individuals with autism spectrum disorder. The board has been tasked with leading out on an agreed set of priorities which will have the greatest impact in terms of improving how services can be delivered to people with autism spectrum disorder. I wish to advise the Deputy that while the work of the board was partly paused in March of this year, it will recommence at the end of this month. My ministerial colleague, Deputy O'Gorman and I, have also written to the Ceann Comhairle's office asking that priority be given to the establishment of an Oireachtas joint committee on disability matters. This committee would be an important interface between the various stakeholders, the HSE and public representatives and could provide an open forum for all those concerned, including people with autism spectrum disorder, their families and other interested stakeholders to address issues relevant to them and voice their concerns.   

In light of the comprehensive actions I have outlined here, the establishment of an Oireachtas committee on autism is not being considered at this time.

In April 2019, Deputy Funchion moved a motion in this House calling for an autism empowerment strategy and the establishment of an autism committee. The motion received widespread party support at that time. A commitment was given to deliver an autism empowerment strategy for Ireland. The issues affecting autistic children and adults are long-standing and families, children and adults have been battling for years for their basic rights and entitlements. Children face lengthy waiting times for assessments, they struggle to locate appropriate school places and autistic adults face huge gaps in the provision of crucial services, particularly in regard to finding work, securing social welfare or living independently. This is totally unacceptable and it needs to change. A stand-alone autism committee would bring that change.

We did incredibly well to ensure we had a full-time committee on disabilities established and I ask the Deputy to write to its proposed new Chairman to outline her requests and see if they can form part of the work programme and the committee's planned schedule.

In order to lead implementation, the HSE set up the national autism spectrum disorder programme, consisting of senior operational and clinical decision makers, as well as independent professional academic support and two individuals with lived experience of autism. The €2 million was secured in budget 2020 for the autism plan and the board was to establish two working groups, one dealing with assessment and pathways and the other to deal with the awareness stream. The pathways group was to help identify a standardised assessment approach for using all autism services and ensure every assessment is accessible and to an agreed standard, regardless of which service is being accessed.

While I welcome a stand-alone committee dealing with disabilities, I do not see autism as a disability; I see it as a different ability, I suppose. There was agreement that the State was failing children with autism and their families and we saw many cases where children's hours were being cut at school because they did not have the proper services or resources available. In many cases children did not attend school at all as a result. We all agreed that was a national scandal at the time.

The failure to make a diagnosis in adequate time for school applications and the lack of places available for autistic children in autism spectrum disorder classes amounts to a denial of a child's right to education. These factors have created a two-tier system in our education sector. It is important that we consider this matter. I take the point about writing to the new committee Chairman detailing my points. I thank the Minister of State for her answer.

The Deputy will be aware that last week, we announced €7.8 million for assessment of needs. As Minister of State with responsibility for disability, I note autism plays a major role within that responsibility and will be one of the key drivers in my work on the programme for Government. To all those who may be listening to proceedings this evening, the Deputy is correct; there was and is a national scandal involving children being sent home from school and not accessing full hours. I agree completely with the Deputy on that. We must review the standard operating procedures for the assessment of needs to ensure it amounts to more than just assessment and there is intervention at the other end.

Hospital Services

Rose Conway-Walsh

Question:

40. Deputy Rose Conway-Walsh asked the Minister for Health the protocols being put in place in order that patients may be admitted directly to Belmullet community hospital having full regard for Covid-19 screening prior to admission in view of the fact they have to be sent to the accident and emergency department of Mayo University Hospital before they can be transferred to Belmullet; and if he will make a statement on the matter. [23698/20]

I send my best wishes to the Minister for Health and thank the Minister of State for stepping in this evening. My question is about Belmullet hospital, which serves almost 10,000 people. I want the Minister of State to explain to me the logic of refusing direct referrals from GPs in the area. Patients are being asked to travel 100 miles to 150 miles in a round trip to stay a night in the acute facilities at Mayo University Hospital before they can be referred back to Belmullet hospital. It makes no sense whatever and is absolutely crazy. Why is this done and when will the practice be stopped?

I would like to correct the record. Speaking earlier, I may have inadvertently put the figures the wrong way around when I should have said there were 357 cases of Covid-19 and three deaths arising from the virus today.

I thank Deputy Conway-Walsh for her question, which refers to Belmullet.  The Health Protection Surveillance Centre, HPSC, has developed an extensive body of guidance and support tools on resident transfers and admissions, which as we all know are available on the HPSC website. The guidance sets out the measures that should be adopted for admissions to residential facilities.

Belmullet district hospital is a step-down facility supporting acute hospital discharges.  It has a bed capacity of 20 but now has a reduced capacity of 12 beds. The eight beds were unoccupied at the time the reduction took place.  Admissions to the district hospital must comply with the infection prevention and control guidance issued by the HPSC.

The HSE has advised the Department that all measures put in place in Belmullet are in order to adhere to Covid-19 infection protection control guidelines to maximise patient safety.  There are no direct admissions from the community to any district hospital across the board since the commencement of the Covid-19 emergency surge in March 2020. I understand the Deputy's point, as more often than not cases like this involve an older person who may have to be transferred to Mayo to spend a night in the acute hospital before being transferred back. However, since the onset of Covid-19 no person is being transferred directly to a community hospital.

In March or April of this year, while on the other side of this House, I would have raised many times the fact that many patients were transferred to nursing homes without being adequately tested for Covid-19. It was a major factor in the number of older people we lost.

I do not accept that. Why are we sending somebody on a trip of 100 miles or 150 miles to an acute hospital before sending that person back? Covid-19 was in Mayo University Hospital as well. Yesterday we had the example of a 95-year-old man who could have been catheterised by a GP and admitted to Belmullet hospital in his local area but instead he was forced to go to Mayo University Hospital, where he took up an acute bed. It was completely unnecessary.

In the hospital itself the X-ray, chiropody and physiotherapy services have been cut. In Erris we believe Covid-19 is being used as an excuse to shut all the services. Belmullet had 40 beds before the Deputy's party cut that number in half. Now the Government is coming along again to cut that number. The only thing that will convince us in Erris that the Government is in any way genuine about us having a hospital and services in the area is if capital is put into them. Doing that will give us the hospital we need in the area.

I ask the Minister to be honest with us. This is like death by a thousand cuts so please be honest with us about what is going on.

Covid-19 is a reality and we are living with it on a daily basis. As I stated, we had 357 cases today, with three people losing their lives. I do not believe that for any reason a medical person would ask somebody to travel that distance unless absolutely necessary.

I have said that no community hospital around the country is taking direct admissions currently. This is best practice and a change in this process will be decided by NPHET and people above my pay grade. I am also aware the HSE has advised a number of specific challenges for Belmullet hospital, including infrastructure issues with the building, which were highlighted by an infection control review and a HIQA inspection of the facility. Infection prevention and control is now paramount and we want to ensure the safety of all patients. This is the reason people are not being admitted directly to community hospitals and are instead attending acute hospitals first.

I thank the Minister of State but I still do not believe this is not being used as an excuse. We have excellent staff in Belmullet hospital and it has the required facilities. We needed some minor works done and it has taken over a year to recruit staff for that. There is a line of matters that are unacceptable. Why is the eye clinic finished at Belmullet and what excuse is there for it? There is always one excuse after another given for services not being provided in the area.

This runs completely against the concepts in Sláintecare, as the Minister of State knows. I know we are living in different times but it makes no sense whatever to take out all these services. The Minister of State mentioned carers earlier but there is no respite or clapping for them. It is not the case that their shift will finish at 8 p.m. and their work is 24-7. The Government has nothing to offer the people of Erris when it comes to health services. We are undermining GPs. Why do we not have proper testing and tracing in order that we can make referrals to the hospital? I ask the Minister of State to ask the Minister to look at this again.

I will bring the Deputy's concerns to the Minister but I have an update for her. A meeting was scheduled to take place this afternoon in Belmullet district hospital between personnel from HSE estates, the chief officer of community healthcare west and the head of services for older people services in order to review the infrastructural deficits within the district hospital and to assess and quantify the levels of work required to address these structural deficits. An action plan has been developed locally to address the issues identified at the district hospital in the HIQA report other than the infrastructural issues.

The Deputy makes a very good case. I will take it back to the Minister and I will examine it myself.

Deputy Higgins is not in the Chamber to ask Question No. 41, so I will move on to Question No. 42 in the name of Deputy Durkan. I am not sure what numbers the Ministers are working from, but the initial question from Deputy Daly was grouped with Question No. 47 in my notes. We are on different number schemes. Deputy Durkan has 30 seconds.

Question No. 41 replied to with Written Answers.

Covid-19 Pandemic

Bernard Durkan

Question:

42. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied that the public continue to strictly observe the Covid-19 protocols in respect of hand sanitisation, social distancing and reduction of interaction; the extent to which an assessment has been done of known breaches which have specifically led to new outbreaks; and if he will make a statement on the matter. [23662/20]

This is a very simple question. It could even asked in less than 30 seconds. I wish to ascertain the reason for the sudden, rapid and worrying increase in cases of Covid-19 throughout the country, and to ask what research has been carried out into this.

I thank Deputy Durkan for his question and for his ongoing support for the public health measures that have been put in place in recent months. While the Government has today launched a new roadmap for the period ahead, as the Deputy points out, following the protocols on hand sanitisation, social distancing and reduction in interactions is still the most important thing to do. 

It is important to remember that Covid-19 is a highly infectious disease. The risk of getting Covid-19 is now part of our daily lives and will remain so for the foreseeable future. The most important actions we can take to interrupt person-to-person transmission are regular hand-washing, good respiratory hygiene and maintaining a physical distance of at least 2 m, that is, 6 ft, between oneself and others.

I am satisfied that the protective public health measures referred to by the Deputy have met with widespread acceptance and buy-in on the part of the Irish public.  I have witnessed inspirational solidarity and co-operation among the vast majority of our citizens, who are following public health advice in order to protect themselves and the most vulnerable in our society.

Encouragingly, the most recent public opinion polling conducted by Amárach Research on behalf of my Department indicated that as of Monday, 7 September, there continues to be a good degree of observance of the Covid-19 protocols. This research found that the rate of compliance with the public health guidelines is continuing at a high level. Compliance stood at 95% in regard to hand-washing; 94% in respect of the use of hand sanitiser; 94% in respect of the practice of social distancing; and 83% in respect of coughing into the elbow. Compliance in regard to the wearing of face coverings was at 89% overall, with 93% of those surveyed using face coverings when shopping and 98% wearing them when using public transport. The research also indicates that most people are planning to continue to adhere to these protocols in the future.

I can also advise the Deputy that 93% of those surveyed state that they follow the recommendations of my Department and the HSE to prevent the spread of the Covid-19. Moreover, it is good to see that younger people have the highest compliance rate of 95% when questioned about wearing masks in public.

I thank the Minister of State for his reply. I am a little bit worried because the figures seem to be going in the wrong direction at a time when the authorities are rightly placing greater emphasis on the need to curtail the virus. It was not evident from the Minister's reply but there must be some identifiable clue as to where the biggest problem is. It has been suggested to me that there is not a great deal of compliance in some quarters, and that meetings, house parties and other gatherings continue to create problems. I am concerned at the effects of bringing people together at different locations and times. I know the new roadmap is going to deal with this but I have to say it is worrying, and I hope the authorities know what needs to be done.

I should first state that I have received information that the Minister for Health, Deputy Stephen Donnelly, does not have Covid-19. I wish him well. It was an honour to be able to step in for him but it is good to know that the Minister does not have the virus. As the Deputy is aware, the virus only needs a small window of opportunity to re-emerge. For everyone's sake, especially the most vulnerable, it is therefore critical to keep the transmission of the virus within the community to the absolute minimum.

Deputy Durkan referred to house parties. This is an issue and the reopening of wet pubs is also causing some concern. However, I hope we will be able to work with all stakeholders to address these concerns. As the Deputy will know, a large number of outbreaks occurred in his own county of Kildare, as well as in Laois and Offaly. Those outbreaks spread rapidly within specific workplace settings such as meat plants. In recent weeks these outbreaks have been dealt with but the Deputy is right to say that we must be very vigilant.

I thank the Minister of State. I agree. We in County Kildare have been in the eye of the storm for some time and we have paid a high price for it. The second lockdown was quite invasive and created significant economic difficulty but the outbreak was dealt with, albeit at great cost.

The national figures are now accelerating at what I would regard as an alarming rate and I am not so certain that we have identified the causes. While the Minister of State's reply was made in good faith, I would like some more information on the direction we are heading. I know the wearing of masks is very important. It seems these guidelines are being adhered to. Why, then, is the virus accelerating? There is a contradiction somewhere that I cannot figure out. Better brains than mine are addressing that issue. I ask that they do so as a matter of urgency.

The Government shares the Deputy's concerns. The National Public Health Emergency Team, NPHET, meets on a regular basis. It reviews current restrictions based on the most up-to-date information and advises the Government accordingly. It is impossible to accurately predict the future trajectory of Covid-19 in Ireland. As the Deputy knows, there is no precedent for dealing with a pandemic such as this. As such, it is impossible to provide assurances that it is safe to lift the public health restrictions.

We are looking at this on a case-by-case basis. Some stricter measures may need to be introduced in the event of a strong upsurge in infections. This is worrying but I understand that NPHET is monitoring the situation very closely.

We are nearing the end of the time for this business but I will allow the last question.

Primary Care Centres

Paul McAuliffe

Question:

43. Deputy Paul McAuliffe asked the Minister for Health the status of the Finglas primary care centre [22250/20]

I welcome the Ministers of State, Deputies Butler, Rabbitte and Feighan, to the House. Having waited eight years for a Minister to champion their primary care centre, the people of Finglas will be delighted that three Ministers of State have come along all at once. This project dates back to 2012. The HSE, local GPs, elected representatives and the community all agree on the need for a primary care centre. The budget and plans were in place and the HSE proceeded, despite being advised by local representatives that planning difficulties would arise on the site suggested. Unfortunately An Bord Pleanála, the independent body making the decision, refused planning permission for that site. There was an unsatisfactory delay of almost eight years in the HSE's identification of a new site but the partnership of Dublin City Council and the local parish has now reached that point. I ask the Department of Health to do everything it can to expedite this. The people of Finglas want to see a fire lit under this project. They want to see it delivered.

The Deputy was supposed to have 30 seconds. I inadvertently took my eye off the clock.

I thank the Deputy for raising the issue of the provision of a primary care centre in Finglas. The development of primary care is central to the Government's objective of delivering a high-quality, integrated and cost-effective healthcare system.

As the Deputy is aware, Finglas has been identified as a location for the development of a primary care centre. As he pointed out, approval for a HSE direct-build primary care centre was granted in 2012. Following review of several sites in the area, a Dublin City Council-owned property on Mellowes Road, Finglas, was identified as the preferred site. Subject to planning permission, the commercial terms for the sale were agreed with officials of Dublin City Council and approved by the HSE.

The planning permission was appealed to An Bord Pleanála, where an inspector upheld the Dublin City Council decision. However, in February 2015 An Bord Pleanála took the unexpected decision not to grant planning permission for the Finglas primary care centre due to the loss of informal open space.

Following this refusal, HSE estates, in conjunction with local primary care services teams, identified an alternative site for a new primary care centre in Finglas and initiated discussions with Dublin City Council in respect of purchasing the site on terms agreeable to both parties.

  Feasibility studies on the site are still progressing.  The HSE will be tendering for the services of a design team to progress the proposed project to completion in the near future, subject to agreeable conclusion to the site purchase.

I appreciate the Minister of State outlining some of the difficulties with the site, but it is clearly water long under the bridge since 2012. What people want to know now is, first, when will the design team be initiated? I appreciate that the Minister of State confirmed it will be appointed, but when will that be done? Second, is the funding in the capital programme to deliver this project? There is no reason that should not be the case. As the Minister of State noted, there is great need for this service. All of the people whom the Minister of State serves, whether they be children with disabilities, older people or those with mental health or addiction issues, will benefit from this site being developed. I ask each of the Ministers of State present to use their influence within the Department and with the Minister, with whom I have previously raised this issue, to do all they can for the people of Finglas.

As I stated, feasibility studies in respect of the site are progressing. The HSE will be tendering for the services of a design team to progress the proposed project to completion in the near future, subject to agreeable conclusion to the site purchase. The HSE advised that discussions with Dublin City Council regarding the proposed primary care centre were delayed due to the pandemic but have recently reconvened in an effort to conclude the site purchase from the council on terms agreeable to both parties. I understand the Deputy's concerns regarding this primary care centre. I have seen such centres in many other areas and know they are of great benefit. They make a significant difference to the areas in which they are located. I know Finglas and that the people of Finglas and the surrounding area deserve a state-of-the-art building such as this one. I genuinely believe the Government will progress it and that the funding will be there.

I thank the Minister of State for his bona fides on this issue. I acknowledge that he is taking the question on behalf of the Minister. We have a very strong team in the Department, led by the Minister and the Ministers of State. I hope that they, working with me and other Government Deputies who represent the area, will be able to deliver on the commitments in the programme for Government and for the people I know each of them wish to serve.

Finglas was identified as a high priority location for the development of a primary care centre. As I stated, a HSE direct-build primary care centre was approved in 2012 in the HSE monthly capital annual plan. Primary care centres offer clear benefits such as bringing healthcare professionals together to operate as multidisciplinary teams in purpose-designed, well-equipped and high-quality modern facilities. This centre will be the focal point for many local health initiatives. I again thank the Deputy for raising this very important issue. I hope the people of Finglas and the surrounding area will have their much-needed primary care centre in the near future.

Question No. 44 replied to with Written Answers.

Disability Services Funding

I do not think the Minster for Agriculture, Food and the Marine has yet arrived, so I will allow Deputy Carthy to ask his question.

Matt Carthy

Question:

45. Deputy Matt Carthy asked the Minister for Health his plans to allocate sufficient funding to the HSE to allow the operation of disability services such as the new group home for persons with physical and sensory disabilities in Carrickmacross, County Monaghan. [23656/20]

I thank the Leas-Cheann Comhairle for allowing me in. I welcome the fact that the Minister for Health has tested negative for Covid and I hope his symptoms resolve themselves very quickly. I also hope that the speediness with which he received his test result - I do not begrudge him that; I think it is very important - becomes the hallmark by which all other tests are measured.

My question relates to the group home for people with physical and sensory difficulties in Carrickmacross. I would very much appreciate a response detailing when we will see this project developed.

The Minister, along with the Minister of State with responsibility for disability, Deputy Rabbitte, is committed to improving services and supports for people with disabilities which will empower them to live independent lives. This year, the HSE will provide more than 8,300 residential places to people with disabilities and will continue working with agencies to explore various ways of responding to this need in line with available resources.

On the residential care facility in Carrickmacross, County Monaghan, I understand that the premises was developed by Respond housing agency in partnership with Monaghan County Council. As the Deputy will be aware, the HSE has been working to make the building operational as a residential care facility for people in the region who have physical or sensory disabilities within the resources available to it.

I am informed that the HSE undertook a procurement process for an external service provider to run the facility and an organisation was identified, but at a cost that exceeded the budget available. I  understand the HSE intends to seek the additional funding required to open this group home through the 2021 Estimates process. In the interim, outstanding minor works relating to the building remain the subject of engagement between the HSE and Respond.

As the Deputy will appreciate, I, on behalf of the Minister, cannot comment at this stage on the outcome of the Estimates process or matters which will be the subject of national service planning in 2021.

The Minister of State has no way of knowing how frustrating his answer is. This issue dates back to the early 2000s, when the families of a group of young women with physical and sensory disabilities first sought for it to be addressed. Those young people had been cared for in their homes all their lives, but their parents were getting older. They approached the health authorities and the local housing services to seek a long-term solution to their needs. Since then, they have met delay after delay and experienced consternation after consternation. Throughout the planning process, one obstacle after another was put in their way. If it was not for the doggedness of the parents of these young people, the building would never have reached completion. It has now been complete for several years and in each of those years, the response which the Minister of State just read out has been returned to the families. They are told that the Government will see whether the project can be included in the Estimates for next year. The Minister is not present, but three Ministers of State at the Department of Health are. I ask them to bring the clear message to the Minister that this issue will not go away. I will raise it at every opportunity available to me until a Minister takes responsibility, grabs the HSE by the scruff of the neck and opens the house in question for these people.

I ask for Deputy Carthy's co-operation. I extended the timeframe to allow him to ask his question.

An on-site meeting with HSE CHO 1's head of social care, general manager disability services and service manager disability services, a representative from HSE estates and a representative from the Respond housing agency took place on the morning of 12 February last. The purpose of the meeting was to consider any outstanding minor works to be completed and to carry out a walk-though of the premises with the Respond architect and members of the HSE estates. Agreement was reached that a list of minor works would be compiled with HSE estates and forwarded to Respond for consideration. Discussions have taken place with the family of a potential resident and the HSE has submitted the remedial works plan required to the Respond housing agency to request agreement on which remedial works the latter will fund. I understand the Deputy's interest in the project. I know he has tabled many parliamentary questions on the issue. My fellow Ministers of State and I will bring this issue to the Minister and try to clarify the matter for once and for all.

I wrote to the Minister only last week to suggest that he facilitate a meeting with me and officials from the HSE, Respond housing association and, if necessary, Monaghan County Council. There has been too much back and forth on this issue. Respond housing association has a vested interest in ensuring the building becomes operational because it currently has a building for which it is not receiving any rent. It makes no sense that it would be the source of any delay. I ask the Ministers of State to request that the Minister, when he is back on his feet, ensure that meeting be facilitated such that we can get this building operational in the interests of these people who have very severe disabilities and whose families want them to have as independent lives as possible.

This building has been identified as being crucial. The HSE, over a decade and a half ago, recognised the value and importance of this building. What I am seeking needs to happen.

I understand that the HSE CHO1 notes that the funding to make this facility operational has been included in the Estimates process for 2021. I understand the Deputy's concerns. We will bring them to the Minister. Hopefully, this issue can be resolved.