Adjournment Matters

Local and Community Development Programme Planning

Senator Kathryn Reilly

I am delighted the Minister for the Environment, Community and Local Government, Deputy Hogan, is present for this Adjournment matter.

The alignment proposals seek to achieve better working relationships between local authorities and local development companies, an objective that has been broadly welcomed by many local development groups. The main issue of contention, however, is one element of the plan under alignment, which is to transfer the funding from core programmes run by local development companies, LDCs, for example, Leader and the local and community development programmes, to socioeconomic committees set up under the control of local county councils.

Most people would say that over the last 21 years community bottom-up delivery of the local development programmes has served local and rural communities very well. There is a real concern among community groups, especially those that deliver the programmes, that moving control of programme funding away from communities will do serious damage to the concept of community activism and volunteerism. The local development model is managed by voluntary boards with strong community input. It is committed to maintaining the bottom-up approach and to participatory development with a clear focus on addressing the identified needs and allocating resources to the most disadvantaged within communities. It is flexible at local level to tailor local actions in line with local needs and priorities. It has a capacity to leverage additional funding for agreed priorities and, most importantly, for every €1 of core funding LDCs leverage an additional €1.59 in funding into local communities.

Since the establishment of these groups in 1991, Ireland has developed the most effective and highly-regarded local development structures in Europe, with the strongest administrative capacity. Ireland is the envy of Europe and is highly commended for delivery. A study of the EU local development programmes undertaken by the Directorate General for Regional and Urban Policy concluded that, in practice, local authorities rarely have exactly the same objective as local development groups and their leadership may hamper the commitment of other stakeholders, the quality of the innovative process and the success of the local strategy. Indeed, the European economic and social committee said that this is a structure which effectively complements local authority remits and, at the same time, it is clear that Leader cannot be used as a means of making up for insufficient municipal revenues and financing public services at local level in the EU member states.

With such high praise and support for this model the proposal to transfer the funding for the core programmes could damage, as many of the LDCs believe, the bottom-up approach to local development and call into question the ongoing commitment of strong community and voluntary sector involvement on the boards of local development companies. Has there been a cost-benefit analysis of whether it is more efficient to deliver local services and schemes through local development companies than to do so through local authorities? I understand the Minister has set up an alignment working group involving key stakeholders which is charged with developing the terms of reference for the socioeconomic committees, SECs, over the coming months. Is it correct that the Minister has identified ten front-runner pilot locations for SECs? Finally, can the Minister confirm that no pilot SEC will be established until the terms of reference for the SECs have been agreed by the alignment working group?

Minister for the Environment, Community and Local Government (Deputy Phil Hogan)

I thank Senator Reilly for the opportunity to clarify some the matters that have been in the ether, as it were, and providing a great deal of misinformation to communities. I do not know by whom this has been done.

The proposals I am pursuing regarding enhanced alignment between local government and local development are part of the document, "Putting People First - Action Programme for Effective Local Government". All the concerns the Senator has raised are misinformed and untrue. Local communities will continue to be involved in a bottom-up approach to local development, in conjunction with local authorities. Otherwise, we will not qualify for funding from the European Union under its specific programmes. Local authorities are more efficient than local communities, some of which are spending in excess of 30% on administration. Second, the representation on the socioeconomic committees and the terms of reference of the SECs are the subject of discussion with a working group at present, which is composed of all stakeholders including the community groups. It is making excellent progress and I hope it will be able to conclude the terms of reference at a meeting next week.

I established an expert alignment steering group to look at this area, and its recommendations aim to improve co-ordination of local publicly-funded programmes, improve their efficiency and effectiveness and improve the services for citizens and communities.

These entities are not set up for the benefit of people who are employed, rather, they are set up for those who are unemployed and need services at local level. The implementation of these proposals is happening in a collaborative manner. An alignment working group has been established to assist in their implementation. It has had representations from the Irish Local Development Network, which is the national representative body of Ireland's 50 local development companies, as well as the City and County Managers Association, Pobal and my Department.

The working group is focusing on the practical arrangements to give effect to the new local structures. Pilot committees will initially be established in up to ten local authority areas, and across the remaining areas towards the end of 2013. These committees will have responsibility for oversight and planning for a range of local and community development interventions at local level and will bring local actors together to work in strategic collaboration. They will develop a more integrated approach to publicly funded programmes, and an enhanced focus on getting the right outcomes and matching resources to priorities.

I also intend that they should look at more sustainable programme administration costs and the use of shared services. The ten areas for which pilot socio-economic committees are being considered are Dublin City Council; Dún Laoghaire-Rathdown County Council; South Dublin County Council; Leitrim; Roscommon; Offaly; Mayo; Galway County Council; Limerick County Council, and Cork County Council. Given the tightening of budgets, the collaboration that socio-economic committees will bring will be very important as we work to get the most from available funding. Local authority and local development interests are all involved in the establishment of these pilot programmes.

My Department is also working with colleagues across Government to achieve a coherent, whole-of-government approach to the planning, management and delivery of programmes. Like any change process, I appreciate that change is not easy - I am sure Senator Reilly is also getting representations - and the reforms present challenges for all concerned. About 1,900 people are employed in local development companies, such as Leader, local community development groups, Tús and rural social schemes. The current difficult financial model arises from the multiannual financial framework from the EU in respect of CAP, which provides money for the rural development programme. It is under pressure, and employs 250 people. The programme will continue, but the efforts to make sure we get the same level of funding as we did over the past seven years will be difficult, in light of what I said. We have not achieved the same level of funding through the rural development programme under CAP as we did on the last occasion because from 2007 to 2013 the Governments of the day, with the money available in the country, gave a top-up of 5%.

The one thing we do know is that the status quo will not hold. The funding available, in particular for the administration of programmes, will remain constrained. Therefore, we need a fresh approach based not on preserving structures for the sake of it, but on locally based co-operation, to get the most from our funding for the benefit of communities.

Senator Kathryn Reilly

Will the establishment of the ten pilot programmes come before or after the publication of the terms of reference from the working group?

Deputy Phil Hogan

It will come afterwards.

Primary Care Services Provision

Senator Thomas Byrne

I am very grateful to the Leas-Chathaoirleach for allowing me to raise this important matter on the Adjournment. It relates to primary care. We could discuss primary care centres in Kells, Laytown and Bettystown, and perhaps we will do so again. They are very important, but I will focus on the Ashbourne primary health care centre. It has been built a long time. I ask the Minister of State to provide an update on its position and I will respond when he has given his reply.

Minister of State at the Department of Health (Deputy Alex White)

I thank Senator Byrne for raising this issue. It gives me the opportunity to address the plans for the provision of primary care services in Ashbourne, County Meath, and the wider context.

The development of primary care teams and primary care centres is a priority under the programme for Government and an extremely important element in the health reform process. The provision of primary care centres and teams throughout the country will significantly increase health and social care in local communities, and will be achieved by redirecting services away from acute hospitals.

Primary care infrastructure is being delivered using three mechanisms, as the House will be aware, namely, direct build, the leasing initiative and the public private partnership initiative announced in July 2012. The development of primary care centres, through a combination of public and private investment, will facilitate the delivery of multi-disciplinary primary care and represents a tangible re-focusing of the health service to deliver care in the most appropriate and lowest cost setting. The modernisation of our primary care accommodation and practice is vital to the successful delivery of services in the future. In this regard, 27 primary care centres have opened since May 2011.

The primary care infrastructure model offers a good opportunity for private sector finance. The HSE sought submissions from individuals and companies who were interested in developing health facilities which would accommodate the delivery of primary care services in conjunction with local GPs. Ashbourne primary care centre is being delivered using the operational lease mechanism. The 19,000 sq. ft. centre is located at Declan Street, Ashbourne.

Some three GPs and their practice staff have already commenced services in Ashbourne primary care centre. The commissioning of the telephone system has been completed this week and the transfer of the administrative function will commence next week. Following that, a range of clinical services will transfer into the building over the course of a number of weeks. The full commissioning of the building requires the transfer of some equipment from existing facilitates and the delivery of new equipment, which is ongoing.

When fully opened, Ashbourne primary care centre will accommodate the following services: Ashbourne family practice; public health nursing; physiotherapy; occupational therapy; speech and language therapy; primary care social work; psychology; and a range of outreach consulting services. South Meath community mental health team and mental health day service will also operate from the building.

Staff working in the Ashbourne primary care centre will relocate from a number of other health care facilities, such as the existing health centre in Ashbourne and the health care facility in Dunshaughlin, County Meath. It will be necessary for a number of staff to work across the locations. No specific recruitment campaign will be required.

The development of Ashbourne primary care centre represents a step forward as regards the modernisation and updating of working practices, facilities and equipment and supporting ICT systems. The sharing of accommodation between GPs and HSE staff members in one centre facilitates a team-based approach to service provision, building capacity in primary care and contributing to sustainable health and social development in Ashbourne and its environs.

Senator Thomas Byrne

I welcome what the Minister has said about the opening of the primary care centre in Ashbourne. At the start of the year we were told it would open in the first quarter, then that it would happen in May. From what the Minister of State has said, I note significant progress is being made, which I acknowledge and welcome. It is a shame to see a large building being under utilised, although, as the Minister of State said, the GPs have been in place for some time. I hope the system works and that there will be real co-operation between GPs not just in the centre, but between other doctors in the area who should be able to achieve synergies and facilitate the cross-care requirements of the various therapies and mental health.

Some concerns have been raised about the reduction in the services available in Dunshaughlin, and I may write to the Minister for Health about the matter, but they are not evident from the Minister of State's reply. It may simply be another base for staff to work from for the provision of health care services in south County Meath. I hope that is the case.

Deputy Alex White

I acknowledge and agree with what the Senator said. I thank him for his support on this important new facility which will open in Ashbourne in the very near future. I am glad to able to give more detail about the current state of play. If the Senator or any other Member of the House wishes to obtain information on any additional aspects or raise questions by way of contact with me, I will do everything I can to assist and respond to them.

Hospital Services

Senator David Cullinane

I welcome the Minister of State to the House. Yesterday, the long awaited Higgins report into the establishment of hospital groups in the State was published. As the Minister of State knows, six groups will be established and there will be consolidation of smaller and larger hospitals with academic links to universities. We can differ on whether the concept of groups or trusts is good or bad. I want to raise the concerns of many people in Waterford and the south east regarding what is being proposed.

Waterford Regional Hospital, it seems, will be renamed as Waterford university hospital and become a full teaching hospital. That proposal has its merits and attractions. As it stands, however, Waterford is serving five counties, namely, Waterford, Kilkenny, Carlow, Wexford and south Tipperary. It provides specialist services and tertiary care in areas such as cancer, neurology, renal services, ear, nose and throat, ophthalmology and a range of other services. Most of those specialties require a critical mass to justify their retention, which comes from the population base. In that context, there is a real concern at the prospect of two hospitals in the same region, St. Luke's General Hospital in Kilkenny and Wexford General Hospital, being assigned to an entirely different group or trust from the one to which Waterford Regional Hospital is assigned.

The Higgins report refers to a leakage of patients away from Waterford Regional Hospital to hospitals in Cork and Dublin. In fact, in a briefing last night, Professor Higgins alluded to 10% of patients from Wexford travelling to Dublin. In a situation where Waterford will be in one group with Cork, while Wexford and Kilkenny will be in an entirely different group, and those trusts will in time be competing for patients, how does the Government intend to secure the retention of existing services at Waterford? If the leakage of patients from the region to hospitals in Dublin or Cork continues, then there is a genuine and rational concern that this could, at some point in the future, be used as justification for downgrading services at Waterford. How can we guarantee that Waterford Regional Hospital, if it becomes a university hospital, will continue to function as a regional hospital and will retain all of the regional and tertiary services it currently provides? What guarantee can the Minister give in regard to these services and how can he fulfil that guarantee in actions as well as words?

We were told prior to the publication of the Higgins report that Waterford would be providing cardiology services on a 24-7 basis. This, in fact, was to be one of the carrots contained in the report. However, what the report actually refers to is enhanced cardiology services. Indeed, both the Minister and Professor Higgins were very clear when questioned last night that there is no commitment to the provision of that service at Waterford. Will the Minister of State clarify this issue? The current situation is that Waterford Regional Hospital is not providing a 24-7 cardiology service for the region as it should and must. If the Minister of State is in a position to confirm that this service will be introduced, what timeframe is envisaged for its establishment?

Professor Higgins has indicated that the decision not to recommend the retention of the south east as a region was the lack of shared vision or cohesion among the facilities there. Will the Minister of State indicate what shared vision there is between Mallow General Hospital, for example, and Waterford Regional Hospital? What shared vision is there between Mullingar, Wexford and Kilkenny? The argument regarding lack of cohesion is a red herring and I do not see how the Minister can justify these proposals on that basis. I am asking these questions out of a genuine concern, which is shared by many people in the region, regarding the retention of services at Waterford Regional Hospital.

Deputy Alex White

On behalf of the Minister, Deputy James Reilly, I thank the Senator for raising this matter, which provides an opportunity to discuss with the House the reports that were launched yesterday. As the Minister has said, these proposals signal a fundamental modernisation of our health system organisation in line with best practice. The objectives of the hospital groups are: to achieve the highest standard of quality and uniformity in hospital care across each group; deliver cost effective hospital care in a timely and sustainable manner; encourage and support clinical and managerial leaders; ensure high standards of governance, both clinical and corporate; and recruit and retain high-quality nurses, non-consultant hospital doctors, consultants, allied health professionals and administrators in all our hospitals. The introduction of groups will provide for organisational change in the first instance, offering more autonomy to providers and better enabling the reorganisation of services in a well-planned manner. Over time, this will help to improve services and deliver better outcomes for patients.

When it became clear in November 2012 that there might not be sufficient medical professional consensus and support for a stand-alone network or group in the south east, a further period of intensive discussions with the four acute hospitals took place. As a result, there is now a broad acknowledgement within the consultant establishment in those hospitals that the future development and prosperity of all four facilities is best served by accepting the proposal outlined in the Higgins report which places Waterford Regional Hospital and South Tipperary General Hospital, Clonmel in the south-south-west hospital group and Kilkenny and Wexford hospitals in the Dublin east group. Waterford will continue to be a cancer centre under the national cancer control programme. It will, in addition, be the hub for the south-east renal service and a regional trauma centre. It will also continue to provide invasive cardiology services for the population of the south east.

In addition, an undertaking was given that the Department and the Health Service Executive would work with University College Cork to enable Waterford hospital to become a university teaching hospital linked to UCC. Discussions with the university have also taken place and agreement reached in principle on developing closer links, leading in due course to parity status with Cork University Hospital. These discussions have been shared with the Royal College of Surgeons in Ireland, which has a strategic interest in Waterford Regional Hospital as a major undergraduate teaching campus for its students. In short, Waterford Regional Hospital is to become a fully recognised university teaching hospital linked to UCC, with all the privileges associated with that status. In furthering this proposal, UCC is committed to putting in place academic clinical appointments on an incremental basis at professorial, senior lecturer and tutor levels, with associated administrative support. Discussions within the new group's corporate governance structure and in turn with the HSE and the Department of Health will now commence to give effect to these changes.

The traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. Experience in Ireland and beyond informs us that a co-ordinated system of care is clearly better for patients than a more sporadic approach from hospital to hospital. I am confident that the formation of hospital groups will lead to safer, more effective and more efficient services for all patients. We are all agreed that the focus in all of this must be on what is best for patients. That is the starting point. We do not start from an existing hospital - I am speaking generally here, not specifically about Waterford - and look outward in terms of seeing how we can maintain or preserve everything that has always been available at that particular location. I appreciate that this is not the Senator's perspective, but it is important to state it. We must begin by considering how best to serve the needs of patients and organise care at the optimum level for all citizens. People are usually patients for a short period of time but they are citizens all the time. The focus must be on building the best possible services around the interests of the patient. From his contributions in the House, I know the Senator will share that perspective.

Several commentators, including the leader of the Senator's party in the other House, expressed concern yesterday about a lack of detail in the proposal. Once the groups are established, it will be a matter for each of them to examine some of the outstanding issues that need to be addressed in terms of the best configuration of care across the group. Those types of decisions will be left to the groups.

In terms of the specific issues the Senator raised, I have indicated that Waterford Regional Hospital will continue to be a cancer centre, a hub for the south-east renal service and a regional trauma centre. I also referred to the enhancement of the status of the hospital through its links with UCC. We would all agree that the teaching element of a modern hospital is vitally important. In fact, there would be questions to answer if a hospital as advanced and important as Waterford were left without a teaching dimension to its work.

That would be of concern to people, and that will not happen here. There will be professorial and teaching positions in this hospital, which will give it great strength and endurance. I have no doubt that Waterford Regional Hospital will endure to serve patients for a considerable period into the future.

Senator David Cullinane

Waterford Regional Hospital is a teaching hospital. What is being proposed is that it become a fully recognised university teaching hospital, and that has advantages. However, I have not received a reply to the core question from the Minister for Health, the Minister of State, Deputy White, or Professor Higgins. Following the establishment of these new groups, two hospitals in the region will be in a different group from the group of which Waterford Regional Hospital will be a part, which is the Cork group. What will happen in a situation where those trusts or groups will compete against each other? If we have a situation where there is a leakage of patients away from Waterford Regional Hospital towards hospitals in Dublin, and that will be a natural dynamic, can the Government continue to support services in Waterford Regional Hospital?

Of course the patient comes first, but we are trying to protect the status of Waterford Regional Hospital and the full complement of services in the region. History has shown that Ministers can give commitments, but the reality can be different. If over time there is, unfortunately, a further drift of patients away from Waterford Regional Hospital, there is a genuine fear this could be used as an opportunity to tell the hospital that as it does not have the critical mass, it cannot justify retaining certain services. That is the core fear of the people in the south east and I am anxious to impress that upon the Minister.

I welcome the clarifications given by the Minister of State. Given that this is very significant for acute hospital care and will have profound implications for acute care in the State for generations to come, it is important to tease out all the issues and seek clarifications so we will have the certainty and clarity we need.

Deputy Alex White

I do not have much to add to what I have already said. I do not wish this to be interpreted as a rebuff in any sense to the Senator, but absolute guarantees for anything in the future are not attainable. There is no absolute way of looking into the future and knowing precisely how things will be five, ten or 15 years hence. The hospital in Waterford should, and does, have confidence that it will be a hugely important part of the delivery of health care in this country. Waterford is entitled to have that confidence for the future. However, nobody can have absolute certainty as to precisely what future patient movements or pathways will be, not just in the case of Waterford but with regard to anything we are doing in the reorganisation across the country. The way to deal with it, as the people in Waterford have dealt with it, is to put safeguards in place - in some cases one could call them guarantees - which means strong foundations that will be there into the future. They have been put in place and that is the guarantee, coupled with the sense of confidence and excellence that Waterford Regional Hospital will continue to provide. That is as close as one can get to guarantees.

The Seanad adjourned at 7.05 p.m. until 10.30 a.m. on Thursday, 16 May 2013.

Seanad Éireann debate - Wednesday, 15 May 2013