Commencement Matters

Hospital Waiting Lists

I welcome the Minister of State at the Department of Health, Deputy Jim Daly.

I thank the Minister of State for taking the time to deal with this issue. I am concerned about the waiting time in having cataract operations performed and accessing the required expertise to deal with eye problems, particularly for elderly persons. In the past six months I have received many queries about the waiting list and waiting time for cataract operations, particularly in Cork. One of the things I want to find out is how the issue can be dealt with now to make sure patients receive treatment in a timely matter. I ask the question because the greater the delay in receiving treatment the less likely it is that a specialist will be able to solve eye problems. The issue is extremely important because the loss of eyesight leaves a person extremely limited and in need of a lot support from the health service. It is extremely important, therefore, that anyone who has problems with his or her eyes, his or her eyesight in particular, and requires a cataract operation have the procedure carried out at the earliest possible stage. It is in that context that I raise the question. I want to know, in particular, whether services for the people who are waiting can be outsourced and the number who can be accommodated in accessing treatment, particularly in Cork.

I welcome the opportunity to address the House on this issue. The Minister for Health, Deputy Simon Harris, has committed to tackling long waiting lists. It is acknowledged that cataract surgery is among the most common surgical procedures carried out in the ophthalmology speciality. It was with this knowledge, when proposals for the joint HSE-National Treatment Purchase Fund, NTPF, inpatient and day case action plan were under development earlier this year, that the Minister sought a particular focus on waiting times for a number of high volume specialties, including cataract surgery. The action plan allocated one quarter or 5,000 of the 20,000 planned NTPF procedures to cataract treatments. Furthermore, under the action plan, the NTPF commits to offer treatment to all clinically suitable patients who have been waiting more than nine months for a cataract procedure. By the end of August over 4,100 patients had received cataract treatment through NTPF funding. This represents 83% of the target of 5,000 set in the action plan.

The impact of the action plan can be seen in the improvements to waiting lists for cataract procedures which have seen a reduction of over 3,100 in the past 13 months. The August 2018 figures show that there are 6,868 people on the waiting list for cataract procedures compared to over 10,000 in July 2017. However, the reduction in waiting list numbers does not fully reflect the progress made. In January 2018 as many as 8,027 patients were awaiting cataract surgery.

Between January and August, 5,982 patients were added to the waiting list, therefore numbers have more than halved from 14,000 to 6,900 in the eight-month period. In addition, the number of patients waiting longer than nine months for a cataract procedure has gone from over 4,300 in July 2017 to 1,078 in August 2018, with 64% of patients waiting three months or less. Between January and August, the NTPF issued almost 7,300 offers of treatment to patients awaiting cataract surgery who were clinically suitable for outsourcing.

The action plan also recommends that the HSE and the NTPF identify sustainable initiatives to improve waiting times. A dedicated cataract theatre in Nenagh hospital opened in July. Since the service commenced in July, 53 patients have been treated and it is expected that more than 200 cataract procedures will be undertaken by the end of the year. Yesterday's budget announced an allocation to the NTPF of €75 million in 2019 from which the NTPF plans to fund 25,000 inpatient day case treatments. Under these plans, I would expect that the number of cataract procedures to be funded in 2019 will be similar to 2018 levels.

I thank the Minister of State. I note the figures to which he referred. Unfortunately, the people who have been in contact with me have not benefitted under outsourcing. It is in that context that I raised the question. How are people selected to receive treatment under the NTPF? How are they prioritised? Is it based on the period of time they have been waiting or on decisions made by people within the administrative system? I am a bit concerned as to why some people who have been on the waiting list for quite a long time are not selected. It does not appear to be based on the time one has been waiting but rather on random selection. I am not clear on how it is being dealt with. Could I have some clarification on that?

The important thing to note is that the number of patients waiting longer than nine months for a cataract procedure has gone from over 4,300 in July 2017 to 1,078 in August 2018. It is clear that in that 12-month period almost 3,300 people were taken off the list of those waiting in excess of nine months. That is where the focus has been.

If the Senator looks at the earlier figures with regard to the number of patients who have left the list altogether, which states that 83% of the 5,000 person target has been achieved, he will see that the majority of that decrease, 3,000 of more than 4,000 patients, came from the list of those waiting in excess of nine months. The primary focus is on those waiting longer than nine months. They would all be offered treatment. Not everyone would want to accept, but they are the first priority. There would then be a number of exceptions made on clinical grounds and so on. I assume the HSE or a clinical team could make a decision in that regard. The primary focus, however, is on those waiting a long time, as evidenced by the figures which show that 3,300 have left the list of those waiting longer than nine months.

Special Educational Needs Service Provision

I wish the Minister of State a good morning and thank him for coming but, as he can imagine, I was expecting the Minister for Health. While I value the Minister of State's time I feel this issue deserves the attention of the Minister. I will ask my questions, however, because they are important. I will relay them as I would have to the Minister in order that the Minister of State will be able to take my message back in full.

Last month the Taoiseach came to Carlow. I asked him to come to have a meeting and to wish a happy birthday to Holy Angels, a very special facility for children with special needs in Carlow. I hoped he would see the need and know that it needs help. It would also allow the centre to raise its concerns. He could not come because his schedule was tight but I have serious questions to ask this Government about promises which were made and not kept. I now put these questions to the Minister of State.

The Holy Angels centre in Carlow recently celebrated its 40th birthday with a fundraising night. Families who used the service over the four decades joined in the celebrations and were more than generous, but fundraisers for this incredible facility are a regular occurrence because there is no other help for it. Our community in Carlow is amazing. It digs deeper and deeper again and again, but it is not fair. The centre has been promised capital funding and has been waiting years for it.

The Holy Angels Day Care Centre was established in the basement of Carlow's old district hospital in 1978 because there was a need for day care for children with special needs. There is still that need today but the centre is in urgent need of investment. The centre is now a designated specialised preschool for children aged from 18 months to six years and caters for children with a range of disabilities such as Down's syndrome, cerebral palsy, spina bifida, autism and rare conditions such as Pierre Robin syndrome and Rett syndrome. There are 35 children in the school, which has a waiting list of 20 because it is still waiting for capital funding which was promised more than 11 years ago. An interim amount of €150,000 was given last year. That was urgent. The Minister, Deputy Harris, had to come down because the roof was leaking and the flooring was in a very bad state. As some service users use wheelchairs, all that flooring had to be taken up and new flooring put down.

From a basement to prefabricated accommodation, the staff have had to work in these conditions and they deserve better. The children deserve better, as do the parents of those children left idling on waiting lists. They were given promises and commitments but they have not received their new school. Essential maintenance work was completed but that is just not good enough. They all need a school for Holy Angels that is fit for purpose. The facility has a wonderful hydrotherapy pool for the users of the centre, from which the wider community also benefits. This 21 year old hydrotherapy pool needs to be upgraded. This facility was promised funding for a new school and pool but, again, nothing has happened.

As someone who has been on the board of Holy Angels for the last few years, I would like to say that we have been getting information from the HSE. It is telling us everything but telling us nothing at the same time. We are told there is a site. We have been told that and told it again. We are just waiting on the capital funding because the school's current location is too small to allow for extension. We need a larger site. The HSE has a site in Carlow. It is telling us that it is there. I am looking for full commitment from the Minister of State on that funding.

The second status report I seek is on the overnight accommodation for respite services for parents of children in Carlow. These services were previously provided by Holy Angels in a house in Carlow called Tír na nÓg which closed in December 2015. Arrangements for alternative respite provisions were set up in partnership with the HSE and Holy Angels and extended until a tender process for the provision of respite services in Carlow-Kilkenny was completed. Enable Ireland was the successful tenderer. Since 1 September 2017 Enable Ireland has taken over the provision of respite services to children with complex disabilities in Carlow-Kilkenny. The matter of providing overnight respite services to families in Carlow-Kilkenny has not yet been dealt with. A house, formerly a Patrician Brothers home, was purchased in Tullow and the families were promised that the renovation and setting-up of the house was to be fast-tracked and that they would see a new service later this summer. That has not happened. The house was supposed to be ideally suited to the needs, and renovations were not expected to cause any delay. When are the children going to be put in this overnight respite service that was promised? It is three years since we had overnight respite in Carlow. It is unacceptable.

The reason I brought this up today is because we spoke about people in need in respect of the budget. We have Holy Angels and a respite service in a house called Tír na nÓg in Carlow. Holy Angels is in prefabricated accommodation. This is 2018 and this has been going on for 40 years. It is unacceptable.

On behalf of my colleague, the Minister for Health, Deputy Harris, I am happy to provide an update to this House on the status of the Holy Angels Day Care Centre and its respite service in Carlow. As the Senator may be aware Holy Angels is a designated, specialised preschool for children aged 18 months to six years who have special needs and caters for children with a range of disabilities such as Down's syndrome, cerebral palsy, spina bifida, autism and rarer conditions. Facilities include a hydrotherapy unit, a soft play area, a multisensory room, an outdoor play area, a family room and three classrooms. Holy Angels Day Care Centre is funded by the HSE and almost €580,000 has been allocated for 2018.

Efforts have been ongoing in recent years to secure a new school building. One of the issues that management at the school faced was trying to secure an adequate site for the new school building. This hurdle has now been overcome as the HSE has said that it will make land available at Kelvin Grove for the new school. In the interim, major renovations and a general revamp have been carried out in recent weeks on the Holy Angels building at Strawhall Estate. This included floor replacement and repairs to the roofs of the prefabricated units. The children's toilet has been moved to a different location and new fire doors have been installed.

Historically, respite care was provided by Holy Angels in Carlow and by St. Patrick's Centre in Kilkenny. However, following inspection by HIQA, both of these centres fell short of the necessary standards. The HSE carried out a mapping exercise of the need regarding children's respite for Carlow and Kilkenny and concluded that a single service provider should provide respite services to children in the Carlow-Kilkenny area. Following a tender process Enable Ireland was named as the successful service provider to provide respite care services for children with disability and complex care needs including autism spectrum disorder in the Carlow-Kilkenny area.

Enable Ireland has taken on the responsibility of children's respite services in the Carlow-Kilkenny area from September 2017. The matter of providing overnight respite services to families in Carlow-Kilkenny is of key importance to the HSE and Enable Ireland. A property has been identified to provide overnight respite and the process of purchasing this property is under way. Once the purchase is complete, the property will be refurbished in line with Health Information and Quality Authority, HIQA, standards in order that it is an appropriate setting to deliver overnight respite services to children. Until this property is available, Enable Ireland will work with the children and their families from the Carlow-Kilkenny area in order that it can continue to offer alternative respite supports to these families.

I thank the Minister of State. Will he clarify what he meant when he mentioned facilities, including a hydrotherapy unit, a soft play area and a multisensory room? He said that almost €580,000 has been allocated by the HSE? Has this money been allocated to the Holy Angels centre?

The respite services in Tullow went for tender months ago, but we have had no update on that. Is there a problem with the funding? We were told the children would have access to overnight respite by early summer, but this has not occurred as we approach the end of the year. It is all about timescale. I need clarification from the Minister of State today on what exactly is happening. The Holy Angels centre needs more than €5 million to build a new school. The HSE has told us we have the site.

I have raised this issue three times.

The Senator has made her points clearly.

I am not getting answers. I accept that the Minister of State is just covering for the Minister of Health.

The Senator should allow the Minister of State to answer her now. As she has put him on the spot, here we go.

It is frustrating that, with the budget process under way, babies and children are in prefabricated buildings 40 years after the Holy Angels organisation was founded. We still have no commitment to a building for Holy Angels. I ask the Minister of State to resolve this issue. I know he will revert to the Minister of Health, but we need an answer on this.

I also need clarification on the €580,000 in funding. On what exactly is that being spent?

I have given the Senator answers. I can clarify that the figure of €580,000 is for 2018, not 2019. It has been allocated by the HSE for the Holy Angels centre. The Senator said that not a cent had been given and the centre was relying on fundraising. That is not correct. Some €580,000 was given.

I am on the board and we need to clarify this.

I have no problem giving the answers that the Senator seeks if I am allowed to do so. She asked a number of questions about the future. I confirmed that the site had been secured and provided by the HSE, which allows it to progress to the next stage. She also asked about respite and I replied that a review of the services had been carried out. Many counties are well behind Carlow-Kilkenny in that area and their reviews have not taken place. The review has taken place in Carlow-Kilkenny, the outcome has been agreed, a tender process has been carried out, and a successful conclusion to that process has resulted in Enable Ireland getting the contract. There is a building to be procured, the sale of which is going through at the moment. Once it has been procured, there will be additional capacity for Enable Ireland and the HSE to provide additional respite services.

I have given a number of answers now, and I reiterate that the money has been given to the services, there has been a review of the respite services, a site has been chosen and agreed for the brand new school, and a new building is in the process of being purchased for the additional respite provision.

I thank the Minister of State but we need this in writing because the information I have differs slightly from the information he provided.

Health Services Provision

I thank the Minister of State for coming to the House to address the issue of chronic pain, which I deal with on a day-to-day basis in my practice. More than 500,000 people in Ireland suffer from chronic pain, which is pain that lasts longer than three months. The prevalence of chronic pain is approximately 35% of the population. As we know, it increases with age and manual labour. Lower back pain is the most common form of chronic pain syndrome. Some 12% of people with chronic pain are unable to work or have reduced working hours. This is not only a public health problem, therefore, but it also has serious economic ramifications.

When people are in debilitating chronic pain, they often phone their general practitioner from bed because they are unable to get up or move. I have taken many of these calls over the years and visited the patients in question. A pain management clinic, led by a consultant anaesthetist who specialises in pain management, is a viable option for these patients. It is not an ideal scenario to have such clinics located more than two hours away from patients. I am not calling for an accident and emergency department in every back garden but for a much-needed facility to be established in County Mayo, where there is a population of 140,000. Patients in the county and also in County Roscommon are forced to travel either to Sligo University Hospital or University Hospital Galway to access a pain management service. These patients are usually maxed out on oral and topical medications and patches, many of which are opioids which are not good. The GP will be at the end of his or her tether because the patient has maxed out all the medications. The patients tend to be elderly and they may be forced to travel on a poor road network or on an inadequate public transport system.

Pain management clinics provide a vital service and we need one in County Mayo. The Sligo pain management model, for example, has consultant orthopaedic surgeons, consultant anaesthetists in pain management, consultant rheumatologists and specialist physiotherapists all working together as a team. There is an excellent orthopaedic service in Mayo University Hospital. Recently, after many years of campaigning, the decision was taken to provide for a visiting rheumatologist from Manorhamilton. The missing cog here is a consultant in pain medicine.

Increased interdisciplinary pain rehabilitation programmes are essential to improve quality of life and they can reduce the economic burden of chronic pain in Ireland. I ask the Minister of State to investigate the possibility and feasibility of opening a pain management clinic in Mayo University Hospital.

I welcome the opportunity to provide an update to the House on this issue. Chronic pain is a major problem, which the Senator, who is a practising medic, understands well. He has eloquently outlined the case here for those suffering from the condition. It is important that patients have access to diagnosis and effective pain management programmes as quickly as possible. The delivery of services in the most appropriate environment and location with the required multidisciplinary team expertise is a key element of the Saolta University Healthcare Group's clinical strategy.

Unfortunately, however, there are no immediate plans to commence a pain management service in Mayo University Hospital. The pain management service within Saolta is currently delivered from University Hospital Galway and Sligo University Hospital with a limited service in Letterkenny University Hospital. I acknowledge there are waiting lists for pain relief services at University Hospital Galway and Sligo University Hospital. Improving access to hospital treatment is a key priority for Government and yesterday's budget announced an allocation to the National Treatment Purchase Fund, NTPF, of €75 million in 2019, from which the NTPF plans to fund 25,000 inpatient day-case treatments.

The priority of the Department of Health is to maintain a seamless continuation of the considerable progress made this year into next year. The Department is working closely with the NTPF and the HSE to finalise a coherent waiting list action plan for 2019 before the end of this year.

It is deeply disappointing to learn there are no plans to open a pain management clinic at Mayo University Hospital. While I acknowledge the Minister of State's comments on the expansion of the NTPF, what will inevitably happen is these people will still have to travel to Sligo or Galway to access the service. It is unfair to people who have chronic pain. There are 140,000 people living in County Mayo. A clinic in Castlebar could also facilitate patients travelling from County Roscommon. This issue needs urgent attention and I ask the Minister of State to look at the matter again.

Also, will the Minister of State give an update on the proposal for the 20 additional acute beds in Mayo University Hospital which were meant to be delivered through the modular building unit? Are there any plans for the redevelopment of Belmullet Community Hospital?

The Senator has shone a light on this issue and I welcome the opportunity to comment on it. I understand the Senator's passion, conviction and ability to comment on such issues as someone who practises on the ground. That is what this forum is for and what politics is about. It is people like him who bring that knowledge with them to put the focus on the national organisation that is the HSE through the Department of Health. I certainly will do so for the Senator. I will convey his request and strong belief that it is necessary to provide a pain management clinic at Mayo University Hospital. Obviously, there are waiting lists in other hospitals, but I certainly will support the Senator in his endeavours to have such a clinic provided. I will raise the issue with my colleague, the Minister for Health, and the relevant departmental officials. I will also obtain an update from the Minister on the modular beds provided in Mayo General Hospital and the upgrade of Belmullet Community Hospital. I undertake to come back to the Senator on both issues.

I thank the Minister of State.

Foreshore Licence Applications

I welcome the Minister of State at the Department of Housing, Planning and Local Government, Deputy Damien English

I, too, welcome the Minister of State.

There is an interesting backdrop to my Commencement matter. As we all know, applying for a foreshore licence is a long, difficult, slow and tedious process. At 6 a.m. on 4 January 2014 the shoreline in the village of Lahinch, County Clare was destroyed. Millions of euro worth of damage was caused and the incident had a significant impact both on the lives of the community and businesses in the village. To be fair, everyone rallied around and a significant job of work was done to restore the village. With the support of Clare County Council, the Department of Housing, Planning and Local Government, the Office of Public Works and all other stakeholders, together with business people, the streetscape, promenade and general facilities in Lahinch are superior to what existed pre-2014. Obviously, because of the climatic changes we are experiencing, the difficulties and challenges remain. I refer to the effects the Atlantic Ocean could have if a similar incident was to happen.

The Department has spent several million euro, through Clare County Council, in installing coastal protection features along parts of the promenade in Lahinch. Work still has to be done on a significant part of the promenade, but it has been earmarked and funding is available for it. There is one small problem, that is, the granting of a foreshore licence. I have been advised by officials of Clare County Council that the process has been continuing a long time and that if the foreshore licence was granted, that the coastal protection works would be carried out very quickly. When can we expect the foreshore licence to be granted? What is the timeline? What are the issues which are delaying the granting of the licence? When it is granted, it will facilitate the quick completion of the coastal protection works which are very important. I would like to see the works being carried out before the 2019 tourism season commences next April or May. Perhaps that is an ambitious target, but I have been advised that once the foreshore licence is granted, the works can commence very quickly.

I thank the Senator for raising this matter in the Seanad, outlining the background to it and explaining how we have ended up where we are. I also thank him for reminding us about the importance of undertaking coastal protection works and the power of the oceans which, in turn, highlights the importance of the upcoming marine strategy which will look ahead for the next 20 years. It will deal with all of these matters and is a chance to conduct a review. I understand how crucial the coastal protection works are in ensuring the integrity of the pier and other areas in Lahinch. I am also aware of the need to have the works completed in advance of the 2019 Irish Open Golf Championship which is due to be hosted at Lahinch Golf Club in early July. I acknowledge the significant boost the hosting of the event will give to the local economy, as well as to the tourism industry in the region next May, June and July. I, therefore, welcome the opportunity to provide details of this issue to bring clarity to it. I hope we can move on the matter as quickly as we possibly can.

Before I address the specific case, I will outline my responsibilities under the Foreshore Act 1933, as amended. I am responsible for regularising the use of the foreshore in accordance with the legislative provisions set out in the Act. I must also ensure proposed developments or activities comply with relevant European legislation such as the environmental impact assessment, EIA, directives, the birds and habitats directives. In addition, I must be satisfied that any consent given under the Act is in the public interest.

The application concerned has yet to be brought before me for a formal decision. However, I can say it was received from Clare County Council in December 2016 for the repair of existing wall structures, the construction of a new rock armour revetment and other ancillary works at Lahinch. When the works are completed, they will protect public infrastructure, public property more generally and private property. They require a number of consents under the Foreshore Act, including a lease and a number of licences. I understand the importance of the project and my Department has progressed the application in the normal way. As applies to all applications of this nature, it has consulted the relevant bodies and sought the views of the public through a public consultation process.

The application has also undergone a technical examination by the marine licence vetting committee, an ad hoc group of experts, that has for many years advised successive Ministers on foreshore related matters. The committee has recommended that a licence, a lease and a temporary licence for a haulage and access route be issued. This addresses most of the areas highlighted in the application for development. In addition, the council indicated in its application that an area of 0.6326 ha was in private ownership. Where work is to be carried out on a privately owned foreshore, a lease or licence under the Foreshore Act is not necessary. However, the owner of the foreshore must still submit plans and other information such as environmental data to my Department for my approval. In addition, any work carried out must be in accordance with the plans as approved. Under the Foreshore Act, this is known as section 10 consent.

As all of the foreshore is assumed to be owned by the State, unless it can be shown otherwise, my Department has sought evidence of title to this area of the property before submitting the case to me for consideration. However, the council has been unable to provide the necessary evidence. It has further advised that the property is unregistered and that there is no legal instrument. Given the complexities this presents, my Department has sought legal advice from the Office of the Chief State Solicitor which has since referred the matter to the Office of the Attorney General. My Department awaits the outcome of their deliberations. While awaiting the advice of the Attorney General, it is actively examining potential solutions, with the support of our legal advisers in the Office of the Chief State Solicitor. Once the issue of the area which is purported to be privately owned has been resolved, my Department hopes to bring the matter to a speedy conclusion. I will certainly stress to everyone the importance of trying to have the matter resolved as quickly as we possibly can.

The Minister of State has clarified the complexities and difficulties associated with the foreshore licence application. I ask him to have a word with the Attorney General to ensure his opinion is articulated to the Department of Housing, Planning and Local Government as a matter of urgency in order that the matter can be brought to a conclusion. I make my request because the Atlantic Ocean and inclement weather will not await the advice of the Attorney General or the Office of the Chief State Solicitor. The ultimate solution is for the foreshore licence to be granted to enable the coastal protection works to proceed and be completed before the Irish Open Golf Championship is held in Lahinch next July.

I again thank the Minister of State for his intervention and coming into the House to address the matter. I know that, as a result of having raised it in Seanad Éireann, there will be a new impetus to get it over the line as a matter of urgency.

I again thank the Senator for raising the issue which is of local and national importance. I will discuss it with all relevant bodes to try to secure a speedy decision.

My Department would like to conclude the matter to enabling the works to be completed.

I thank the Minister of State.

Sitting suspended at 11.10 a.m. and resumed at 11.30 a.m.