Commencement Matters

Garda Deployment

There is rarely a day when policing scandals are not front page news. From made-up figures to the smear campaign against whistleblowers, it is frankly becoming an issue that even the Government cannot spin its way out of. Crime is rampant and people are suffering, including the ordinary garda on the street. It is within that context that I have asked for the Minister to be present and to comment on the shocking cut of 136 gardaí in my area of Dublin South-Central.

I will start with some information I collected from a constituency-wide survey I carried out last year. When asked what was the biggest issue for the area, 20% of people said anti-social behaviour. Crime, dumping, drugs, gangland activity and murder accounted for 36% of answers. There is no doubt those issues have not been dealt with because of the lack of gardaí. When asked what people would change about the area, one constituent referred to anti-social behaviour and a lack of Garda presence.

The nitty-gritty of the cuts the Minister has imposed on Dublin South-Central are as follows. Kevin Street station has lost a massive 52 gardaí in the past seven years. Crumlin and Sundrive Road stations have lost 24 gardaí over the past seven years, and the number of gardaí in Ballyfermot station has reduced to 16. Last year the acting Garda Commissioner said that Ballyfermot would be one of the areas where a new Garda station would be opened rather than the suspect decision to reopen Stepaside Garda station. What possible justification is there for such cuts? There simply is not one. Saving money to spend on a Government spin unit is not of equal worth to the safety and security of people.

The details of the cuts to the number of gardaí is as follows. Dublin South-Central has lost 31 Garda sergeants since 2010. A newspaper ran a story only last week about the predicted crisis nationally from the delay in recruiting new Garda sergeants. Why should that be imposed on the people of Dublin South-Central? What about community gardaí? Nationally, the number of community gardaí in the force has fallen from 1,112 in 2010 to only 691 in 2017, a decrease of 38%. That shows the Government has no interest in investing in community policing although that is the future. Community gardaí are at the front line in tackling anti-social behaviour and creating good community relations. Having community gardaí can be transformative for communities. A good community garda can make connections, build relationships and work with the people in a community. In spite of that, Dublin South-Central went from having 99 community gardaí in 2011 to only 30 last year. That is a significant drop and the community is paying for it.

The effect of the drastic lack of numbers means gardaí experience fear on the streets. It is dangerous for the force not to know whether backup is needed in dangerous situations. Sinn Féin submitted a comprehensive document on the future of policing last month. I wonder whether the Minister read it. In it, we made more than 50 recommendations for the reform of policing. Those included reversing cuts to community gardaí, but there were also measures to strengthen accountability and protect whistleblowers. I urge the Minister to read it if he has not already done so.

Very good. I thank Senator Devine. We are under time pressure this morning.

I understand, a Leas-Chathaoirligh, but this is an extremely important policing matter.

I do not wish to take from the importance of the matter Senator Devine has raised.

I should say at the outset that the distribution of gardaí is exclusively the statutory responsibility of the Garda Commissioner. As Minister for Justice and Equality, I have no direct role in the matter. I am informed by the acting Garda Commissioner that in regard to the deployment of Garda personnel, a distribution model is used which takes into account all relevant factors, including population, crime trends and the policing needs of each individual Garda division, including the Dublin metropolitan region, south-central division, with a view to providing an effective and responsive police service.

I am further informed by the acting Garda Commissioner that the overall strength of the DMR, south-central division, as of the 31 January 2018 was 612. When appropriate, the work of local gardaí in the south-central division is supported by a number of Garda national units such as the armed support unit, the National Bureau of Criminal Investigation, the Garda National Economic Crime Bureau and the Garda National Drugs and Organised Crime Bureau.

Senators will be aware that the closure of the Garda College in Templemore in 2010 and the moratorium imposed at that time had a negative impact on Garda numbers across the country in all divisions. Since the Government reopened the college in Templemore in September 2014, just under 1,600 recruits have attested as members of An Garda Síochána and have been assigned to mainstream duties across the country.

Of those, 719, or 45%, have been assigned to Dublin, of whom 141 have been assigned to the south-central division.

Senators will appreciate that the challenges presented by gangland crime in the Dublin area have necessitated additional investment in the specialist units to enhance their capacity to support the fight against this scourge. I am advised by the acting Garda Commissioner that extra gardaí have been assigned to the specialist units over recent months, including the drugs and organised crime bureau, which is particularly active in the fight against organised crime in the Dublin region. In addition, a dedicated armed support unit for the Dublin metropolitan region, DMR, was established at the end of 2016 to enhance armed support capability in Dublin and free up the resources of the emergency response unit. I understand that the allocation of resources to these units has affected disproportionately the number of divisional gardaí in the Dublin region. This will be one of the factors taken into account by the acting Commissioner when considering the allocation of new Garda recruits. I am pleased to say that 200 new gardaí will pass out of the Garda College next week and be assigned to locations around the country, with a particular focus on the Dublin region.

I assure the House that the Government is committed to ensuring a strong and visible police presence throughout the country, including on the streets of our capital city, to maintain and strengthen community engagement, provide reassurance to citizens and deter crime. To make this a reality for all, the Government has in place a plan for an overall Garda workforce of 21,000 personnel by 2021, including 15,000 Garda members. Real and tangible progress has been made towards this goal. Garda numbers, taking account of projected retirements, increased to 13,551 at the end of 2017, a net increase of more than 600 since the end of 2016. I am pleased that funding is in place to maintain this high level of investment in the Garda workforce. This year, a further 800 new Garda recruits will enter the Garda College in Templemore, with 200 having already entered since 29 January. In total, 800 Garda trainees are scheduled to attest during the year, with 200 due to attest next week. Taking account of projected retirements, Garda numbers are on track to reach 14,000 by the end of this year. Undoubtedly, the ongoing recruitment process will support all Garda activities, enhance visibility within our communities and enable the acting Commissioner to provide additional resources across the DMR, including the south-central division, as new Garda recruits come on stream.

The Minister stated that the distribution of gardaí was "exclusively the statutory responsibility for the Garda Commissioner". As an elected Deputy and someone who has been appointed to the position of Minister for Justice and Equality, though, surely he should take a more hands-on approach to the root-and-branch reform of the Garda, especially given the scandals. He needs to have a more direct role. We have seen the skewed and inappropriate behaviour at some levels within the Garda Síochána. Perhaps the Minister should have more of a guiding input into how the reform is undertaken. It is doubtful that the scandals of last year can be put to bed at this stage, but I call on the Minister to be more proactive with the Garda after the necessary root-and-branch reform. In the meantime, we need to invest in the Garda in Dublin South-Central, which has increased in terms of its population and, unfortunately, crime levels.

"Hands on" one day is "political interference" the next. I assure the House that the Government's focus on investment in personnel is critical. The moratorium on recruitment introduced in 2010 resulted in a significant reduction in the strength of the Garda. We are now rebuilding the organisation and providing the acting Commissioner with the appropriate level of resources needed to deploy increasing numbers of gardaí across divisions, including the south-central division. In addition to the Government's plan for an overall Garda workforce of 21,000, the investment in personnel is complemented by a substantial investment in resources across the board. A total budget of €1.65 billion has been provided to the Garda this year, an increase of 2% on 2017. Some €98.5 million has been provided for Garda overtime this year, representing an increase of €10 million on 2017's initial allocation. It should be noted that the Garda allocation continues to benefit from the significant additional funding that was provided in 2016 and maintained in 2017 to fund a sustained response to gangland crime and the continuation of Operation Thor and measures to prevent international terrorism.

Some €342 million, including €217 million in additional funding under the capital plan, is being invested in Garda ICT infrastructure between 2016 and 2021. This investment will continue under my watch and facilitate the provision of more effective policing services. I expect that the south-central division, like all other Garda divisions, will continue to benefit from the new resources that are now becoming available.

I thank the Minister and Senator. Their co-operation was appreciated, as we are under time pressure.

Mayoral Election

I welcome the Minister of State, Deputy Phelan.

I thank the Cathaoirleach's office for selecting this Commencement matter. I warmly welcome the Minister of State with responsibility for local government and electoral reform, Deputy Phelan. To get to the kernel of this Commencement matter, there has been media coverage in recent days relating to the proposal or suggestion of an elected executive mayor for the Dublin area, including the commuter belt towns of Kildare, Wicklow and Meath. That this has been reported is not to say it is fact, but it was published in the media. There was also the suggestion of a directly elected executive mayor for Cork city and county. Will the Minister of State outline the facts of this case?

I wish to home in on the question of devolving powers. It is a great idea, but from whom are we taking those powers and to whom are we giving them? With devolved power comes devolved responsibility. Who are we taking responsibility from and to whom are we giving it? With devolved power comes funding, with the implications of that for the local property tax and commercial rates. Who are we taking the funding from and to whom are we giving it? To whom will these people be accountable?

I would appreciate it if the Minister of State shared with us his vision in this regard, throw some light on the facts and tell us how the Government intends, if it intends at all, to proceed with having elected mayors. Will they be figureheads or executive elected mayors? There is a subtle but important difference.

I apologise for being late. Traffic on the Naas Road is unpredictable at the best of times and chaotic at the worst.

I thank Senator Boyhan for raising this matter. A Programme for a Partnership Government sets out a number of requirements in terms of local government reform, some of which we have discussed previously. In particular, it envisages the submission of a report to the Government and the Oireachtas on potential measures to boost local government leadership and accountability, and to ensure that local government funding, structures and responsibilities strengthen local democracy, all of the issues that the Senator referenced.

Proposals to address a number of the programme for Government requirements have been the subject of consideration by the Government, most recently last week, in light of which it is envisaged that the matters involved will be referred to the Oireachtas for consideration. Among the issues being addressed in this context is municipal governance, including the questions of town or borough status and local electoral areas, as referenced in the programme for Government. Pending referral of the matters involved to the Oireachtas, I am not in a position to provide full details on them, but I am prepared to have a further discussion.

The Department is preparing a report on the programme for Government commitment on directly elected mayors for Dublin and Cork. This paper will examine the range of functions that might be assigned to a directly elected mayor and the governance structure that would underpin the role. Of importance is the geographic area relevant both to the mayoral role and the electorate that would vote for it. Consideration must also be given to potential impacts on existing local government structures following on from the establishment of directly elected mayors in those city areas.

At its meeting on 26 September 2017, the Government agreed as part of an indicative schedule for a number of referendums over the next 18 months that a plebiscite on directly elected mayors could take place in October 2018. The Department is drafting the legislation required to give effect to this decision and it is included in the Government's legislative programme as a Bill to be published in the first half of this year.

I also note that proposals brought to the Government and the Oireachtas on directly elected mayors will need to be cognisant of the new national planning framework and its strong focus on sustainable unpacked development of Ireland's cities and urban areas. Work on the report on directly elected mayors for cities is at an advanced stage in the Department. I thank the Senator for his interest in the matter.

Local government performs a wide range of functions and delivers a broad array of services. Any change must strengthen it and ensure it will remain fit for purpose. I also take the opportunity to thank the staff and membership of local authorities across the country who responded so effectively in the past few days to events during Storm Emma.

In the case of Cork city and in respect of the newly expanded boundary which has not yet been provided for in law but which will, it is hoped, come into effect in the middle of the year with a local government Bill, it seems pretty clear, based on the geographic area, where a directly elected mayor will operate. In Dublin some people believe a directly elected mayor should just be for the city; others believe he or she should be for the four Dublin authorities, while others believe the area should stretch to include the three neighbouring authorities in counties Meath, Wicklow and Kildare. There is the question of whether such a role should slot into a similar pattern as in the case of the existing local government heads rather than have executive power. In the case of Dublin and Cork, that would mean a change in the role of the chief executives in these organisations. A directly elected mayor would have these powers and carry out these functions for the term for which he or she was elected. All of these matters are being considered. It will be another month before the report goes to the Government and it will include the options. The Government will make its decision and there will then be a discussion in the Houses of the Oireachtas.

I thank the Minister of State. There is still a lot more work to be done, from which I am not taking away. The Minister of State used the term "plebiscite". Whatever decision is made, there has to be change. We should never be afraid of change, but it is important that, in respect of local democracy and government, we initiate a plebiscite. There is now a connection with local property tax and for the first time people believe they are putting their hands in their pockets. It is to be hoped there will come a time when all taxes gathered locally will be retained locally, but we are a long way from that happening. Where I live, money is being handed the other way. Empowering people through a plebiscite is a very important aspect of any change. I again thank the Minister of State for his comprehensive reply.

Gender Recognition

I thank the Minister of State for coming into the House to take this matter.

I commend the work of the Transgender Equality Network of Ireland, TENI, and the #ThisIsMe campaign which has been raising issues about a clinic for some time. I also commend the work of the Department and the HSE which have committed to the provision of additional resources for the clinic which should help to make an impact on waiting lists. However, there is currently only one full-time public endocrinologist who is based in St. Columcille’s Hospital, Loughlinstown with expertise in hormone replacement therapy, HRT, who serves the needs of adult transgender people in the State. The number of posts will soon be increased to two. There is also a part-time clinic in University College Hospital Galway, UCHG, with very limited hours. Owing to HSE policy, HRT is only administered to trans people at these two clinics, despite the fact that HRT prescribed for cisgender people or in any other instance can be administered and monitored by a local GP.

In the clinic in Loughlinstown there is a two-year waiting list. The waiting time has been attributed, not to service users but to the cancelling of clinics by consultants and the enforcement of the medical and diagnostic model by the HSE. The additional resources can be largely offset as the lead consultant within the clinic, Professor O’Shea, takes on the role of clinical lead for obesity. While I hope waiting times will improve, all of the indications point to the fact that the clinic will continue to be stretched beyond capacity. It is also worth noting that those aged 16 or 17 years who wish to apply for a gender recognition certificate must have supporting documentation from the clinic which will only accept referrals from certain psychiatrists who also have strained waiting times.

The model of a full-time Dublin-centric clinic meeting the needs of a community spread across the State is one that contravenes international best practice, namely, the World Professional Association for Transgender Healthcare, WPATH, guidelines which are the standard for most developed countries and also in keeping with the European Social Charter. It is not viable for a Dublin-centric clinic to support the needs of our island-wide trans community. It is fair to say the current position has led to a spike in mental health issues and the incidence of suicidal ideation among vulnerable persons and a rise in unmonitored self-treatment where individuals are forced or opt to buy hormones online.

I thank the Senator for raising this issue.

The NTPF publishes the inpatient and outpatient waiting list figures by specialty and hospital each month. This information is available on ntpf.ie. The most recent figures published by the NTPF for January 2018 indicate that there is a total of 38 people on the national inpatient day case waiting list for endocrinology and a total of 9,339 on the outpatient waiting list for endocrinology. Of this figure, almost 1,900 are on the waiting list at St. Columcille’s Hospital. Figures show that 42% of these patients have been on the waiting list for 12 months or less. Almost 40% have been on it for 18 months or more. However, I am advised by the HSE that urgent referrals are usually accommodated within four to six weeks. It is important to highlight that the NTPF waiting list data are extracted from the overall waiting list figures for the specialty and do not differentiate specific procedures for transgender patients from procedures for other patients on waiting lists. Reducing waiting times for the patients who have been waiting the longest is one of the Government’s key priorities. Consequently, in budget 2018, €55 million was allocated for the NTPF. This significant increase in funding almost trebles its 2017 total allocation of €20 million. To date, the transgender service in Loughlinstown has developed on an ad hoc basis and all referrals are managed within general endocrinology OPD clinics. The service is operated between the psychiatry services, primarily in Cluain Mhuire, and the endocrinology service in St. Columcille’s Hospital. Patients who require an endocrinology assessment must have been initially assessed and referred by a consultant psychiatrist. The psychiatry clinics are held weekly in St. Columcille’s Hospital and can accept only one new referral per week.

It is welcome that the HSE has, as part of its 2018 budget, allocated funding of €100,000 to St. Columcille’s Hospital which will ensure dedicated funding for transgender services and see increased capacity within psychiatry and psychology services. This will increase the capacity of the clinic to see additional referrals. The HSE has advised that recruitment to fill the additional new posts at St. Columcille’s Hospital will commence in early 2018.

The existing care pathway for transgender people in accessing HRT follows international best practice. The guidelines were devised by experts in transgender health care, with members of the international transgender, transsexual and LGBT community, and supported by TENI. The care pathway generally begins with an approach by an individual to his or her GP. The GP may refer the person to the local community mental health team for support and a diagnosis of gender dysphoria by a psychiatrist or a clinical psychologist. A thorough assessment is a prerequisite to commencing hormone suppressers. This is to ensure the correct path is being taken for the individual and comorbidity issues are identified and addressed.

It would be inappropriate for me as Minister to comment on the assessment process as this is a matter between clinical personnel and the individual concerned.

Does the Senator wish to ask a supplementary?

The waiting list time and the admission that this service has developed on an ad hoc basis proves that this model simply is not working or is not economical in the long term. I accept that the waiting list data are extracted and do not differentiate specific procedures for transgender patients. However, if we accept that there are 1,900 people on the waiting list and compare that figure with the number of people who have availed of a gender recognition certificate in this State, which would be about 300, although I do not know the number off the top of my head, those numbers are staggering in comparison with those who have availed of a gender recognition certificate, so that is a concern. As I said in my opening speech, it is not international best practice for a service to be so Dublin-centric and to not be available around the State.

Will the Minister of State commit to working with the Department and the HSE to ascertain if we can broaden access for hormone replacement therapy? What medical professionals would be able to administer and monitor the treatment? Will the Minister of State request that the Minister meet TENI and the This is Me campaign? The need to meet the Minister results from the fact that all the correspondence that TENI, the community or we get is from the Loughlinstown clinic itself. There is a bit of silence on the part of the Department, so that is a concern given that there were hundreds on the streets of Dublin at the beginning of this year.

I reiterate that recruitment is taking place, as I alluded to in my speech. This involves one consultant endocrinologist, one social worker, one speech and language therapist, two senior psychologists, one clinical nurse specialist and one grade five. Some of them will be whole-time equivalents and some will be part time. That should help the waiting lists but I will certainly pass on the Senator's concerns to both the Department and the HSE. I will also pass on to the Minister the Senator's request that he meet TENI at the first opportunity.

Hospitals Building Programme

I thank the Minister of State for taking the time to be here today. I very much appreciate it. My Commencement matter relates to the proposal in the national development plan, Project Ireland 2040, for a new hospital in Cork. The priority is not long fingering it and leaving it as just a proposal. I want action to be taken. The population of Cork has increased from 410,000 to 542,000 in the past 30 years. It will continue to grow under Project Ireland 2040. Cork city and county will be the fastest growing area of the country. Therefore, there is a need for improved medical facilities and one of those facilities is a new hospital. The first job is identifying a suitable site and then starting and proceeding through the planning process. The first priority is identifying a site. What action has the Department and the HSE taken with regard to progressing that matter?

I thank the Senator for the opportunity to address the Seanad on the proposals in the recently published national development plan with regard to a new hospital in Cork. The health service capacity review, which was published on 23 January 2018, identifies additional capacity requirements in our health service and also makes it clear that, in the absence of major reforms, the demand on our hospital system in particular will become unsustainable. The review clearly states that, together with reformed models of care, we need extra capacity across acute hospitals and primary and social care. It concludes that acute hospital bed capacity will need to increase by 2,600. I am delighted that the very significant increases in capital funding in the health service as a result of the national development plan will allow us to deliver on this capacity as well as on a range of other health capital projects and programmes across acute, primary and social care.

Under the national development plan, capital funding for our health services will be 165% higher for the next ten years than it was for the past ten years. This is a sea change commitment to capital investment in our health services. A total of €10.9 billion over the next ten years provides a real, long-term opportunity to improve our services, drive down waiting lists, increase bed capacity, reform pathways of care, and modernise how we deliver health services. The new hospital for Cork is one of the major investment projects promised in the national development plan.

It is important to recognise that the national development plan is a long-term plan. It provides for a large number of health developments throughout the country, including both national programmes and individual projects across acute, primary and social care. Many of its proposals are at an early stage of development, including the new hospital for Cork. Further planning to progress the investment in a new hospital for Cork will now be undertaken. This will include full evaluation of local capacity and infrastructural needs as well as a framework for decision-making on the optimal location from a clinical and population needs perspective. For all projects, we must ensure that we carefully plan the use of all capital funding using robust methods of appraisal, assessment and selection to meet population needs and achieve value for money. In this way, the unprecedented health capital investment of €10.9 billion over the next ten years will allow the health services to provide the necessary infrastructure and equipment to support the Government's vision for a high-quality, safe, accessible and sustainable health care system into the future.

Unfortunately, the reply that was furnished to the Minister of State by the Department and the HSE does not actually deal with the question. The question is quite specific. I just asked what process has been put in place to identify the site. It is important that we establish a group or that a process is clearly identified to identify this site and move forward with this project. I suggest that I be allowed to raise this issue again to allow the Minister of State to get further information so that we can find out whether this is just on paper at the moment, whether some process has started, if one has not started, when it will start, and the target date for identifying a site. This is important information for me because I do not want to be raising the same matter in 12 months with nothing done.

I appreciate the Senator's sentiments and that my response was rather vague on detail at this stage. If the Cathaoirleach is happy to allow the matter to be raised again in the House, I am happy to come back and get more detail for the Senator. I have some knowledge of it as a Minister of State from the area and had some discussions with the hospital group on the future of this hospital before the national development plan was announced. One thing I remember being struck by at that meeting was that one of the difficulties and challenges faced by the HSE, and I appreciate that this is a separate debate, was having to deal with two separate local authorities when discussing issues of infrastructure, sites and support services. Be that as it may, there is nothing we can do about that in this forum. I am happy to get further information for the Senator on the specifics of the process involved in identifying a site.

Sitting suspended at 11.20 a.m. and resumed at 11.30 a.m.