I welcome the Minister for Health, Deputy Leo Varadkar.
Commencement Matters
Hospitals Capital Programme
I also thank the Minister for coming to the House. On a side issue, I compliment him on his appearance on "The Late Late Show". It looked like a very enjoyable one for him.
As the Minister will be aware, the background to this debate is the withdrawal by HIQA of the registration of St. Patrick’s Community Hospital in Carrick-on-Shannon. This decision which was made amid great controversy received a negative reaction from the staff and supporters of St. Patrick’s Community Hospital, particularly for the manner in which it happened. However, my understanding now is that steps are afoot to improve the situation at the hospital to comply with HIQA regulations. I also understand the imminent opening of a new 20-bed primary care centre in Ballinamore, County Leitrim which will result in the transfer of 20 patients from St. Patrick’s Community Hospital to Ballinamore will go a long way towards compliance. The view of HSE North West is that St. Patrick’s Community Hospital will be re-registered in a short space of time. That is the background and context to this debate.
The HSE has made an application for funding for the construction of a new 90-bed state-of-the-art unit on lands adjacent to St. Patrick’s Community Hospital that have been acquired. My understanding is that plans and proposals are at a very advanced stage and that a commitment from the Minister and the Department to fund the new facility is all that is required now. I am sure the Minister will confirm that or clarify the position.
St. Patrick’s Community Hospital was originally a Famine workhouse. As it has been there since 1841, plainly it is not fit for purpose. While I appreciate that there are similar establishments across the country with a similar history, I would like to think the St. Patrick’s Community Hospital facility is rather unique in this regard. It is a great tribute to the doctors, nurses and general staff of the hospital that they have maintained it to the highest possible standard.
Despite the conclusions of the HIQA report, the general view of the public and particularly of family relatives of those who are cared for at St. Patrick’s Community Hospital is that it is a facility of the highest standard and that the commitment of the nursing staff and doctors is unrivalled. It is for that reason that the HIQA decision caused a great deal of local anger and was seen as an unfair portrayal of an institution that has struggled to maintain those high standards in the face of serious difficulties for a long period of time.
As I said, it looks like this particular issue is going to be resolved in the short term. I hope that will happen. The main purpose of my contribution is to plead with the Minister to provide the necessary funding in order that the new state-of-the-art facility in the capital town of County Leitrim can go ahead forthwith.
It is vitally important that such a facility be located in the county and I would hate to think anything would endanger the future of such a facility and that it would be due to lack of funding, given that all the t's have been crossed and the i's dotted in that regard.
I thank the Senator for reporting this important issue. I am taking the debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is at another event.
The Government's policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. If it becomes necessary for an older person to move to a nursing home, appropriate accommodation must be available that meets his or her care needs and matches his or her wishes. The HSE is responsible for the delivery of health and personal social services, including those at St. Patrick's Community Hospital, Carrick-on-Shannon, County Leitrim. The hospital was built in 1841 and has been used as a care facility since 1928. The centre has an occupancy of 85 beds, comprising 63 continuing care beds and 22 short-term care beds used for rehabilitation, convalescence, respite or palliative care.
Since 2009, all nursing homes - public, private and voluntary - have been registered and inspected by the Health Information and Quality Authority, HIQA. The most recent HIQA report on the hospital was published last July. Although the report acknowledged that progress had been made and improvements were evident since previous inspections, some concerns were reported, including the physical infrastructure of the facility. I have been informed by the HSE that a substantial action plan has been submitted to HIQA. This sets out what has already been achieved since the inspection and provides identified dates for the actions required by HIQA to be completed. Part of the HSE longer term plan for County Leitrim includes the opening of a newly built, 20-bed community nursing unit in Ballinamore. The HSE has applied to HIQA to register this facility and is in the process of recruiting staff. It is expected that the unit will open before the end of this year. This will allow patients from the area who are currently resident in St. Patrick's Community Hospital to transfer to Ballinamore. As a result, there will be some reduction in bed numbers at St. Patrick's Community Hospital, allowing more space, privacy and dignity for the remaining residents, thus addressing HIQA's concerns about lack of privacy for some residents in St. Patrick's Community Hospital. The opening of Ballinamore will ensure overall bed numbers are maintained in the south Leitrim area. The new unit will be operated and run by the HSE.
A number of community nursing units, CNUs, similar to St. Patrick's Community Hospital are very old and it can be very difficult or costly to adapt them to modern standards. Discussions are ongoing between HIQA and the HSE about the conditions that will apply to public facilities across the country. Later today I will announce the total funding that will be available for capital investments in the health sector in the coming years. This will allow the HSE to frame a capital plan that balances priorities across the health service with the available funding. The overriding objective will be to ensure, in so far as possible, that when older people need care in public and residential facilities, it is available for them. Although many public facilities are not in line with how modern residential units are designed and configured, the standard of care provided to residents is generally of a very high standard. Residents and their families frequently express their appreciation of the care they receive and continue to choose such facilities even when alternatives are available. My Department will work with the HSE to allocate whatever funds are available in the most effective way possible, with the safety and welfare of residents being our top priority.
The Senator is probably aware that the capital plan for 2016 to 2021 was published in the last hour or so. It allocated an additional €300 million to the Department of Health for community nursing units and disability facilities in the next six years and this is in addition to what was already in the budget. Although I cannot say at this stage how it will break down and which projects will be funded when, the Minister of State, Deputy Kathleen Lynch, is working with the HSE on it with a view to making an announcement on a national basis during the next couple of weeks.
I am very grateful to the Minister. It begs the obvious question which he has partially answered as to whether, as a result of the increased allocation in the community service sector which is welcome, the new unit in St. Patrick's Community Hospital in Carrick-on-Shannon will go ahead. I understand it is not necessarily directly in the Minister's brief and that the Minister of State will make the allocations. When the Minister said it would be a matter of weeks, will it be before or after the budget?
Only today did we know for sure what was available in our capital envelope for the next six years. The Minister of State, Deputy Kathleen Lynch, with my oversight, will meet the HSE, go through it and devise a six-year capital plan for community nursing units and disability residential centres.
It will certainly be in there, I just cannot tell the Senator today exactly when it will start and finish and so on. Obviously some of these will require planning permission. All that now has to be worked out. It is a little like the schools programme which will be ready for publication in a few weeks. There will be a similar programme for community nursing units and disability homes.
Cancer Screening Programmes
I thank the Cathaoirleach for giving me the opportunity to raise this critical issue. I welcome the Minister, Deputy Leo Varadkar, and I am pleased to be able to raise the critical issue of the rolling out of free BreastCheck screening for women between the ages of 65 and 69 years. Since the introduction and publication of my first policy paper, A New Approach to Ageing and Ageism, in 2006 I have been passionately campaigning for the abolition of the 64 year age limit on BreastCheck screening as one in ten of all breast cancers occur in women between the ages of 65 and 69 years.
On 15 October 2014 the Minister announced that free BreastCheck screening would be rolled out to women between the ages of 65 and 69 years. I spoke to him that day and was absolutely thrilled because I had been campaigning for that for a long time. Everyone at the announcement on 15 October was beaming with delight. The Irish Cancer Society welcomed the decision to make the necessary investment to ensure BreastCheck screening was extended to women aged 65 to 69 years, stating it was the right decision which would save a minimum of 87 women's lives per year. Some time later, in response to a parliamentary question submitted by Fianna Fáil spokesman on health, Deputy Billy Kelleher, I learned that free BreastCheck screening for women aged 65 to 69 years would not commence until the fourth quarter of 2015. I could not believe it. The Minister announced it on 15 October and I was sure something was going to happen quickly.
I also learned that the screening of women in the 65 to 69 year age group would only be fully implemented by 2021. In the meantime, 609 Irish women will lose their lives before any real progress is made by the Government in meeting the 2021 target. The day the Minister launched it, on 15 October last year, I was genuinely thrilled and so impressed with him. We then found out a couple of months later that it would not be rolled out until the fourth quarter of this year. I am very disappointed. I felt I had been led astray when the public announcement was made outside the gate of Leinster House. It was said it would commence in the fourth quarter of this year. I do not want to hear about administrative difficulties or the lack of radiographers. We were not told anything about this on the day of the launch. I am a very straight person and this is business, not personal. Given that the Minister launched it that day, I felt I had been deceived to hear that this would take so long and that we would have to wait until the first quarter of 2015 for this free BreastCheck screening being rolled out.
It is ageism that women are not having a free BreastCheck examination. From my experience, there is ageism to a greater degree in Ireland than in any other country in the world. I do not notice it myself - I am very lucky - but it is endemic in society. This is typical. Women in this age group are more prone to contracting breast cancer.
I thank the Senator for raising this issue again in the Seanad.
BreastCheck is now in its 16th year and currently offers a free mammogram every two years to women aged 50 to 64 years. Under BreastCheck, more than 1.3 million mammograms have been provided for more than 478,000 women, and more than 8,300 cancers have been detected. Last November, I announced the extension of BreastCheck to the 65 to 69 year age group, in keeping with EU guidelines. The age extension will be complete by 2021. The additional eligible population is approximately 100,000 and, when the programme is fully implemented, 540,000 women will be included in the BreastCheck programme. Due to the number of people who will be added to the breast screening service and the fact that women are screened on a two-year cycle, the task of extending the age cohort is a major logistical and operational undertaking. That is why the age extension will be implemented on an incremental basis in line with the capacity of the service to manage the additional screening and follow-up workload.
The National Screening Service will need to recruit and train additional radiographers, medical consultants and administrative support to accommodate the increased demand for the BreastCheck programme. Funding for this and for additional mobile units and medical equipment will be made available across the implementation period. A provision of €100,000 was made to commence implementation in the final quarter of 2015.
Breast cancer survival in Ireland has improved significantly in recent years, with the five-year survival rate now estimated at 81% for women diagnosed between 2006 and 2011. This is an increase from 72% for women diagnosed between 1994 and 1999. The increase is due to a combined approach of screening, symptomatic detection and improved treatment.
The national cancer control programme has focused on improving the quality of cancer services through reorganisation and expansion and by applying best practice in areas such as prevention, early detection, diagnosis and treatment. Surgery has been reorganised into the eight designated cancer centres, and full breast cancer services are also provided at Letterkenny General Hospital as a satellite of University Hospital Galway. Referral guidelines for GPs have also been developed to achieve a more effective and integrated service. In June 2015, I launched the national clinical guidelines on the diagnosis, staging and treatment of patients with breast cancer. Clinical effectiveness is fundamental to the health service, and implementing good-quality clinical guidelines and audit can improve health outcomes for patients, reduce variations in practice and improve the quality of clinical decisions.
I am committed to extending BreastCheck to those aged 65 to 69 years on a phased basis between now and 2021. It is necessary to do this on an incremental basis in line with the capacity of the service to manage the additional screening of approximately 100,000 women and then to follow them up properly. If BreastCheck managers believe the process can be done more quickly, they will have my support, but I will not rush them. If the process is rushed, the standards may fall. I regret that the Senator felt led astray or deceived in any way, but I was very clear in my budget statement that week as to what was happening. It was also made very clear in the service plan published in November. I certainly would encourage the Senator to inform herself fully by reading those speeches and the service plan before coming to conclusions. It may be the case that she was not led astray or deceived but rather that she was not fully informed.
To be honest, I took at face value what the Minister said on the day I met him. I believed he would roll it out quickly. I will ask one question before pointing out another issue relating to BreastCheck. How many women in the final quarter will be able to avail of the free BreastCheck examination?
A serious matter was drawn to my attention by a woman at the weekend. She is not able to avail of the service because it has not yet been rolled out for her age group. She was also under the impression that the service would be rolled out.
Does the Senator have a question?
This is critical.
All of the issues are critical.
This woman said she would pay for a breast examination, but she wanted to have it carried out in the facility where she had had free examinations up to the age of 64 years. She was told she could not do this. It is unbelievable how this country can be run in silos. She was willing to pay money to BreastCheck and the medical personnel could have examined all of her screenings to date.
She would have liked to have been able to do this. I suggest the Minister does this. One of the advantages of the free BreastCheck service is that a letter is sent to every woman, but those aged over 64 years stop getting letters to remind them to avail of the free BreastCheck examination. Many issues surrounding BreastCheck need to be dealt with efficiently. I thank the Minister and wish him good luck.
On the first question, I do not have the figure available, but I will certainly ask BreastCheck to forward it to the Senator. On the second question, it is not possible for anyone to pay for a BreastCheck examination or any of the national screening services. They are not run that way. They are run in such a way that they are population based screening programmes and people cannot buy their way in. Everyone is treated regardless of income or ability to pay. If people do want to pay, I imagine they can be referred privately through their doctor if that is what they wish to do, not to BreastCheck but to a different-----
I find that an appalling response-----
There is no provision for a further intervention.
-----that a woman who has availed of free BreastCheck examination for two years cannot follow up when she is over the age of 64 years to continue in the same institution.
Please, Senator.
It is typically Irish.
School Accommodation Provision
I welcome the Minister, Deputy Alex White.
I call on the Minister for Education and Skills to provide an update on the Department's review of the post-primary school places that will be required from 2017 onwards, specifically in Newbridge and south Kildare. When is it expected that the review will be completed? A colleague of mine asked me to raise this issue. Today, we will announce the Government's capital spending plans for the remainder of the decade and our spending plans for education are vital. It is important that we continue to invest in education, expand choice and end the era of Fianna Fáil flat-pack prefab schools. It is also important that we get the future development of the sector right and ensure such mistakes are not made again. Will the Minister provide an update on the review of the post-primary school places that will be required from 2017 onwards? A specific concern has been brought to my attention in Newbridge and south Kildare. I would like a specific timeline for the completion of the review.
I thank the Senator for raising this matter and will respond on behalf of my colleague, the Minister for Education and Skills. I welcome the opportunity to set out the position on the Minister's behalf on the Department's review of the post-primary school places that will be required from 2017 onwards.
Owing to unprecedented demographic growth, 27 new primary schools and 26 new post-primary schools will be established, or will be in the process of being established, between 2011 and 2016. The purpose of each of these schools is to meet a specific demographic need within a defined geographic area, that is, to ensure every child and young person living in a particular area can have access to a physical school place within that area.
The Department uses a geographical information system, GIS, to identify where the pressure for school places will arise. The GIS uses data from the Central Statistics Office, Ordnance Survey Ireland and the Department of Social Protection in addition to the Department’s own databases. It also uses data from the local authorities. With this information the Department carries out nationwide demographic exercises at primary and post-primary level to determine where additional school accommodation is needed.
The Department is in the process of concluding a report on the outcome of an exercise to determine where additional post-primary school accommodation will be needed from 2017 onwards. The demographic exercise encompassed all areas of the country, including Newbridge and Kildare. The Minister will shortly announce the details of the new post-primary schools to be provided nationwide arising from this exercise.
Arrangements will also be made to provide additional post-primary accommodation for existing schools where the demographic demand warrants this. Where new schools are to be established, the Department runs an open patronage determination process to decide who will operate the schools. It is open to all patrons and prospective patrons to apply under this process.
More than €2.2 billion in funding is being invested by my Department under its five year school capital investment plan 2012 to 2016. In excess of €1.5 billion of this is being allocated for the funding of major school building projects. The balance is being used for the additional accommodation scheme, the prefab replacement initiative, the emergency works scheme and the acquisition of sites. Full details of all projects both planned and ongoing are published on the Department’s website.
Earlier this year the Minister announced that seven new primary schools would be established in the next two years to meet demographic needs in different areas of the country. Nine new post-primary schools will open over the same period. This includes a new 1,000 pupil post-primary school, Celbridge community school, which opened in interim accommodation this September 2015. A new 1,000 pupil post-primary school, Maynooth community college, opened in 2014. Both of these projects are on the five-year plan, as is a replacement school building for the existing Maynooth post-primary school. Planning is also under way on the next five-year school capital investment plan.
I thank the Minister for that comprehensive response. My only question which I doubt the Minister will be able to answer is how he defines the word "shortly" when it comes to the report being compiled? Is it today, this month or this decade? That word is vague in terms of an answer, but I appreciate the comprehensive nature of the rest of the information in the reply.
I appreciate what the Senator says about "shortly". It is a sort of term of art in government, but I understand from the Minister that this work is ongoing, as I stated in the response, and that she intends expediting it as soon as possible. There is no question of it amounting to a period of years. I hope it will be in the coming period. Obviously, the announcements to be made today in the context of the capital programme are relevant also in terms of the funding that will be available for this critically important agenda.
I thank the Senator for raising the issue. If I can assist her in any way, in contact with my colleague, the Minister, Deputy Jan O'Sullivan, I will certainly do so.
Alternative Energy Projects
I thank the Minister for taking this debate personally, as it does not happen too often in this House. As he is aware, I am not a fan of wind energy, which I believe is a folly. When we do a cost-benefit analysis subsequently, we will discover that. However, that is not the essence of the matter I raise, which is to discuss the community fund these wind farm developers put in place. When communities fight against these developments and lose and these unsightly turbines are imposed on them, there should be certainty as to how much the community will benefit from the wind farm developments. They need to be set by the Minister and not the way it is being done, which is that the more one objects, the more one will get and if one does not object to a wind farm development, one will get nothing.
I will give the Minister an example. In Sliabh Bán, County Roscommon, there are 20 wind turbines which stand 130 m high into the sky. They will destroy the landscape of Sliabh Bán. On initial consultation the wind farm developers were offering €57,000 a year to the local community. Following further consultation and discussion they increased that to €87,000 per year. The first problem with that is that in the United Kingdom - we always say we follow the UK model because that is the way they do their business - they decide how much the community gets based on a certain amount of money per megawatt produced. That is £5,000 per annum per megawatt being produced. If that were to apply to Sliabh Bán, County Roscommon, the community would be getting €420,000 per annum.
It appears that, through negotiation, the Sliabh Bán group has managed to get €1,500 per megawatt produced, while in the United Kingdom the amount would be €7,500 per megawatt produced. A fair fee needs to be set by the Minister. What is not fair is the negotiated amount in place. Second, the wind farm developers need to deal with a local community group to decide where the money is spent. What is happening in this particular case is that the developers are handing the money over to the Leader programme. The Leader programme will accept applications from football clubs and so on but many local people will not benefit. Farmers who are adjacent to these developments, perhaps 500 m away, have their land devalued as a result and get nothing. Many of the local people will end up with nothing. We are buying off community groups with a set of jerseys every year. It is not fair on most of the people who lose out as a result of these developments.
I thank the Senator for raising this issue.
One of the central themes in the Green Paper on energy policy, published in May 2014, is citizen engagement. Following its publication, the Department undertook a public consultation process which included analysis of more than 1,200 written submissions and 13 stakeholder seminars, held in Dublin, Westmeath, Sligo, Cork and Wexford, on the various priority areas highlighted in the Green Paper.
A recurring message coming from the written submissions and the seminars was the role that community energy could play in our future energy systems. The views submitted are being considered in the formation and finalisation of the energy White Paper which will be published before the end of the year and which will, inter alia, address community energy projects and how best to facilitate communities in playing their part in the energy transition.
My Department is also preparing to publish a draft renewable electricity policy and development framework. The framework which addresses the matters of early consultation, community engagement, and building community gain considerations into energy infrastructure planning and budgeting will be published for public consultation in the coming weeks. I look forward to receiving submissions which will be considered in the context of the strategic environmental assessment, the appropriate assessment under the habitats directive and the subsequent finalisation of the framework.
I should also highlight the various community-level initiatives administered on behalf of the Department by the Sustainable Energy Authority of Ireland. These include the development of community energy projects through the Better Energy Communities programme which allows community- and locally based organisations to apply for funding on a competitive basis to support sustainable energy upgrades to existing buildings and facilities. It also promotes the creation and development of locally based entities that can engage and mobilise community resources to lower energy bills and boost employment.
On the specific issue the Senator has raised, the notion that community engagement and citizen engagement could be reduced to, as he rightly put it, the idea of a set of jerseys for the local team is completely unacceptable and inadequate in terms of constituting any kind of community engagement policy. Despite the impression conveyed by the Senator's question, the community benefit fund was established by the developers. It is not something they do in agreement with me. As matters stand, I do not have any legal or other means to intercede or to involve myself in the community benefit fund. However, what we have done as a Government, and what my predecessors have done, is to set a policy directive in relation to community engagement. That community engagement has to be real and robust and in many cases it has been neither. Certainly, that has to be greatly improved and I think the White Paper will help us to do this.
I should also clarify for the Senator and the House that the Minister of the day does not have an involvement with wind farm developers in that way; in other words, it is not a question of me as Minister, or my predecessors or successors, entering into agreements or contracts with wind farm operators. That is not the way the system works. We have a price support system through REFIT.
When project promoters are successful in terms of gaining access to REFIT funds, that is administered by the regulator. There is not this kind of close nexus, that may be suggested, between the Minister, whoever the Minister is, and particular wind farm developers.
It is not possible under current arrangements to do the sort of thing that the Senator has advocated. I agree with his basic point that we do not currently have in place a sufficiently robust regime of community engagement. We must do an awful lot to improve it and the White Paper will help us to do so.
Community and citizen engagement has proved to be a joke in the past, but I hope the position will improve. I read in my local newspaper this week that the ESB has launched a scheme called community fund 2015 for another development in County Roscommon. At least it has advertised that it is willing to sit down with communities to talk to people and agree a set figure.
I shall return to the point I made earlier. In Sliabh Bán people were originally offered €1,000 per MW produced, but that offer was increased to €1,500 after negotiations. A Minister in the United Kingdom - this is why I suggest the Minister here should analyse how the calculation came about - introduced a rate that is five times greater than what wind farm developers get away with here. The final rate is purely down to the Minister here. I would appreciate if he would examine what mechanisms were brought into place in the United Kingdom that have given greater security to communities there. People know what they are going to get when they learn what size of wind farm development is going ahead.
What the Senator has said is not unreasonable. I will carefully consider what he has said. I have looked at the models adopted in other countries. It is not just in the United Kingdom but in northern Europe where a regime has been developed whereby communities, local groups, sometimes co-operatives have equity in wind farms comprised of one or two turbines and, in some cases, larger enterprises. The Senator has made a very helpful and useful point which I shall carefully consider.
I thank the Minister.
Sitting suspended at 3.15 p.m. and resumed at 3.30 p.m.