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Seanad Éireann debate -
Wednesday, 21 Mar 2018

Vol. 256 No. 12

Commencement Matters

Care of the Elderly

I welcome the Minister of State. I very much appreciate him dealing with this matter, which relates to the increase in demand there will be for home care now that we have an increasing number of older people in the country. That number will continue to increase at a dramatic pace in the next ten to 12 years. The figures, as I understand them, indicate that 637,000 citizens are over 65. Within 12 years, that will be 1 million. While there has been an increase in the number of people who are being provided with home care, we also need to plan for the long term. In particular, we need to plan to upskill people who will be able and available to provide home care.

The other challenge we face relates to the fact that because of the increase in employment, people will not be attracted into providing home care because there are more permanent jobs available. We will have to look, therefore, at what kind of mechanism we should put in place to ensure that people have job security. That is becoming more of a challenge for those who want to provide home care. It is in that context that I am raising this issue. I would like to know what action the Government and the Department of Health are taking to deal with this issue.

In common with other developed counties, Ireland is experiencing the ageing of its population. As the Senator rightly pointed out, this is giving rise to some significant challenges for us. The proportion of the population aged 85 and over increased by more than 20,000 between 2006 and 2016 and is projected to increase by a further 36,000 by 2026. This effectively means that this age group is expected to more than double over a 20-year period. Based on current CSO population projections, it is expected that population ageing will continue in the forthcoming decades. This, of course, has direct implications for health and social care services because demand is highest among those in these age groups.

The HSE, working within its available resources, has sought to maintain and, where possible, expand the range and volume of services available. These services include supporting people to remain in their own homes and preventing early admission to long-term residential care, as well as supporting people to return home following an acute hospital admission. Home support services were a particular area of focus in budget 2018, with an additional €18.25 million allocated. The additional resources made available in 2018 bring the total budget for the direct provision of home support services to €408 million.

The HSE's national service plan provides for a target of just over 17 million home support hours to be provided to 50,500 people.

Turning now to the steps that have been taken, I can advise that at the end of last year the Minister for Health, Deputy Harris, launched the national strategic framework for health and social care workforce planning. The framework aims to support the recruitment and retention of the right mix of workers across the health and social care system to meet planned and projected service needs. The framework proposes a consistent approach to strategic workforce planning together with the establishment of structures and governance arrangements that support and enable the application of this approach in the health sector and cross-sectorally where appropriate.

One of the early actions identified as necessary to implement the framework is the development of a more formal and structured arrangement for engagement between our health and education systems to ensure the development and retention of the appropriate competencies and skills in the system. As with all health and social care workers we must ensure that the competencies and behaviours being developed by those who wish to become home care providers take account of developments in health and social care delivery. It is essential that educational and training courses are provided to these individuals with the core competencies which are required for their future profession. Ensuring closer engagement between health and education and training systems is vital to achieving this goal. The development of a protocol for engagement between the two sectors is a high-level objective of the framework's implementation plan. I am fully aware that home care providers play a vital role in improving the health and well-being of our older population by supporting and looking after them at home, which is usually their preferred environment. In terms of the provision of training, the HSE provides training to its home support workers. The current programme in health service skills leads to an award at level 5 recognised in the national framework of qualifications or equivalent. This skills programme is available to staff working in the HSE and section 38 agencies. This ensures that they have the necessary competencies required for their role meeting all the quality standards required for effective patient and client care.

Does the Senator have a supplementary question?

I thank the Minister of State. He has acknowledged that there will be a substantial increase in the demand for home care. In the context of the national strategy framework for health and social workforce planning, do we have a five-year or ten-year plan to develop this service or are we merely going from year to year? My concern is that it is the latter.

I can appreciate the Senator's concerns because the demographic trends are frightening to say the least. It is staggering to think we will have 1.2 million people over the age of 65 years living in this country in the next 20 years or so. There is a huge challenge and that is why, early in my tenure in this role, the Minister for Health, Deputy Harris, and I launched a consultation on a new statutory home care scheme that would mirror the fair deal scheme. It would be underpinned by statute, would be guaranteed funding and would be a demand-led scheme. Part of that is looking at our workforce planning and the issues surrounding ensuring that we have availability. It is a challenge in many different regions and it contributes to the ad hoc nature of delivery today. The upskilling and recruitment, as well as the maintaining and keeping in the system of home care workers, is part of that statutory scheme and is part of the planning process that is being undertaken at the moment. I assure the Senator that we are aware of that challenge and that is to the fore in our development of the new statutory scheme, which we hope to have up and running within the next two to three years.

Hospital Services

I thank the Minister of State for coming to the House to take this matter. Two operating theatres in Merlin Park University Hospital, Galway were shut on health and safety grounds last September when significant leaks in the roof were discovered. Repair works were completed on 1 November and yet, more than three months later, the theatres are still not open. An independent clinical assessment has been undertaken to assess the feasibility of returning these theatres to use and I understand that correspondence was issued yesterday to the effect that one of those theatres may be in a position to open today. Can the Minister of State confirm this? More importantly, can he also confirm that it would be adequately resourced, keeping in mind that it is more than six weeks since the Taoiseach stated in the Dáil the Government's commitment to ensuring the restoration of a full elective orthopaedic service to Merlin Park University Hospital, Galway? For such a service to be restored, the promised modular theatres on the Merlin Park site need to be put in place immediately. I have been in contact with the chair of the HSE forum, Councillor Mary Hoade.

She has echoed the concerns of all the forum members from all parties, all the staff members from University Hospital Galway and Merlin Park and, more importantly, the concerns of the public in general. Over six weeks ago, the Taoiseach said that the tender process for these modular units was in the final stages and it was expected that a contract would be awarded in the coming weeks. Can the Minister of State confirm whether this contract has been awarded and provide a timeline as to when work is due to begin?

With respect to Galway University Hospital emergency department, Eilish O'Regan reported last week that patients were falling victim to outbreaks of deadly superbugs in dangerously crowded hospitals. We know that the emergency department of University Hospital Galway is dangerously overcrowded. It has consistently been at the top of the trolley watch indicators, which is a shameful accolade. A 2017 report found that conditions at the emergency department were chaotic and nothing short of scandalous. The eyewitness report commissioned by the Saolta group stated that patients are crammed together, within touching distance of each other for the most part and with little or no privacy. Is it any wonder that patients in close quarters are contracting and passing on superbugs, which are becoming increasingly resistant to antibiotics? The CPE bug is particularly nasty and has multiplied and evolved since my days of working in accident and emergency. It is dreaded because it is almost untreatable. It is immune to some of the last resort group of antibiotics that are used when all other drugs fail. It usually leads either to a pneumonia-type infection in the chest or an E. coli infection in the bladder or digestive system. It kills around half of patients whose bloodstream it enters. Some 17 new cases were detected between 19 February and 12 March in Ireland, including in University Hospital Galway. I ask the Minister of State to update the House on the current stage of works at the new emergency department block. I urge him to acknowledge that there is a real need to put all shoulders to the wheel in this regard.

I welcome the opportunity to address the House on these matters on behalf of the Minister, Deputy Harris. The leaks in the roof of the building that houses Merlin Park University Hospital’s orthopaedic theatres occurred in September 2017, necessitating the closure of both theatres in the interest of patient safety. A full repair to the membrane of the roof was required to secure the integrity of the building and these works have been completed. I am pleased to have the opportunity to inform the House that following completion of remedial works identified as part of a further external assessment, one of the theatres has become operational today.

It has been evaluated that the best way of restoring effective capacity at Merlin Park is the construction of two modular theatres on the Merlin Park site. The HSE has advised that the tender process for these modular units is now complete and a contract has been awarded. Contract documents have been exchanged and active engagement with the successful company is in progress.

I assure the Senator that the Department and the HSE have implemented a number of measures to address overcrowding at University Hospital Galway. The Government is committed to fixing the situation in our emergency departments and breaking the cycle of overcrowding in the health service. To do this the Department is pursuing three priorities in 2018, namely, increasing capacity across the system using evidence provided by the health service capacity review beginning with some additional hospital beds; implementing reform through Sláintecare; and increasing services provided through primary care by negotiating a new GP contract.

The situation in University Hospital Galway is challenging, with 41 patients waiting on trolleys yesterday morning. Infection control issues remain of concern with six beds closed due to norovirus, which is impacting on congestion and admissions and transfers to wards. I wish to acknowledge the distress for staff, patients and their families of the current situation. Funding has been provided in 2018 to open 28 additional inpatient beds in University Hospital Galway and access was provided to seven additional home care packages per week and two additional transitional care beds per week for the duration of winter. Furthermore, the Department of Health is also engaging with the HSE to fast-track the recommendations of the recent health service capacity review with a view to opening more new beds within the system as soon as possible this year.

Both the Department and the HSE are working on alleviating the overcrowding situation at University Hospital Galway and ensuring that the orthopaedic theatres at Merlin Park are operational as soon as possible.

I acknowledge the opening of the theatre in Merlin Park and I am delighted that one theatre is opening. However, there is a huge backlog of surgery with over 1,000 patients awaiting elective surgery in Merlin Park. When will the second theatre open? A huge phase of catch-up work needs to commence as soon as possible.

I acknowledge that the contracts have been issued for the modular units but the Minister of State did not answer my question with regard to when work will begin on those modular units.

On the Senator's second question, as negotiations are continuing with the contractors, I do not have a date for when the work will begin but I will seek an update on the matter for him. I will also ask the HSE to respond directly to the Senator on the timeline for the opening of the second theatre.

I had occasion to visit Merlin Park recently. It is a fantastic asset.

Family Resource Centres

I thank the Minister of State, Deputy Daly, for taking this matter but I had hoped the Minister, Deputy Zappone, would be here to address the urgent need for a family resource centre in Erris, north Mayo. I welcome the recently announced additional family resource centre provision but, unfortunately, there is no provision for north Mayo. I have not intervened on this matter up to now because I was sure the urgent need for a family resource centre in Erris would be recognised. I am not sure if the Minister of State has been to Erris but I am sure he has heard of Belmullet which has a population of almost 8,000 people. In terms of isolation and the difficulties around access to services, it is a 154 km round trip to the county town of Castlebar and a 124 km round trip to Ballina. The primary and secondary routes connecting to those towns are prone to flooding and in need of urgent upgrade. However, that is a matter for another Minister.

The recent Social Justice Ireland report shows an increase in poverty in rural areas. There is also a poverty of access to essential services. It is not feasible for support services, such as those provided by Tusla through the family resource centres, to travel to and from Erris to meet the needs of individuals and families. That Tusla and HSE staff have to spend half their days travelling to and from the main centres is not the best use of their time and not conducive to providing quality support services to individuals and families. The reality is that families and individuals are being deprived of the life-saving and life-changing supports and services available to people living in other areas.

A family resource centre located in Erris would facilitate an early intervention and prevention approach that would assist in preventing cases escalating to the social work teams and mental health teams that are already overstretched. Following on from the closure of community development projects in 2015, there is an even more severe gap in services for the Erris community. Over the 13 year timeframe that the CDP was in existence, along with the one-to-one supports provided by it, initiatives such as whole community responses to bullying, domestic violence, poor mental health, isolation and many other key issues, were developed. It also acted as a facilitator and an anchor for parenting programmes, community participation in primary care and other anti-poverty and social inclusion initiatives. The combination of family support services and community development that could be provided by a family resource centre would tackle disadvantage and address the inequalities that are preventing people from living full, healthy and self-determined lives.

Erris is a wonderful area in which to live or to visit. The deprivation statistics included in the application for a family resource centre in Erris speak to the underlying severe disadvantage when it comes to accessing services, unemployment levels, the level of lone parents and the number of people living in isolation.

It speaks to all of those things. Young people with acute mental health difficulties must still travel to north Mayo CAMHS which is based in Ballina. If a young person recovering from a bereavement or something traumatic needs the support of CAMHS and other services, it is not feasible to take him or her out of school for a whole day to access those services. That is why I ask the Minister of State to reconsider the family resource centres and to put one into the Erris area as a matter of urgency. I would not ask if it were not desperately needed. I ask on behalf of the families and individuals.

I welcome the opportunity to respond to the issue raised by Senator Conway-Walsh. The family resource centre programme was established in 1998 and was overseen by the former Family Support Agency until the transfer of responsibility to Tusla, the Child and Family Agency, on its establishment in 2014. Until 2018, there were 109 family resource centres in the programme, seven of which are operational in County Mayo at Ballina, Castlebar, Westport, Claremorris, Ballyhaunis, Ballinrobe and Kilmovee. Family resource centres are independent voluntary organisations that deliver universal services to families in local communities based on a life-cycle approach. Centres seek to combat disadvantage and provide supports to improve family life. The family resource centre programme emphasises the involvement of communities in tackling the problems they face, working inclusively with service users and creating successful partnerships between voluntary and statutory organisations at community level.

In budget 2018, the Minister for Children and Youth Affairs, Deputy Katherine Zappone, secured an additional €3 million for Tusla to support the family resource centre programme. The additional funding is being used to support existing family resource centres and to provide for the expansion of the programme with the inclusion of 11 new centres. Following a public application process, Tusla announced recently the 11 centres which are being included in the programme this year. I understand that applications to Tusla to join the programme were of a very high standard. The criteria considered included the size and make-up of the geographical area, the social and economic conditions in the specified area and the overall population breakdown of the area that would be serviced by the proposed centre. The criteria also considered the structure of the organisation applying to the programme, its objectives, targets, current relationships with other organisations and the inclusion of available research, community projects and needs assessments with the application. A high number of applications, 47 in total, were received by Tusla, one of which was from an organisation based in the Erris area of Mayo.

Tusla was faced with a difficult decision-making process to select 11 new centres for inclusion in the programme. It is important to emphasise that Tusla recently established an online virtual child and family support network for Erris and Ballina. Child and family support networks represent services which play a role in the lives of children and families in a given area such as statutory service providers and local voluntary and community services. The aim of these networks is to ensure that if a family presents to a service which cannot meet its needs, the service can redirect the family to another service which is more appropriate. The new online network will enable services to develop an understanding of the work of other providers in order to facilitate the provision of a more integrated service to families in the community. Tusla has advised that it also funds a full-time family support worker in the local area. The Mayo children and young people service committee also brings together representatives of State bodies and community and voluntary services who work with children and young people in the county. The committee is currently finalising a three-year plan for Mayo which will include an audit of services working with children, young people and families in Mayo, as well as a local needs analysis. Future commissioning of services by Tusla in County Mayo will take the completed local needs analysis into account, including any gaps in services wherever they may be identified. Through its prevention partnership and family support network, Tusla will continue to provide supports through the targeting of additional resources to services which will impact positively on vulnerable children and families.

I thank Senator Conway-Walsh for raising the matter. It is of key importance that the needs of children and families are met in the best way possible, in particular in areas of disadvantage. I assure the Senator that my colleague, the Minister for Children and Youth Affairs, will continue to support the work of family resource centres. Family support is a key priority for her.

I hear what the Minister of State is saying. I have worked in the middle of all of this. In the context of interagency co-operation and the work that can be done, what is needed is a family resource centre. I welcome the fact that a support worker will be in place but it is not enough. However, that is not adequate to replace the community development project and the extra family support that is needed in the area.

The Minister of State will know there has been severe tragedy across that area in recent years and even in the last number of months. These services are desperately needed. I will contact the Minister, Deputy Zappone, separately but I ask the Minister of State to ask her about this.

There are exceptional needs in this area which will not be covered in the local needs analysis. There will be lives lost in three years. The quality of life in those three years for people who desperately need the services which could be provided through a family resource centre will not be improved. That really concerns me. We have all these headline figures. We need to get down to these people who are extremely vulnerable. Time is of the essence in doing so. I will write to the Minister separately to ask her to consider Erris on an exceptional needs basis. I do not want to get caught up in an audit. The deprivation figures speak for themselves. This has the backing of all of the statutory agencies, which do not do things like this lightly, because they know the need. Some of them are working in the area and people who they work with in their teams have to travel out to the Erris area. I thank the Cathaoirleach and the Minister of State, but this is just the beginning of the fight for a family resource centre in Erris.

I will just reiterate the point that the Minister, Deputy Zappone, is very committed to supporting Tusla in its work, which we all acknowledge. Tusla is doing a very good job in the area of children, an area in which I have a particular interest having chaired the relevant committee previous to my current appointment. There was an additional €3 million allocated for family resource centres this year, which was very positive and which was an acknowledgement by the Government of the good work which they do and the need for them in communities. We are all in agreement with the Senator on that.

As I said in my initial reply, there were 47 applications. Only 11 were successful on this occasion. I cannot speculate on the level of funding which will we be made available in 2019 but I will sincerely be supportive and hopeful that an additional allocation will be made next year. If there is, I have no doubt that the Department will be more than willing to work with the Senator, the Mayo children and young people's services committee and the child and family support network for Erris and Ballina in order to identify the needs there and to recognise the very genuine and legitimate issue which the Senator has raised here today.

GLAS Administration

I would like to thank the Cathaoirleach for selecting this item, which relates to agriculture and GLAS 3 payments terms and conditions. I acknowledge the presence of the Minister of State, Deputy Jim Daly, who has kindly agreed to step in and take this issue on behalf of the Minister, Deputy Michael Creed. I received a telephone call from the Minister's office today informing me that he was unavoidably absent. I fully understand and respect that.

I want to address a number of issues. As part of the criteria for GLAS 3, there is a requirement to undertake a soil analysis and nutrient management plan. An applicant must be compliant with that to avail of the funding and supports under GLAS 3. I have had a look at the guidelines provided by the Department of Agriculture, Food and the Marine in respect of the European regulations on the GLAS payments and the co-funding for them. I have set this out in an email to the Minister, but on page 36 there are strict criteria. Failure to comply with the nutrient management plan and to have it filed by 31 March 2018 will incur penalties. No GLAS payment will issue to farmers for completion of the nutrient management plan if they fail to comply with the terms and conditions.

My case and the case of farmers and people who have lobbied me in this regard is that we know that the land is swamped. I spoke to a farmer in Tuam the other day. His land is swamped with water and yet he has to have soil cores bored and tests complied with and filed by 31 March. He will simply not be able to do it. Anyone, urban or rural, driving around this country in the last few weeks would be aware that we had Storm Ophelia, Storm Eleanor, Storm Fionn and Storm Emma. We had vast flooding of our grounds. Nobody wants not to comply with the terms and conditions of GLAS 3. We heard time and time again of the failure of farmers under GLAS 1 and GLAS 2. We still have ongoing issues with people not receiving their payments. Some of that was to do with compliance. We cannot tolerate people who do not comply. I accept that. I am not here to make a case for people who do not comply with the GLAS terms and conditions. I am here today, as someone who sits on the agricultural panel in Seanad Éireann, to make a strong case for flexibility and a reasonable approach by the Department and all those involved.

I accept that it had these terms. My proposal, which I ask the Minister to consider, is that as we monitor the situation in the run-up to 31 March, the Minister and those administering the scheme, both locally, nationally and through the European funding mechanisms, should have some flexibility. Can we extend that period for up to three or four weeks? That is a reasonable request. I acknowledge the Minister will have to be consulted but I ask the Minister of State to revert to the Minister and to the Department and to make a case for a reasonable, fair approach to farmers whose lands are swamped and who cannot comply with the soil testing and the nutrient management plan data they have to file by 31 March. These farmers need leeway in order that they will not be penalised and struck off for what is effectively a substantial and important payment for them under the green low-carbon agri-environment scheme, GLAS 3.

I thank Senator Boyhan for raising this matter and ask him to please accept the apologies of the Minister, Deputy Creed, for his absence, as he is at a funeral this morning.

On his behalf, I wish to outline the current position regarding GLAS. We are very pleased that the GLAS scheme has proved to be such a popular scheme among Irish farmers and that the original target of 50,000 participants was surpassed well ahead of the date scheduled. Given that the first approvals under the scheme run from 1 October 2015, it is a remarkable achievement that this 50,000 target was exceeded within a period of 15 months. GLAS has a maximum annual payment of €5,000 under the general scheme, with provision for payment up to €7,000, known as GLAS+, where the farmer is required to give exceptional environmental commitments in a limited number of cases. Last year we paid out almost €200 million on GLAS and have continued payments each week this year with a further €32 million paid to date.

GLAS, like previous agri-environment schemes, supports participants in improving their agricultural productivity and practices in a sustainable manner. GLAS was opened in three tranches. The issue being raised here today relates to the third tranche of the scheme, known as GLAS 3. There are more than 13,000 participants in this tranche who are required to submit a nutrient management plan to the dedicated online nutrient management planning, NMP, system operated by Teagasc. The deadline for the submission of these plans is, as Senator Boyhan pointed out, 31 March 2018. This deadline, as with all such deadlines, is being monitored on an ongoing basis. The relevant participants have received ongoing reminders of this deadline and it is matter for them now, in conjunction with their advisers, to ensure that they meet this deadline.

The GLAS scheme delivers overarching benefits to the rural environment and addresses the issues of the mitigation of the impacts of climate change, the enhancement of biodiversity and the improvement of water quality. The scheme provides valuable support to participants who deliver public goods and environmental benefits that benefit all of us. The scheme is co-funded by the national Exchequer and the European Agricultural Fund for Rural Development. As required under EU regulation, two payments issue each year, namely, the advance payment followed at a later stage by the balancing payment. In 2016 and again in 2017, the advance payment represents 85% of the annual payment, with a balancing payment being 15%. The 2017 advance payments commenced on schedule in November 2017 and continue to be made on an ongoing basis as tranches of cases are cleared. The current position is that 97% of eligible participants have now received their GLAS 2017 advance payment. In some of the outstanding cases, applicants remain ineligible for payment until they complete the steps they must take before the Department can process their payment. There is nothing we can do to advance these payments until the applicant completes their obligations. In most of these cases, this relates to outstanding documentation which they must submit. As soon as this is received and assuming everything is in order, the Department will move immediately to issue payments. The main issues include the need for advisers to commence a commonage management plan in the case of participants with a commonage action and to submit the required documentation in the case of the low emission slurry spreading and rare breed actions.

It is simply not possible for the Department to make payments in these cases because the participants have not met the requirements. I appreciate that the Senator has made the same point. Updates are published weekly on the Department’s website and clearly show that steady progress is being made. While the officials are prioritising the clearing of cases and where a farmer has been contacted for additional information, it is important that any such request is responded to as the information requested is essential to finalise all checks. While the issue of payments is of importance, we must also recognise what the scheme is delivering in terms of the environmental and public goods. What the buy-in to the scheme by the farming community is achieving includes the fact that the low-input permanent pasture and the traditional hay meadow actions are delivering more than 350,000 ha of diverse grassland species. Moreover, 29,000 km of river bank are managed to protect rivers from pollution under the protection of watercourses from bovines and riparian margins actions.

There are over 200,000 ha of farmland bird habitat managed to protect bird species, over 20,000 ha of wild bird cover planted, providing winter feed for farmland birds, over 2 million trees planted, almost 5,000 farmers using new technologies to spread slurry, and 10,000 ha of arable land cultivated using minimum tillage techniques. These achievements will deliver public goods across the key areas of water quality, biodiversity and climate change, and will place Ireland in a positive position in discussions on future agri-environment schemes.

I thank the Senator for the opportunity to outline the achievements under the GLAS scheme.

The Minister of State's reply is comprehensive, though I note the reply spells my name wrong. It is Boyhan, not Boylan.

We will not blame the Minister of State for that.

I want to keep the focus on one simple thing, namely, that there have been storms Ophelia, Eleanor, Fionn and Emma and lands are flooded. The Minister needs accurate readings and to get them one needs proper, drained soil. There are many complications because people feed cattle out on the land and we need appropriate readings in order to comply with the conditions for grants. The issue is a four-week extension but I accept that the Minister of State cannot tell us today that he is extending this for a month. Nevertheless, I ask that he keep it under consideration, engage with and consult the relevant people in the area and, perhaps, come back to us before the end of the month. There is a crisis and there will be weather issues in the next week or two. I will not support people who do not comply but I know the Minister is flexible and reasonable. He comes from the agricultural sector himself so he will have experience of these difficulties.

The Minister has assured me that it is still being monitored. I thank the Senator for being reasonable. He makes a logical and reasonable argument and I will relay it to the Minister for Agriculture, Food and the Marine.

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