Dáil Éireann debate -
Thursday, 29 Sep 2022

Vol. 1026 No. 8

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services

Deputy Jackie Cahill

I will make a point before I start and I intend no disrespect to the Minister of State who is here. I have looked for this Topical Issue matter on a couple of evenings and it has been selected for this evening. The Minister of State, Deputy Butler, has responsibility for the area that I wish to discuss and I am disappointed I was not informed by the Ceann Comhairle's office that she was not available. The Minister of State is hard-working and this is in no way a criticism of my party colleague. She has been very helpful to me on a number of issues and I have been discussing the issue of dementia care with the her. We all wait for our slots in Topical Issue debates and it would be only proper and courteous that if the Minister with responsibility for that area is not available, we be told in order that we can wait for a time slot when that Minister is available. It is no disrespect to the Ministers of State who are present but Deputy Butler is the Minister of State with responsibility for dementia care. She is developing a new strategy for dementia care and it is to her I wished to make my points on dementia care in County Tipperary.

When a Minister is not available, the Ceann Comhairle's office should inform us of that and give us the opportunity, if we so wish, to wait for an opportunity for the relevant Minister to be in the Chamber. I make no criticism of the Minister of State, Deputy Butler. I have an excellent working relationship with her. This evening did not suit her work schedule, which I fully appreciate and accept, but I wish to make the point.

Dementia, unfortunately, is becoming an ever-bigger issue in our society. We had an historic budget this year that we have been talking about for the past number of hours. It includes €180 million for older persons. I give great credit to the Minister of State, Deputy Butler, for securing that in this year's budget. She has worked extremely hard to get her budget increased and has managed to do so for older persons in this year's budget. She has clearly stated that she wants to develop a dementia strategy following this budget allocation. I also welcome the announcement that a further €50 million of funding will be allocated to deliver a target of 24 million hours of home care in 2023. The Minister of State's priority and focus on development of dementia services and supports will continue. There has been an increase of 15% in new home-care hours ring-fenced for people with dementia, with a continuation of dementia home supports and continuing funding of the Alzheimer Society of Ireland. This is all very welcome news that will be viewed positively by many families throughout the country who have loved ones living with dementia.

I will highlight a serious need for long-term care for people with dementia in my home county of Tipperary. While I appreciate and fully support the fact that we should care for older people in their homes as much as possible, there are times when this is simply not an option for families. The Minister of State, Deputy Butler, and I visited a dementia-specific nursing home village in Bruff, County Limerick, which is leading the way in dementia-specific care in that area.

I was most impressed by the standard of care in this facility, the resources available and the specialised approach being taken to the residents. It was top class.

That is what I am looking for for my county. I am aware the Minister of State, Deputy Butler, is developing the strategy. Both she and I were there that day at the village in Bruff and we saw the excellent care and the model that is there. I want to push with the Minister of State, Deputy Butler, for us to get that nationwide and obviously as a Deputy representing Tipperary I am looking for the county to host one of the pilot dementia village projects.

Acting Chairman (Deputy Cormac Devlin)

I thank the Deputy. Before I call the Minister of State, in fairness to the Minister of State, Deputy Butler, she is generally here for the Topical Issue debate herself, as Deputy Cahill knows.

Deputy Jackie Cahill

I accept that fully and am not criticising her in any way. I just feel the Ceann Comhairle should inform us and give us the choice if the Minister or Minister of State with responsibility is not available.

Acting Chairman (Deputy Cormac Devlin)

That is a fair point.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I thank Deputy Cahill for raising this issue. Improving services for people with dementia is a priority for the Government and the past three years have seen significant new investment in dementia-specific support services and care countrywide. Next year will see a further €12.16 million investment dedicated to dementia and this is in addition to the cumulative €27.9 million provided across 2021 and 2022.

I will bring the Deputy's concerns back to the Minister of State, Deputy Butler. In fairness to her, she is very much to the forefront of fighting for funding in her area and is a pleasure to work with in the Department. This funding over three years is allowing for the rapid expansion of dementia diagnostic services and post-diagnostic supports through the provision of new memory assessment and support services as well as two new specialist memory clinics in Cork and Galway. It is also providing for numerous other initiatives including: dementia-specific day care; quality improvements in hospital and mental healthcare; improved access to the National Dementia Adviser Service; dementia-specific education for home support workers; and the implementation of a national clinical guideline on the appropriate prescribing of psychotropic and antipsychotic medication. In addition, it is targeted at increasing the proportion of new home support hours specifically for people with dementia to 15% in 2023, which is up from 5% in 2021 and 11% in 2022.

In recent years the national network of memory technology resource rooms has expanded to 23 centres. Of these, two are located in County Tipperary. One is in Thurles and the other in Clonmel. These provide an occupational therapist assessment and guidance along with the opportunity to find out about assistive technology options to help manage memory difficulties. Dementia-specific day care is provided in Clonmel and Thurles and taken together all these investments are rapidly improving access to diagnostics, post-diagnostic supports and ongoing care for people with dementia.

While national policy on care for older people is focused on supporting people to remain at home for as long as possible, the national dementia strategy recognised that for some people long-term residential care may be required when home care is no longer feasible or appropriate. A majority of people with dementia reside in generic residential care facilities and this is reflected in the 2016 revised HIQA National Standards for Residential Care Settings for Older People in Ireland. The standards place a strong focus on quality of life and a person-centred approach to care for all residents, including those with dementia.

With regard to residential care for people with dementia in north Tipperary, following a meeting last month at Government Buildings, HSE mid-west community healthcare is preparing an options appraisal document for older people services in the north Tipperary area. As agreed at the meeting, the service is reviewing all options for the Dean Maxwell unit and the progression of the new older persons unit in Nenagh. The service is also examining the overall requirements for older people services in the region. HSE mid-west community healthcare is committed to delivering the best possible older people services to the people of north Tipperary and it is expected an options paper will be presented in quarter 4 of 2022. As for dementia-specific residential care services provided in south Tipperary, the Cashel residential older people services provides an 11-bed dementia-specific service for women configured as nine single rooms and one double. All other long-term residential beds are profiled as generic beds in order to meet the need.

The Deputy talked about the great facilities and excellent care in Bruff, County Limerick. I will also bring that to the Minister of State's attention.

Deputy Jackie Cahill

In case there is any misunderstanding, I am not criticising the Minister of State, Deputy Butler, in any respect. She delivered a Jigsaw project for Thurles that is fully operational now. We were waiting a long time for it and I am thankful. She has such an excellent record of delivery that I wanted to make the points about a dementia unit to her personally. She is developing the strategy for dementia.

The case I want to make is parochial and fairly straightforward. I have seen the facility in Bruff and it is an excellent model. The Minister of State, Deputy Butler, intends to examine a range of long-term residential care models for people with dementia and I want to strongly press that we want one of those facilities for Tipperary.

Early next year the National Dementia Office will publish a model of care for dementia that outlines care pathways for people living with dementia, from identification of symptoms through assessment, diagnosis, disclosure, care planning and post-diagnostic support. Other Government Teachtaí Dála will also be pressing the Minister of State to have their county included. We have a need for it in my county. There have been ongoing discussions about long-term beds in the Dean Maxwell unit in Roscrea. I am aware there are ongoing discussions with the HSE that were initiated by the Minister of State, Deputy Butler. I hope these will bring a resolution of long-term public beds for Roscrea. While those discussions were ongoing we talked about a dementia village and, as I said, we went to see Bruff. I am asking strongly that when the Minister of State, Deputy Butler, is putting our national strategy together, she consider County Tipperary for a pilot project. Unfortunately, if there is a unit put in place it will be fully utilised.

Deputy Frankie Feighan

I outlined earlier the unprecedented level of investment made by the Government since 2021 to improve diagnostic and post-diagnostic care and support for the 64,000 people with dementia throughout Ireland. Last Wednesday was World Alzheimer's Day. This provided an opportunity to reflect on what more we need to do to ensure people with dementia can live well as valued citizens of this country. I am pleased to note that early next year the HSE will publish a model of care for dementia that outlines care pathways for people living with dementia, from identification of symptoms through assessment, diagnosis, disclosure, care planning and post-diagnostic support. This model of care will be used as a basis for future dementia-specific investment.

As I said previously, HSE mid-west community healthcare is preparing an options-appraisal document for older people services in the north Tipperary area. It is expected this will be presented in quarter 4 of 2022. There may also be opportunities to identify scope for a dementia-specific independent living unit to support people to age well independently for as long possible in the Roscrea area.

It was a good idea to go see the Bruff centre. I am in interested in calling down to see it as it seems to be the way forward.

Community Welfare Services

Deputy Brian Stanley

I welcome the opportunity to raise with the Minister of State the need for local face-to-face community welfare officers. It is an important service and sometimes it is vulnerable people who need it most. They may have no transport, may have run out of money or may not be in receipt of any payment from anyone anywhere. They may be out of work or perhaps out of work due to ill health and not had their claims processed yet. The service is therefore the last hope for people in dire straits through no fault of their own. There was a strong network going back over the years in every county and in key local towns.

There might be between six and ten of them in a county, depending on the size of it. It is for people who do not have a computer and may not have a phone or phone credit. It is important that the walk-in service is there. Sometimes I come across people who are accessing that service who have a learning disability or intellectual disability and may not be au fait with laptops. They may not have a laptop and may not even have a phone. There is more demand now than ever for this service. The additional needs payment is welcome for people who are in energy poverty or energy hardship, to meet once-off demands with the current energy crisis and so on. There is a growing demand for that service. It was never needed more than it is at the moment. It is the last hope for those who are in a bad situation or who are in dire straits.

I raised this with the Minister, Deputy Humphreys, on 8 September and she sent me back a reply stating that continued in-person customer engagement remains a pivotal feature within the community welfare service. She outlines that this is still available at two locations in Laois. I would contradict that. This is not the fault of the local community welfare officers. She also says there is a free-phone helpline in Dublin and that people can send an email. She says there is no longer a requirement for a person to meet a community welfare officer to make a claim. There is. That is what I contend. The Minister goes on to say that it is important to note that the assessment and decision on claims and any further customer interaction is carried out locally, based on community welfare officers, as it always has been. Her letter states that the delivery of a locally based community welfare service remains the cornerstone of the service.

I would question that seriously, given the way it has been centralised. This service has been overly centralised over the last couple of years. Gone is that network of face-to-face walk-in services where the community welfare officer came to a particular health centre, Government office or wherever for two hours, typically, on some morning during the week. The one community welfare officer would cover a whole county doing it. They would not even need to spend all their time at it, just a couple of hours in each town. Now people are being told to email Dublin or contact the national helpline. Telling people that is absolutely daft. People are being told to download forms on a computer. We are talking to people in a lot of cases who do not have a computer and are not computer-literate. This service has really deteriorated. The assurances given by the Minister here and what she said in the letter do not reflect the reality on the ground. That network of community welfare officers is no longer in place. I ask the Minister to address this.

Minister of State at the Department of Public Expenditure and Reform (Deputy Patrick O'Donovan)

I apologise on behalf of the Minister, Deputy Humphreys. She is at a conference in Cavan today for rural development Ministers from the OECD. I thank Deputy Stanley for raising the issue. The supplementary welfare allowance scheme is the safety net within the overall social welfare system that provides assistance to eligible people in the State whose means are insufficient. The community welfare service, CWS, remains a flexible service which meets the varied needs of vulnerable people and the Minister wants to be absolutely clear that it continues to provide local access to local community welfare officers, CWOs, in local areas across the country and there are no plans to change the service. Her Department has maintained staffing levels in the CWS nationwide in recent years, during times when demand decreased. This is reflective of the commitment to continue to support delivery of locally based services to customers.

CWOs can facilitate urgent and in-person meetings in 51 Intreo centres across business hours five days a week. In addition to meeting citizens in the Intreo offices, branch offices and Department of Social Protection offices, CWOs can facilitate an appointment within a short time of a person requiring a meeting at a mutually agreed location including the person's home. The Department of Social Protection has introduced innovations this year which have increased efficiency in processing applications for the supplementary welfare allowance payments. One of these is the establishment of a back-office team to undertake preparatory work on applications. That includes registration of claims and the gathering of supporting documentation that is necessary to assess and finalise a claim. Providing this clerical assistance has been found to be very effective in releasing the CWOs from administrative tasks and allows them to focus on delivery. It allows for increased capacity of CWOs to meet people locally or to travel with them as customers as required, and also for more timely processing of claims.

The Minister firmly believes that a modern community welfare service should be easily accessible to all customers. For this reason customers no longer have to meet in person with a CWO to make a claim. This significant change ensures enhanced access to the welfare system. It means, for instance, that those who require community welfare assistance in a more remote rural area no longer need to wait for an outreach service to be available. The application form is available to download for those who can access it online. It can also be requested by phone through the dedicated CWS free-phone line, and also by email. The Minister cannot emphasise enough that while changes to modernise and improve the service for customers are a feature of welfare services, the delivery of a locally based service will remain a cornerstone of her commitment in the Department. I thank the Deputy for giving me the opportunity to respond on behalf of the Minister, Deputy Humphreys.

Deputy Brian Stanley

I thank the Minister of State for his reply. Unfortunately the reality in County Laois does not correspond with what he has outlined. Councillors from the Government parties raised this matter at the monthly meeting of Laois County Council last Monday and are very exercised about it. It is a real problem. I understand the Minister cannot be here and appreciate that the Minister of State is standing in for her. I ask the Minister of State to get the Minister to investigate this and examine what the situation is on the ground. What she sent me in this letter of 8 September and what the Minister of State has outlined is just not the case. The Minister of State has outlined that it is a safety net. It is a safety net and the last hope for a lot of people. The Minister of State mentioned that people are doing back-office work and preparatory work. Sometimes the people who are going in need help filling out forms, be it the community welfare, the supplementary allowance form, the additional needs form or the urgent needs payment form. They need help with those. The CWO going around and having the local network of five or six clinics in a county provided that help for them. The further we take things away, the more complicated they get.

The other thing that is missing is that there was a local appeals system. There was a superintendent in each county or one for every two counties. If a case failed, there was an opportunity for the person to appeal to that superintendent. Now it goes to D'Olier Street and by the time it comes out of D'Olier Street, God help anybody who would be waiting on it. The Minister of State knows from his own office that it can take six or nine months or longer to get stuff back from D'Olier Street. If there was a justifiable, genuine case there, the appeal could be made to the local superintendent who would review the case again and maybe there was additional information required. We cannot pull away all of that. People talking to a phone, getting through to a chasing line telling them to press this button, press that button, or trying to download forms on a computer when they do not have a computer just does not work. This is causing real hardship. People who are in this situation are already in hardship. I do not want to see them put in further hardship. I am appealing to the Government and the Minister of State to review this and try and get the network back in place in County Laois.

Deputy Patrick O'Donovan

I omitted to say in my earlier remarks, although Deputy Stanley is probably aware of this anyway, that in the Laois-Offaly constituency there are no CWO vacancies and there is a full complement in Laois of six and in Offaly of five. In respect of the changes that have been made around modernisation, it has been in response to a lot of calls from Oireachtas Members and public representatives, including a colleague of Deputy Stanley's, Deputy Kerrane, who on a number of occasions in this House has called for community welfare services to be made available online-----

Deputy Brian Stanley

And face to face. She has also raised that.

Deputy Patrick O'Donovan

-----for customers who do not want to meet face to face. If I could finish, it is very clear in the earlier response I made that the Minister, Deputy Humphreys, is committed to a blended format, making sure that it is accessible. It goes without saying that of all Ministers in the Government who are rooted in rural areas, everybody on both sides of the House would fully appreciate the commitment she has to the maintenance of rural services.

School Facilities

Deputy Steven Matthews

I was contacted by the line Minister, who was unavailable. I thank the Minister of State, Deputy O’Donovan, for being here, because the question is on refurbishment and retrofitting. The Minister of State with responsibility for the Office of Public Works, OPW, has good experience in the fine work that the OPW carries out on many of our buildings across the country.

I want to ask about the retrofitting of our schools across the country. Many of us visit and talk in schools. Schools we visit can have varying, different standards of buildings. I visited a school recently in Rathnew, namely, St. Coen’s, which was newly built and is absolutely fantastic. There are high energy-efficiency measures within the building - everything from the taps to the water conservation measures and more. It has water attenuation tanks outside that catch rainwater from the roof and then regenerate back into the building. The roof was wired for solar panels but they did not have them. They asked me to look into that, so I would be delighted to go back to them now to tell them that we are putting free solar panels on schools. That is a bit of good news going back.

However, other schools we visit – the Minister of State knows ones I am talking about – where you go in and there are the badly-fitted windows, the central heating is pumped up to 90 and the heat is all going out through the windows. The heating is blasting out, but yet the children are cold in the classrooms.

I tabled a parliamentary question to the Minister for Education on it, and the response came back about the energy retrofit pathfinder programme, which is a programme to identify and assess schools for retrofitting. I just do not know how a school actually applies for it, how it is assessed or how it gets onto that pathfinder programme. We know the tremendous work that the teachers do in the classroom and the school principals are absolutely up to their eyes, so I do not know if they would have time to sit down and look into how to apply for a retrofit for their schools. It would be good if we could make it easier for those schools to apply for those energy retrofits to get the assessments carried out to see what the best return for them is, for example, new windows, thermostatic controls, lighting controls or something to help them with those huge energy bills, especially where they are dependent on oil heating. It is expensive, wasteful and bad for our environment.

I do not know if the Minister of State has any information on that. However, I would like to be able to go to the schools and tell them about the pathfinder programme that was introduced and is a collaboration between the Department of Education and the Department of the Environment, Climate and Communications. How do school apply for that programme?

Deputy Patrick O'Donovan

At the outset, I want to thank Deputy Matthews for raising this issue. My office had, through the offices of the other Ministers for whom I am deputising, reminded them to tell colleagues if they were not available, so I do not know what happened in respect of the other issue.

I want to thank the Deputy for raising this issue, as it provides me with an opportunity to outline the current position on retrofitting and sustainable energy in school buildings for the Department of Education. The Department is at the forefront of design with respect to sustainable energy in school buildings. This performance has been recognised at both national and international levels.

The National Development Plan 2021-2030, which was published on 4 October, provides capital funding of more than €4 billion for investment in school infrastructure during the period of 2021-2025 and there continues to be a strong climate action dimension in this. The Department of Education’s technical guidance documents set the benchmark for sustainable design in school buildings with a clear focus on energy efficiency. Schools that are designed and built in accordance with the Department’s school technical guidance documents have been receiving A3 building ratings since 2009, with current schools typically achieving up to 20% energy performance and 25% better carbon performance than required by the current building regulations, along with 10% of primary energy provided via photovoltaics and infrastructure provided for electric vehicle charging. All new technologies and approaches are tested to ensure compatibility with school design and operational requirements. Successful and repeated results are then incorporated into the new school designs and refurbishments.

The Department’s policy is supported by a strong research programme with more than 50 research projects at various different stages. In the interest of sustainability, it is critical that renewable applications are properly suited to the schools’ needs, so as to reduce energy costs and carbon and not just apply for the sake of having renewables. It is also critical that we minimise the demand for energy before we invest in renewable energy applications. This has been assisted in previous years with wall and attic insulation programmes and a water conservation programme, which the Deputy referred to.

The Department of Education and the Department of the Environment, Climate and Communications jointly funded the pathfinder programme, which the Deputy also referred to. That is administered through Sustainable Energy Authority of Ireland, SEAI. The pathfinder is a great example of collaboration, ensuring deployment of new design approaches and technologies are introduced in an education environment and an evidenced-based approach. The programme continues to assist the Department of Education to explore options and test various solutions in the school building network. It is paving the way for and informing a much larger national programme for the energy retrofitted schools built prior to 2008, as included in the national development plan, NDP. It is facilitating research on a range of typical retrofit options, which will have to be tried and tested, and is providing valuable development information for a solution-driven delivery strategy, which will be founded on a solid evidence base and proven to be robust and scalable, of renewable solutions within the school sector.

The pathfinder programme has retrofitted 41 schools across the country to date, with work on an additional 15 currently at various stages of design. Each school undergoes a comprehensive assessment to ensure that the measures are suitable for that school and will deliver value both to the school and the environment. The works typically include upgrades to the building's fabric, including walls, roof, doors, windows, airtightness improvements, lighting, heating and other renewable technologies. As part of the cost-of-living measures to be enacted this year, €90 million is being provided in a once-off additional funding to support increased running costs for primary and post-primary in the free education scheme in dealing with the challenges that they face due to high energy costs. This will be paid at a rate of 40% of schools’ basic and enhanced rates of capitation.

Deputy Steven Matthews

I completely agree that the first step should be energy reduction. That is what we should be pursuing. It is encouraging to hear that 41 schools had pathfinder works carried out and another 15 are under assessment. That is kind of what my question is about. How does a school apply for or get on the radar of the Department for an assessment to be carried out?

I visited a school in Wicklow town recently. It was a school that had two buildings. One was the original 1955 block with high ceilings and high windows. It was the type of classic, old Irish national school building. I went in to have a look at it and I could see very simple measures that could be introduced there, for example, interior wall insulation, rather than exterior, because it is a classic looking building and you do not want to take away from that classic look. There were very simple measures that could be carried out that would reduce the heating costs in that school. If we can reduce the heating bills for the school, it will reduce the pressure on principals who want to keep the schools warm and comfortable for children and staff. The bills roll in and that money could be better spent on other provisions in the class. I have no doubt that many principals would have many other things to spend the money on rather than high energy bills.

Particularly, in relation to St. Patrick’s school in Wicklow town, I would appreciate if the Minister of State could relay to the Minister for me that it is a school that would be very suitable for that pathfinder programme. Generally, how does a school apply? Does it go on the SEAI website like a residential or business user would? Is there a direct line to the Department where you can tell it the school is freezing, the bills are huge or the windows are drafty and ask to be put on the pathfinder programme? If the Minister could come back to me at a later stage, I would very much appreciate that.

Deputy Patrick O'Donovan

I will ask the Department of Education, through the office of the Minister, Deputy Foley, to respond to the Deputy directly.

On the retrofitting of older buildings, Deputy Matthew’s commented that the OPW is steeped in this. Every old building presents its own challenges. In many cases the buildings the Deputy referred to are listed buildings. This includes primary and post-primary schools, that are either listed on the city and county development plans or, in some cases, are protected structures. That creates a difficulty as well for the board of management in terms of what can be done on the external elevations and windows. We have to be practical as well in relation to making sure that these buildings are comfortable. This is where often there is a clash in the prioritisation of needs.

We all have in our constituencies old buildings where children are trying to be educated. These buildings are on the list of protected structures or somebody's list of protected structures. Unfortunately, however, the comfort and needs of the children, teaching staff and support staff often fall far down the pecking order. Where there is a mass concrete building, the difficulties associated with attaching external or internal insulation must be borne in mind. If it is a stone building, the stone has to be able to breathe. The lime has to be able to breathe. This comes with a lot of complications, and these are not easily rectifiable.

We encounter these problems in the Office of Public Works when dealing with older buildings, particularly given the fact that a building will actually tell one what it is and is not capable of taking by way of modern infrastructure placed upon it. Therefore, it is not easy, particularly where buildings built before 2008 are concerned. Many of these were built in the 1960s and 1970s, and many of us were educated in them. To be quite honest about it, there is probably a bigger question to be asked regarding whether it is sustainable to try to insulate a building of the scale, nature and age that I describe instead of constructing a replacement one, for instance.

Cuireadh an Dáil ar athló ar 5.42 p.m. go dtí 2 p.m., Dé Máirt, an 4 Deireadh Fómhair 2022.

The Dáil adjourned at 5.42 p.m. until 2 p.m. on Tuesday, 4 October 2022.