Commencement Matters (Resumed)

I join the Leas-Chathaoirleach in welcoming our visitors from Slovenia. They come from a fabulous country. I climbed one of their mountains many years ago and I really liked the country. It is similar to Ireland when it comes to rural tourism.

I thank Senator Ó Domhnaill for providing me with an opportunity to outline the position in regard to this important matter for those affected throughout the State. I agree with him that it is an important issue. Like Councillor Bonner who asked the Senator to raise the matter, I have had many contacts from residents of estates in Meath and other counties facing the same issue. It is of concern and it needs to be addressed. We are certainly aware of it. It can cause great difficulty. While it does not happen every week, one can suddenly experience conditions that cause the problem, at which point it becomes an urgent issue for the families involved. I will take the opportunity in my reply to set out the legal position but there is a commitment to work with local authorities and Irish Water to find a solution. We have to do that.

As the House is aware, the Government, Irish Water and local authorities are continuing to deliver on an ambitious transformation programme of the water sector in Ireland. Since 1 January 2014, Irish Water has had statutory responsibility for all aspects of water services planning, delivery and operation at national, regional and local levels. The Water Services (No. 2) Act 2013 provided for local authorities to act as agents for Irish Water with this relationship being expressed through service level agreements. Through these 12-year agreements, local authorities are utilising their experience and expertise in asset management and operations to provide services on behalf of Irish Water. This expertise is being combined with the considerable network and utility management experience available to Irish Water. The agreements are based on partnership, continuous improvement and the delivery of efficiencies. Each service level agreement in place with a local authority is supported by an annual service plan which reflects the required programme of transformation for that authority. It also outlines agreed objectives and standards of performance set against a budget covering headcount, goods, services and investment in the coming year. Annual service plans encompass a set of operational objectives, key performance indicators and a related budget, including payroll. The plans set out the context for the delivery of water services for each local authority for a given year.

The Water Services Act 2007 sets down the obligations and responsibilities of water services authorities and property owners in respect of water infrastructure. Sections 43 and 54 of the Act provide that the property owner is responsible for the maintenance and replacement of any water or wastewater pipes, connections or distribution systems which are connected within the boundary of their property. This was the case also prior to the transfer of responsibility for public water services from the local authorities to Irish Water. However, I am aware, as the Senator says, that individual local authorities may, at their own discretion, have undertaken clearance works in respect of common wastewater infrastructure on private property in the past. I am familiar with cases like a particular terrace in Navan and St. John's in Kells where this has happened. At the time, the local authority did the right thing because garden boundaries had often extended out to take in some of the public infrastructure, which caused a difficulty. These works were not a requirement of the law pertaining at the time and not every local authority provided such services. Those that did acted in good faith in my opinion. The Water Services (No. 2) Act 2013 transferred responsibility for the maintenance and repair of pipes and combined drains under publicly owned roadways and pathways to Irish Water while responsibility for storm water sewers remained with local authorities. The position as set out in legislation provides clarity on the responsibility for the maintenance of common sewerage pipes.

Notwithstanding the legal position, I recognise the importance of local authorities and Irish Water working together to agree operational guidelines on this and other boundary type matters so as to provide clarity to householders as to the services which they can expect to receive from Irish Water working in partnership with the local authorities under service level agreement arrangements. While further legislation in this area is not envisaged, my Department is engaging with Irish Water to set out clearly the responsibilities of Irish Water and property owners in regard to water supply and wastewater infrastructure. We will find a solution to this working together with local authorities. We will not have to go down the legislation route albeit there may have been a missed opportunity at a previous stage. We can resolve it without doing so, however, and already some local authorities are making great progress, including Westmeath County Council. It is about bringing in a system whereby this can be dealt with nationally.

I thank the Minister of State for his excellent understanding of the matter. He is well aware of the issues. I acknowledge his sentiments and ask him to look at the difference between the reply to the parliamentary question asked on 7 October 2015 and the reply today. In October 2015, the former Minister, Deputy Alan Kelly, referred to the curtilage of the private property. The reply today refers to the boundary of the private property. If it were the curtilage of the private property, it would solve the problem. It would be like the situation where the water network is within the curtilage of the property and the responsibility of the property owner and thereafter Irish Water is responsible. If we could define it as just the curtilage of the property instead of the boundary, it would resolve matters because the boundary includes the whole estate and all those parts which are in charge.

A solution is urgently required. Having spoken to Irish Water, I believe it is very anxious to resolve the issue which has major implications for its good name. I am sure Irish Water does not want this to turn into a huge issue. I urge the Minister of State to find a resolution and to ascertain from the Department why there is a different response today to the one provided in the Dáil on 7 October 2015. The legislation has not changed in the intervening period but clarity is required. If it is possible, I ask the Minister of State to come back to me with that clarity when he has an opportunity. There is no rush.

I will certainly come back to the Senator with that clarity. The reply today is similar to the reply I gave here a number of weeks ago when I addressed the matter first with some of the Senator's colleagues. I committed then and commit again to the Department finding a solution to this as it is the right thing to do. This situation leaves people very vulnerable. They cannot afford to fix the problem and the solution is often outside their boundary whereas the problem is being caused on their properties. It can cause difficulties for neighbours. In some cases, it is something that was always fixed or addressed over a period of 30 or 40 years. We will find a solution. Regardless of differing versions over the last year or two, there is a commitment to resolving the issue.

Dental Services Waiting Lists

I welcome the Minister of State, Deputy Marcella Corcoran Kennedy, to the House.

I welcome the Minister of State. I think it is my first time speaking in her presence in this Chamber. She is heartily welcome. I congratulate her on her well-deserved appointment. As a Deputy and as a former councillor over the years, I am sure she has experienced the issue I am raising today. Children who have difficulties with their teeth can become agitated, difficult and demoralised. Their parents can become anxious. They become worried and concerned. Many ordinary children who have braces on their teeth, or other dental difficulties, are bullied and suffer difficult challenges in school. We can imagine what it is like for children with special needs who have been diagnosed as needing urgent, detailed and intensive dental treatment. It causes awful anxiety and desperate worry for such children. Their parents experience unbelievable uncertainty, fear and anxiety.

I am dealing with a client, a child with special needs, who has been identified as being in urgent need of intensive dental treatment. My office has been in weekly contact with the HSE to try to get this child's dental treatment approved. We have been told it could take up to a year, which is an unacceptable wait for the healthiest, brightest and most confident child, but is just appalling and disgraceful for a child with special needs. I believe this case warrants a special intervention by the Minister for Health. He should direct the HSE to provide the funding that is necessary for this child's dental treatment as a matter of urgency. I have received the standard Civil Service replies from the Department telling me that this is a matter for the HSE, which is responsible for managing the health services. That is fine in ordinary day-to-day situations, but in a specialised situation like this the Minister can and should direct the HSE to put this case at the top of the queue. He should instruct the HSE to provide the necessary funding immediately. I look forward to getting a favourable reply from the Minister of State on this specific case.

I thank Senator Conway for raising this important issue. As he knows, the provision of dental and other services to patients with special needs is a priority. The public dental service of the HSE provides dental services to children up to 16 years of age, and to people of all ages with special needs, through its dental clinics. All HSE dental clinics prioritise emergency care for children up to the age of 16 and treatment for special needs patients. As it is not always possible or appropriate to provide oral health services to special needs patients in dental clinics, some dental services, including general dental anaesthetic services, are provided in general acute hospitals, particularly for patients who require special care. The HSE's policy is that general anaesthesia should, if possible, be avoided in the practice of dentistry. I am informed by the HSE that since 2012, it has been upskilling dental teams in conscious sedation as an alternative. The upskilling of senior dentists in other behavioural techniques and in sedation reduces the reliance on staff in the acute sector, thereby improving access and providing a range of modalities to dentists to treat patients with special needs. These developments, together with regular validation of waiting lists, aim to provide more appropriate and timely access for patients who require these specialised services. Nevertheless, general anaesthetic services continue to be provided on determination of clinical need.

The HSE has advised me that it is aware of and is dealing with the delays that have been affecting patients in area 5 of the community health organisation, which includes south Tipperary, Carlow, Kilkenny, Waterford and Wexford, due to a lack of local access to general anaesthesia in acute facilities. I can inform the Senator that three full-day general anaesthetic sessions are to be facilitated exclusively for patients with special needs at Aut Even Hospital in Kilkenny. Two full days will be facilitated before Christmas, providing treatment for up to ten patients within area 5, and a further day will be provided in early January 2017 to provide treatment for a further five patients. Up to 15 patients will receive treatment under this initiative. The success of this initiative will be evaluated to assess whether it should be further developed. I am informed by the HSE that it is considering other options to provide these services in area 5. As Senator Conway has mentioned, under the Health Act 2004 the HSE is required to manage and deliver health and personal social services, or arrange for such services to be delivered on its behalf. Section 6 of the Health Service Executive (Governance) Act 2013 prevents the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual. However, it does not prevent the Minister from making representations in this regard.

I have no doubt that the Minister of State is genuine in her offer to get the Minister to make representations in this specific and unique case. I would like this young fellow to be treated at one of the sessions in Aut Even Hospital in Kilkenny, which is not that far from where his parents live in Clonmel. I would like the Minister of State to ask her private secretary to talk to the HSE. If the private secretary makes contact with my office with the reply, I will most grateful.

I will undertake to do that.

Cancer Screening Programmes

I welcome the Minister of State, Deputy Marcella Corcoran Kennedy. I am delighted that she is here to speak on such a relevant topic. The BreastCheck programme is currently available to women between the ages of 50 and 69. According to the BreastCheck website, "the Department of Health and Children chose this age group for screening as there is a greater proportion of women at risk of dying from the disease in this age group". However, recent statistics have shown that the greater age group is actually those between the ages of 35 and 50. Under the screening programme for women between the ages of 50 and 69, women are checked for breast cancer, regardless of whether they have any symptoms. Screening and surveillance are secondary preventive measures that aim to detect breast cancer at the earliest possible stage to reduce the rate of breast cancer death. Screening refers to monitoring those at average risk of disease. Surveillance refers to the monitoring of those known to have an increased risk of the disease. Internationally recommended surveillance imaging options include digital mammography, magnetic resonance imaging or a combination of the two.

Every year, approximately 2,600 women are diagnosed with breast cancer and approximately 660 women die from the disease. One in ten women in Ireland will have breast cancer at some stage of their lives. I know from my own experience that women under the age of 50 are at a crucial stage of their lives in this respect. I went to school with three sisters, two of whom were diagnosed with breast cancer at the ages of 38 and 41. Their treatment has been very successful for them to date, but the fear is always there. The devastating effects of being diagnosed with advanced cancer for women under the age of 50 and their families should not be underestimated from an economic and social perspective. By the time women present with symptoms of breast cancer, it can often be quite advanced and may have spread. Approximately one in five women already have metastatic or secondary breast cancer at first presentation. Finding cancer as early as possible gives a large survival advantage in any age group.

The American Cancer Society and the American College of Radiology suggest that women should have annual mammograms from the age of 40. Many countries that have a basic screening service from the age of 50 also give women the option of avail of screening from the age of 35. BreastCheck plays a pivotal role in the prevention of breast cancer. Of the 92,061 women over the age of 50 who were screened between 2008 and 2009, 4,119 were recalled for further assessment and 672 were diagnosed with breast cancer.

This represents 7.3 cancers per 1,000 women screened. The Health Information and Quality Authority, HIQA, recommended recently that for women with an identified risk of breast cancer an annual MRI between the ages of 30 and 49 is cost-effective compared with no surveillance. In another small cohort of women who have a high probability of breast cancer annual surveillance between the ages of 20 and 49 is the optimal strategy recommended by HIQA. It also advised the national cancer control programme on the implementation of an organised surveillance programme for women under the age of 50 in Ireland who are known to be at elevated risk of breast cancer due to these genetic or family history factors. I call on the Minister of State to consider reducing the age from 50 to 40 in the hope that this very worthwhile screening will save the lives of many women.

I thank Senator Byrne for raising this issue. We all have family members or friends who have been touched by this illness. I thank the Senator for giving me the opportunity to address the House on the national breast screening programme, BreastCheck. Population based screening programmes are an important element of early detection of cancer. BreastCheck provides free mammograms to eligible women every two years. This service is provided free of charge by the Health Service Executive, HSE, through its national screening services which also operate the CervicalCheck and BowelScreen screening programmes.

The EU guidelines on effective screening for breast cancer recommend that screening should be offered to women aged between 50 and 69 employing two-yearly mammography. BreastCheck has been available nationwide to women aged 50 to 64 for several years. The roll out of this service to women aged 65 to 69 began in late 2015. This age extension brings the screening programme fully in line with international best practice. The additional population who will be eligible for this programme is approximately 100,000 and, when fully implemented in 2021, a total of 540,000 women will be included in the BreastCheck programme. BreastCheck continually reviews new and emerging evidence on the benefits of screening, including the optimum age range for screening. International evidence does not currently support the introduction of population based breast screening below the age of 50. The risk of developing breast cancer increases with age and there is a higher prevalence of breast cancer in women aged 50 and over.

Screening aims to detect cancer before symptoms appear. Regular screening can help to detect cancer at an early stage when it is easier to treat and there is a higher chance of a good recovery. I welcome the current BreastCheck advertising campaign which aims to boost uptake rates and urges all women to take the time to do something very important for themselves by availing of the invitation to have a mammogram.

Breast screening is one element of our comprehensive cancer control programme. As part of its work across the full range of cancers, the HSE’s national cancer control programme provides symptomatic breast clinics in each of the eight cancer centres, with a satellite clinic of the Galway service in Letterkenny. Breast cancer survival in Ireland has improved significantly in recent years due to a combined approach of screening, symptomatic detection and improved treatment. Five-year survival for breast cancer is now estimated at 82% for people diagnosed between 2008 and 2012. This is a most encouraging figure and it shows a significant improvement from 75.1% for people diagnosed between 1994 and 1999.

In conclusion, BreastCheck is aimed at the age groups that will benefit most from a population based breast screening programme. While the international evidence in this area is continually under review, it is not envisaged at this time that the age range will be reduced below the age of 50. I take this opportunity to encourage all eligible women to avail of the free breast screening mammogram when it is offered to them. I assure the House that comprehensive breast services are also available to women in the designated cancer centres. Those of any age who have concerns about breast cancer should seek the advice of their general practitioner, GP, who will, if appropriate, refer them to the symptomatic breast services.

I thank the Minister of State for her response. I too would encourage all women to avail of the service but I also urge the Minister of State to keep it under review and take the statistics into account because there are people being diagnosed at a younger age, which is frightening. I would like the Minister of State to monitor that.

The next matter is in the name of Senator Nash but as there is a division in the other House we will have to suspend the sitting.

I propose a suspension of the sitting until the conclusion of the division in the Dáil.

Is that agreed? Agreed.

Sitting suspended at 11.07 a.m. and resumed at 11.23 a.m.

Schools Building Projects

We understand the exigencies of office. I welcome the Minister of State at the Department of Education and Skills, Deputy Halligan.

I will cut right to the chase as I explained earlier. Three years ago the previous Government ensured that a commitment was made in the five year schools' capital programme to build a new school at Whitecross national school in Julianstown. The Minister of State will be aware that the Louth and east Meath areas are one of the fastest growing areas in the country. The demographics are such that the schools' capital programme initiated by the then Minister for Education and Skills, Ruairí Quinn, ensured that 10% of all of the new school projects in the State would be developed in that area. Apart from the new school developments, objectively, "ancient schools" and I use that term advisedly, ancient schools such as Whitecross national school in Julianstown needed to be replaced entirely.

The conditions at Whitecross national school are appalling, they are deplorable. Teachers battle to teach in prefabricated classrooms that are too hot in the summer and far too cold in the winter. Mould appears on the ceilings and on the walls. There have been rodent infestations with all of the related health and safety risks. There is no hot water in the bathroom for children to wash their hands after using the toilets. The cold water is far too cold for people to safety put their hands under the tap. To put it bluntly, the school should probably be condemned.

It is long past time that the new building was commenced and that the Department indicated a timeline for the commencement and completion of the work. The time for excuses has long past. The school is not fit for purpose. In my opinion - and I am not prone to exaggeration - this is a health and safety nightmare, an accident waiting to happen. The patience and tolerance of pupils, teachers and staff has worn extremely thin, particularly in recent months. All they want for Christmas, as one young person told me, is their new school. Children have told me they would forego their toys if it was a case that a new school would be developed soon. We secured the resources for the new school in 2013-14 under the then capital programme. The then Minister for Education and Skills, Deputy Jan O'Sullivan, announced a new capital programme last year. A significant number of new schools have been built in the area in recent times that, in a sense, leapfrogged Whitecross national school. It is high time that the bureaucratic foot dragging that is delaying this project is brought to an end.

When will the project commence? What is the timeline for the commencement and completion of the project and when does the Minister envisage that children from Julianstown in east Meath will be taught in a building that they, the staff and the parents deserve?

I thank Senator Nash for raising the matter. It provides me with an opportunity to go through a few points with him. I know Senator Nash and if he says the school is in that state, I believe him.

The brief for the major building project for Whitecross national school is to provide a refurbishment and an extension on the existing site to cater for a 16 classroom school. The staffing allocation for Whitecross national school is currently a principal with 16 mainstream teachers. Enrolments in September 2011 stood at 410 pupils. The enrolments in September 2015 stood at 432 which shows an incremental growth of 5%.

The design team was appointed in March 2011 with a brief to provide the extension and refurbishment work on a phased basis with a partial decant of classrooms on the existing site. The project was included in the five-year construction programme 2012-16 and was scheduled therein to commence construction in 2014.

Planning permission was granted in January 2014. Since then the board of management and its design team have presented a number of proposals to the Department to change the brief to one which involves a single decant and a single phase delivery during construction. This has led to significant delays in the progression of the project. The most recent decant option, which included the provision of significant levels of new temporary accommodation on site, involved an additional cost for the project in the region of €2 million - an increase in the overall cost of the project of around 40%.

The project has reached an advanced stage of architectural planning, stage 2b, which involves securing all statutory approvals and the preparation of tender documents. All statutory approvals have been secured. However, the difficulty is that the additional €2 million cost for the project arising from the board of management's single phase decant and construction proposal raised serious questions as to the viability of the project.

The board of management and the design team were invited to a meeting with the Department in order to resolve all outstanding issues and enable stage 2b to be completed. That meeting was held on 11 November 2016 and agreement was reached in regard to the scaling back of the temporary accommodation costs, which should now allow the project to progress to the completion of the design stages. I understand that the design team is working to complete the stage 2b report for submission to the Department in the coming months. When the submission has been reviewed, the Department will revert to the school regarding the further progression of the project at the time.

If there are further difficulties, there would be no problem with the Minister for Education and Skills, Deputy Richard Bruton, meeting Senator Nash to discuss the project.

Progress has been made, if not to the complete satisfaction of the Senator. A very good meeting took place with the project team from the school and there is agreement to move forward. Something significant will happen. I have been told to say that if the Senator requires a further meeting with the Minister, Deputy Richard Bruton, and me, we would be delighted to meet him.

I thank the Minister of State for bringing clarity to this matter. I would be happy to lead a delegation of parents, teachers and members of the school's board of management to meet the Minister, Deputy Richard Bruton, or the Minister of State. One of the problems I have discerned from the process is a lack of communication, poor communication or miscommunications along the way. It is a complex process. The Minister of State can imagine the frustration on the part of parents seeing a considerable number of schools in the area being built while the school they fought hard to secure a number of years ago under the schools capital programme has been repeatedly long fingered and delayed.

We were aware that there were issues several years ago with proposals around decanting children from the school to an alternative location in Drogheda. The Department expressed concern about logistical arrangements to allow it to happen. It may have delayed proceedings regarding reaching this point in the project. It is a complex and difficult site. We all want the school to be built, in the interests of the staff, pupils and teachers.

Julianstown school was once a very small, rural school. However, given that the area is one of the fastest-growing in the State, there has been a considerable population increase in the area, with new housing developments. Given the number of young couples in the area, the demographic profile is set to increase during the next few years. We need the school to be built as soon as possible. I appreciate the Minister of State's intervention and I will take up the opportunity to meet him, the Minister, Deputy Richard Bruton and relevant Department officials to expedite this necessary project. It is very much appreciated.

The problem was the extra €2 million, which increased the cost by 40%. The board of management and design team had a very forward-reaching meeting with the Minister and the Department on 11 November and there is an agreement to scale down. I am confident some arrangement and agreement will be made. The agreement was to scale back on the temporary accommodation, which will reduce the cost. I am confident that some arrangement can be reached that will be satisfactory to the board of management, the Senator and the pupils and families.

The school and the principal expressed concerns about the cost of the prefabricated accommodation. I am pleased that an agreement appears to have been reached to scale it back and that it can be progressed as soon as possible.

One supplementary question is all that is normally allowed.