Commencement Matters

Primary Care Centres

Senator Keith Swanick

I thank the Minister of State, Deputy McEntee, for coming to the House to answer questions which have been worrying the community of Kinlough, County Leitrim. While canvassing the area during the Seanad elections, I had the pleasure of visiting the health centre and speaking with the local public health nurse. It was clear from speaking to the various people I met in the area that they felt very let down by the HSE in respect of the primary health centre.

A GP service is currently offered at the health centre twice weekly, on Tuesdays and Fridays, by appointment. In June of last year, I made representations to the HSE regarding the lack of adequate GP cover in the area and I was informed that there are no plans to increase the level of GP cover in the area. I was also informed that on Mondays, Wednesdays and Thursdays there is GP cover at the health centre in Bundoran, which is three miles from Kinlough, or at the primary care centre in Ballyshannon, which is seven miles from Kinlough. A person in the full of their health would have no problem travelling these distances but we need to keep in mind that the people visiting GPs and care centres are not in the full of their health. They are in need of medical attention and, as such, we can rightly assume that they are in some form of pain or distress. The fact they cannot visit a doctor in their own locality only adds to this distress and, in my opinion, it is disgraceful in this day and age. There are other rural locations with a full-time GP service, for example, Bangor Erris and Glenamoy in County Mayo.

For 150 years following the Great Famine, the population of Kinlough village stood at just 350 people. The 2006 census showed an increase for the first time, the 2011 census figures had the population at just over 1,000, an increase of 47% on 2006. The preliminary results from the 2016 census show that this trend is continuing. Kinlough is the third largest urban area in County Leitrim and has the county's largest primary school, which 270 pupils currently attend. It also has three preschools and, like the rest of the country, is home to an aging population.

As a GP, I am only too aware of the pressures on general practice. However, I also feel that, in this instance, there is a compelling argument for an enhanced service. I ask the Minister of State to examine the feasibility of returning the responsibility for Kinlough health centre to the Leitrim primary care area, as opposed to the Ballyshannon-Bundoran area. The community of Kinlough deserves better. They need services which will address the needs of the population, both young and old.

Minister of State at the Department of Health (Deputy Helen McEntee)

I thank Senator Swanick for raising this issue, which I am taking on behalf of the Minister, Deputy Harris, who sends his apologies. I have been advised by the HSE that primary care services in Kinlough are currently delivered from a rented premises in the town. I understand the services delivered include GP services, public health nursing, including child development clinics, consultant psychiatry clinics, community mental health nursing, counselling services and autism therapy services. As the Senator said, the GP service is provided as an outreach from the main centres of practice in Bundoran and Ballyshannon and the centre is an extremely important part of the community.

The primary health care centre is Kinlough was rented by the HSE in 2004. As this was originally a domestic type dwelling, a number of works were carried out to make the property fit for purpose.

The HSE has advised that an issue has arisen about the negotiation on the rental value of the property which is ongoing and as this is a private matter between the owners and the HSE, I am sure the Seanad will appreciate that I cannot comment on this particular issue. However, I want to reassure the Senator that the HSE has informed me that services are continuing to be provided from these premises in Kinlough.

As Senator Swanick is aware, one of the Government's key priorities is to implement a decisive shift in the health services to primary care. Our ultimate goal, and as Minister of State with responsibly for older people, my goal is to make sure that people get the care they need as close to home as possible and have access to a greater range of health and social care services within their community. Enhancing and expanding capacity in the primary care sector is crucial to ensuring delivery of a preventive, joined-up approach to the management of the nation's health and the modernisation of primary care delivery. In a fully developed primary care system, 90% to 95% of people's day-to-day health and social care needs can be met within that primary care setting. It is very important to stress that from the point of view of people using the wide range of services provided by the HSE at community level, services must be responsive to their needs. It must also enable them to receive a joined-up service that results in the most favourable health outcomes.

It is on the record that this Government is steadfast in its support of the decisive shift to primary care and it is useful to point out that some of the successes in helping to achieve this include the extension of eligibility for GP cards to children under six and those over 70, the development of diabetes cycle of care and ongoing investment in the physical infrastructure for primary care. Quite significant investment has also been made in the development of the primary care capacity, particularly in the therapy area.

The Senator will also be aware that the Oireachtas Committee on the Future of Healthcare is considering issues such as the long-term vision for health policy, the implications of demand projections for the preferred model of care and how this can be achieved, and the associated funding models. It is important that the committee will make recommendations to guide us on the journey to universal health care. Primary care must and will be a key feature and I await with great interest the outcome of the committee's deliberations.

The Senator's suggestion that this would move into the Leitrim primary care area is something that might be raised after the committee has finished its deliberations and once it is planning the future of what primary care in this country will look like.

Senator Keith Swanick

I thank the Minister of State. I have liaised closely with local councillor, Justin Warnock, on this issue. There are a few important issues arising which I will refer to briefly. Over 10% of the total population of Leitrim live in the Kinlough area. Currently, hearing and dental checks are not being conducted in the health centre, but in the local school which has 270 pupils. This causes major disruption. The village continues to grow. The people of Kinlough deserve a full-time GP service, five days a week. I welcome what the Minister of State has said but I will continue to lobby on this issue.

Deputy Helen McEntee

I will bring this information to the Minister and raise this with him.

Disabled Drivers and Passengers Scheme

Senator Maria Byrne

I rise to raise the issue of the primary medical certificate. This is required by people who apply for a disabled driver's pass. The disabled drivers scheme is very positive. There have been a number of initiatives that have been improved in recent years such as the amount of money that is allowed towards the car adaptation. Disabled drivers can park in disabled parking spaces and this helps many people who have severe disabilities. The rules state that applicants: "must be completely or almost completely without the use of both legs, or completely without the use of one of the legs, and almost completely without the use of the other leg to the extent that you are severely restricted as regards movement in your legs, be without both hands or both arms, be without one or both legs, be completely or almost completely without the use of both hands or arms and completely or almost completely without the use of one leg or have the medical condition of dwarfism and serious difficulties of movement of the legs."

While I understand that people with these conditions qualify for this primary medical certificate, I am aware of a case involving a gentleman with no sight in one eye and only 40% sight in the other eye. He is obviously not allowed to drive, but under the scheme a family member can apply for the pass on their behalf and avail of the benefits which go with it. This man also uses a walking aid. Due to the fact that the scheme is so restrictive, there is no scope for discretion which is what I am looking for. Each case would have to be taken on its merits and if people were trying to fool the system I would agree that they should not qualify. However, I would like that some form of discretion would be included in the scheme so that each case would be taken on its own merits if it does not qualify within the original rules.

Minister of State at the Department of Finance (Deputy Eoghan Murphy)

I thank the Senator for raising this issue in the House. I am very sorry to hear about the difficulties faced by the individual referred to by the Senator. As she will be aware, the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994 provides relief from VAT and VRT, up to a certain limit, on the purchase of an adapted car for transport of a person with specific severe and permanent physical disabilities, payment of a fuel grant, and an exemption from motor tax.

To qualify for the scheme an applicant must be in possession of a primary medical certificate. To qualify for a primary medical certificate, an applicant must be permanently and severely disabled within the terms of the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994 and satisfy one of the following conditions which the Senator listed in her remarks. The senior medical officer for the relevant HSE administrative area makes a professional clinical determination as to whether an individual applicant satisfies the medical criteria. A successful applicant is provided with a primary medical certificate which is required under the regulations to claim the reliefs provided for in the scheme.

An unsuccessful applicant can appeal the decision of the senior medical officer to the disabled drivers medical board of appeal, which makes a new clinical determination in respect of the individual. The regulations mandate that the medical board of appeal is independent in the exercise of its functions to ensure the integrity of its clinical determinations. The criteria to qualify for the scheme are necessarily precise and specific. After six months a citizen can reapply if there is a deterioration in his or her condition. The scheme represents a significant tax expenditure. Between the vehicle registration tax and VAT foregone, and the fuel grant provided for members of the scheme, the scheme represented a cost of €65 million in 2016. This does not include the revenue foregone to the local government fund in respect of the relief from motor tax provided to members of the scheme.

The Minister for Finance recognises the important role that the scheme plays in expanding the mobility of citizens with disabilities and that the relief has been maintained at current levels throughout the crisis despite the requirement for significant fiscal consolidation.

From time to time the Minister, Deputy Noonan, receives representations from individuals who feel they would benefit from the scheme but do not qualify under the six criteria. While he has sympathy for these cases, given the scale and scope of the scheme, the Minister for Finance has no plans to expand the medical criteria beyond the six currently provided for in the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994.

Senator Maria Byrne

I thank the Minister of State for his reply. While I understand that there are many people in receipt of the scheme, the Minister of State might take back to the Minister the need to assess individual cases. There is an appeals process but the Minister might consider the inclusion in the regulations of a word relating to discretion.

Deputy Eoghan Murphy

I thank the Senator for her comments and I will relay the substance of the debate and the changes she is looking for to the Minister. I would remind the House that the scheme was examined in 2015 in order to target the available resources at those most in need of the scheme and, as a result of this, the Minister introduced a significant number of improvements from January 2016. I can give the Senator a list of these, although I am sure she already has them.

Invasive Plant Species

Senator Brian Ó Domhnaill

I welcome the Minister of State at the Department of Agriculture, Food and the Marine. I am raising this issue on behalf of Councillor Gerard Flynn who is a member of Clare County Council. It relates to the burdensome problem of wild ivy attaching itself to trees, a problem that arises not just in County Clare but also throughout the country. The ivy which is sometimes referred to as "English ivy" is causing damage to the native tree population, both in public amenity areas and also on private property. It does not kill a tree, but the resulting activity after it has started to grow can kill the tree. It creates competition for nutrients, water and sunlight. It makes a tree weaker and more prone to disease and branch dieback. It also contributes to the added moisture around the bark which attracts bugs and accelerates rot. As it grows from the ground up, branch dieback is usually evident at the bottom of the tree initially. This leaves the tree looking like a stalk of broccoli, with a head at the top. It creates an imbalance for branches and there is the added weight of the ivy at the top. As a result, the tree is more prone to falling during drastic weather events, which means that it is also a safety issue. I live in County Donegal and the wind on the western seaboard can be atrocious, particularly during the winter. Trees that are heavily weighted with ivy at the top are less balanced and can fall in the wind. They have been known to cause accidents when they fall across a road. I have often encountered instances of trees falling across a public road, resulting in it being blocked or an accident being caused.

I am not sure whether the Department has conducted an analysis of this issue as it might be a new or emerging problem, but on behalf of Councillor Flynn I am asking the Minister of State to carry out a nationwide review to ascertain the extent of the problem and whether a policy intervention by the Department is required. Perhaps he might consider my request. I am not sure if it is an issue in County Wicklow, but I am told it is a growing problem along the western seaboard. People in the United States refer to this as the "English ivy" problem. To remedy it, they do not cut the ivy away from the tree, as Senator Billy Lawless will be aware, but cut it at the bottom of the tree and pull out the roots to stop it from growing. It then dies. Perhaps that solution might be considered. It is probably an extensive problem if it has to be dealt with on a countrywide basis, but it might be more prevalent in some counties than in others. Has the Department carried out any analysis?

Minister of State at the Department of Agriculture, Food and the Marine (Deputy Andrew Doyle)

I thank the Senator for raising this issue. In preparing my response I learned a little more about ivy which will come across in my reply.

An Leas-Chathaoirleach

We are all in the same boat.

Deputy Andrew Doyle

I will be happy to discuss other aspects of the matter later.

Ivy is an evergreen shrub that is found growing in the wild in Ireland. It is a native species that contributes to the diversity of plants growing in many habitats, both within woodland settings and on individual trees. As a species, the native ivy has received criticism in some quarters. Ivy uses trees for support and to climb and takes no moisture or nutrients from the tree. In other words, it is not a parasite. Its benefits are wide-ranging and play an important role in contributing to the biodiversity of woodland ecosystems and individual trees. The shelter and nesting opportunities provided by ivy are beneficial for many species of birds. It also provides habitats for insects. The berries produced provide a source of food for birds during the autumn and winter months when food is scarce. In addition, the nectar and pollen produced by the flowers are important for different species of insects.

In some cases, ivy can be found growing in large quantities on trees that are unhealthy and not growing well. Trees suffering from diseases or stress may have more open crowns which, in turn, allow the ivy present to grow vigorously with increasing light levels. In these situations the ivy can appear to be the cause of a tree's decline but, in effect, there are usually other underlying factors. The Department periodically carries out national forest inventories which collect a wide range of data that are used to assess, among other things, the total forest cover and the health of the forest estate. All plant species are recorded in forest plots taken as part of the inventory which includes ivy if it is present. The latest published forest inventory results from data collected in a period between 2004 and 2006 found that, in general, the health and vitality of forests in Ireland were considered to be good. The national forest inventory estimates that the total area of forest cover in Ireland is approximately 11% of the land area. As with all living things, there is a natural process and trees will either be felled for timber, succumb to disease or die of old age.

In the normal course of forest management ivy is not routinely removed and, in general, does not affect the productive capacity of healthy trees. In some cases, heavy growth of ivy on trees can make it more difficult to fell trees, but the impact is limited. Individual trees growing on roadsides can sometimes carry large amounts of ivy owing to a tree's weakened condition which can make a tree liable to fall over in high winds. Landowners in general should continue to monitor the condition of their roadside trees and remove unhealthy dangerous trees in the interests of health and safety.

In summary, it is not necessary to carry out a national tree survey to assess the impact of ivy on tree growth. That would prove to be an extremely costly exercise when it has been found that the current health and vitality of trees in Ireland’s forests are generally good. Even if Ireland were to instigate a strategy to remove or limit the growing of ivy, it would have consequences for biodiversity and reduce shelter for other species. Controlling ivy by removing a portion of the stem of the plant by manual cutting would have little impact as new plants would regenerate. Embarking on a national survey and control programme would not be effective and would not provide value for money. We should accept ivy as part of the community of plants found on trees.

Senator Brian Ó Domhnaill

I accept the Minister of State's response. The Department would certainly have the best data available. One interesting point made in the Minister of State's response is that he agrees with my position on trees on the roadside and the danger of their being blown down. There is one option that could be considered and which might provide value for money. Perhaps the Department, in conjunction with local authorities, might carry out some evaluation of roadside trees that have ivy attached to them to ascertain the danger they pose. If local authorities could be provided with a small contribution, I am sure they would carry out such an assessment as a first step in mitigating any danger of roadside trees falling over as a result of being damaged by ivy. That useful first step could be carried out on a pilot basis. It could even be carried out in a number of counties, starting in County Clare, to ascertain if there was a need to roll it out further. It might be a way of mitigating any huge financial burden on the Department.

Deputy Andrew Doyle

The last inventory was carried out in the period 2004 to 2006 and there is another assessment under way. It is expected that the status of the general health of the tree population of the country will not have changed that much, save to say that in the interim, Chalara fraxinea, or ash dieback as it is commonly known, has been identified on an all-county basis. That has been accepted by the Department. I am not ignoring the Senator's core point but I wish to explain the context that it is a disease we will have to manage rather than eradicate or eliminate.

Much of the ash was traditionally used on roadsides. To return to the Senator's point, while Chalara fraxinea itself can cause the disease, it does not necessarily undermine the vitality of the tree. In the ongoing assessment of Chalara fraxinea and the monitoring of ash, it might be possible to keep an eye on the ivy and to assess it. The reason roadside trees are often planted on mounds is because road traffic undermines the roots and they get caught in winds, and that is why they become so susceptible. They tend to have been planted many years ago before we had an afforestation programme. Their age profile, if one can use that term, is considerably older than many of the trees which were planted in forests per se.

Every county has trees but in Wicklow there is a higher proportion of forest estates than anywhere else and we also have a lot of roadside trees. It is an ongoing issue. My perception of it is that the ivy was causing the problem but sometimes it is the other way around. In monitoring the safety of trees on roadsides in particular we need to assess the amount of ivy and ascertain whether it is an issue. Senator Ó Domhnaill referred to pulling up the roots. Just cutting ivy without uprooting it would slow it down but it would not stop it regenerating because the nutrients that allowed it to grow in the first place are still in the surrounding area. It is a climber which will continue to climb. I thank the Senator for raising the issue. I have learned a lot by having to deal with the issue today.

An Leas-Chathaoirleach

We all have.

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

Seanad Éireann debate - Wednesday, 5 Apr 2017