Adjournment Matters

Accident and Emergency Services

Senator Terry Leyden

I thank the Cathaoirleach for allowing this motion on the Adjournment and I thank the Minister of State, Deputy Cannon, for coming to the House to take it.

Concerned constituents have brought to my attention their fears for the future of services at Roscommon County Hospital and the staff changeovers due on 11 July. It is vital the Minister, Deputy Reilly, clarifies this issue immediately. It is unacceptable to me that services at Roscommon County Hospital would be withdrawn. It is unacceptable that the accident and emergency service would only be open from 8 a.m. until 8 p.m. daily and close from 5 p.m. on Friday until 8 a.m. on Monday. It is essential that accident and emergency services are available at Roscommon County Hospital on a 24-7 basis, as has been the case up to now. It is to be hoped the HSE suggestions in this regard will be overruled by the Minister.

Prior to the election, the Minister said that safety was not simply about surgical competence but also about timely access. Timed treatment, especially to remote geographical locations, is crucial. I wish to quote an extract from a pre-election commitment of the Minister:

This is key to allowing Roscommon Hospital, which does not have complex surgery, to retain the skillset required to incubate and ventilate and to have the ability to undertake less complex surgical procedures ... Furthermore, in the event of the A&E being downgraded, we are committed to reinstating a 24/7 service, where feasible ... To again reiterate, our core principle regarding health is that the patient be safely treated as close as possible to their home and Roscommon County Hospital is an integral part of this objective.

I hope the Minister of State will confirm that Roscommon County Hospital will retain its 24-hour, seven-day a week accident and emergency unit. This is crucial and is the most important issue in the constituency of Roscommon-South Leitrim, as it was when I was a Minister of State who successfully retained those services in the 1980s.

Senator John Kelly

I welcome the Minister of State. I raised this issue in the House earlier as it is a serious one for Roscommon. As I do not wish to repeat what Senator Leyden said, I will focus on a couple of points. It was only in recent months that, as a county councillor attending meetings with the HSE, I realised the HSE wanted to abandon any past notion there was "the golden hour". The HSE now suggests it was never an issue of patient safety but it is a serious issue. Roscommon is 35 miles from the nearest accident and emergency department. Given the response times of ambulances and the distance they must travel to pick up patients and take them back to accident and emergency departments, people in County Roscommon will lose their lives unless this issue is addressed.

When in Roscommon prior to the general election, the Minister for Health gave a clear written commitment on the future of accident and emergency services at Roscommon hospital and stated there would be no downgrading of services there. I am also conscious of the fact the HSE, in its quest to downgrade Roscommon hospital, is manipulating figures in that it uses the ambulance service to redirect patients who should be going to Roscommon accident and emergency department to other hospitals in the region in order that the figures for Roscommon suggest the HSE has an argument. I call on the Minister of State, before decisions are taken and given this is proposed to take effect from 11 July, to ensure a survey of other hospitals, namely, Sligo, Galway and Ballinasloe, is carried out to ascertain how many patients who are proper to Roscommon hospital accident and emergency department are using other hospitals. I hope the Minister for Health will honour his firm commitment to the people before the general election that there will be no downgrading of services.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I thank the Senators for raising this important matter. The Government's priority in regard to acute hospital services is to ensure safe, high quality care for patients, provided at the most appropriate location. The Minister is committed to ensuring all care is provided at the lowest level of complexity, consistent with safe practice. Roscommon County Hospital provides an important range of elective and emergency services and treats cases on both an inpatient and a day case basis.

In recent weeks, HSE management and clinicians at Roscommon County Hospital have been engaged in discussions to try to ensure any clinical risks and patient safety issues at the hospital are anticipated and fully addressed in advance. The main concern is to ensure the hospital has sufficient staff with the required qualifications and experience available to maintain safe levels of service. The hospital is one of a number of hospitals nationally whose progress in regard to the implementation of the Health Information and Quality Authority, HIQA, Ennis report recommendations is being monitored. Similarly, all hospitals will in future face regulatory, licensing, staffing and accreditation requirements.

An overriding and immediate concern, however, is that, like a number of other hospitals, Roscommon has experienced problems for some time in recruiting junior medical staff and nursing staff, with further recruitment difficulties anticipated from July as part of the next rotation of junior hospital doctors. Roscommon hospital and Ireland are not unique in this regard; other countries are also experiencing difficulties in recruiting non-consultant hospital doctors, NCHDs. There is also a significant level of vacancies in Northern Ireland and elsewhere in the UK. As a result, Roscommon hospital has had to rely heavily on agency staff, which creates challenges for quality, continuity and certainty in respect of covering rotas.

The HSE has developed a range of strategies and initiatives to maximise recruitment of NCHDs, particularly for the development of training posts. The HSE has also developed a centralised recruitment process for service posts, introduced a single contact point for HSE agencies to obtain locum or temporary medical staff, and agreed less burdensome visa and work permit arrangements for doctors from outside the EEA. In addition, as part of the recruitment campaign, senior HSE staff travelled to India and Pakistan to conduct interviews and progress offers of employment in early May. It is intended that this will result in the recruitment of a number of additional NCHDs. In this regard, the HSE has engaged with the Medical Council to ensure that, subject to successful candidates meeting the council's registration requirements, they can be registered to practice in Ireland as quickly as possible.

On behalf of the Minister for Health, Deputy James Reilly, I assure the House that Roscommon hospital is a vital part of the health service infrastructure in the west. The Government will ensure as many services as possible can be provided safely in smaller local hospitals. Roscommon hospital has a clear future role in serving the local community. Our continuing focus will be on maintaining a high quality, safe service for patients in Roscommon, and all our efforts will be directed to this end.

Senator Terry Leyden

There is no reassurance in this statement from the Minister of State on behalf of the Minister, Deputy Reilly. I am very disappointed with the response. I point out that a copy of the Minister of State's script has not been circulated, as is normal practice in the House on the Adjournment. What I glean from the statement from the Minister of State is that no commitment is being given to the retention of 24-hour, seven day a week accident and emergency services at Roscommon County Hospital. It is clearly not implied in the statement, and we will have a further——

An Cathaoirleach

Does the Senator have a question?

Senator Terry Leyden

I am calling for a further debate. The Minister of State, Deputy Cannon, is not in the Department of Health. I want the Minister, Deputy Reilly, to come to the House and make a full and detailed statement. I call on my colleague, Senator Kelly——

An Cathaoirleach

That is not for a matter the Adjournment.

Senator Terry Leyden

I will ask our leader to request a debate.

Hospital Services

Senator David Cullinane

In 2009, the 19-bed St. Brigid's ward in St. Patrick's Hospital, Waterford, was closed by the HSE on foot of a report from HIQA which cited concerns in regard to health and safety. At the time, many public representatives, including myself as a councillor for Waterford city, as well as the Friends of St. Patrick's, a support organisation that was in place, and a campaign group which had been established met senior figures in the HSE and the then Minister for Health and Children. We were given a clear commitment by the then Minister, the HSE and the parties in government locally that when the ward was closed, it would be replaced with a new 50-bed unit on the grounds of St. Patrick's Hospital. The ward was closed and, since then, there has been a desperate attempt by the campaigners to ensure the HSE and the current Government live up to the commitment made by the previous Government and deliver the capital funding necessary to build this new 50-bed unit.

I asked Deputy Caoimhghín Ó Caoláin to table a Dáil question in respect of this matter and the response of the Minister is interesting:

The Executive, at the time of the closure of St Brigid's ward, did indicate that it would examine the provision of a new 50 bed Community Nursing Unit (CNU) on the grounds of the hospital. Such a construction project would require capital funding and the HSE must prioritise all capital infrastructure projects nationally within its overall capital funding allocation.

The Minister accepts the commitment was given, but now states it is subject to the capital funding being made available. I call on him to deliver on the commitment given. The campaign group holds a weekly vigil, comprised of family members of people who live in St. Patrick's Hospital, in an effort to get the unit.

The Minister cites the Prospectus report, which deals with the total number of nursing home places, public and private, across the south east. The report, published in 2008, states that no additional nursing home places are needed before 2013. However, the Minister fails to acknowledge that St. Brigid's ward was closed in 2009, after the report was published. He also does not recognise that St. Patrick's is a hospital, not just a nursing home. It is unfair to compare bed provision in a private nursing facility with bed provision in a public hospital such as St. Patrick's. I urge the Minister of State to take this strong argument back to the Minister and to urge him to listen to those people who have been campaigning and to what the HSE had to say and the commitments it gave and to honour those commitments. I urge him to ensure the capital funding is provided for the older people who need these places. There are long waiting lists for beds in St. Patrick's Hospital. My grandfather was a patient there for four years and I know the quality of care patients get in the hospital, a fantastic facility. However, the closure of St. Brigid's ward created a deficit in terms of bed capacity. The only way that can be fixed is if the capital funding is provided by the Government. I urge the Minister of State to relay the message to the Minister that he should deliver on the commitment given and release the funding.

Deputy Ciarán Cannon

I thank the Senator for raising this issue as it provides me with an opportunity to update the House on the matter and to outline the background to the current situation and the action taken by the Health Service Executive.

As the Senator is aware, Government policy is to support older people to live with dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where this is appropriate. The HSE continues to develop and improve health services in all regions, ensuring quality and patient safety.

The Health Service Executive has operational responsibility for the delivery of health and social services, including those at facilities such as St. Patrick's Hospital, Waterford. St. Patrick's Hospital is a Health Service Executive residential facility for older people in Waterford city. It has 96 beds, consisting of 72 continuing care beds, 20 rehabilitation and four respite beds. The residential services are located on the ground floor and consist of three wards, St. Patrick's ward, St. Malachy's ward and Our Lady's ward. During the year St. Patrick's operates with a small number of vacancies, which vary from day to day. Concerns had been expressed with regard to health and fire safety at St. Brigid's, a 19-bed ward, which was the last remaining ward on an upper floor of St. Patrick's Hospital. As a consequence of these concerns, the HSE decided that it was no longer viable to continue to accommodate residents in the ward and it was closed on a phased basis in 2009. The primary focus of the decision was the care and welfare of each resident.

I am sure the House will agree that the safety and well-being of older people is of critical concern. Quality care and patient safety come first and all patients must receive the same high standard of quality-assured care. Patient safety is everyone's concern and I reassure the House that the decision to close St. Brigid's ward was taken with this in mind. In view of the closure of St. Brigid's ward, the HSE took steps during 2009 to ensure that there was no reduction in the number of public beds to support older people in Waterford city. Arrangements were made for a total of 30 private nursing home beds to be made available. This was prior to the commencement of the nursing homes support scheme.

At the time of the closure of St. Brigid's ward, the HSE indicated that it would examine the provision of a 50-bed community nursing unit, CNU, in the grounds of the hospital. Such a construction project would require capital funding and the HSE must prioritise all capital infrastructure projects nationally within its overall capital funding allocation.

The Prospectus report, which was prepared for the HSE in 2008, assessed the provision of nursing home places across the country and the need for additional places to meet demographic change. The report found that there were sufficient places in Waterford at that time and additional places would not be needed before 2013. The Department is engaged with the HSE in planning the provision of long-term care places, taking account of public and private nursing home provision. This will give further consideration to the Prospectus report recommendations and the requirements to upgrade facilities to meet the standards for nursing homes. It will also consider local demographic pressures and the extent of existing public and private provision, with a view to developing an overall strategy on how the HSE should continue to provide this service in view of current budgetary and other pressures. The House will appreciate that such reviews are essential to ensuring that resources are properly channelled and that thechanging needs of older people are suitably addressed. The future provision of long term residential services for the Waterford area in general will be considered in the context of this review.

Senator David Cullinane

The last line of the Minister of State's response states that provision will be considered "in the context of". Every time I hear a Minister or Department member state something will be considered "in the context of", I am concerned that the "context" will be that funding will not be available and that all sorts of reasons will be cited.

I pointed out that the ward was closed in 2009, but the response cites the Prospectus report which was published in 2008 and refers to bed capacity. Does the Minister of State accept that the Prospectus report should not be cited as the ward was closed after the report was published? There is an anomaly in the response the Minister needs to address. Also, the Minister has not addressed the question of when the capital funding will be released. He accepts a commitment was given, but he has not given any indication as to when the funding will be delivered.

An Cathaoirleach

There is no provision on the Adjournment for debate. The Senator is abusing the privilege he was allowed. There is no allowance for questions, but I allowed the Senator to put a brief question.

Deputy Ciarán Cannon

The Prospectus report concluded in 2008 that there were sufficient places in Waterford and that additional places would not be needed before 2013. Following on the closure of St. Brigid's ward, I understand arrangements were made for 30 nursing home beds to be made available to replace the 19 beds closed as a result of the health and fire safety concerns at St. Brigid's. Therefore, the bed shortages were more than adequately addressed by the HSE at the time. I accept the Senator's bona fides in making the case for the construction of a new ward. All such demands will be reviewed in the context of an overall national review on the provision of long-term care places. That is the only commitment that can be given at this time.

Schools Refurbishment

Senator Trevor Ó Clochartaigh

Cuirim fáilte roimh an Aire Stáit. Mar chomhghleacaí ó Ghaillimh, ba mhaith liom gach ádh a ghuí air in a ról agus a phost nua. Go n-éirí an t-ádh leis sa jab sin.

D'ardaigh mé an cheist seo ar son coiste tuismitheoirí scoil náisiúnta Thír an Fhia. Rinne an scoil seo iarratas ar thacaíocht le haghaidh athrú a dhéanamh ar fhuinneoga agus doirse sa scoil, mar tá an scoil i ndroch chaoi. Cé go bhfuair an scoil seo tacaíocht anuraidh le haghaidh córas teasa a chur ar fáil sa scoil, tá an teas sin anois ag dul amach trí fuinneoga agus doirse atá i ndroch chaoi le blianta. I raise this issue on behalf of the Tír an Fhia parents' group because the school there is in quite bad condition. The school is grateful that it got support several years ago to put in a heating system, but the problem now is that the heat goes straight out through the doors and windows because they are in such a bad condition.

Tá fadhb freisin maidir le cursaí sláinte agus sábháilteachta. Tá caonach liath ag fás ar na ballaí agus ar an síleáil agus bíonn orthu iad seo a ghlanadh agus a phéinteáil go minic. Gach cúpla mí bíonn orthu seo a dhéanamh, agus níl an fhadhb á leigheas. There is a health safety issue also. Several children have asthma and there is mould growing on the ceiling. The only solution parents have is to paint it every few months, which is costing a significant amount of money. It is the dampness and the situation with regard to the windows and doors that create the problem.

The issue concerns the process to deal with the application made by the school. It submitted its application on a number of occasions, but it has been turned down. It has appealed that decision. It has not been given a proper reason for having been turned down and it sees other schools in the area getting the assistance they need.

Tá mé ag cur ceiste faoin gcóras atá ag an Roinn maidir leis an gceist seo. Cén fáth ar dhiúltaíodh iarratas na scoile seo? Cén fáth nár éirigh leis an achomharc? Cén fáth go bhfuil scoileanna eile sa cheantar ag fáil tacaíochta nuair nach bhfuil an scoil seo á fháil? Cloisim an chaint atá á dhéanamh maidir le cúrsaí airgid. Tugtar an leithscéal nach féidir go leor rudaí a dhéanamh ós rud é go bhfuil an buiséad teoranta ó thaobh scoileanna. Ní ghlacaim leis an argóint sin, i ndáiríre, go háirithe toisc go bhfuil €24 billiún curtha isteach sna bainc. Chualamar i rith na seachtaine go bhfuil €500,000 in aghaidh na míosa á thabhairt don chomhlacht atá ag plé leis na tolls ar na motorways. Tá an t-airgead sin á thabhairt mar chúiteamh ar an gconradh. Chaitheamar €30 milliún ar chúrsaí slándála nuair a tháinig an banríon agus Barack Obama ar cuairt. An bhfuil an Roinn ag rá linn go bhfuil an Bhanríon Éilís níos tábhachtaí ná na páistí scoile i dTír an Fhia? Má tá, ní ghlacfaimid leis sin. Ní ghlacfadh muintir Chonamara nó tuismitheoirí scoile in áit ar bith leis an argóint sin.

The lack of funding cannot be an argument in this case. The Government had enough time and wherewithal to give the banks €24 billion; it was willing to give €500,000 per month to the company that runs the tolls on our motorways and spend €30 million on security for the visits of the Queen of England and President Barack Obama, yet it tells me it does not have a few thousand euro to help fix windows and doors in a school that, according to the Department, is doing fantastic and exemplary work. If it tries to tell me that the Queen of England and President Obama are more important than these children I will not accept that argument and believe its priorities are wrong.

I welcome the Minister of State. Will he clarify the situation and tell the House what criteria were used in this application? Will the school be reassessed, reappraised and put back on the list, and is there a chance this funding can be made available in the very near future?

Deputy Ciarán Cannon

I am taking this Adjournment matter on behalf of my colleague the Minister for Education and Skills, Deputy Quinn. I thank the Senator for raising the matter as it provides me with the opportunity to outline to the Seanad the Government's strategy for capital investment in education projects and the current position on summer works scheme.

The summer works scheme covers projects in school buildings such as gas, electrical and mechanical works, roof replacements and repairs, window replacement, toilet upgrades, access works and structural improvements that, ideally, can be delivered during the summer months. The Senator will be aware that on 30 March 2011 the Minister announced a list of 453 schools that were successful under the summer works scheme 2011. Applications from primary and post-primary schools for gas, mechanical and electrical works were prioritised for summer works funding this year. The Department has sought to prioritise the funds that are available towards works that are most relevant to the health and safety of staff and students alike in our schools.

In light of further funding being made available under the Government's jobs initiative, projects submitted under the 2011 summer works scheme were considered further. As announced on 10 May 2011, an additional 374 schools were successful under the jobs initiative scheme and these are published on the Department's website. Some €40 million will be made available through the jobs initiative to fund these 374 primary and post-primary school building projects. These funds will allow schools to carry out small and medium scale building works such as special needs access, toilet facilities, roof works at primary and post primary level and window replacements at post primary level. In its programme for Government, the Government committed to advancing with shovel-ready projects as quickly as possible — this investment in our schools will create much-needed jobs in the construction sector.

The capacity of schools to take responsibility for delivering small and medium-scale projects is a key component of the summer works scheme and the Minister is pleased to be in a position to make funding available this year. I am confident that school authorities will be able to achieve the best value for money on prices for jobs, given the competitive construction market at present. I call on schools to ensure they maximise the benefit to their schools of the works sanctioned.

As outlined in the circular governing the operation of the summer works scheme, applications for works in the higher categories were prioritised. Unfortunately the application from scoil náisiúnta Tír an Fhiadh, Leitir Mór, was a category 7 project at primary school level and, due to the scale of demand for funding under the scheme, it was not possible to grant aid category 7 primary school projects. Applications from schools for gas, mechanical and electrical works were prioritised for summer works scheme funding this year. Unfortunately, due to the scale of demand for funding under the scheme, it was not possible to grant aid all applications and, accordingly, it has been necessary to prioritise some categories of works over others. The Department has sought to prioritise the funds that are available towards works that are most relevant to the health and safety of staff and students alike in our schools, and which have the most potential for job creation.

In the meantime, for works that are of a very urgent nature, it is open to the school authorities to consider whether the works in question qualify for funding under the Department's emergency works scheme. An emergency is deemed to be a situation which poses an immediate risk to health, life, property or the environment which is sudden, unforeseen and requires immediate action and, in the case of a school, if not corrected would prevent the school or part thereof from opening. Details of the scheme, together with an application form for grant assistance, can be accessed on the Department's website at www.education.ie. This year, almost €383 million will be invested in school building infrastructure under the school building and modernisation programme.

I thank the Senator for raising the matter and confirm my commitment and that of the Minister to advance capital projects in line with available resources.

Senator Trevor Ó Clochartaigh

Is the Minister of State, Deputy Cannon, stating it was more important to prioritise security for the Queen of England and President Obama than to spend on children in our schools? Sufficient capital has not been made available.

Deputy Ciarán Cannon

The visits of both leaders have greatly benefited Ireland and already, from a tourism point of view, we can see such benefits. As a result of the visits and the increased consequent income one hopes we may be able to consider expanding summer works schemes to include schools such as that in Tír an Fhiadh.

The Seanad adjourned at 6.30 p.m. until 10.30 a.m. on Wednesday, 15 June 2011.

Seanad Éireann debate - Tuesday, 14 Jun 2011