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Seanad Éireann debate -
Wednesday, 4 Dec 2013

Vol. 228 No. 2

Adjournment Matters

Chronic Disease Management Programme

I thank the Minister of State for taking this Adjournment matter. I want to tell her about a particularly troubling illness called Huntington's disease on which I am sure she has accumulated some information. For the benefit of the uninitiated this is a disease which has an incidence of about one in 10,000 in the European population. It is a disease which is incredibly cruel in its trajectory. It is a genetic disease which is governed by a form of inheritance called autosomal dominant inheritance which means that if one has the disease there is a 50% chance one will pass on the gene to any offspring child. If he or she has the gene they will develop the disease. There are certain quirks in the genetics of the disease. It sometimes occurs in earlier manifestations in succeeding generations. People who courageously elect to have the test to see if they carry the gene, even though they are in good health, often do it to make important life decisions, reproductive decisions. If they carry the gene they know they are facing an utter inevitability of a serious illness which will give them catastrophic physical and mental decline. Typically, the time of the appearance of the first symptom to the time of death is about 20 years. Most people develop the symptoms during their mid-30s which means that during their latter young years and their early middle years they are developing severe progressive neurological abnormality, progressing ultimately to paralysis, dementia, heart failure, etc.

The reason I find this issue topical is that a citizen of our Republic wrote to me asking that I bring her plight to the attention of the House.

This was a young woman who had a husband in his early 50s who had been diagnosed with Huntington's disease and he would rapidly reach the stage of requiring absolute care and could no longer be cared for at home. He required, for want of a better word, institutionalisation in a nursing home. He was assessed there, as would any other resident of a nursing home be, and they have found themselves making a major contribution to the care in a commercial nursing home on the basis that they had an asset, namely, their mortgaged home.

I guess what really brought the matter to my mind was the fact that patients who have the disease do not automatically quality for a medical card. They may qualify for a medical card on the basis of a means test but they do not qualify statutorily because the disease is not on the list of conditions that grants automatic access to a medical card. The matter needs to be rectified. Patients will often get a medical card but, as things stand now, they must go through a renewal process even though the circumstances for people with the disease do not change. Let me rephrase that by saying that their circumstances do change because they get worse. It is cruel that people who have the disease are asked to renew medical card applications with the uncertainty that they may not get one. In truth, the condition is of such catastrophic severity and so uncommon that a caring society should make a provision that basic care associated with a medical card should be made available to people.

I know the Minister was dealt a miserable set of cards at the time he found himself in public office in terms of the public finances. I understand that there are a number of demand restriction measures that take place across the health, social and educational services. It is hard to escape the conclusion that the new focus on the assessment of "probity" for medical card applications has something to do with demand limitation.

I ask the Minister of State to take a special look at the plight of people who have Huntington's disease and other chronic neurodegenerative conditions where no cure is available and treatment is purely palliative. The diseases make people completely disabled and place an extraordinary burden on sufferers and their families. It is estimated that every Huntington's disease patient directly affects the lives of at least four other people in Ireland. I thank the Minister of State for paying attention to this Adjournment matter.

I thank the Senator. I shall commence by saying that I know about the disease. I first encountered it because my neighbour had the disease but it was called Huntington's Chorea at the time. It is a most distressing and cruel disease. Huntington's disease is a genetic neurological disorder and is classified as a rare disease. I shall not deal with the medical card issue raised by the Senator in my reply but I take on board what he has said and shall convey the matter to the relevant Minister.

The supports provided by the Health Service Executive to people with Huntington's disease involve a multidisciplinary team approach to the provision of health and personal supports. It incorporates acute hospital services, primary care, community services, specialists, disability supports and supports services.

The Huntington's Disease Association of Ireland provides consultation, information and individualised supports to those diagnosed with Huntington's disease, their families and their health care team. The Health Service Executive recognises the valuable contribution the association provides to those who suffer from Huntington's disease, their families and carers. It provided a grant totalling €66,887 in 2013 to support the association in its work.

Other developments that are under way and relevant to people's families and staff working with Huntington's disease include the following: the development of an implementation plan for the national policy and strategy for the provision of neuro rehabilitation services; the HSE clinical care programme in neurology and rehabilitation medicine; and the finalisation of a plan or strategy for rare diseases in Ireland, as recommended by the Council of the European Union.

Any patient with a diagnosis of Huntington's disease will be treated and cared for in one of the HSE's neurological departments. The diagnostic process will involve assessment between a consultant neurologist and other disciplines such as neuro psychology as part of the diagnostic process. Patients may also have a specific genetic test undertaken to confirm a diagnosis of Huntington's disease. The genetic test is carried out by the National Centre for Medical Genetics. The centre also offers patients with a known family history of Huntington's disease the ability to undertake a predictive test to assess the likelihood of inheritance. Predictive testing is only performed in conjunction with a counselling programme run by the clinical genetics division of the National Centre for Medical Genetics. I have been informed that there have been 27 clinical referrals in 2012 and 21 clinical referrals to date in 2013 in respect of Huntington's disease.

Beaumont Hospital provides specific clinics in respect of people with Huntington's disease and its department of psychology provides a specialist neuropsychology service for people diagnosed with Huntington's disease. Patients referred to the service receive a detailed neuropsychological assessment that examines aspects of thinking, emotion and behaviour in line with international guidelines on the assessment of Huntington's disease. Patients can also receive supportive psychotherapy and behavioural management, where appropriate. A supportive service for carers and family members of patients with Huntington's disease is also available. The HSE has informed the Department that the clinic currently operates fortnightly but individual sessions are available by appointment outside of clinic hours.

In Galway, patients with Huntington's disease are referred to the hospital's movement disorder clinic. A clinical nurse specialist also attends the clinic in addition to providing a telephone advice and support service to patients each day during the week.

A six-storey unit in the Mid-Western Regional Hospital in Limerick will be completed in early 2014. It will bring together existing and, in some cases, deliver new services for patients under one roof at the hospital. Floor 1 of the unit will include a six-bed acute stroke unit with the most advanced diagnostic equipment. In addition, the floor will also accommodate a neurological centre. Among the neurological conditions to be treated in the new unit will be Huntington's disease, Parkinson's disease, motor neurone disease and muscular dystrophy.

I thank Senator Crown for raising the issue of Huntington's disease. The Government is committed to advancing treatment and support for people who have rare neurological conditions through improved standards, quality of care, improved access to service and improved costs and efficiency. As I said, I have not addressed the medical card issue but I shall ensure that his message is delivered loud and clear.

Gabhaim buíochas leis an Aire agus fáilte arís. I thank the Minister of State for her reply and I am grateful for the attention paid to the matter.

I ask her to convey three messages. First, please examine the medical card issue. I know that she will do so because I respect her word on the matter. Second, there must be some assessment of the adequacy of the arrangements that are in place for providing long-term care for the patients who sadly reach a very advanced stage of neurological deterioration that requires professional institutionalised care so can no longer can be cared for in the home. We must establish whether it is appropriate that they are assessed in the same way as everyone else who enters nursing home care. Third, we must consider establishing a national strategy for chronic neurodegenerative care. I thank the Minister of State.

Cycling Facilities Provision

I would like to ask the Minister of State with responsibility for sustainable transport, Deputy Alan Kelly, to consider establishing a small group to oversee the delivery of a national network of off-road cycle trails in order to assist with the timely delivery of the national cycling strategy and to create a network of trails to attract some of the cycling tourism business which is so successful elsewhere but which does not exist in Ireland.

Ireland does not have a long cycle trail as is the norm in the rest of Europe. Our existing short greenways merely provide day trips or weekend break products as well as a local amenity. They cannot form the basis of a week long cycling holiday. We need a number of long trails which will attract the fastest growing leisure pursuit in Europe. We own significant linear corridors, such as canal and river navigation towpaths, and disused railway lines. However, the creation of long trails on these assets on a county-by-county basis will result in unacceptable delays, a lack of standardisation of the product and an inability to leverage these assets further by co-locating services, such as broadband cabling, on these corridors. A small focus body would fast-track this urgent infrastructure and would achieve economies of scale which would provide best value for the taxpayer.

This is a summary of what can only be described as the debacle of cycling and long distance walking infrastructure in Ireland. Both sectors need to be examined together. Long trails in other countries are enjoyed by both walkers and cyclists for the benefit of local and national economies. Ireland has a particular problem in respect of developing off-road trails. We have access issues and an attitude which is rooted in landownership and small farm sizes. As a consequence, we have tended to create trails where we could rather than where they would be most effective. In countries like the UK, footpaths co-exist happily with farms, and walkers and cyclists respect the country code and cause no problems for landowners. We have some way to go before that level of understanding is achieved.

We, therefore, need to concentrate in the first instance on lands which are in public ownership and we need to utilise any such assets to create a basic network that would give us a place at the table of European leisure tourism. Currently, we have no such presence. In 2006, a Fáilte Ireland report showed that Ireland had almost no penetration in the cycling holiday sector and nothing has been done in the meantime to address that deficit. If we extrapolate Fáilte Ireland's figures in this regard, we are behind European norms by at least €300 million annually on the cycling side alone which is estimated to translate into approximately 5,000 jobs. The long distance walking business added to that equation would further enhance it. We have no idea of the greater potential that is there.

Our colleague, Deputy Arthur Spring, is very passionate about this issue also. He suggested that a subsidiary body of the National Roads Authority would be an option to deliver this project and to bring about the connectivity needed to bring all the local authorities together. As the Minister of State, Deputy Kelly, knows, some local authorities might be passionate about this issue while others might be more passionate about protecting old railway lines. The EuroVelo project in Europe has received funding of €1 billion while a 150 km walking project in New Zealand creates one job per kilometre.

I have a report produced by Mr. John Mulligan who has an in-depth knowledge of all the various cycle routes around the country, including Dublin to Stamullen, Dublin to Strokestown via Mullingar and Longford, Dublin to Shannon Harbour, a Dublin-Limerick-Tralee route and the Boyne Valley. The list is endless. The Minister of State is probably aware of this report but I will give it to him anyway. As I said, Mr. Mulligan has an in-depth knowledge of this issue and has done some excellent work.

The Minister of State will see that what we are doing currently is not working, so we must come up with a different strategy. The suggestion I made about a separate body to head this up is the way to go and I would appreciate the Minister of State's help in delivering it.

I thank Senator Kelly, who always makes a very valuable contribution, for raising this issue and giving me the opportunity to outline this Government's commitment to the development of a world class national cycling network for Ireland. I know the Fáilte Ireland figures, to which the Senator referred, in regard to tourism and there is some work to be done, although there has been some progress over the past number of years.

Domestically, cycling, as an activity, has gone through the roof. The number of people cycling for leisure and tourism purposes is phenomenal. One does not even need to see the statistics as anyone travelling around the country can see that. Trying to build cycling more into people's lives as regards their commute to school and work is a critical component which I want to push as well, in particular given that 400,000 people travel 4 km or less to work each day. From a tourism point of view, developing the infrastructure, about which the Senator spoke, is the critical issue.

The suggestion to establish a working group to oversee the delivery of cycling infrastructure has merit and has been the subject of recent discussion within my Department.

I would first like to advise Senator Kelly of the national trails advisory committee, which does some of this work. This committee, which operates as a sub-committee of the Irish Sports Council, includes representatives from a number of agencies and bodies involved in recreational trail development in Ireland. Those represented include my Department, Coillte, Cycling Ireland, National Parks and Wildlife Service, Fáilte Ireland, National Trails Office, the Irish Local Development Company Network and Waterways Ireland among many others. The functions of the committee are to oversee the implementation of the Irish trails strategy and to achieve agreement on a harmonised approach to certain elements of trail provision. The committee meets on a regular basis and is in the process of developing guidelines for the development of cycle infrastructure in Ireland. To date, the committee's work has been largely within the context of delivering on the Irish trails strategy but has allowed for information sharing on the broader issues of cycle infrastructure development in Ireland.

As the Senator knows, the demand for off-road cycle infrastructure has increased dramatically in recent years, particularly with the phenomenal success of the greenway in Mayo. This is apparent from the number of applications submitted to my Department by local authorities under the recent national cycle network funding call 2014-2016. A total of €6.5 million has been set aside for the duration of this programme to deliver a small number of greenway projects and 38 proposals were submitted from 28 authorities. I have visited many of the projects and would love to fund them all. Some of them are fantastic but we just cannot fund all of them.

There is good reason for this interest. Cycle projects, particularly off-road projects, are popular with local authorities and the general population because of the following: they are well-received and promoted by local communities; they are easy to provide from a construction perspective; and capable of providing significant benefits in line with many cross-cutting policies such as community, recreation, health, transport and tourism. They create jobs too in their construction and maintenance and through the services provided for them. I am conscious too that cycling infrastructure is being considered and delivered by several Departments and agencies across several funding programmes. This needs to be addressed too. There may even be potential for future co-funding with our European partners under the next INTERREG scheme and, once finalised, the next European regional development fund, ERDF, operational programme 2014 to 2020.

Given the ongoing demand for such projects, there may be some merit in broadening the scope of the existing cross-sectoral work through a high level group, which would formulate an agreed and consistent approach to delivering cycling infrastructure in line with the national cycle policy. Such a group would include many of the aforementioned from the national trails advisory committee as well as the National Transport Authority and the National Roads Authority. It is very much along the lines of the Senator's suggestion. The programme for Government provides for the targeting of available resources on developing and co-ordinating niche tourism products and activity packages including continued investment in the national cycle policy. A key task for any group established would be to ensure that there is a long-term vision in place that recognises the importance of investing in projects which have the potential to be branded collectively as a national product. I have no doubt that the existing cooperation between all public authorities, community groups and companies will continue into the future and we can look forward to many diverse off-road trails and cycle ways opening up around the country in the coming years.

In this context, I am very open to considering the best mechanisms for delivering such co-operation because I believe that strategic investment now will deliver returns in a multitude of ways and will make a significant contribution to our long-term goals for sustainable travel and transport. I will take the Senator's suggestion, which I welcome, and look on it positively and will return to him soon to report on the actions I will take to achieve the goals that we share.

Road Traffic Legislation

I am glad that the Minister of State is here to respond to my question about regulating the clamping industry, particularly on private property. The Minister for Tourism, Transport and Sport, Deputy Varadkar, published heads of a Bill earlier this year and hoped to present the Bill now. Twice in the past week people have told me stories about the terrible way that clampers treat people, particularly on private property. We need to regulate the practice to give certainty to car owners and to the owners of private property. We do need a clamping process in private facilities but it needs to be regulated.

The statement the Minister made earlier in the year was very welcome. He said that the National Transport Authority would oversee the regulation and that clampers would be licensed. Other measures to be put in place include a complaints procedure. At the moment there is no such procedure and one must write to some PO Box somewhere. It is an important issue. It is a commitment in the programme for Government and needs to be addressed and moved forward and I will be grateful for the Minister of State's response on where this stands.

The regulation of clamping activities is a matter of public concern, and I have had to deal with this in the past on behalf of constituents. I thank Senator Clune for raising the issue. This is a good time to update everyone on this legislation. The Senator would be surprised at the number of people who raise the issue. People very much welcomed the fact that it was stuck into the programme for Government because they rightly have issues about certain practices in the clamping industry which need to change.

The programme for Government contained a commitment to "legislate to regulate the vehicle clamping industry". This commitment stemmed, principally, from concerns expressed by members of the public in regard to the activity of some clampers on private land, and the extent to which this activity may have been carried out in a less than fair manner with no mechanism to appeal against perceived abuses. Sometimes some of the fines, the manner in which they were decided and their cost left a lot to be desired. It was deemed appropriate to address these concerns, and that the Oireachtas should clarify for citizens and property owners an activity which has become an increasing feature of urban life in Ireland.

While section 101B of the Road Traffic Act 1961, inserted by section 9 of the Dublin Transport Authority (Dissolution) Act, 1987, provides the basis for clamping on public roads, there is no extant legislation governing clamping on private land or property. In seeking to meet the Government's commitment, the Minister presented a discussion paper to the then Oireachtas Joint Committee on Environment, Transport, Culture and the Gaeltacht in December 2011, outlining the various policy proposals available, and asked the committee to take a role in the pre-heads of Bill stage of the legislative process. Specifically, the committee was invited to examine the relevant issues which should be addressed and to prepare a report outlining its views on the shape such legislation might take. Following public hearings and a number of written submissions on the matter, the committee responded at the end of March 2012 with a comprehensive report. This report, which is publicly available, contained a number of recommendations, the majority of which were included in a general scheme of Bill which was approved by the Government in March 2013.

The detailed legislation is at an advanced stage of drafting in the Office of the Parliamentary Counsel, which I can confirm, and it is expected that the Bill will be published by the end of this year or early in 2014. We hope that it will be published this month. The Bill will not propose an outright ban on clamping on private property. Landowners need to be able to deal in a fair manner with nuisance parking, such as parking of cars all day in a shopping centre to the disadvantage of other customers. There is, however, a clear need to establish broad rules to govern how clamping is carried out. In general, this Bill will provide safeguards both for those operating a clamping regime as well as for motorists who may have their vehicles clamped.

The public is well aware of cases where private clampers have behaved in a manner that gives rise to serious concerns. Under the principal provisions of the Bill, the National Transport Authority, as regulator, will ensure the provision of adequate advisory signage in locations where clamping is in operation, set maximum clamp release periods and fees, and establish an independent appeals process. These provisions will apply to clamping activities on the public road, as well as on private property where the public has an invitation to park, whether explicit or implied.

Best practice aspects associated with such clamping activities on the public road, such as the current appeals process operated by Dublin City Council which has operated for many years - indeed I have had to lodge appeals - might be equally successfully replicated in respect of clamping on private property and be given the full authority of statutory provision in the public and private spheres. We are taking some of the public practice into the private sphere.

As outlined both here and in the joint committee's deliberations on the matter, consideration of the various issues surrounding the use of clamping as a parking enforcement mechanism demands that any intended legislation will provide appropriate measures in legal terms. There is a clear need to strike a balance between the rights of individual landowners effectively to enforce parking restrictions on their own property, and the rights of individuals to utilise a finite parking resource for the common good.

This latter point is best borne out by the experience in the public arena. Prior to the introduction of clamping in Dublin, the problems associated with illegal parking were endemic, causing difficulties for residents and traders alike who could not access parking during business hours, as metered spaces were often occupied by all-day commuters. In essence, the proposed legislation is intended to provide a balanced regulatory framework within which legitimate clampers may operate but which also protects motorists from disreputable practices. The Minister expects to introduce the Bill in the Oireachtas early in the new year following its publication, hopefully later this month. What is being proposed is fair, balanced and totally necessary.

I thank the Minister of State. I am glad to hear about the legislation and I look forward to its introduction. This House will be ready to take it whenever the Minister is ready to move.

The Seanad adjourned at 7.28 p.m. until 10.30 a.m. on Thursday, 5 December 2013.
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