Seanad Éireann debate -
Thursday, 29 Sep 2011

Vol. 210 No. 8

Adjournment Matters

Hospital Services

Senator Kathryn Reilly

I welcome the Minister of State to the House for this Adjournment matter. The Minister for Health recently confirmed that there will be a reduction in the opening hours of the minor injuries unit in Monaghan General Hospital to an eight hour, five day service to take effect from 1 November. Essentially, minor injuries will only be dealt with in Monaghan during business hours. Who knew that medical injuries had business hours and could be dealt with in that way? The reduction in hours for the minor injuries unit is a serious and life-threatening matter and it could be dealt with by the Fine Gael and Labour Party Government if there was a strong political will to do so.

The stripping of services from Monaghan General Hospital will have a massive knock-on effect on Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda. These hospitals are already unable to cope with the demands currently made on them. Every day we hear about hospital overcrowding, with patients on trolleys, chairs and even on the floors of hospitals throughout the State. In addition to these service cuts and the centralisation of services at Cavan and Drogheda, there are ongoing cuts in health spending and the embargo on recruitment in the health services. Front-line staff in Cavan, like those in Monaghan, Drogheda and Dundalk, are doing their best in the face of insufficient resources and, indeed, poor planning by the HSE and the last Government. Does the Minister, Deputy James Reilly, support his party's local councillors and some of his party's Deputies in the north-east region of Cavan, Monaghan and Louth who have opposed the transformation agenda?

The decision to reduce this unit's hours is more about saving money for the Government than about patient care and safety. We are told the annual savings from the reduction will be approximately €400,000. What about the people who cannot travel to other hospitals outside these hours, the people who are living on the breadline and struggling to survive? What about those who have a minor injury but who cannot arrange a lift to a hospital further away in Cavan and Louth? The roads linking Cavan, Monaghan and Louth are not exactly the best. What about the overcrowded accident and emergency departments where seriously ill people are already waiting for hours to be seen? Is it prudent to reduce the hours of the minor injuries unit? It means that outside these hours other hospital services will be flooded with minor injuries that could have been dealt with in a more timely and efficient manner.

We should consider how the axe fell in this case. The current Minister for Health promised the people of Monaghan before the election that there would not be a reduction in hours. Post-election, however, the axe was sharpened and the services in Monaghan General Hospital have been hatcheted once more. In a reply to a parliamentary question from my colleague, Deputy Ó Caoláin, the Minister said: "Underlying the health service is the principle that the patient should be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible." Now, however, the Minister is presiding over a reduction in hours for the most basic and closest services for the people of Monaghan.

Has any consideration been given to the knock-on effects and to the effects of reducing the hours of a service for the lowest level of complexity at Monaghan General Hospital? Will the Minister make a commitment to revisit the failed hospital configuration in the north east, specifically as it affects Monaghan General Hospital, while recognising the knock-on effects on Cavan General Hospital and the impact of the loss of services at both Louth County Hospital and Our Lady's Hospital in Navan?

Minister of State at the Department of Health (Deputy Róisín Shortall)

I am replying to this Adjournment matter on behalf of my colleague the Minister for Health, Deputy James Reilly, and I thank the Senator for raising it.

In view of the current budgetary and financial position the efficiency of services is being reviewed by the HSE. The Minister has emphasised to the HSE that budgetary compliance must be maintained alongside the delivery of service levels set out in the national service plan. In this regard the minor injury unit in Monaghan General Hospital was analysed by the HSE in terms of risk assessment, patient activity levels, staff resources, service impact and service unit cost. The review was undertaken in the context of addressing levels of agency and overtime costs in the Cavan-Monaghan hospital group.

The minor injury unit in Monaghan opened in July 2009 and currently provides a service seven days a week from 9 a.m. to 9.30 p.m., with two nursing staff and a registrar in emergency medicine rostered on duty during these hours. Based on statistics for the first six months of the year, the unit sees, on average, 23 patients a day, six of whom are repeat patients. On average, seven patients a day attend the unit after 5 p.m. In the light of this analysis, the HSE has decided to change the opening times to 9 a.m. to 5 p.m., Monday to Friday, and expects the revised hours to take effect from 1 November. This change is the direct result of the current budgetary and financial position facing the health system. While the HSE has reviewed other possible options to save money or increase revenue, it has concluded that they would not generate sufficient savings in the short term. It has estimated that full year savings of almost €400,000 would be generated with the alteration of opening hours. The change to the unit in Monaghan is to be viewed as a temporary measure and will be reviewed in 2012 in the light of budgetary considerations and patient activity levels at the unit in the future.

The Minister for Health has emphasised to the HSE the need to ensure the impact of such changes on patients is minimised and that all changes are fully communicated. The HSE has advised the Minister that patients attending the unit after 5 p.m. are mostly review patients who are recalled to the service and can be easily accommodated with minimal inconvenience within the changed opening times. The Minister has also been informed that the internal communications to date in Monaghan hospital have included a series of meetings with key staff and their union representatives and that agreement has been reached on a number of staff redeployments to specific areas of choice.

An external communication plan for members of the public, local GPs, public representatives, media and key stakeholders is being finalised. Part of the plan will be a public awareness campaign to minimise the impact of the service change on patients. All decisions on the alteration of patient services are carried out by the HSE in the interests of patient safety and kept under regular review.

Senator Kathryn Reilly

When in 2012 will the review of this temporary measure be carried out? There is a danger that the opening times will be further restricted. Will an analysis be conducted of the patients who had to attend hospitals in Cavan, Dundalk and Drogheda outside the unit's opening hours? If we are examining activity levels of patients who need minor injury care outside the unit's opening hours, it is important to determine how many had to travel elsewhere.

Deputy Róisín Shortall

The HSE will keep the matter under review. The decision will be formally reviewed early next year once the new arrangements have been in place for some time to determine their impact on services for patients. The majority of patients present within the proposed new opening hours and arrangements are being made to ensure repeat visits take place within these hours or are accommodated elsewhere where this is not possible. The review will examine the impact of the decision and the difficulties which have arisen. These issues will be addressed by the HSE.

Youth Services

Senator Averil Power

I urge the Government to provide the same level of funding for the City of Dublin Youth Service Board as it has done heretofore in order that it can continue to support the Sphere 17 Regional Youth Service. The project is based in Darndale and covers the entire area of Dublin 17, including Priorswood and Coolock, which as the Minister of State will be aware, is one of the most socially disadvantaged areas of the country.

The Sphere 17 Regional Youth Service is doing fantastic work with young people in the area. It deals with children from the age of ten years to the time they become young adults at the age of 21 and has been getting great results. The new building constructed for it several years ago contains excellent facilities and it has top quality staff and volunteers from the community, including individuals who benefited from the project and now want to give something back. It is keeping children out of trouble and helping to increase their self-respect by offering a level of support they may not receive at home.

Youth projects such as the Sphere 17 Regional Youth Service play an important role in tackling problems such as social exclusion, mental health, youth suicide - one of the biggest problems the country faces, drug abuse and teen pregnancies. It would be short-sighted to cut funding for the project in question if it meant it could no longer reach these children. Earlier this week I joined other public representatives in attending a meeting to discuss the impact even a small cut would have on the project's services. It has already pared back its activities to the limit and any further cuts would have a severely negative impact on young people in Darndale, Coolock and Priorswood.

Has the funding level for next year for the City of Dublin Youth Service Board which, in turn, funds the Sphere 17 Regional Youth Service, been determined? This issue has generated a degree of confusion locally. The service has heard that the board knows how much it will receive in 2012, but project staff have not yet been informed. I am sure the Minister of State will appreciate the level of stress caused by the inability to decide staffing and programmes for next year. I am aware of the pressure under which the Government must operate and acknowledge the need to make cuts in the coming budget, but, from a long-term point of view, this is not the area to target because the children in question only have one chance. It would be crazy to take it away from them now when we can prevent them from getting into trouble because we would otherwise have to spend multiple amounts to deal with the social costs that ensue for the children, their families and communities. I urge the Minister of State to prevent this from happening.

Deputy Róisín Shortall

I am taking this Adjournment matter on behalf of my colleague, the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald. I welcome the opportunity to address the issue and thank the Senator for raising it.

The Minister is conscious of the great benefits that can accrue to young people and society as a whole from involvement in youth work. She is also aware this recognition requires appropriate support. Through the youth affairs unit of the Department of Children and Youth Affairs, work is ongoing with the national youth work advisory committee which includes representatives of the National Youth Council of Ireland, the Irish Vocational Education Association and other Departments and interested parties to support youth work policy development and activities. Support is provided by way of financial and other assistance.

Youth work programmes and services are delivered to over 1.2 million participants in the various programmes by some 1,100 youth work staff and a volunteer base of 62,015. Youth projects and organisations present valuable opportunities for the social and personal development of young people. Qualities and skills such as leadership, co-operation, decision making, motivation and responsibility can be acquired through learning by doing. The aim of the youth service is to assist all young people to become active participants in a democratic society. In essence, the primary objective of the service is to help realise the potential of each young person and facilitate his or her full participation in community life.

More than €60 million is being provided in 2011 by the youth affairs unit of the Department to support the delivery of a range of youth work programmes and youth services for all young people, including those from disadvantaged communities, by the voluntary youth work sector. The focus of this financial support in 2011, as in previous years, is on the consolidation of existing youth work provision and safeguarding front-line programmes, services and jobs, particularly in disadvantaged communities, through the youth service grants scheme, the special projects for youth scheme, the youth information centres, the young peoples' facilities and services fund, the local drugs task forces, initiatives such as the local youth club grants scheme, the national youth health and arts programmes, as well as EU initiatives such as youth in action.

In the light of budgetary constraints, the youth budgets in 2011 and 2012 will require careful management, with a focus on prioritising front-line services and protecting jobs and pay in so far as is possible. Officials from the Department have met representatives of the youth sector, including the City of Dublin Youth Service Board, CDYSB, on an ongoing basis to ascertain the sector's views on how best to minimise the impact of budgetary constraints with a view to consolidating, in so far as is practicable, the progress made in previous years. Every effort will be made to notify the various youth work organisations and administering agencies, including the CDYSB, of their 2012 allocations as speedily as possible. The Department has also exhorted all of the national youth organisations and vocational education committees to revisit their level of expenditure to determine where cost savings can be achieved.

The CDYSB is in receipt of funding from the youth affairs unit in the Department for a number of schemes and programmes. These are the special projects for youth scheme, the young people's facilities and services fund, rounds one and two, and the local drugs task force initiative. The 2011 allocation to the CDYSB for these schemes is almost €14 million.

The Minister is very much aware of the valuable services provided by the Sphere 17 Regional Youth Service for young people aged between ten and 21 years in such areas as Bonnybrook, Darndale and Priorswood across Dublin 17. She visited the service last week. It provides young people with a wide range of programmes and activities, seven days a week, which reflect their needs, interests, capacity and age profile. These programmes and activities include personal and social development, with a particular focus on recreation, education and health. The service also has a significant and impressive youth justice element aimed at addressing anti-social behaviour and under-age drinking. Projects engage with young people in an open, creative and health focused way, using a variety of youth friendly approaches. A team of trained and dedicated staff work with and for young people in the Dublin 17 area, supporting them to achieve their potential and contribute positively to their communities.

In the context of the 2012 and future budgets, one of the key aims of youth policy development will be to ensure optimum use of all the financial and human resources available. Accordingly, the development of the Department's policy on young people will focus specifically on ensuring greater coherence, co-ordination and impact in youth policy and provision so as to ensure quality outcomes for all. It is intended that the policy framework will also facilitate and promote co-ordination and coherence across Departments and services and set out the priorities, rationale and criteria for future funding programmes. It will also accommodate issues relevant to young people within the ten to 24 year age range in informal or out-of-school settings that fall within the remit of the Department. The overall aim will be to clarify and enhance coherence, connectivity, co-ordination and delivery of youth and related out-of-school services for young people and to ensure such provision is both quality and outcomes-based. As part of this approach, the Department is in the process of commissioning a review of international best practice in the area of youth development and support. The findings from this work will inform the Department's policy objectives and future funding provision, with the aim of ensuring young people engaging in youth services derive maximum benefit from that engagement. Projects such as the Sphere 17 Regional Youth Service will continue to play a central role in this provision.

Senator Averil Power

I appreciate that the Minister of State is here to represent the Minister and acknowledge that it is difficult for her to answer some of the more specific questions posed, but I urge her to talk to the Minister about them. While that was a good general response written by the Department in acknowledging the value of youth work, there was not a great deal in it about the Sphere 17 Regional Youth Service. It certainly will not provide any comfort for those in Darndale, Priorswood, Bonnybrook and Coolock who are worried about the continuation of their services. I would be a little concerned in that regard. Of course, it is important to have the correct policy frameworks and reviews in place. In fact, the Sphere 17 Regional Youth Service was one of the first to sign up to a new project in respect of a quality mark in evaluating youth services and is fully in favour of ensuring every euro is spent properly and in line with best practice.

The Minister of State mentioned a review. I would be surprised if it was finalised before the budgets are drawn up for next year. I would be concerned if it was a holding tactic or to be used as an excuse to cut staff numbers. Will the Minister of State ask the Minister if the funding for the City of Dublin Youth Service Board in 2012 and, in turn, for the Sphere 17 Regional Youth Service has been agreed to? It is only fair, if it has been agreed to, that they be made aware of this.

I note the Minister visited the service last week. She is a good and decent person who would want to help the sector. She needs to fight for it because, as I stated, cuts will have to be made somewhere. This would be a crazy place to make them, given all of the statistics we have available for the challenges being faced in Dublin 17. This is not the place to make cuts.

Deputy Róisín Shortall

The Minister is well aware of the excellent work being done by the Sphere 17 Regional Youth Service. I am also conscious of the fact that in many areas youth workers and organisations are struggling. As they do valuable work, we must protect these services to the greatest extent possible. Regrettably, in the past three years the youth work budget was cut by 15%, as a result of which many youth organisations are struggling. However, there is a commitment to ensuring youth work will continue. We value very much the role it plays in communities, particularly in disadvantaged communities. As the Senator is aware, decisions on budgetary provisions for the new year have not yet been taken, but there is a clear commitment to support youth work services because their value is recognised.

The Seanad adjourned at 1.40 p.m. until 2.30 p.m. on Tuesday, 4 October 2011.