Commencement Matters

Ambulance Service Provision

I thank the Minister of State for taking the time to discuss this important matter. Last week I met people living with the impact of a stroke in the community. A new stroke support group has been established in County Roscommon, led by the Irish Heart Foundation. One of the issues raised at the meeting was the concern for people who attended the group and every person living in a rural area. We face real challenges in terms of the ability of the ambulance service to respond quickly in rural areas.

The Lightfoot report was published last May. It examined two performance standard response times, namely, eight and 19 minutes. It found that one in 15 ambulances reached patients in need of emergency care within the eight minutes target in rural areas. It also found that ambulances in the west were meeting the 19 minute response time in the case of about 55% of calls. The report provides evidence beyond question of the strong case for the HSE to increase resources in order that we see improvements in ambulance services, especially in identified black spot areas such as west Roscommon. It shows that people who are living in ambulance black spot areas are exposed to an increased risk in terms of delayed intervention, which has been shown to have a negative impact on functional outcomes. For example, the likelihood of recovery after stroke dramatically improves the sooner the patient is assessed and treated.

We also know that ambulances are sometimes forced to wait with patience outside emergency departments for considerable lengths of time before being permitted to transfer patients into emergency departments owing to overcrowding. This further reduces their capacity to deal with other emergencies.

The 2014 HIQA report shows that people from west Roscommon must, on average, wait the longest for an ambulance to arrive. The new ambulance service based at Loughglynn in west Roscommon is being operated by a crew from Roscommon town. We need to deal with the urgency of this matter. Loughglynn was identified as a particular black spot area, as per a 2014 HIQA report. It is not acceptable that no extra resources have been allocated to this area.

We cannot continue to build a health service supporting an urban centre. We know that medical treatments and procedures have become more specialised and centralised, which is really important in delivering the best possible care for patients. However, we need people in rural areas to be able to access the services as quickly as possible to avail of these benefits.

We have seen the immense impact of the air ambulance service which has been positive in improving response times and getting critically ill patients to centres where they can be treated effectively. However, we need the air ambulance service to operate at night time.

The 2014 HIQA and Lightfoot reports provide stark evidence that urgent action is required. Additional ambulances and personnel must be directed towards areas of greatest need. There are real difficulties in rural areas and I ask the Minister of State to outline what the Government is undertaking in terms of an action plan, particularjly in the light of the recent Lightfoot report.

I thank the Senator for raising what is a very important matter, not only in her area but also nationally.

The National Ambulance Service has undergone a major programme of reform and innovation in recent years. The programme is ongoing. In 2016 additional funding of €7.2 million has been provided for the service which includes €2 million to fund new developments. The new funding has and will facilitate the recruitment of additional personnel, the acquisition of new technology, the initiation of the first phase of a hear and treat care pathway, expansion of the community first responder network and assist in the delivery of a children’s ambulance service. We are now deploying ambulances better. Regional call centres have been consolidated and a single national control system has been put in place in the national emergency operations centre. Ambulance dispatchers now have sight of every National Ambulance Service resource in the country. This enables them to make better decisions on how resources should be deployed. Developments such as digital radio, computer-aided dispatch, mobile data and electronic patient recording allow the National Ambulance Service to deploy resources more effectively and on a national basis rather than within small geographic areas. We also have the emergency aeromedical support service, EAS, which was established on a permanent basis in 2015. It is tasked to carry high acuity patients, generally in the west, where it is considered that the journey time by road could contribute significantly to clinical risk. I acknowledge the Senator's positive comments in that regard. The EAS has been hugely successful to date and particularly beneficial for time-dependent cardiovascular patients. I should also mention that we have introduced the intermediate care service to undertake inter-hospital transfers. This frees up the emergency fleet to deal with emergency calls. The National Ambulance Service capacity review was published earlier this year and identified particular difficulties in serving rural areas. However, the report’s recommendations endorse a number of policy initiatives which are already in progress as part of the reform programme. It includes the policy of strategic deployment, with resources being used across a region in order that if demand increases in one area, other resources can provide cover, as required. The review also endorses the existing policy to support voluntary community first responder initiatives. Community first responders are members of the community who are equipped with a defibrillator and supported by the National Ambulance Service to provide an initial emergency response in rural areas. There are 137 community first responder groups linked with the national emergency operations centre and we are confident that we can continue to hope to grow this number.

The capacity review identifies a need for a very significant programme of investment in ambulance services. It is clear to me that a phased investment in a multi-annual programme involving manpower, vehicles and technology is required. In that context, A Programme for a Partnership Government commits to additional annual investment in ambulance personnel and vehicles. It is important to acknowledge the progress being made to reform and develop the National Ambulance Service. I again thank the Senator for raising this issue and providing me with an opportunity to update the House on the very significant service developments there have been in recent years.

I thank the Minister of State for her comprehensive response. I am encouraged by the fact that the programme for Government sets out that there will be a multi-annual programme which will focus on providing an enhanced ambulance service, involving increased personnel, improved technology and improved ambulances. However, we are dealing with a very urgent issue, particularly in known identified black spots, as per the 2014 HIQA report. Again, I emphasise that west Roscommon, an area with which I am very familiar, is a known identified black spot and that we have not seen additional resources being provided in it. It is really important that that issue is dealt with as quickly as possible. We need to make sure the air ambulance service which, again, has been very effective has the capacity to operate at night time. That is critical in getting very ill patients to the centres where they need to be quickly. I thank the Minister of State for her contribution. I will continue to raise the issue and work with her on it.

I will convey the Senator's concerns about the position in Loughglinn and the additional resources required to the Department and the HSE. I will also convey her suggestion that the air ambulance service should be able to operate at night. It seems to make perfect sense and I will be very happy to convey it to those involved in the relevant areas.

Before we proceed, I acknowledge the presence in the Visitors Gallery of a former Senator and very valued colleague, Michael Mullins. You are very welcome, a Mhichíl.

Brexit Issues

I welcome the Minister of State and thank her for taking this very important debate.

I have said it here and in many other forums that Brexit will be an absolute disaster. It will be massively negative, especially for Ireland, in economic terms. However, it will present a few slim opportunities on which Ireland must capitalise in order to offset the negative economic impacts. In the financial services sector and attracting foreign direct investment, the opportunities are quite obvious. However, from an institutional point of view, the European Medicines Agency is one of just two decentralised EU agencies in the United Kingdom, the other of course being the European Banking Authority. With the European Medicines Agency seeking a new home, Ireland could and should be the obvious location for it.

Why do we want the European Medicines Agency to relocate to Ireland? It has a secretariat of over 600 people and an annual budget of over €300 million. Relocating from London to Ireland would provide a massive, direct boost to the economy. The European Medicines Agency is a beacon for many international pharmaceutical companies which wish to be based close to the central regulatory body for the industry. Bringing it to Ireland would see a surge in interest among pharmaceutical companies that are looking to relocate to Ireland. A number of Japanese pharmaceutical companies based in London are on record as stating they will go wherever the European Medicines Agency goes. As matters stands, the European Union is the source of about one third of the new drugs brought onto the world market each year. Bringing the European Medicines Agency to Dublin would provide a huge boost for the research and development sector.

The question is where in Ireland should the European Medicines Agency be located. I know that my colleague, Senator Frank Feighan, has put the case for it to relocate to Carrick-on-Shannon. While a case could be made for its relocation to Cork or Galway, the obvious destination would be Dublin which meets many of the criteria various media outlets and trade publications have laid out as being vital to wherever the European Medicines Agency relocates. Ireland is home to many of the world’s leading pharmaceutical companies, including GSK, Pfizer, Abbott and Wyeth, all of which, among others, have offices in Dublin. Both Trinity College Dublin and UCD have large schools of pharmacy. Loughlinstown in south Dublin has already enjoyed great success in being home to the European Foundation for the Improvement of Living and Working Conditions and its staff of about 100. In south Dublin, in particular, there are three international schools, St. Andrew’s College in Booterstown, St. Killian’s Deutsche Schule in Clonskeagh and the Lycée Français in Foxrock, that offer the international baccalaureate, a very important aspect when looking to relocate the families of people working for the European Medicines Agency.

Dublin is only a short flight from London, which would allow for easy telecommuting for those who for various reasons would remain in London during the early stages of relocation, particularly when compared to the other leading candidate cities, namely, Milan and Stockholm. As we always say on the world stage, Ireland is a country in which English is spoken and has a low-tax and open economy, with a highly intelligent local population, something Milan and Stockholm do not offer.

I wish the Minister of State and the Government the very best in their efforts to bring the European Medicines Agency to Ireland. Much like the bid to host the 2023 Rugby World Cup, it is vital that all of our political, civic society and commercial leaders come together to back the bid to have the European Medicines Agency relocate to Ireland.

I thank the Senator for raising this important issue. He has been very clear in flagging the challenges we will face as a consequence of Brexit. I acknowledge that he has also been to the forefront in having the European Medicines Agency relocate to Ireland.

The European Medicines Agency plays a very important role in the protection and promotion of public health through the scientific evaluation, supervision and safety monitoring of medicines for human and veterinary use in the European Union. As a consequence of Brexit, a decision will have to be made on a new location for the European Medicines Agency. The Government believes this decision should be made relatively quickly once Article 50 is triggered, which, as we know, is to happen in March next year.

It is imperative that the relocation be managed in a way that will ensure it has minimal impact on the vital work of the European Medicines Agency during the transition period and beyond. My colleague, the Minister for Health, Deputy Simon Harris, has made public his intention to put forward Dublin as a suitable location for the European Medicines Agency and requested officials to prepare a bid setting out the reasons it would be a suitable location. To date, his officials have consulted other Departments, including the Departments of the Taoiseach, Foreign Affairs and Trade, Jobs, Enterprise and Innovation and Agriculture, Food and the Marine, as well as the Health Products Regulatory Authority, HPRA, State agencies such as IDA Ireland and Science Foundation Ireland, SFl, and pharmaceutical industry representatives. There has also been a range of informal contacts on this issue with individuals at home and abroad who have provided useful insights.

Arising from this consultation process, officials have identified a number of factors which would make Dublin particularly suitable to host the European Medicines Agency, including, as the Senator noted, the fact that the city is an English language location and English is the working language of the agency and the pharmaceutical industry. A further factor is proximity to the Irish medicines regulator, the Health Products Regulatory Authority, which has an excellent track record, already made a significant contribution to the workings of the European Medicines Agency and would provide strong support in the event of a move. On the retention of expertise, Dublin’s proximity to London would prove attractive to some EMA staff with families who are well established in the UK capital as they could decide to commute. In addition, commonality of language and other facets of life may make it more likely that staff would remain with the European Medicines Agency, rather than leave when the agency has to move from the United Kingdom.

A further factor is that Ireland is one of the leading locations for the pharmaceutical industry in the European Union. Nine out of the ten largest pharmaceutical companies in the world have operations in Ireland and we also have a strong research and development sector. In addition, Dublin has an airport located between 20 and 30 minutes from the city centre, with excellent air connectivity with EU capitals and internationally. The airport also continues to expand its routes.

Last week I had a bilateral meeting with the European Commissioner for Health and Food Safety, Mr. Vytenis Andriukaitis, following a seminar in Brussels on the Public Health (Alcohol) Bill. As recently as last Monday, at a meeting of EU Health Ministers in Bratislava the Minister for Health discussed with the Commissioner Ireland's interest in hosting the European Medicines Agency. Work will continue in the coming weeks to prepare Ireland's bid and Ministers and officials will use every possible opportunity to present the case for Dublin, both at home and abroad.

I welcome the reassurance the Minister of State has provided regarding the great efforts being undertaken by the Minister and his ministerial team to bring the European Medicines Agency to Ireland. I underline my view that we must involve the private and commercial sector and civic society in this process and make clear to them that they have a vested interest in achieving this objective. The Government will not be successful if it acts alone, which means that the process must be all-inclusive.

When negotiations commence following the invocation of Article 50, it must be made clear that Ireland will suffer more than all other member states as a result of Brexit. The economic and social decline we will inevitably experience as a result of Brexit must be offset by policy changes at European level. The European Union must pay more attention to Ireland, for example, by making it a key location for financial services companies which decide to move their operations from the United Kingdom. These companies are calling themselves "the old exiles". One of the EU agencies based in the United Kingdom, preferably the European Medicines Agency, should also relocate to Ireland to give something back to a country that has always been pro-European and a positive member state.

The Government is concerned about the impact Brexit will have on the economy and society. While we can do a certain amount, there is also much that we cannot do or control. For this reason, we must try to mitigate the consequences of Brexit. No stone is being left unturned in our efforts to attract the European Medicines Agency to relocate here.

The Senator's comments on engaging with the private sector and civic society resonate with me as such an engagement would be a positive step forward. The Government will not be found wanting in its efforts to mitigate the consequences of Brexit and attract companies and agencies, including the European Medicines Agency, to locate here in the aftermath of the United Kingdom's decision to leave the European Union.

Free Travel Scheme Eligibility

Before calling Senator Brian Ó Domhnaill, I welcome to the Visitors Gallery Councillor Michael O'Brien of Westmeath County Council who has a particular interest in the matter the Senator proposes to raise. I also welcome the Minister for Social Protection, Deputy Leo Varadkar.

I thank the Minister for taking time to come to the House. He has a busy schedule as the budget approaches; therefore, I appreciate the effort he has made to come to the House to respond directly to the issue I raise.

Councillor Michael O'Brien of Westmeath County Council has made an excellent proposal that a free travel scheme be introduced for third level students attending college. While the scheme would cost money, it would ease the financial hardship faced by many students. Councillor O'Brien's colleague, Deputy Kevin Boxer Moran, has been advocating in the other House for the introduction of such a scheme. The proposal merits consideration and deserves our support.

The rationale for introducing a free travel scheme for third level students is that the costs associated with third level education have been increasing, especially this year, as a result of rising rents and a shortage of student accommodation, both in the capital and nationwide. Dublin Institute of Technology, DIT, produced a cost of living guide for students which estimated that travel costs per month in the 2015-16 academic year amounted to €135 per third level student. The increase of 13% on the figure for the previous year means that annual travel costs have reached approximately €1,215 per student. If this cost could be offset by support from the Department of Social Protection or the Department of Education and Skills feeding into the Minister's budget, it would alleviate much of the hardship being experienced by third level students.

As the DIT guide notes, students can be divided into two groups, namely, those who live at home and those who live in rented accommodation. According to the guide, the financial breakdown for both classes of students was identical and they experienced the same monthly travel costs of €135. Students who travel to college from home probably face higher travel costs, although they do not incur rental costs. Overall, however, the subsidy would have the same impact on both sets of students.

I am aware that budget day is approaching. The Union of Students in Ireland argues that the increased costs of third level education are leading to elevated fears among students that they may have to leave third level education. As Councillor O'Brien has pointed out, a USI survey shows that 87% of third level students are living in fear of having to leave third level education as a result of the increased costs they face. While I acknowledge that the Minister does not have responsibility for third level education, he is responsible for the excellent free travel scheme which is available to the elderly population. Will the Department or the Department of Education and Skills examine the case for reducing the costs of travel for third level students?

The Leap card is capped at €30 per month in the city, but that card is only one element of the equation. For example, a student coming from County Westmeath, County Donegal or County Kerry must provide for travel on a weekly basis to the city, after which he or she must also pay for the Leap card. The card is not the solution in itself. The Minister's consideration would be greatly appreciated.

I thank the Senator for raising this innovative idea. I acknowledge the high cost of third level education for students which is attributable to travel and accommodation, in addition to fees.

Services for students and the adequacy, or otherwise, of their supports are matters for the Minister for Education and Skills. Transport is primarily a matter for the Minister for Transport, Tourism and Sport. However, my Department provides a free travel scheme as a secondary benefit for older people and certain people with disabilities who are already customers of my Department, that is, people who receive a weekly welfare payment from us. This provides free travel on the main public and private transport services for those eligible under the scheme. There are approximately 864,000 people in receipt of free travel, but many do not use it regularly and prefer to travel during off-peak periods when seating is readily available.

The measure proposed would cater for the needs of students who are not our existing customers and who will be students for only a few years or, in some cases, only a few months. Any such scheme would require a more significant operation than that which administers my Department’s free travel scheme as it would have to grant and withdraw potentially hundreds of thousands of passes each year, using information that ultimately would have to be provided by all colleges in the State.

Income support and services for students are in the policy domain of the Minister for Education and Skills and my Department is not the best placed to calculate the cost of the proposed measure or to decide whether it would be an appropriate way to supplement or replace other supports available for students from the relevant funding streams. Any increase in eligibility under the scheme would require a substantial increase in funding at the expense of the taxpayer. The current funding for the scheme is €80 million per year and any scheme that extended a similar service to students would most likely require a substantial increase in funding, even taking into account the fact that many providers already operate reduced fares for students. No such provision has been made in my budget for 2016. I am, therefore, not in a position to operate such a scheme or comment on whether it would represent equitable use of resources. However, I encourage the Senator to discuss the matter further with the Minister for Education and Skills and the Minister for Transport, Tourism and Sport.

I thank the Minister and acknowledge that the third level education sector does not come within the realm of his Department. When I was submitting this matter for debate today, I initially contacted the Department of Transport, Tourism and Sport. Officials within that Department advised that the matter was more appropriate to the Department of Social Protection. However, I appreciate and agree with what the Minister has said. If the Department of Education and Skills was willing to engage with the Department of Social Protection at ministerial or official level on this question, would the Minister consider it?

This is an innovative and good idea. Of course, I would be happy to engage with the Department of Transport, Tourism and Sport and the Department of Education and Skills on any idea like this. Joined-up thinking is important in government. There are, of course, other good ideas. Free travel for children is a good idea. When I was Minister for Transport, Tourism and Sport, I was involved in providing free days for children on the Luas, in addition to making a decision to link up the Luas lines. In certain other jurisdictions there is free transport for children. I believe London Underground, for example, provides free transport for all children under 16 years.

As with any good idea, one must consider the cost. There are two sets of costs. One is the cost in money terms. I do not have much money. Every day there seems to be somebody demanding €100 million in additional spending in my Department, but they do not seem to want to give me the money. Aside from the monetary cost, there is also an opportunity cost. I refer to all of the other things one could do with the money such as reversing some of the cuts made to the disability and carer's allowances and blind person's pension. This is the battle I am trying to fight. As the Senator can imagine, there are many demands. Given the new political scenarioin which we find ourselves, I expect Fianna Fáil to produce its budgetary proposals in the next couple of days. Perhaps the first step might be to ensure the Senator's proposal is included as one of the party's priorities. We could take it from there.

Sitting suspended at 11.05 a.m. and resumed at 11.30 a.m.