Commencement Matters

National Dementia Strategy

I welcome the Minister of State.

I welcome the Minister of State. I would like to share time with my colleagues, Senators Devine, Swanick and Humphreys. I know it is unusual, but we wish to outline a cross-party approach to the matter. We are all members of the all-party Oireachtas group on dementia. I thank Senator-----

It was submitted in all our names.

I regret that no notice was given of this intention.

It was submitted in all our names.

I am advised it was not.

It is a Commencement matter, not a motion.

However, it was submitted in all our names.

It was submitted in all our names.

It is in Senator Kelleher's name only.

However, I submitted it in all of our names.

The Senator cannot submit a Commencement matter on behalf of other Senators. She could do so for a motion, but not for-----

I will speak on behalf of everybody else, but we all signed and it was an idea that came from the group.

I am advised that in the circumstances, I could give a minute to each of the others.

We have it worked that way.

Senator Kelleher can take two minutes and I will give the others a minute each.

The Leas-Chathaoirleach is very generous.

However, there is no arrangement. I am totally reliant on the advice I receive, as Senators will understand.

We appreciate the Leas-Chathaoirleach's largesse.

It is an unusual situation. We will allow it. Senator Kelleher has two minutes and the other Senators have a minute each.

I thank the Leas-Chathaoirleach and the Clerk of the Seanad for allowing us the opportunity to raise this important issue. I welcome the Minister of State, Deputy Jim Daly, to the House. Dementia is an issue that affects every community throughout Ireland. An estimated 55,000 people live with the condition with this figure expected to more than double in the next 20 years. People with dementia need a wide range of community services to support them from the moment of diagnosis and throughout their journey. We are all aware of the significant gaps in these vital services and supports in every county.

We have worked hard together as a group. Today we made a decision to focus on the estimated 4,000 people who develop dementia each year. That is at least 11 people per day. Those are not my estimates; they come from the HSE's Understand Together information campaign. Each one of these 11 people and their families need access to a dementia adviser to support them as they embark on their journey with dementia, which can last years or even decades. Many of us in the group have medical backgrounds and we have had hands-on involvement with the frightening terror when somebody is given that diagnosis.

A dementia adviser works with people with dementia and their families, providing a highly responsive and individualised support to the person with dementia from the moment of diagnosis onwards, and includes their carers. They help people to connect with dementia supports and services in their areas. However, there are only eight such advisers throughout Ireland. Access is on the basis of a postcode lottery.

The Senator's time is up.

As a member of the all-party Oireachtas group, I am acutely aware of the lack of equity. Sinn Féin's budget submission strongly advised the Government to provide funding for an increased allocation for dementia advice.

I thank Senator Kelleher for sharing time. A recently published independent report, Evaluation of The Alzheimer Society of Ireland Dementia Adviser Service Report, by UCC, which was commissioned by the HSE's national dementia office as part of the implementation of the national dementia strategy, highly recommended an increase in the number of dementia advisers to meet the increasing demand as a result of increasing prevalence of dementia in Ireland. The report also recommends the development of the service to achieve national coverage.

This independent evaluation is the first external evaluation of the dementia adviser service in Ireland and it has provided evidence of overall high levels of satisfaction with the service. People living with dementia, their carers, and health and social care professionals reported satisfaction with the information, advice, peer group and signposting of services provided by the service. The report found challenges with equity of access to the dementia adviser service across the country and a large number of people with dementia, including some in counties Roscommon and Mayo, and their families simply cannot access a dementia adviser because of where they live.

This is a vital support for people suffering from dementia and their families.

Will the Minister ensure that funding for an increase in the number of dementia advisers will be included in the upcoming 2019 HSE service plan? Nothing less is needed for these families. Will the Minister also commit to building up a national network of dementia advisers in order that there is one in every primary care unit in the country? We have seen the changes at first hand and how a dementia adviser can help families and sufferers. It is vital we provide this service throughout the country. Will he ensure the funding is put in place in the 2019 HSE service plan to ensure dementia advisers are easily accessible for people diagnosed with dementia?

I thank the Senators for raising the issues. As a response to the challenges facing people with dementia and their families and carers, the national dementia strategy was launched in December 2014. It contains 35 priority and additional actions and its implementation is led by the national dementia office in the HSE. Plans are progressing to further implement the dementia strategy through the national dementia office, including in the area of diagnosis, post-diagnostic supports and care pathways.

In 2016 and 2017, the national dementia office partnered with the Alzheimer Society of Ireland on a project to map dementia-specific community-based services and supports. It provides a useful snapshot and baseline study into what, where and when dementia services are offered. The study was also used to inform a service finder hosted on the national dementia office’s website, which allows people to search for dementia-specific community services in their area.

There are gaps in access to services and a large variance in what services are provided across the country. The national dementia office met with senior HSE officials in each community healthcare organisation region to highlight gaps in each area and develop local action plans to improve service provision. The national dementia office also developed a needs analysis framework to support local dementia service planning and development. This framework is a mechanism to help the office direct time, energy and resources into dementia care that most appropriately meets the needs of people with dementia. It will be used to make dementia service development more responsive and consistent around the country.

The national dementia strategy calls for the HSE to consider the provision of dementia advisers, based on the experience of demonstrator sites. There are nine dementia advisers in the country, eight of whom are hired by the Alzheimer Society of Ireland. The HSE contributed €400,000 to the service in both 2017 and 2018. An evaluation of the dementia adviser service was published on 26 September and recommended the continuation and expansion of the service to ensure equity of access country-wide. The Government welcomes the positive results of the evaluation and will continue to work to improve service delivery for people with dementia.

Dementia advisers are not the only community support being given to people with dementia and their families and carers. The Department of Health secured funding through the Dormant Accounts Fund for numerous projects to improve care and supports for people with dementia, including the delivery of post-diagnostic supports, a dementia diagnostic service for people with intellectual disability, a national network of memory technology resource rooms, the development of a national dementia registry, the national roll-out of a dementia training programme for HSE home care staff, the development of dementia resource centres, funding for a dementia community activation co-ordinator and community support projects for people with dementia. On the Senator’s request to increase the number of dementia advisers, the quantum of services to be provided by the HSE is being considered as part of the HSE’s 2019 national service plan.

I am disappointed that all the Minister of State can say is that dementia advisers are being "considered" rather than committed to. This is after several budget submissions on our behalf and a clear evaluation by University College Cork. The national dementia strategy is welcome but it does not go far or fast enough. It is time for the Government to make good on dementia commitments and recognise the emergency that faces people with dementia and their carers in Ireland. People feel that while they may be heard by the Government and sympathetic Members, hearing and listening are not being matched with real money and public investment for real supports and services for which people with dementia and their carers are crying out. There is strong cross-party support for supports and services such as a national network of dementia advisers, a real uplift in dementia-specific home care, day supports, Alzheimer's cafes and the range of supports that are needed in every county.

As the Minister of State will know, in Cork, where we are both from, according to the Alzheimer Society of Ireland, ASI, there are approximately 4,000 people with dementia, who are cared for by 12,000 people, and an additional €500,000 is needed in 2019 to bring it up to the minimum level. That is why ASI is holding an emergency dementia summit next Wednesday to be followed by an AV room briefing by the all-party group on dementia. This is an emergency on which there is an urgency to act, and I am disappointed by the Minister of State's response.

I regret the Senator's disappointment but the HSE's service plan is in the gift of the HSE and has not yet been passed back to Government. It is up to the HSE as the Minister does not write the service plan. It must examine all areas and divide up its budget and present it to the Minister, which I expect will happen by the end of the month.

In the interim, I cannot start part-writing it nor make part-commitments on the floor of the House, which might box in the HSE. We must wait and see what the HSE will decide. While I had numerous discussions with the HSE before its preparation about what I would like to see in it, it must revert with its plans and, therefore, I will not prescribe anything here. It is not within my gift to do so until the service plan is presented to me at the end of the month when I will be in a position to comment further.

Psychological Assessments Waiting Times

I go door to door as often as I can and the other night in Raheny I came across two families with children in dire need of help from the Government. One family has a child in need of a psychological assessment in a school where there are 12 such children in need of a psychological assessment. Three of them will be able to get that assessment but this child is not one of them. The parent is now faced with the prospect of either going privately, at a cost of €650, or not having an assessment at all. What are the Government's plans to ensure every child who needs an assessment can obtain one in order that he or she can maximise his or her potential?

I came across another family where the situation was even more worrying and distressing, and the family has no problem with me naming them. Abigail, the daughter of Claire and Mark, was diagnosed with autism at the age of two. They also have two younger children and difficult enough as it is to hear that type of news about the daughter they love dearly, they have fought a war since that diagnosis to get any sort of early intervention from the HSE to benefit their child. In recent days, they were told the earliest they will get help from the early intervention team in north Dublin is approximately six months' time. The child will be almost five years of age. She will finally get help almost three years after her diagnosis. She is approximately 150th on the list, but there are hundreds and hundreds of children on the list.

Unfortunately, in this country, not only must people deal with the difficulty of managing a child with autism, as well as every other aspect of family life such as looking after other children and doing their best for them, they must also embark on a war with the State. Unless people kick, shout, roar and scream, it appears they get nowhere, and it is utterly exhausting. I do not know of any other European country that has a waiting list of this nature for a child as vulnerable who needs this intervention. There may have been an argument a number of years ago, in the pit of an economic recession, that there was no money. We could have argued over and back about the priorities in budgets and so on. In the current circumstances, however, when it is clear there are resources, why must Abigail wait three years to get access to an early intervention team in order that she can begin the journey of maximising her potential as a little girl?

I thank the Senator for raising the issue of access to children's early intervention services and psychological assessment in north Dublin.

As the Senator is aware, there is a very high demand for early intervention services. Regrettably, there are now very significant waiting times in Dublin north city and county as well as other areas. There are a growing number of local factors driving this demand, including the increasing child population and growth in terms of the number of children presenting with complex needs.

The early intervention service for the area receives, on average, between 13 and 14 new referrals a month. A high level of requests for assessment of need are also received. These are typically carried out by therapists who also work in the early intervention service. From January to August of this year, 1,251 assessments of need were completed by the HSE disability service in north Dublin.

The HSE fully acknowledges the stress that delays in access to services and assessment can cause to families and is actively working to address the waiting times. The HSE disability service in Dublin north city and county has begun recruiting for five additional posts, one in each of the following services: psychology; occupational therapy; speech and language therapy; physiotherapy; and social work. These additional staff will further contribute to a reduction of waiting times for early intervention services across the area.

The local HSE disability service is currently engaged with the HSE nationally in the reconfiguration of services for children to deliver a new model of assessment and intervention that will provide a clear pathway for children aged zero to 18 years. The progressing disabilities services programme aims to achieve a national equitable approach in service provision for all children based on their individual need and regardless of their disability, where they live or where they go to school. The programme is doing this by forming partnerships between all of the disability organisations in an area and pooling their staff, who have expertise in the different types of disabilities, to form local children's disability network teams who will provide services for children with a significant disability, regardless of their disability. Evidence to date from areas where this has been rolled out shows that implementation of this programme will also have a positive impact on waiting lists both for assessments and therapies.

Senators will be aware that funding for an additional 100 therapy posts was secured as part of budget 2019. These additional posts, along with the reconfiguration of services and other initiatives, are expected to have a significant positive impact on waiting times for early intervention and assessment of need. It will also help meet the needs of children and young people in a more efficient, effective and equitable manner.

I thank the Minister of State.

I acknowledge that the Minister of State is a compassionate individual who feels strongly about this issue. What time does he think is reasonable to wait from the diagnosis of a child just like Abigail to the beginning of intervention? What time does he aim for? What is his vision? Does he feel that three years is too long? I am sure that he does. What is a reasonable length of time for a family in this scenario to wait? I mean the families that have children like Abigail.

I do not think it is good enough for a family to be stressed over waiting for an intervention. They will have to deal with this diagnosis for many years to come as will other members of the family. Everybody around the family will be clued in to this issue. There is a constant state of conflict with agencies that are supposed to surround people with care and compassion. As happens in other jurisdictions when there is a diagnosis like this, one automatically feels as if there is a team of people working with the family and the child to improve his or her circumstances. The situation is completely different in Ireland where one feels almost completely abandoned and must work through this by oneself. The stress, as one can appreciate, is quite substantial. I ask the Minister of State the following again. What timescale does he think is appropriate from the time that a child gets a diagnosis to the time that the early intervention team can click into place? Are we working towards that timeframe? Then we can have a sense that we are all working together.

I understand what it is like for a child to be diagnosed with needs and for a child not to get services. I am a parent of a child with special needs. Like the Senator, I am a former school principal and understand the situation very well.

I also understand, as the Senator does as he formerly held my current ministerial position as a Minister of State, the challenges that exist within the system. In his opening speech he said that he understood a few years ago why every child did not get what he or she needed but now he cannot understand why every child does not get what he or she needs and inferred that there are plenty of resources available. I refute that inference and state that there are insufficient resources in the country. Despite having the largest health budget ever in the history of the State amounting to €17 billion next year we will not go anywhere near coping with the demand that is placed on that budget. Whether it is children with special needs or, like the previous Commencement matter, Alzheimer's disease, which affects the elderly, for whom the Senator cares a great deal, they are all competing needs. We also have acute sectors of hospitals and nursing homes. All sectors and all strands of society compete for funding.

To answer the Senator's question directly, it is immaterial what I think is a reasonable waiting time for a child.

I cannot accept that.

I do not mind whether the Senator accepts what I say and I am stating a matter of absolute fact.

The Minister of State must have a view.

It is completely immaterial what my opinion or belief is.

The Deputy is a Minister of State in the Department of Health so he must have a view on what is an appropriate waiting time.

I do not mind what the Senator accepts or does not accept.

There is a procedure here.

It is completely immaterial what my opinion is. We are working on a finite budget. There are competing demands for that budget across a wide variety of sectors.

That answer is absolutely unacceptable. I genuinely do not want to do this but it is unbelievable.

I cannot allow Senator Ó Ríordáin in again, unfortunately. I thank both the Minister of State and the Senator.

I assure Senator Ó Ríordáin that we have noted his concerns and interest in the area that he represents, and his desire to see those waiting lists dealt with. This is an area for the Minister of State at the Department of Health, Deputy Finian McGrath. We will continue to work with the HSE, which is the service delivery organisation, to reduce the waiting times and continue to invest in the issue, as resources allow.

Tenant Purchase Scheme

I thank the Minister of State at the Department of Housing, Planning and Local Government, Deputy English, for coming to the Chamber.

I would like him to outline the Government's plan to amend the tenant purchase scheme thus allowing Part V tenants an opportunity to buy their properties if they so wish. Most people, where possible, would like to own their own home and a home is also a very important asset for families. Amending the tenant purchase scheme would facilitate a positive transfer of wealth to a section of society that does not have that opportunity too often. Under the tenant purchase scheme, Part V houses are excluded. I believe the provision discriminates against the people who occupy such properties. There are approximately 4,000 Part V houses in the entire country. In County Monaghan there are 154 Part V properties out of a total housing stock of 1,550 units and the figures are similar for County Cavan. In my travels I have spoken to a number of young families who are heartbroken because a clause prevents them from buying the Part V properties in which they live. They dream of owning a home. Unfortunately, their dream is out of reach and will never be realised due to the way the scheme is currently designed.

From the State's point of view, it is difficult to understand why the Part V provision preventing the purchase of a home has been included. The sale of Part V properties, like other council properties, will generate much-needed revenue for the State and mean that the State is no longer responsible for their maintenance thus saving money. The moneys that accrue from sales that are part of tenant purchase schemes should be ring-fenced and given to the local authorities concerned and where the sale occurs.

In summary, I want to give the people who live in Part V houses hope that some day they will fulfil their dream of home ownership, which is currently out of their reach. I earnestly ask that the Government amends the condition in the Part V regulations that prevents people from buying their homes. The removal of the condition will allow people an opportunity, if they wish to avail of it, of investing in a property that can be their own home. Many of them have spent money on home improvements and they dream of ultimately owning those homes. I ask that the condition that forbids people from purchasing is removed so that they can, if they so wish, purchase their homes like other people do under the tenant purchase scheme.

I thank the Senator for raising this issue. It is an important issue, which has been raised at council meetings around the country and by colleagues of the Senator in this House.

The new tenant incremental purchase scheme for existing local authority houses came into operation on 1 January 2016. The scheme is open to eligible tenants, including joint tenants, of local authority houses that are available for sale under the scheme. To be eligible, tenants must meet certain criteria, including having a minimum reckonable income of €15,000 per annum and having been in receipt of social housing support for at least one year. The terms of the scheme involve discounts of 40%, 50% or 60% off the purchase price of the house, linked to tenant income. On the sale of a house under the scheme, the local authority will place an incremental purchase charge on the house equivalent to the discount granted to the tenant. Generally, the charge withers away over a period of 20, 25 or 30 years, depending on the discount involved.

The provisions of Part V of the Planning and Development Act 2000, as amended, are designed to enable the development of mixed-tenure sustainable communities. Part V units are excluded from the tenant incremental purchase scheme 2016 to ensure that units delivered under this mechanism will remain available for people in need of social housing support and that the original policy goals of the legislation are not eroded over time. The continued development of mixed-tenure communities remains very important in promoting social integration. There is a concern that if people were able to buy out all the Part V houses, they would not be used again for social housing, which would defeat the purpose of what we are trying to achieve with the Part V mechanism, which is social integration. Having said that, we are conscious that there are many people, with probably hundreds in counties Cavan and Monaghan as well as in my own county of Meath, who would like the option of buying a house and who did not realise the option would not be there. Following consultation with colleagues of the Senator and others around the country, we committed to examine the issue to see if we could find a solution but our desire is to continue with mixed communities and the social integration that goes with that. We do not have a magic solution but we are looking at it because this issue causes concern for people. Not everybody would avail of the option but they would like to have it.

Local authorities may also, within the provisions of the regulations, exclude certain houses which, in the opinion of the authority, should not be sold for reasons such as proper stock or estate management, such as in the case of houses for elderly people, in particular bungalows. It is a matter for each individual local authority to administer the scheme in its operational area in line with the overarching provisions of the governing legislation for the scheme, and in a manner appropriate to its housing requirements.

In line with the commitment given in Rebuilding Ireland, a review of the first 12 months of the scheme’s operation, including the issue raised by the Senator, has been undertaken. The review has incorporated analysis of comprehensive data received from local authorities regarding the operation of the scheme during 2016 and a wide-ranging public consultation process, with submissions received from individuals, elected representatives and organisations. The review is complete and a full report has been prepared, setting out findings and recommendations. I hope to publish the review shortly, following consideration of a number of implementation issues arising.

Clearly, the tenant purchase scheme offers tenants the option to purchase their homes, something the Government and I are supportive of as we acknowledge that people want to own their own home, if possible. It is critical, however that we balance this against the need to maintain our stock and add to our social housing stock over the coming years. We are committed to increasing the number by a minimum of 50,000 houses by 2021 under Rebuilding Ireland and we want to continue that. Any house sold through the tenant purchase scheme needs to be replaced, with the money ring-fenced and put back into housing.

Not everybody will wish to purchase their own homes, but for those who do it is heartbreaking that they are not allowed under current regulations. I know of a couple of cases in County Monaghan where there are Part V houses in a development alongside local authority properties. A person in, say, No. 5 may be allowed to buy out their house but somebody in No. 12 might not, and that is unfair.

I welcome the fact that the review will be published shortly. The Minister of State might outline a date for when it will be published and when he hopes to be in a position to act on its recommendations. It would be interesting if the Department could carry out a survey of how many people in Part V developments, of which there are 4,000 in total with only 160 in Monaghan, would be interested in purchasing their home. It may not have the effect on the social mix that the Minister of State suggests.

We have committed to completing and dealing with the report in this quarter but it may be in the new year as some legal issues have to be sorted out. Once it is published, we can make decisions and we will do so early in the new year because it is an important area. I do not promise the full solution sought by the Senator but we are trying to find one that solves the issue as it relates to Part V houses. Not everybody will want to avail of it and we will consider that aspect of the issue as well.

We need a tenant purchase scheme that works for everybody. The current scheme does not work for everybody and the generous discounts need to be examined as well, as we have to make sure we use taxpayers' money wisely. The social housing build programme had a budget of €2.4 billion and next year an additional 10,000 social houses will enter the system. This year it will be more than 8,000 and we want to get to the magic number of at least 10,000 per year. Beyond 2021, we have committed resources to build 12,000 social houses per year, which will also give us scope consider issues under the tenant purchase scheme.

Sitting suspended at 11.07 a.m. and resumed at 11.30 a.m.