As ever, the Minister of State is welcome.
Commencement Matters
Emergency Departments
I thank the Leas-Chathaoirleach.
We are taking Senator Aodhán Ó Ríordáin's matter first, if that is all right.
We will give him the primary slot.
I thank the Minister of State for being here to discuss this matter. I am quite sure he is aware of the ongoing issues in the emergency department in Beaumont Hospital. In the past few years, as an active representative and a Member of the Oireachtas, I have visited the emergency department on a number of occasions and met staff there and senior management. What senior management has told me in stark terms is that the emergency department is physically not fit for purpose. There are also other issues. There are staffing issues, with the fact that the demographics indicate that patients are particularly elderly. These are eminent staff who are experts in the field. They know their hospital well and care for their patients extremely well. Anybody who has visited it will attest to the fact that the physical environment of the emergency department is not up to standard and if the senior management team in the hospital is stating it is not safe and that they cannot stand over it, clearly something has to happen.
We are obviously in a period where the Exchequer is in a healthier place. Hospital management has put together a plan. It has a vision of investment in the emergency department to bring it up to standard and provide a much better service for the local community in Dublin and the wider region. It has estimated the cost at €45 million. The previous Government, in the guise of the then Minister for Public Expenditure and Reform, Deputy Brendan Howlin, and me, met senior management. We were in a position to commit to working with senior management to deliver the plan, that the investment would happen and that the emergency department would be reconfigured and reconstructed in order to be a much better physical fit for the hospital. I have been running a local campaign in which constituents who want to see the investment happen have been engaging.
Have the Minister for Health and the Department committed to implementation of this €45 million plan? Has the Minister met senior management? Is it part of the Estimates process? Is it something that will be delivered in the short to medium term because anybody who has visited the emergency department in Beaumont Hospital will realise what is happening there cannot continue? While I did not see anything in the Estimates process and the budget announcements about Beaumont Hospital, I was eager to have this discussion today because, before we head into the winter months, it is important for the staff in Beaumont Hospital and the wider community to know that the Government takes this issue seriously and wants to deliver a better service in the hospital.
I thank the Senator for raising this important issue. It is appropriate because I have just come from a meeting in Hawkins House. I will deal with the response to the points made about the Beaumont Hospital issue later in my contribution.
This has been an exceptionally busy year in acute hospitals. The increase in hospital activity can be seen across the board, particularly in emergency departments.
To date this year the Health Service Executive, HSE, has reported an average increase of approximately 5% in patient attendance at emergency departments. This increased demand is being driven in part by demographics and an ageing population profile. In that context, it is worth noting that the 2016 census identified 8% growth since 2011 in the population of Fingal which is predominantly served by Beaumont Hospital. Being cognisant of the current demands on Beaumont Hospital's emergency department and projected population growth in the area, the development of a new emergency department at the hospital has been identified as a commitment in A Programme for a Partnership Government.
It is noteworthy that A Programme for a Partnership Government also commits to proceeding to the design and planning stage for a dedicated cystic fibrosis unit at Beaumont Hospital for inclusion in the 2017 capital plan review. The HSE's cystic fibrosis clinical programme is developing a cystic fibrosis model of care that will be important in ensuring the unit proposed for Beaumont Hospital will meet the needs of patients and the health service. It is my understanding both of these projects are also a priority for Beaumont Hospital and the Royal College of Surgeons in Ireland hospital group, of which it is part. As such, Beaumont Hospital is in the process of finalising business cases for these new developments. The business cases will be reviewed by the HSE's capital and property steering group which approves projects for inclusion in its multi-annual capital plans in line with the Department of Public Expenditure and Reform's guidelines. As part of this process, funding provision will be made available for the planning and design phases of the proposed new developments in preparation for the capital plan review in 2017.
I also mention that as part of the recently published winter initiative for 2016 to 2017, Beaumont Hospital will be provided with the resources to open ten additional beds to increase capacity in order to support its emergency department during the crucial winter period to meet the expected surge in volume. Furthermore, under this initiative, funding has also been provided to expand community intervention teams, additional home care packages and transitional care beds in north Dublin that will support Beaumont Hospital through the winter months. This measure is part of a much larger package of €40 million of additional funding for the HSE aimed at managing winter pressures on the health system by striking a balance between hospital avoidance measures, supporting patient flow through acute hospitals and increasing the availability of social care services.
Beaumont Hospital is very important. I accept the point that we need capital investment in emergency services and that there is an issue with the ageing population in local communities. The physical environment of the emergency department is not up to standard, which is something that will be pushed along in the next couple of weeks also.
I thank the Minister of State for his reply. I sometimes get a little worried when people use the phrase "it is my understanding" and I had hoped for something a little stronger. The Minister of State indicated that Beaumont Hospital was in the process of finalising business cases for these new developments, but it is my understanding the hospital had completed its business case for the emergency department because it was handed to me almost a year ago. It details the €45 million it believes would be required for it. He stated the business cases would be reviewed by the HSE capital and property steering group which approves projects for inclusion in the multi-annual capital plan in line with the Department of Public Expenditure and Reform's guidelines. The business case has been finalised, but the Minister of State's reply indicates that it will be reviewed by the capital and property steering group and that, as part of the process, funding provision will be made available for the planning and design phases of the proposed new developments in preparation for the capital plan review in 2017.
I was hoping there would be a commitment that the capital plan, as outlined by senior management in Beaumont Hospital, of which I have a copy, was being taken seriously and would be delivered. The reply seems to suggest the business plan has not been finalised, but it has been. It also implies that it will be reviewed. The community in the Minister of State's constituency was hoping for something a little stronger. I totally understand there are other issues, including staffing and demographics that are particular to Beaumont Hospital and the wider area. The business case has been produced and I am worried about timelines and the commitment that can be given about the delivery of the physical infrastructure the hospital states it needs. It cannot stand over the service it provides, which I am sure the Minister of State will agree is extremely worrying.
I thank the Senator for his response and I am always concerned too when I see phrases such as "it is my understanding". I give him a commitment that we will have movement on this issue and that we will provide timelines.
On the business plan, I have discovered in recent days that they needed a more comprehensive business case than what was referred to by the Senator. That was in order to comply with the Department of Public Expenditure and Reform's guidelines, as set out in the public spending code. I also requested my adviser to meet the Secretary General of the Department of Health in order to set out a work plan to accelerate this process and they met the same day as Beaumont Hospital's submission was received by the Department. The work plan involves the Department, the HSE and Beaumont Hospital prioritising and clarifying the timeframes for the submission, with the appraisal of a business case for approval by the project team and establishing a design team. This work is a priority and, as I stated, I raised the matter this morning with the Department at the ministerial and management advisory committee meeting. I have also contacted the chief executive officer of Beaumont Hospital to outline the next immediate steps to be taken, that the project is a major priority and that it has our full support. I have secured funding for the planning and design phases in preparation for the capital plan review in 2017. I have also contacted the Minister for Public Expenditure and Reform, Deputy Paschal Donohoe, both verbally and in writing, to seek funding priority for the project in 2017. The planning and design stage figures are in the region of €3.6 million and the capital plan goes beyond the €20 million mark. I give a commitment that I will not accept any windy statement from any section. I will demand movement on the project because this is a very important local hospital with wonderful staff and we need commitments. I have given a commitment, but we also need timelines. We need to get on and do the job.
Legal Aid Service
I will speak about the provision of free legal aid, something which is very close to my heart. There is no such thing as free legal aid, something that should be clarified and addressed. The cost of providing legal aid in dealing with family law matters involving domestic violence, guardian access and maintenance payments is a minimum of €130. There is no free legal aid in dealing with family law matters aside from child care and child abduction issues. Legal aid in dealing with such matters must be applied for and applications can take a number of weeks to be processed, as opposed to criminal law cases in which an accused person can request a service, have it granted and be appointed with a free legal aid solicitor there and then. The cost of legal aid in family law cases started at €30 before increasing to €50. In September 2013 it increased again to €130. It was a significant increase and done without consultation with organisations or consideration of people's ability to pay. The cost of poviding legal aid is prohibitive for women seeking protection in domestic violence cases. That is a crucial point.
The Minister for Justice and Equality has been implementing changes to Acts dealing with domestic violence that are to be commended and welcomed.
If the women these changes are supposed to help cannot afford to access legal representation, they are rendered useless and will make little or no change in dealing with the serious issue of domestic violence. Where an interim barring order has been granted against an ex-partner, a hearing for a barring order must be heard within eight days. This timeframe does not allow the woman concerned to apply for legal aid, have her application processed, pay her fee by postal order, have her pink certificates sent to her and find a solicitor. This means that she often has to represent herself in court at a barring order hearing. That is unacceptable because she is going up against someone who could have abused her, her children are there and she cannot afford the fee of €130. Legal aid costs can be paid in instalments, but this can result in a woman having to make an extra payment of up to €20. The cost of buying postal orders, stamps, etc. amounts to ten weekly payments of €13. The nearest offices to Carlow are in Kilkenny and Portlaoise. The legal aid boards cannot issue the pink certificates required by solicitors to represent a client until the full payment has been made. Some solicitors will see clients for an initial consultation, but without the pink certificates they cannot be represented in court. The woman can request a waiver or a reduction, but this involves getting a statement of means from a client and providing a letter of support and the process is too long. I am sure the Minister of State has seen the form required to receive free legal aid, one of which I have to hand. Applying for legal aid is almost like applying for a mortgage or local authority housing. It is unfair on the most vulnerable women in our society. There is a perception that there is free legal aid. There is no such thing. Even if a woman applies for the reduction and the waiver which she rarely receives, it is so long in coming that she has to either go back home or cannot afford to get it. She has to go back to the environment she wants to leave. That is crucial.
The most vulnerable people in our society are children and women. Will the Minister of State ensure there is free legal aid available? I have recently dealt with many such cases. In Carlow we offer free legal aid to women and on Friday mornings give out food parcels from supermarkets to them. This is an emergency. Women are entitled to free legal aid. When they seek it, they are told that there is a waiting list and that they could be waiting for weeks. That is too long.
On behalf of the Tánaiste, I thank the Senator for raising this very important matter. The provision of civil legal aid is a long-established practice in Ireland with the original scheme for the provision of civil legal aid having been established in December 1979. It is a prerequisite to obtaining legal services from the Legal Aid Board that a person meet the financial eligibility criteria. If people do meet these criteria, the contribution they pay is based on their income and potentially also on their capital.
The contributions regime has always been premised on the basis that a person pays a one-off contribution for legal advice and a further single contribution for legal aid representation in court. The contribution for legal advice is set at a minimum of €30 and a maximum of €150. This could cover a single consultation if that is all that the client requires or it could cover the negotiation and completion of a separation agreement over many months. The legal aid contribution can rise to a maximum of €1,755 based on a person’s income and can be significantly higher if he or she has assets other than the family home. However, it should be noted that there are some caps on the contributions payable. For most family law cases in the District Court, the contribution will be limited to a sum of €417.
It is also important to note that there are, of course, provisions in place which allow a waiver of the contribution in the event that it would cause undue financial hardship, with clear guidelines provided for the interpretation of financial hardship. I will bring the points the Senator raised to the attention of the senior Minister, Deputy Frances Fitzgerald. They include a provision that regard should be had to the immediacy of the requirement for legal aid and the nature of the case to which the application relates. For example, if the applicant is seeking a legal aid certificate for the purpose of taking a case on foot of the domestic violence legislation, the guidelines state a sympathetic approach should be taken to an application for a waiver or a reduction in the contribution, particularly if the applicant’s sole income is a social welfare payment. The Senator's point about vulnerable women will have to be made forcefully to the Tánaiste.
These are the general arrangements in place. There are also categories of cases where the provision of legal services is free and there are other categories where specific arrangements apply. For example, persons who have been served with proceedings by Tusla will need to meet the financial eligibility criteria, but they are not required to pay a contribution.
Services under the new Abhaile scheme are provided free of charge for eligible persons and asylum seekers are charged a €10 contribution fee for services in relation to international protection matters. The Tánaiste is aware that the Legal Aid Board is keen to ensure nobody will be deprived of appropriate legal representation in court proceedings. The board keeps the contributions regime under active review and I anticipate that the new board which the Tánaiste will appoint shortly will also take an active interest in making sure the contributions regime is appropriate and fair. The Tánaiste also knows that the board is working to ensure a consistent message about its guidelines for waiving or reducing contributions will be given to persons who may have difficulty in paying a contribution. It has recently launched a new website, with a view to making more information available online.
Senators will be aware that the Legal Aid Board is also responsible for the provision of the State’s family mediation services. As recently as Monday, the Tánaiste officially opened its first co-located law centre and family mediation office. The family mediation services it provides are free and the Tánaiste very much hopes more people will seek to use mediation to address family problems, although, of course, she realises mediation is not the solution in every case.
While paying a legal aid contribution can be a difficulty, it is important to note that they are one-off payments that most people are unlikely to experience more than once or twice in their lives. As I have indicated, the waiver applies in the most sensitive cases. I will bring the issues the Senator has raised about these important matters to the attention of the Tánaiste.
I thank the Minister of State. It is good that the Tánaiste is considering the use of mediation services because that is appropriate. It is just a perception, but people in receipt of social welfare payments or stay-at-home mothers have to receive their entitlements. My biggest concern is that there are many waiver schemes that are not being addressed. I would like the Minister of State to address this issue and give those who are entitled to it free legal aid.
I agree with the Senator about stay-at-home mothers and waivers. I accept the point that we have to examine applications and that where an applicant is entirely dependent on social welfare payments, we must be very sensitive. I will bring the points made by the Senator to the attention of the Tánaiste, Deputy Frances Fitzgerald, and hope we will see progress being made on the issue.
Sitting suspended at 11 a.m. and resumed at 11.30 a.m.