Commencement Matters

Coastal Erosion

Cuirim céad fáilte roimh an Aire Stáit. Táim an-bhuíoch de as teacht isteach chun an cheist seo a phlé.

Climate change is one of the hot topics this week. In 2013 and 2014 we experienced particularly bad winters during which there were many storms and a great deal of damage was caused in the context of coastal erosion. Counties Galway and Mayo were particularly hard hit in terms of the amount of damage done. Senators will recall the scenes of roads being washed away that were shown on television. A friend of mine who had no access to her home for weeks because the access road had been washed away had to have a new roadway constructed. Many graveyards were damaged and fields were either damaged or washed away. I know from contact with the local authorities concerned that they were under severe pressure at that time in terms of the amount of maintenance and other work they had to do. There were some great projects undertaken in my own local area, including at Spiddal. While the local authorities and their staff are to be commended on their efforts during that time and their ongoing work in this area, a great deal of work remains to be done in places such as the Aran Islands where, as I am sure the Minister of State is aware, roads were washed away or left impassable as a result of the damage caused by storms.

Coastal erosion is not a phenomenon that is going to go away. While 2013 and 2014 were unprecedented in terms of severe weather conditions, storms are occurring with greater frequency. I know from research in this regard that similar phenomena occurred in 1974, 1983, 1989, 2004 and 2008 and that pattern is expected to continue.

There will be rising sea levels and increasing frequency and intensity of storms. There is a real threat to coastal infrastructure but in other countries they have longer term monitoring programmes and they map changes on their coastlines to enable them to plan in advance. It was strange that, in 2013-14, the Government did not seek funding from the European Union for work on coastal erosion issues and to combat coastal erosion and potential storm damage. A number of people felt an attempt should have been made to access funding from the European Union as it related to a natural disaster. It was unprecedented and something over which people had no control. Local authorities told us their hands were tied as regards resources and that these resources were limited, although the Government told them it was giving them the resources that were available.

It is frustrating that people who see roadways or infrastructure damaged close to their homes, but not on land owned by the local authority, get absolutely no support unless locals help them to repair damage. I have been contacted recently by people around Tawin Island and Oranmore who asked me to raise this issue with the Minister as theirs is a low-lying area. There has been severe coastal erosion in recent times and the foreshore is of a particularly delicate nature. As Oranmore is very close to the city, a large number of people live there and they are concerned that if there are other severe storms, their houses and lands will be in danger. I am grateful to the Minister of State for coming in and hope he can elucidate where we stand, particularly in counties Galway and Mayo and in Tawin and Oranmore, in particular. Will he say what is being done, what can be done and what will be done by the Government?

I thank the Senator for raising this matter and giving me the opportunity to update the Seanad on the subject of coastal erosion. I echo his comments on the courageous work carried out by local authority workers right around the country, including in Galway, during the very difficult storms and floods we experienced a number of years ago.

Coastal erosion is a natural and ongoing process which takes place right around the entire coastline of Ireland. Coastal erosion may threaten human life, land or infrastructure such as roads. However, it must be recognised that coastal erosion also has beneficial effects such as providing natural nourishment and supply of sediment to adjacent beaches. Due to the considerable extent and nature of the Irish coastline impacted by erosion and the fact that it is an ongoing natural process it would be uneconomical and impractical for the State to protect all of this coastline. In the first instance, it is a matter for the local authorities to identify and prioritise areas of their respective coastlines considered to be under significant threat from erosion. Any approach toward addressing problems of coastal erosion must be informed by an assessment of the risks involved. In some cases a "do nothing" or "no active intervention" approach might well be the most appropriate management response and international studies have borne this out. Some previous interventions to solve local erosion problems have exacerbated coastal erosion at other locations or have generated other environmental problems.

The OPW requires that proposals and funding applications for structural measures to prevent or mitigate coastal erosion should be made in conjunction with an appropriate coastal erosion risk management study which fully investigates, substantiates and demonstrates the merits of any measure being proposed. Before we spend taxpayers' money on fixing a problem we need to check it is the right solution and does not have any accidental consequences. Such measures usually require the investment of substantial amounts of public funds. In order to ensure value for money, it is considered best practice to carry out a study in advance of undertaking any measures. A study should include technical, economic, social and environmental criteria and should ensure that due consideration is given to the full range of management options. The Irish coastal protection strategy study, ICPSS, has surveyed and assessed the coastal erosion risk along the entire national coastline. This study is available on the OPW website, where the exact risk to various parts of the coastline is shown. The information is available to all local authorities to enable them to develop appropriate plans and strategies for the sustainable management of the coastline in their counties including the identification, prioritisation and, subject to the availability of resources, the implementation of coastal protection works both of a structural and non-structural nature as appropriate.

I am informed that Galway County Council has carried out some works reinforcing bridges on Tawin Island. Galway County Council was allocated funding of €441,990 for works on the south shore of Inishbofin and €90,000 for a study on Inishbofin as a whole in 2015, under the minor flood mitigation works and coastal protection scheme. Under this scheme applications are considered for measures costing not more than €500,000 in each instance. Studies are also funded under this scheme; therefore, it is a direct way for the local authority to apply for minor flood mitigation and coastal protection scheme funding, up to €500,000, if there is an area they need to examine to see if action can be taken. Funding of up to 90% of the cost is available for eligible projects from my office, subject to criteria, and any application which the council may make under the scheme will be considered by the OPW in accordance with the scheme's eligibility criteria. No application for funding for works on Tawin Island was submitted by Galway County Council under this scheme but the option remains open to it. The OPW has not received any application for funding under this scheme from Mayo County Council for 2015.

Following the storms of December and January of 2013-14, the Government made funding available for the repair of specific public infrastructure and facilities damaged by the severe weather events. The amount allocated to Mayo County Council by the Government for coastal repair and reinstatement works was €4,205,000. Galway County Council was allocated €1,144,800. Tawin Island was not included on the programme of works for coastal storm damage repair submitted by Galway County Council. In recent weeks, however, I have been able to make an additional funding allocation in recognition of storms that occurred in February 2014 and under this funding allocation I provided a further €6,000 to Mayo County Council. Based on the very substantial works identified previously by Galway County Council, it will be allocated a further €498,000. I have given local authorities discretion in how they use the funding so they must pick the coastal repair or flood repair projects they think most appropriate. It may be open to Galway County Council to consider Tawin Island under that, and it may submit an application to my office under the minor works scheme.

I thank the Minister of State for his clarification. A large proportion of the funding to which he referred should go to counties in the west because that is where one finds most of the coastal issues. Is there a limit to the minor flood mitigation and coastal protection scheme fund? How much is in the fund and will there be more money there for local authorities to apply for? The Minister of State said no works were applied for in Tawin Island. Is there a particular reason for this? Is the scheme open only to lands or shoreline in the ownership of the local authority? If not, would that be why Tawin Island and other such places do not receive support to put in rock armour or coastal barriers to alleviate coastal erosion?

It stands to reason my office can only fund projects it has been asked to fund. If we have not received an application we cannot assess the application. Without knowing the specific details of Tawin Island, Galway County Council will be well aware of the criteria for the minor works scheme and if it sees merit in submitting an application I assure the Senator it will be assessed as a matter of priority when it comes to my office. It may also be possible to fund the work under the €498,000 in additional funding to Galway County Council as the council has discretion over how to spend it. I know it has many priorities and the western counties took quite a battering. The minor flood mitigation and coastal protection scheme is not capped and councils can apply as often as they wish for projects of up to €500,000, but it has to come out of my overall OPW budget. There is not a limited pool of money in the scheme as it is demand led and we assess each application based on the criteria.

I assume Galway County Council will also be seeking funding in the context of coastal management and protection arising from the western CFRAM study. We published draft maps last week and, should it highlight any coastal flood protection requirements, there may be an opportunity for further funding. In the light of the capital plan which we published recently we expect to spend, as a country, more money on flood mitigation measures and coastal protection in the next five years than we did in the past 20 years. Given the issues arising from climate change, it is right and proper that we do this. It is a serious investment on behalf of the State and my office will continue to work with local authorities on the issue.

Flood Prevention Measures

I welcome the Minister of State. As this is the first time I have had the opportunity to address him since he took office, I am glad that he is here as the matter is a pressing one for the people of east Galway. It is not a new issue either.

The Dunkellin river has flooded on a number of occasions in the past six years and these events have had a major impact on the local people, who live in constant fear for their homes and livelihoods. Something needs to be done urgently to mitigate the threat of flooding in the area. Local residents, businesses and farmers have a right not to live in constant fear that everything they hold dear might be washed away in the next flood. All it takes for the river to burst its banks is a few inches of rainfall. In the event of a torrential downpour, many locals are left completely helpless.

Initiatives aimed at relieving the pressure from potential flood risks have been raised during the years, well before the Minister of State or I ever got into politics, but nothing constructive was ever done to help the people living along the banks of the Dunkellin river and the Aggard stream. I have witnessed such flooding during the course of my duties as a public representative and I can tell the Minister of State and his Department that they cannot act with enough haste on this issue. We must consider introducing a scheme of works on the river, perhaps through community employment initiatives, to try to solve the problem if funding is the issue. If planning is the problem, we cannot engage enough with stakeholders and with those who might object to any works that could take place so that we can reach a solution to improve the lives of the families living along the river and give them the basic human right of safety in their homes. It is fundamentally wrong that local residents in Craughwell and Kilcolgan and all along the Dunkellin river and Aggard stream should have to become so comfortable with using sandbags as a last means of protecting their properties and families. To add insult to injury, the properties these people own are worthless as a consequence of this being allowed to happen so frequently.

I call on the Minister of State and his Department to take immediate action to implement some flooding relief measures that would be adequate to ensure people along the Dunkellin river in County Galway no longer have to fear rainy days. I know that the Minister of State is trying to do what he can on this issue, but if he is mindful of dealing with the issue, could he try to implement adequate flood relief measures as soon as possible? That would be most helpful. It is heartbreaking to see a local resident in Craughwell on the front page of The Connacht Tribune drenched by the rain and his property surrounded by floods. It is heartbreaking that this should be allowed happen and something needs to be done with haste.

I thank the Senator for raising this important matter, on which she has been working for quite a few years at this stage. I hear, and share, her frustration that this is going on so long. Only a few weeks after taking up this role, I had the opportunity to meet a number of residents in the area and know the grave difficulties they have experienced and their continual fear of future problems. It is frustrating because, as far back as 2009 - in the light of a flood event in November that year - a joint working group of representatives from the OPW and Galway County Council was established to examine flooding problems in the Galway area. In addition, a study was commissioned by my office at that stage to identify additional practical measures that could be found to address flooding on the Dunkellin river and in its catchment area. Consulting engineers produced a report identifying a flood relief for the area. I accept and share the Senator's frustration that this has been going on for a very long time and I am very conscious of the damage and harm caused to people and their homes and businesses by severe flooding.

The Office of Public Works is committed to addressing, in an effective way, all significant flood risk throughout the country and has agreed to fund a programme of flood alleviation works for the Dunkellin river from Craughwell to Kilcolgan and for the Aggard stream and its tributaries up to Cregaclare. Galway County Council is the contracting authority with overall responsibility for the flood relief scheme. The council appointed the engineering and environmental consultants needed to complete the design of the scheme and to attain the necessary statutory permissions for it. Galway County Council is progressing the scheme through An Bord Pleanála under the Planning and Development (Strategic Infrastructure) Act. A particular feature of the proposed scheme is that, having regard to its location, there are a number of environmental considerations associated with the proposed works which have had to be examined carefully and sensitively.

Works proposed under the Dunkellin river and Aggard stream flood relief scheme can be divided into two distinct channels, namely, the Dunkellin or Craughwell river from upstream of Craughwell village to the N18 at Kilcolgan, and the Aggard stream and Monksfield river from Cregaclare, near Ardrahan, to its outfall at the confluence of the Dunkellin and Craughwell rivers. Works on the Dunkellin river will consist of channel-deepening from Craughwell village to the confluence with the Aggard stream, local channel widening at Rinn Bridge and out-of-channel maintenance from downstream of Rahasane turlough, to Rinn Bridge. The proposed works for the Aggard stream are minor in nature and will be limited to the replacement of field wall crossings and culverts which are blocked or undersized or which have collapsed, together with the removal of fallen trees and minor obstructions in the channel. Maintenance works on the Aggard stream will include the non-invasive trimming of bank-side vegetation and the removal of areas of accumulated silt along the full length of the channel. Galway County Council and their consultants finalised the environmental impact statement and Natura impact statement for the scheme in October 2014.

The scheme was submitted to An Bord Pleanála for consideration in November 2014 for planning approval in line with section 175 of the Planning and Development Act 2000, as amended. A number of submissions from interested parties were received by An Bord Pleanála in respect of the proposals and the board issued a request for further information to Galway County Council on 2 March 2015. The council requested an extension of time in which to respond to the board's request and the period for response was extended to 10 July 2015. In light of the significant additional data submitted by Galway County Council, An Bord Pleanála requested that both the statutory authorities that were advised of the planning application and the general public be made aware of the additional information and that further submissions or observations could be made to the board within a specific timeframe. As the Senator will be aware, an oral hearing on the proposed scheme commenced on Tuesday, 27 October 2015. The hearing concluded on Tuesday, 3 November 2015 and An Bord Pleanála has indicated that it would be making a decision on the application as expeditiously as possible. I certainly hope that is the case.

I fully acknowledge that bringing forward the proposals for the Dunkellin scheme has taken considerable time and that people affected by the flooding in the area are very anxious that works commence as soon as possible. Galway County Council has been working as diligently as possible to advance the proposed scheme, while having regard to the environmental complexities and sensitivities involved. We must wait for An Bord Pleanála to issue its determination on the proposals but, subject to this, I assure the Senator that the Government remains fully committed to the provision of a flood relief scheme for the Dunkellin river and Aggard stream. We want to see this project under way as quickly as possible. As soon as the board make a decision, and should that decision be favourable, we will get on with it as quickly as possible. Crucially, in terms of funding, the OPW has made provision for the cost of implementing the scheme in its multi-annual budget profiles into the future. The funding is in place as is the commitment from Government, the council and the OPW. We just need the board to make its decision.

I thank the Minister of State for his very detailed response. As somebody with an interest in the environment who once wrote a thesis on intergenerational equity and the environment, I totally understand the environment considerations in respect of this project. However, there is a trade-off going on between the environment and the human right to safety for the people living along the river and the stream. Far be it from us, as politicians, to intervene in the planning process. When that was done in the past, we had two planning tribunals; therefore, I will totally respect whatever decision An Bord Pleanála makes. However, if there is a positive response for the families living along the Aggard stream and the Dunkellin river, I hope the Department and Galway County Council will act as expeditiously as possible and put in place the flood relief measures that are so badly needed for this area.

As soon as An Bord Pleanála makes a decision, a matter in which I do not wish to interfere, if we are ready to proceed with the scheme, I will be delighted to meet the Senator and update her on the timeline for getting these works in place. We are very committed to this. We want to see it happening. It has been a long time in the offing. We have set aside the funding and there is a political and official will from Galway County Council and the OPW to make it happen. This matter is a priority for us.

General Practitioner Contracts

I thank the Minister of State, Deputy Kathleen Lynch, for making time available to deal with this matter which relates to the new contract for GPs. It is an urgent matter in that many GPs are under pressure. Things have changed quite substantially during the past four to five years. While GPs have been able to carry them for the past four to five years, the additional costs they have incurred and the drop in their incomes cannot continue ad infinitum. I know a new contract is being negotiated but it would be helpful for the House if we were made aware of what progress has been made. We need this information, particularly in respect of rural practices. One GP told me that €200,000 was coming into the practice four or five years ago in respect of the provision of care for medical card patients.

The number of medical card patients in his practice has increased substantially, but the amount of money he is getting has decreased to €120,000. That represents a drop of over 40%. Most GPs are experiencing similar reductions at a time when they have to maintain rent payments or service mortgages for their premises and meet the cost of rates, insurance and wages. In addition, the cut in funding for practice nurses has led to a reduction in the number of hours for which GPs can afford to pay such nurses. It is extremely important for us to get this part of the health system right. The sooner we do so, the better. GPs provide a comprehensive service. They are extremely committed to their patients. They do everything possible to provide the best standard of care to their patients. It is in that context that I am raising this matter and calling on the Minister of State to bring us up to date on the current status of the negotiations.

I assure the House that the Government is strongly committed to the future of rural Ireland. We recognise the contribution that rural communities have made to overall national economic development and the development of local areas. Our vision is of rural areas that are vibrant, inclusive and thriving economically. People in rural communities should experience a quality of life that is at least as high and probably better in several respects as that experienced in urban areas. The Government is committed to ensuring patients throughout the country continue to have access to GP services, especially in remote rural areas. We will ensure general practice is sustainable in such areas into the future.

The HSE, the Department of Health and Irish Medical Organisation are engaged in a comprehensive review of the general medical services and of other publicly funded health sector GP contracts. One of the issues encompassed by this review process is support for general practice, especially in remote rural areas. While I do not propose to comment on the detail of the ongoing negotiations, I wish to depart from the prepared script by saying we are looking at the possibility of practice nurses being hired by the State in order that GPs are no longer responsible for their recruitment. I think this is one of the issues that will be discussed in the negotiations, even if it is not completed or agreed on. Under the current general medical services contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual allowance of just over €16,200. They also qualify for more favourable subsidies towards the employment of staff, including practice nurses and secretarial support. More advantageous supports for locum costs for leave are also payable.

The HSE has recently produced revised rural practice allowance guidelines for remote rural areas. The purpose of the new guidelines is to ensure consistency, transparency and fairness when decisions are made about the relevant discretionary provisions of the general medical services contract as they apply to rural GP practices. The guidelines also provide for a level of flexibility in considering applications from GPs which is greater than that provided for in the original governing circular. The guidelines also provide additional options to support GPs. From time to time, HSE local offices offer other incentives to attract GPs into rural areas, such as access to HSE facilities. Additional contracts are also offered such as contracts to provide medical officer services for nursing homes.

I am aware that some isolated rural areas and deprived urban areas, often with limited private practice opportunities, may find it difficult to attract GPs to fill vacant posts. However, I have been assured by the HSE that where a general medical services GP vacancy arises, it takes the necessary steps to ensure continuity of service to general medical services patients is maintained. On 1 November last, there were just 20 general medical services lists out of a national total of more than 2,400 such lists without a permanent GP in place. Eight of the 20 vacancies are in rural areas with populations of less than 1,500. The full range of GP services continues to be provided to the patients concerned through a locum GP or a neighbouring GP. A key objective of the engagement that is taking place with the Irish Medical Organisation is to achieve revised and modernised contractual arrangements which support the sustainable delivery of enhanced GP services in local communities. These services constitute a key element of the range of public and privately provided services, including health and social services, that people need so that life in rural areas remains attractive and sustainable for them at all stages of their lives.

I thank the Minister of State for the comprehensive reply. I know that the negotiations are ongoing and understand progress is being made. Do we have any guideline on whether any aspect of the contract can be concluded? I do not want to tie down the Minister of State on this. I suppose the big problem is that GPs are dealing with such uncertainty. Is there any way that a timeline might be set so that some part of the contract, at least, can be finalised and put into place? I am aware that the contract which is currently in place is over 40 years old. I understand the process of negotiation is very detailed. Is there anything we can put into place to encourage and help GPs in rural practices?

This is a very extensive process because of the generalist nature of the work of GPs which has changed dramatically in recent years. Things such as the minor surgery piece and the chronic care cycles will be rolled out into primary care and GP services. It is an incredibly wide brief. On the other hand, we do not have control of all of this process. The negotiations between the Department and the Irish Medical Organisation are just one aspect of it. As we know from the work that was done on the contracts for those under the age of six years and those over the age of 70, these matters have to be referred to the GPs and the medical community within primary care. We have no control over this. It is hoped that we will get it done as quickly as possible. Much of the preliminary stuff was done during the negotiations on the contracts for the provision of GP services to those under the age of six years and over the age of 70. A great deal of the talking was done at that time, even if no agreement was reached. The needs were very clearly laid out. We hope the negotiations will be concluded as quickly as possible. We will not have control of the process after that point, however. That makes it very difficult to say when this process will be concluded. There may be elements of it with which the GP community does not agree. In such circumstances, we will have to come back into negotiations again. We will do what we can as quickly as we can. There will be no delay.

I appreciate what the Minister of State has said.

Neuro-Rehabilitation Services Provision

The Minister of State is aware that I have been tracking the issue of neuro-rehabilitation services for several years. Such services are essential to support recovery and prevent disability for people with acquired brain injury, stroke, multiple sclerosis and a range of other neurological conditions. Thousands of Irish people still cannot get the rehabilitation they need when they need it. They face a lifetime of unnecessary disability, which can prevent them from returning to work and regaining their independence. It is estimated that there are 25,000 patients in need of rehabilitation in Ireland.

I have raised this issue because I am concerned about the deficits in this area such as, for example, with regard to community teams. Since the three-year national strategy was published and came into place, little or progress has been made to deliver on any of its recommendations. For example, nine neuro-rehabilitation teams are needed in the community, but just three partially staffed teams are in place. No new teams have been established since the strategy was published in 2011. On the basis of the guidelines set by the British Society of Rehabilitation Medicine, the size of the population means that 270 specialist inpatient beds are needed in this country. We have less than half of that number.

If we look at other rehabilitation services, we have a lack of longer term rehabilitation supports, such as step-down units, transitional units and intensive home care packages, to allow people to go home after rehabilitation has come to an end. This means that they end up in totally unsuitable facilities. For example, young people have to live in nursing homes, in acute hospital beds or in long-stay units with no ongoing rehabilitation. It is important to remember that people with neurological conditions need intensive therapy within a window of recovery. I know the Minister of State is aware of this. Those who are waiting to get specialist rehabilitation lose vital recovery time every day of their waiting periods.

The national policy and strategy for the provision of neuro-rehabilitation services in Ireland 2011 to 2015 was published by the Department of Health and the HSE in December 2011. A joint HSE and Department of Health working group was established in 2013 tasked with the development of an implementation plan. Earlier this year the HSE committed to releasing a draft implementation plan for consultation in December 2015. I now understand this will not be released until 2016, which is why I have tabled this matter. Separately, a model of care for specialist rehabilitation services is being developed by the national clinical programme for rehabilitation medicine. The draft of this model of care is being reviewed by the HSE following its submission in September 2015 and no date is available for its publication. Without the publication of the implementation plan for a neuro-rehabilitation strategy no money is being invested, no services are being put in place and thousands of people are not getting the rehabilitation they need. Yesterday, Mags Rogers of the Neurological Alliance of Ireland spoke about condemning people to live with an unnecessary disability. We are speaking about the vital window of recovery. As I have tracked this issue it has been a catalogue of delays, U-turns and no implementation plan. I have met many people in recent years whose quality of life would have been greatly improved if we could have intervened earlier. We have a strategy. Why do we not have a plan and why are we not implementing it?

We had a difficulty at the outset which I encountered very quickly, apart from having no money which was the biggest difficulty of all, as there was a difference of opinion as to how it should be delivered. It is very difficult to say to one specialist that what he or she is saying is wrong and say to another specialist that he or she is right. There was a clear difference of opinion as to how it would be delivered. This is why the implementation plan and the national clinical programme are so important.

The report, National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011–2015, made a number of recommendations for services for people with rehabilitation needs, including clinical, therapeutic, social, vocational and community supports. Following the development of the report, the Health Service Executive established the rehabilitation medicine clinical programme. The scope of the programme covers the whole of the patient's journey from self-management and prevention through to primary, secondary and tertiary care. This provides a national strategic and co-ordinated approach to a wide range of clinical services. The programme includes the standardisation of access to and delivery of high-quality, safe and efficient hospital services nationally, as well as improved linkages with primary care services. This is where the dispute arose with regard to whether it was better to do it within the community or whether it should be attached to an acute hospital.

The rehabilitation medicine clinical programme is nearing completion of a model of care for the provision of specialist rehabilitation services in Ireland, which will be the basis for the delivery of the service. The HSE disability services division has a role in certain key aspects of neuro-rehabilitation services, primarily the provision of community-based therapy services and personal social services. The disability services division will use the recommendations of the value for money and policy review of disability services to focus on disability funded rehabilitation services and enable reconfiguration of existing provisions through the establishment of demonstration sites. Close links will be maintained with the rehabilitation medicine clinical programme to ensure there is no duplication of effort and that all initiatives receive optimal support. Demonstration sites have been identified by disability services and mapping has commenced.

Having regard to the foregoing details, it is not accurate to say no element has been delivered. A national steering group, chaired by the Health Service Executive social care division, has been assigned the task of developing an implementation framework for the national policy and strategy for neuro-rehabilitation services. The steering group includes representation from the national clinical programmes for rehabilitation medicine and neurology, the Department of Health, primary care, therapy professions and the Neurological Alliance of Ireland. Once the implementation framework has been agreed by the steering group, it will then go for consultation to the wider stakeholder interest groups. Following consultation, the framework will be revised and will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level. The HSE is very aware of the needs of people with neurological conditions - it could not but be - and will continue to work towards improved services, making best use of available resources.

The disability sector is now connecting and yesterday I met Enable Ireland which could play a very big part. We all know the other non-governmental agencies with a particular interest in this area. The new hospital in Dún Laoghaire is on its way and will provide not only outreach therapies but also additional beds. It should have been done ten years ago as the Senator and I know this, but with regard to thrombolysis, while prevention in emergency departments has played a significant role, much more needs to be done.

I agree with the Minister of State. As she knows, I have been tracking this issue since I entered the Seanad. With regard to the people living with acquired brain injuries, strokes, multiple sclerosis and a range of other neurological conditions, if we got in during the window of recovery, we would not be speaking about disabilities but recovery. I said no element has been delivered, but for those looking for services during that period, they are not in place. It is not good enough and we must do more. I appreciate what the Minister of State said. We should see the implementation plan. We must give people hope, and the services should be in place in the way they are needed, whether in the community or in settings. The pathway will very much depend on need. I will continue to track the issue for the remaining weeks I am here because it is an issue close to my heart, because of my father and because I have met too many people who would not be suffering every day if we had been able to intervene earlier.

I believe some of it has been put in place, based on a personal family experience. There is not one of us who will not have had such an experience as we go through life in whatever form. This will have involved going to an emergency department at noon on a Saturday and walking out, having been discharged at midnight.

That is the window of recovery.

The difficulty is that it is like suicide in that we will never know how many people we divert from the path of disability. It is difficult to know. However, we need to treat differently those whom we do not divert. The implementation plan and strategy must be published as quickly as possible.

On that we agree. The plan must be published.

Sitting suspended at 11.20 a.m. and resumed at 11.30 a.m.