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Seanad Éireann debate -
Wednesday, 21 Feb 2018

Vol. 256 No. 5

Commencement Matters

National Dementia Strategy

The Minister of State, Deputy Daly, has stepped once more unto the breach. He is very welcome to the House.

I thank the Cathaoirleach for allowing me to raise this important issue and I welcome the Minister of State, Deputy Daly, to the House. Dementia is an issue that affects every community throughout Ireland, and an estimated 55,000 people are living with the condition, with this figure expected to more than double over the next 20 years. People with dementia need a wide range of community services that will support them from the moment of diagnosis and throughout their journey. We are all aware of the significant gaps that exist in these vital services and supports.

Under the national dementia strategy, the HSE committed to reviewing health and personal social services for people with dementia to identify these gaps and prioritise areas for action. I am aware that this mapping project was undertaken by the HSE in partnership with the Alzheimer Society of Ireland and concluded in October 2017. That was four months ago and during those four months another 1,300 people have developed dementia, and still the findings of the HSE review have yet to be published.

As co-convener of the all-party Oireachtas group on dementia, along with Deputy Mary Butler, I am acutely aware of the lack of equity in the provision of dementia services. In our budget 2018 proposals we advised the Government to provide funding for 30 dementia advisers throughout the country, increasing this funding over the following two years to reach 90 dementia advisers, one for each primary care network. Dementia advisers signpost people to services and provide much-needed support training, information and support to families and communities, and yet there are only eight of these advisers in Ireland. Access is on the basis of a postcode lottery, and for people living in counties such as Mayo, Roscommon, Kildare, Wicklow, Meath and Wexford, where the demographic profile and prevalence rates for dementia confirm a strong dementia population, this vital support does not exist.

The gap in post-diagnostic support was also highlighted recently by a former Minister for Justice, Nora Owen, on 8 February at the all-party Oireachtas group on dementia in Leinster House, and again in conversation on radio with Marian Finucane on Saturday last. She told us that it took 18 months from her husband Brian’s diagnosis of dementia to a visit from the HSE occupational therapist. That is a very long waiting time. This is not good enough for the estimated 4.000 people who develop dementia each year. That is at least 11 people per day. Those are not my estimates, rather they come from the official HSE Understand Together information campaign.

Other gaps that exist include the lack of intensive home care packages for the majority of people with dementia who want to remain living in their own homes as part of their communities. The all-party group advised that an additional €6 million should be invested in intensive home care packages for people with dementia this year, moving towards €30 million by 2021. Such funding needs be ring-fenced and there must be equality of access, with these packages being made available to people with dementia under the age of 65.

We also need to address the gaps that exist in services and supports for specific groups, particularly for those living with dementia and Down's syndrome. People with Down's syndrome are at a much higher risk of developing dementia. An estimated 700 people with dementia and Down's syndrome live at home with ageing parents. Professor Mary McCarron, who presented to our group in June, estimated that 88% of people with Down's syndrome will develop dementia compared with 7% of the general population. We are not prepared for this challenge and must begin to establish regional centres of excellence with trained and experienced staff to complete assessments and to offer advice and support to people with Down's syndrome living with dementia and their family members.

While I welcome the work being done by the HSE’s national dementia office to implement the national dementia strategy, the Government must now give a clear commitment that it will provide the resources required to plug the gaps which exist in dementia community-based services and supports. Will the Minister of State ensure the findings of the HSE’s mapping project, completed four months ago in October, are published as soon as possible? Will he also set out clearly the specific actions that will be taken to address and close the gaps in each community in order people with dementia and their carers all over Ireland can have a better life?

I thank Senator Kelleher for raising this important matter and for giving me the opportunity to respond to the issues raised.

With some 55,000 people living with dementia, and 4,000 new diagnoses every year, it is important to ensure appropriate services are available to meet the various needs of people with dementia. To determine what supports are required, a mapping of services currently available needed to be conducted. To support the future development of services and supports for people with dementia, the HSE’s national dementia office and the Alzheimer Society of Ireland collaborated on a project to map dementia specific community-based services across the country. This measure is in line with the national dementia strategy which calls on the HSE to critically review health and personal social services for people with dementia, to identify gaps in existing provision and to prioritise areas for action in accordance with resource availability, with priority being given to the most urgent deficits which can be addressed either within or by reconfiguring existing resources.

This project is one of a series of data collection measures being taken by the national dementia office to increase our knowledge of dementia and the services supporting people with dementia. The project was concluded last October. It illustrates what dementia specific services are available in locations across the country and will support the development and planning of resources in the future. Findings also show that existing services are concentrated around dementia specific day care centres and carer support programmes.

While the final draft of the report has been sent to the HSE and the Alzheimer Society of Ireland for approval, it should be noted the report has not yet been adopted. That said, the national dementia office has used the findings from this project to develop a service finder, which is now available on the HSE’s website. The service finder allows people to search for dementia specific community services in their area. The national dementia office is working with the Centre for Economic and Social Research in Dementia in NUI Galway to identify the full range of services people with dementia can access to further populate the service finder. The evidence will be used to support dementia service planning in each community health organisation area.

The Department of Health is determined to work with the HSE in providing the supports that people with dementia need, irrespective of their location, as well as to ensure that the national dementia strategy is implemented as fully as possible. Resources have been secured from the Dormant Accounts Fund to support people with dementia and their carers across a range of measures such as post-diagnostic supports, assistive technology libraries, community groups and a national dementia registry. Additionally, €9 million is provided in the 2018 HSE’s national service plan for intensive home care packages, many of which are provided to people with dementia. These projects highlight the commitment of the Department of Health to improving the range and quality of supports to people with dementia across the country.

The questions remain unanswered. When will the report be adopted? Who is responsible for its adoption? When will it be published? When will the service planning in each of the community health organisation areas commence and finish?

As the prevalence of dementia increases, greater efforts must be made to provide a range of support services for people with dementia. The national dementia strategy was created with the aim of improving dementia care and to enable people with dementia to continue living and participating in their own communities for as long as possible. The mapping of dementia specific services allows us to see what supports are available and, more importantly, which areas are not offering adequate supports.

The national dementia office and the Alzheimer Society of Ireland have carried out extensive work to map these services across the island. I commend them on this work. The information they have gathered will provide an opportunity for the development of resources in communities all over Ireland and will deliver valuable services with dementia in a greater number of locations.

The HSE has not adopted it as yet. I do not know when it plans to do so. I will find out and get back to the Senator on that. I expect it will be published as soon as it is adopted but not ahead of time.

Neuro-Rehabilitation Services Provision

I thank the Cathaoirleach’s office for facilitating this Commencement matter today. I welcome the Minister of State, Deputy Jim Daly, to the House. I have raised the issue of the National Rehabilitation Hospital approximately 14 times in the House, yet I have only been here for about two years. I live close to the hospital and I know many of the staff who work there and have personal direct contact with them, meaning I am on the inside track, despite what people on the professional side of the service and the executive might say. I also know some of the patients. I am very familiar with the service, having lived right next door to the hospital until a few months ago. When I am persistent in asking the questions, I invariably know the answers already. However, I have a job to do which is to come into this House to ask the Minister of State to explain.

To be fair, the Minister for Health and the Taoiseach recently turned the sod at the hospital for a phase 1 development. My real concern, however, is that in January 2017 the hospital took a decision to close 12 beds. The Department seems to be somewhat confused and cannot understand why it took that decision. The Department, rightly, is of the view that the hospital's resources and their deployment are a matter for the day-to-day operation of the hospital. Between all that, the Minister committed to engage with the hospital administration. The last I heard was that officially seven, possibly eight, of the beds were open. Despite meeting the Taoiseach and the Minister on the site at the opening of the new development, as well as several other Ministers, I was assured the beds would be open in a matter weeks. They too were alarmed and concerned by this.

The key issue is that there is a substantial waiting list to get into both day and residential services in the hospital. A substantial number of these people on the waiting list are holding beds in acute hospitals where we have a crisis with bed provision. I am putting this on the agenda today just to keep the focus on it. We need confirmation as to how many beds will be reopened and some assurance as to when that will happen. It is important that we get these beds back in service.

There is not a more important resource we could be discussing here. Nobody will appreciate the importance of this resource until their own family requires its services. On behalf of everybody in the State, I thank Senator Boyhan for raising this important issue and for giving me the opportunity to respond to it.

The HSE has advised that the complexity and acuity of patients referred to the National Rehabilitation Hospital for rehabilitation programmes has increased in recent years, resulting in greater challenges for the hospital. In response to this situation, management at the hospital took the decision in late 2016 to reduce its existing bed capacity by 12 beds in order to enable the hospital to provide a safe and appropriate level of care to patients from within its existing resources. Eight of these beds were in the brain injury programme and four in the spinal cord system of care programme.

The Department of Health has been assured that the HSE has been actively engaging with the National Rehabilitation Hospital since this time with a view to optimising capacity in the hospital and to address ongoing concerns regarding funding. It should be noted that the bed capacity situation is made more difficult as a result of the challenges associated with discharging patients with complex needs.

I am pleased to report that the situation at the hospital has improved significantly in recent months. In September-October 2017, funding was secured to reopen four of the closed beds. Two brain injury programme beds were reopened in September, while in October another brain injury programme bed reopened along with one bed in the spinal cord system of care programme. In late December 2017, additional funding was secured to reopen a further two beds in the brain injury programme, through the assistance of the HSE’s national social care division as part of its winter planning strategy 2017-2018.

As things currently stand, a total of six beds have re-opened at the National Rehabilitation Hospital, five of which are in the brain injury programme and one of which is in the spinal cord system of care programme.

The Government recognises the excellent rehabilitation programme which the National Rehabilitation Hospital delivers and the hospital’s excellent patient outcomes. In terms of capital developments, the priority at the present time is the delivery of replacement accommodation at the hospital. This development will see the existing ward accommodation replaced by a new fit-for-purpose ward accommodation block of 120 single en suite rooms with integrated therapy spaces, a new sports hall, a hydrotherapy unit and a temporary concourse as well as clinical and ancillary spaces. It will be a major enhancement for rehabilitation services in the country and will have a direct and significant impact on patient recovery by providing an optimal ward and therapeutic environment for patient treatment.

Construction works are currently under way and the new development is expected to be operational in 2020. Funding for phases I and II of this major redevelopment project was included in the Government’s recently announced Project Ireland 2040 policy initiative as part of an overall €10.9 billion strategic investment in health. The model of care proposed in the strategy is a three-tiered model of specialist rehabilitation services, that is: complex specialist tertiary services; specialist inpatient rehabilitation units; and community based specialist neuro-rehabilitation teams.

As a first step, a managed clinical rehabilitation network demonstration project is in development to establish collaborative care pathways for people with complex neuro-rehabilitation care and support accommodation needs. The National Rehabilitation Hospital will be participating in this demonstration project, along with Peamount Healthcare and the Royal Hospital Donnybrook.

I again thank the Minister of State, but we have made no progress. I ask him to look at all of the written replies. We were told that seven beds had been opened, but it now appears the figure is six. I was correct. For little over a year, the Government has presided over the closure of 12 beds at a time when there is a crisis in the hospital sector. We have now been told there are only six beds. Nowhere in the response from the Minister of State has he said that he will open the remaining six beds. I will commit to circulating this to the media today, in particular in Dún Laoghaire. It is a very strong area for the Government, given that three of the four Deputies there are Fine Gael members. This is a major issue there, but it is also a national issue. I will have to make this a political issue week in and week out in here and also locally.

I want to acknowledge the Minister of State's reference to the new capacity building. It is correct that there are 120 beds in the National Rehabilitation Hospital today. A new development will provide 120 beds and the old building will be knocked down. There will be no increase in bed capacity.

Last night I had a look at Project Ireland 2040. I note the suggestion that it deals with this issue. I understand, having engaged with the Minister a few days ago, that this is part of phase II, which is to be welcomed. It is marvellous and I want to acknowledge that, but we have a crisis if we cannot reopen the six rehabilitation beds. We all have to pull together and work to reopen the beds. There is a bed capacity crisis in the hospital. I will come back here next week with the statistics on the number of people waiting because the only way this issue will be dealt with is if I stand here every day, call out the waiting times in the National Rehabilitation Hospital and repeat that six beds are empty. That is the only way to bring attention to the issue. I do not want to be difficult. The issue is important and I do not doubt the commitment of the Minister or Minister of State. We have to get the six beds open, and I would like to think we could have them open within a month.

I again thank the Senator. I have no difficulty whatsoever with his sincerity and commitment to this issue. As I said at the outset, I sincerely welcome it. Anybody who has ever had any experience of the National Rehabilitation Hospital and has waited to access a bed knows the trauma that inflicts on a family at a very difficult time. I support the Senator wholeheartedly in his endeavours and encourage him to continue raising this issue.

Our job as public representatives is to identify issues of real importance to people, and make sure we raise those issues in fora such as this and ensure we get progress. I very much welcome his efforts and will work with him to ensure we can reopen the remaining six beds. As I said at the outset, this is a complicated health and safety issue. It is not a straightforward case of opening beds as happens in other areas. That does not mean it cannot be done and that the necessary resources and assistance cannot be provided. I will help the Senator every step of the way.

Apprenticeship Programmes

I ask the Minister for Education and Skills to include the traditional trade of cooper in the list of apprenticeships for Ireland. I welcome the Minister of State, Deputy John Halligan, to the Chamber. He is a man who has a great passion for apprenticeships. I note the announcement that 50,000 apprenticeship and training places will be brought before Government in 2020 via the new policy. It is an important statement of intent to ensure that trades and apprenticeships are promoted. The Minister of State is leading the way in that regard.

There are 27 different apprenticeships available in Ireland. Other countries, such as Germany, have anything up to 300 apprenticeship programmes which take into consideration some of the more traditional arts. I wish to bring one such trade, which is in many ways a dying trade, to the attention of the Minister, that of cooper. Coopers were a major part of this city and country's heritage over many decades. Hundreds, if not thousands, of coopers worked in Ireland in the 1950s, 1960s and 1970s. They made barrels for the distilling and brewing industries and it is a recognised worldwide trade. Whether one is in Scotland, Canada or other countries, coopers are considered to be skilled artists if not tradespeople.

We should consider having an apprenticeship programme for coopers so we can ensure the trade can be kept alive in Ireland. It is an important and integral part of the whiskey industry. In many ways, it is one of the key elements in ensuring our thriving whiskey industry can move to the next level. In June 2017, we launched a comprehensive tourism strategy for the whiskey industry which proposed tripling the tourist numbers coming to Ireland in terms of the whiskey industry between now and 2025. Part of that involves visitor centres, which are springing up all around west Cork and other parts of Ireland. We need to show how whiskey is distilled and the craft of the cooper so that we can show how barrels and caskets are made. That is an important part of telling this unique story.

We currently have a shortage and we need to work with the Department to ensure we can train skilled craftsmen and that the industry and craft can survive. There is no fear about the whiskey industry, but we need to tell the story from the beginning from where it starts in the fields to the craft of the people who make barrels and how we can ensure this part of our culture can be maintained. We should include coopers on the list of apprenticeships and work with the industry to promote this skill and art so that the entire industry can rise with the rise of the whiskey industry.

I thank Senator Lombard for a very interesting question. I read up on coopers and found it astoundingly interesting. I thank him for his very kind words.

Apprenticeships are demand-driven educational and training programmes which aim to develop the skills of an apprentice in order to meet the needs of industry and the labour market. The Government is committed to supporting the increased registration of apprentices across all sectors. A key commitment in the action plan is to expand apprenticeship and traineeship to achieve 9,000 annual new apprenticeship registrations by 2020; almost doubling current levels of activity.

Since the 1970s it is estimated that over 100,000 apprentices have been trained through the Irish system. Over the last number of decades we have seen major changes to our economy and the nature of our employment, and this is reflected in the types of apprenticeships being developed.

The Government is currently expanding the range of apprenticeships on offer to meet the identified skill needs of industry. Arising from our first call for apprenticeship proposals in 2015, 11 new apprenticeships have been developed in a wide range of sectors, including financial services, engineering, information and communications technology, ICT, and accounting.

In addition, arising from last year’s second call for proposals, we recently announced 26 new programmes for further development into national apprenticeships across a wide variety of sectors, including construction, engineering, horticulture and agriculture. However, currently there are no proposals resulting from our open calls to develop an apprenticeship in the cooper trade and I will go into that further later. The new programmes, in development, will add to and complement the range of apprenticeships currently on offer. It is estimated that the development process will take 12 to 15 months.

I spoke to the Senator outside the Chamber and he made interesting and forthright remarks regarding trades that go under the radar that could have an impact on our tourism industry. The objective of all apprenticeships is job creation first and foremost and the development of the economy through sustainable jobs and the long-term sustainability of crafts. We have many apprenticeships in the crafts sector. I am very interested in what the Senator said. Having read up on cooperage and the craft involved, the Senator's proposal is a very interesting one.

When we do a call out for apprenticeships a combination of factors is involved, including the involvement of the education and training boards, ETBs, businesses and even the trade union movement which will have an interest and will point to the lack of lack of apprenticeships here and there. Cooperage is one that has not come on our radar. Other apprenticeships such as film animation did not come on our radar until people came forward and said there was an interest in it and we then opened up an apprenticeship on it.

I know the Senator has a great interest in this area. He needs to contact the ETBs about this proposal. An assessment of it needs to be done, with which we can help the Senator, to ascertain if there are people interested in cooperage, and I suspect there will be, as it is a great trade. I can appreciate the value of it in promoting tourism and bringing tourists to see a cooper in action. The Senator might contact the ETBs for information on it. Apprenticeships are worked through the ETBs, while traineeships are done through SOLAS. The Senator could ask the ETBs to do an assessment and he could then contact my Department and we would work on it together to see if there is a need for such a proposal. If the indications were such that an apprenticeship in the cooper trade was necessitated, the Senator would have my assurance that we would do a call out for that.

I thank the Minister of State for his forthright remarks. He has been very helpful on this matter. I will definitely abide by his advice and we will work together. It is to be hoped we will be able to get some movement on this important issue.

Without going over old ground, there is a great interest among the ETBs and the Government in crafts and we do assessments on them all of the time. All the apprenticeships associated with crafts are on the increase. It would be interesting for me to make further contact with the Senator to see how we can develop this proposal. It would be a good thing for the Government to do, and it is also welcome that the Senator raised this proposal in the House, because this skill has gone under the radar. Having read all the statistics on it and history of it, it is an important issue for craftsmanship in Ireland and for the development of our tourism industry. We will talk again on the matter.

Northern Ireland

I welcome the Minister to the Chamber and I thank him for his presence here. Thankfully, due to the efforts of many people, citizens can travel freely across the Border with Northern Ireland without having to be stopped at a military checkpoint. We certainly welcome that development and long may that continue. Unfortunately, it was not always the case. In 1988, one checkpoint had a reputation of being one of the most notorious checkpoints throughout the North. It was a very uncomfortable situation and experience for anybody who happened to cross at that point in Aughnacloy on the Tyrone-Monaghan Border. I can testify to that from personal experience.

Thirty years ago today a young County Tyrone man by the name of Aidan McAnespie, then 23 years of age, was shot shortly after walking through that British Army checkpoint there on his way to Aghaloo football grounds to play a football match. The 23 year old, who worked in County Monaghan, was well known and well respected in the area.

The anniversary, as the Minister can imagine, has brought renewed focus on the as yet unexplained circumstances of the loss of his young life. The members of Monaghan municipal district council have joined others in the chorus of calls appealing to the Irish Government to release the report into the killing of Aidan McAnespie by an 18 year old British soldier in February 1988. Manslaughter charges were brought against the soldier but were later dropped. He was fined shortly after that for negligent discharge of a weapon and allowed to return to duty. He was given a medical discharge from the British Army in 1990. The British Army later claimed that three shots were fired that morning after a general purpose machine gun which the soldier was holding slipped out of his hands which, we were told, were wet at the time. Mr. McAnespie was hit in the back by one of those stray bullets which, it was claimed, had ricocheted off a road a short distance behind him.

Before his death Mr. McAnespie complained and had claimed many times that he had been constantly harassed and threatened by British soldiers as he walked through that checkpoint. The Historical Enquiries Team concluded in 2008 that the soldier's explanation was the "least likely version" of events and in 2009 the British Government said it "deeply regretted" Mr. McAnespie’s death. In 2016, the then Attorney General, John Larkin, referred the case back to the Director of Public Prosecutions, and I understand it is still being considered.

The killing, as the Minister can imagine, caused widespread anger, and the Irish Government under the stewardship of Charles J. Haughey appointed Deputy Garda Commissioner Eugene Crowley to investigate the killing. However, the findings of that report have never been made public.

The Irish Government has it within its power to hand over the Crowley report. It would be another step in getting the truth of what happened on that morning. There are many families, as the Minister well knows, from both communities who continue to wait for the truth. It is an injustice to stand in the way of that.

Aidan McAnespie's father, John, is now 82 years of age and in failing health. All he and his family are looking for is the truth of what happened on that February morning 30 years ago today. George Washington once said, "Truth will ultimately prevail where there is pains to bring it to light." I call on the Minister here this morning to help bring the truth of this case to light by releasing the report at the earliest opportunity so that the family can have final closure as to what happened to Aidan on that morning in February 30 years ago today.

I thank the Senator for raising this matter of importance on what is the most poignant day, the 30th anniversary of the killing of Aidan McAnespie, a 24 year old man from County Tyrone who was fatally shot as he walked through the British Army checkpoint at Aughnacloy on this day on 21 February 1988. What happened on that day 30 years ago was a devastating tragedy for the McAnespie family and for the community in the Aughnacloy area. His death was needless. I am very conscious of the continued suffering of his family and the continued concern in the community.

Given the widespread public disquiet at the death of Aidan McAnespie, the Government requested that an inquiry be carried out into the shooting and surrounding circumstances. The then deputy Garda commissioner, Eugene Crowley, was appointed to conduct this inquiry. However, many people in the local community expressed their fears to him as to their safety and security and co-operated only and explicitly on the basis of an assurance of absolute confidentiality and that what they related to Deputy Commissioner Crowley was for the Government only. This report was submitted to the Minister for Justice in April 1988. To release the entire contents of the Crowley report even at this stage, 30 years later, would be a breach of trust of the Irish Government to the parties involved. In 2002, the Government approved an outline summary of the Crowley report’s conclusions and this was provided to the McAnespie family. At that time, detailed consideration was given to producing an edited or redacted version of the report that would be meaningful, would not compromise confidentiality and could be provided to the family. However, given the nature of the report it did not prove possible to do so.

I have recently arranged for further copies of the limited summary and the post mortem report prepared by Professor John Harbison to be provided to the McAnespie family through their legal representatives. Senators will appreciate that the Government has a persisting obligation to the commitment that was given to those people in the locality and elsewhere who co-operated with the inquiry. Under these circumstances, therefore, it is not considered possible to publish or further disseminate the report. It is a source of regret to me that this will inevitably be a disappointment to Aidan McAnespie’s family who suffer from his tragic loss to this very day. However, the fact is that I must have full regard to the expectations of the many people who contributed in good faith to the Crowley inquiry on the basis of an explicit guarantee of absolute confidentiality and to the persisting obligation that I have in that regard.

I thank the Minister for his response which, as he noted himself, will be a disappointment to the McAnespie family. As any parent knows, losing a child is unnatural and goes against the grain but to lose a child in circumstances such as those in which Aidan was lost must be heartbreaking. In addition to the life sentence that they are going through, not knowing the circumstances or the truth of what happened on that day only adds to their grief. With that in mind and noting the Minister's comments, would it be possible for him to facilitate a meeting with the McAnespie family at his earliest convenience? The Minister might be in a position to provide more details to the family, over and above what he has just said in the House, in a private setting so that the family can know exactly what happened on that fateful day 30 years ago.

I would be happy to arrange such a meeting.

Sitting suspended at 11.15 a.m. and resumed at 11.30 a.m.