Nithe i dtosach suíonna - Commencement Matters

Wild Atlantic Way Project

I welcome the Minister of State. I was going to table a Commencement matter to ask the Minister to inform me of all of the successful sports capital grant applications in west Cork, but I am sure he would shy away from informing me about them. Instead, I am seeking an update on the review of the Wild Atlantic Way and the potential inclusion in it of Union Hall.

In July 2017 I had the privilege and pleasure of taking the Minister of State to Courtmacsherry and Union Hall, two beautiful, scenic areas in west Cork. Courtmacsherry has been included in the Wild Atlantic Way, which I welcome. The inclusion of Seven Heads Peninsula is still going through a process and I hope that part of Courtmacsherry will be included in time.

I bring to the attention of the Minister of State the plight of Union Hall, a beautiful village that has so much to offer tourists, including walking and cycle routes and wonderful restaurants, as part of the Wild Atlantic Way experience. We need a timeline for when the review of the Wild Atlantic Way will be completed. This community that is so active in promoting what it has to offer needs some movement on the question of when and how we can actually have Union Hall included in the Wild Atlantic Way. It is located only a few kilometres off the N71. It is a place of unique beauty that would add in many ways to the experience of the Wild Atlantic Way. I hope we can have a process put in place to tie in the village and what it can add. I hope the Wild Atlantic Way can be extended to include these small villages because it has been one of the major successes of the Government. It has been a unique success in what it has brought to the west and south. We need to build on that success by including these small and wonderful communities. If that can be done, we will increase our figures and, in turn, villages such as Union Hall will develop their tourism potential. That is the key to and the strength of the Wild Atlantic Way project.

I thank the Senator for raising this matter. As soon as we know how much money will be allocated to west Cork in sports capital grants, he will be the first to know. We were going to give a lot more only for the Cork footballers improving so much this summer that they do not need as much any more.

It is very cheeky for a Kerryman to come out with such a statement. I recall clearly the day in the summer of 2017 when we visited that beautiful part of west Cork to see exactly what local communities were proposing and how the Wild Atlantic Way could benefit them even more into the future. I also holidayed in west Cork with my wife and children this summer and spent a really lovely day in Union Hall and Glandore. I was there during a period of some really fine weather and the place looked outstanding. All of the way to Ballydehob, Schull, Baltimore, Skibbereen, Clonakilty, Crookhaven and the Mizen was looking fantastic. It is an amazing part of the world and we are very lucky to be living so close to it.

There is a review under way. To be clear, whereas both the Minister, Deputy Ross, and I are responsible for bringing forward policy on tourism, its actual implementation, promotional activities and the management of tourism affairs on the ground are the responsibility of the agencies, Tourism Ireland and Fáilte Ireland. In this case, Fáilte Ireland is responsible for the management of the Wild Atlantic Way. It has undertaken a route review which I understand is due to be sent to the local authorities in the coming week. There will then be further discussion and a collaborative approach with local authorities in agreeing to changes that may come. There will be an opportunity at local level for each community along the Wild Atlantic Way to have its voice heard through its local authority in collaboration with Fáilte Ireland.

When I was there during the summer, I was looking at the logistics and various factors at play in changing the official route. I see all sides of the argument and certainly think there is scope for some changes. There are people who are far better qualified, particularly in the engineering field, who would have to be consulted in that regard. The key point to remember is that even though in most cases the specific route can only pass through one place along the coast, although there are spurs, the level of activity in proximity to the route is key. Visitors are encouraged not to stick to one linear route but to enjoy the experience in the general area. That is where the opportunity arises in west Cork and where I am from in County Kerry. Even if an area is not on the route, if it is in close proximity to it, it is in line to benefit from the Wild Atlantic Way experience and its marketing around the world. The approach taken by Fáilte Ireland is the correct one in collaborating with the local authorities and ensuring local voices are heard. Ultimately, when there is more than one voice looking for different things, decisions have to be made. My understanding from discussing the issue with Fáilte Ireland is that decisions will be made in as collaborative a way as possible. I will be keeping in close contact with Fáilte Ireland.

At local level, there will be an opportunity, through Cork County Council, for local communities to engage further. I look forward to the outcome of the review, but it is critical to emphasise that, regardless of what the specific route will be or what changes may or may not be made, there is a great opportunity for all communities to benefit from the Wild Atlantic Way. Whether the route runs one way or another is secondary. The primary opportunity is to enhance local offerings, the experience of these beautiful parts of County Cork and for communities to build a sustainable tourism sector.

I thank the Minister of State for his kind comments, particularly about Cork football. The draft being given to the local authorities is a great step forward. I was hoping to hear the draft was going to be given to the local authorities in County Cork and that there would be consultation with local communities and councillors, in particular. That is the step we require. We will just have to see how the consultation process will go with local communities and the local authorities. If there are pinch points in the provision of infrastructure, I will hope they can be addressed by the local authorities. I will wait to see the results of the review and if further work is required on the possible inclusion of Union Hall and other villages.

I thank the Senator. On the back of the review, a visitor experience development plan will be developed for the Haven Coast area in west Cork. This is a great opportunity for local communities to become involved in considering how that very special part of County Cork can put its best foot forward, how we can set out its unique selling points as a holiday destination and how we can improve seasonality, which is critical. Bringing in more visitors in the shoulder and off-peak seasons is one of the Government's key policy objectives. It is seeking to bring more people into the regions in the off-peak season in the spring, autumn and winter. There is a great opportunity through the visitor experience development plan process for local communities to become involved and collaborate with Fáilte Ireland.

In terms of the route specifically, the local authority will be in consultation with Fáilte Ireland. The consultation is important because it means that local communities can get in touch with their local authority about that.

Home Care Packages Provision

I welcome the Minister of State, Deputy Catherine Byrne. Tá fáilte romhat. I ask Senator Jennifer Murnane O'Connor to outline her case and she has four minutes.

I thank the Minister of State for her attendance as I have a serious issue to discuss. I seek a status report on the home care supports that are available in the Carlow-Kilkenny region. I also want to know if supports are available, whether they are accessible and how many people await the supports because I have seen and heard conflicting information on the issue. I want to know the actual position in order that I can inform the people who want to know as they are people in my area who have asked for my help.

New data furnished to my Fianna Fáil colleague, Deputy Mary Butler, in the Dáil state that the number of people awaiting home care supports has increased from 6,238 at the end of March to 7,346 in the four months leading up to July. This week, we learned that the HSE's figures revealed that last month almost 800 patients across the country had not been discharged despite being deemed medically fit. Yesterday, staff in hospitals assessed patients to see who they could send home to ensure safety in the event that Storm Lorenzo is worse than first thought. However, I have seen figures that were supplied to the Department of Health that show no one is awaiting home care supports in Carlow-Kilkenny. Officially I have not been given the number of people waiting for supports in Carlow-Kilkenny but I tried to acquire them. I assure the Minister of State present that people await the supports because at least seven families have contacted my office about the matter. I am only one local representative so one can imagine how many more people have made representations to their local politicians.

I am referring to people who cannot leave their hospital setting without important supports being put in place. These are people who may be unable to fight for themselves. In most cases I am contacted by family members inquiring about the provision of supports. I am aware that moneys were provided to the HSE for it to provide these services. Unfortunately, people have contacted my office stating that they have not received the services, despite needing them.

I have heard, anecdotally, of people with severe needs not having anyone to care for them at home and being told that they do not qualify for anything. Patients have been told there is no availability of home care supports in their areas but not to tell anyone, to stop asking for help and to find another solution. I cannot accept such a situation. I have been told by staff in the hospitals and HSE respite settings that they can do nothing for their patients other than hope they can go home because they are in much needed beds that are sought by many other patients. Often people waiting to be discharged suffer a significant deterioration in their health. These people are forced into lengthy stays in hospitals, despite being well enough to be discharged or moved into a nursing home or retirement home rather than being allowed to stay in their own home, which is where they want to be.

We pay for health services by paying taxes but we do not get value for money. We seem to be just putting an ever increasing amount into the children's hospital without fixing existing major problems. We should get more for our money and get value for money. Patients repeatedly lose out and staff are frustrated by these issues as they know there are ways to fix them but they are not being addressed.

Yesterday, we heard that the HSE has a deficit of €280 million and will now try to clawback overspending by cutting the spending on agency staff's overtime and staffing levels. Every year more money is poured into an inefficient system and life is not improved for patients. Not having the correct numbers frightens me. If people are not being counted, how can we help them? There is a genuine care need for these people and the Department wants to help. I am concerned that if the Department does not get the accurate figures, these patients will not be helped. As late as yesterday I had to deal with a family, which is one of many, as the father in the household was in hospital. He was told that there was no home care package for him and he was sent home. He was told that he would get a bed and the facility would try to sort out a bed for him. He was also told that the occupational therapist would pay him a visit when she had an opportunity. I cannot get him medical aids in the form of a seat and a Zimmer frame. I will contact the local authority to get him a bathroom adaptation grant. The service is not fit for purpose. I am more worried that the Department is saying that Carlow-Kilkenny does not have a waiting list for home care packages and patients are being sent home but told nothing is in pace and there are no home care packages.

I thank the Senator for raising this issue. I am taking this matter on behalf of my colleague, the Minister of State at the Department of Health, Deputy Jim Daly, who has responsibility for this area.

Home supports enable older people to remain in their homes and communities, as well as facilitates a timely discharge from hospital. The Government has made improved access to home support services a priority. Progress is reflected in the additional funding made available in recent years with the budget growing from €306 million in 2015 to almost €446 million in 2019.

As outlined in the HSE's service plan for 2019, the executive maximises current resources, prioritising those requiring discharge from acute hospitals, and significant resources and services in 2019 have been targeted to facilitate them leaving. In winter 2018-19, the immediate focus was on reducing delayed patient discharges through mobilising the additional resources made available and ensuring that social care measures were effectively deployed to enable older people to move to a more appropriate care setting, including to step-down or transitional care in their own homes with the supports they need. At the end of July, almost 52,000 people were in receipt of home support, including those in receipt of an intensive home support package, and more than 10.3 million hours have been provided during the first seven months of this year.

Community healthcare organisation, CHO 5, provides community healthcare services to the people of Carlow, Kilkenny, south Tipperary, Waterford and Wexford. CHO 5 continues to profile priority home support clients based on assessed needs and is working to provide services based on its priority profile. This year, €11.7 million was allocated to Carlow-Kilkenny for home supports. The target set was that the HSE would deliver in excess of 419,000 hours to approximately 1,460 people. As of 31 July, 1,469 clients receive home support and, on average, 43,515 home support hours are delivered in Carlow-Kilkenny on a monthly basis. Despite this considerable level of service, 152 clients are on a waiting list for new or additional services. As the numbers in the over 65 years age group are increasing, demand for new home supports increases, and as those in receipt of services are dependent, demand for additional supports for existing clients also increases. All those waiting are assessed and provided with a service, if appropriate, as soon as possible having regard to their assessed needs. In addition, people being discharged from acute hospitals, who can return home with supports, are prioritised.

The level of activity and associated cost of home supports in Wexford and the south east is monitored on an ongoing basis by the south east community healthcare head of social care and the general manager of services for older people. This is done to ensure that the people with the greatest needs are supported and that the overall expenditure on home support services by the HSE does not exceed the available funding.

The Minister of State, Deputy Daly, acknowledges that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that people on the waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources. These cases are determined by the local front-line staff who know and understand the needs of clients. These staff undertake regular reviews of those cases to ensure that the services being provided remain appropriate.

I will come back to some of the questions.

I thank the Minister of State. I knew that the Minister of State, Deputy Daly, was not coming in. I requested his presence but I seem to always get Deputy Byrne instead. She is always courteous to me. I would have loved if the Minister for Health came along because my Commencement matter is so serious. I am concerned with the statement that "152 clients are on a waiting list" and ask for details to be supplied to me.

The lack of home care support packages is a significant issue in the sense that people are leaving Kilkenny hospital, and families are in dire straits, but these people are crying out for help having been told that there are no home supports or support care available. The families are all working and we are trying to sort them out. They cannot avail of respite care. They are, therefore, in a serious state. I ask the Minister of State to respond on these matters.

I knew the Minister of State, Deputy Daly, was not coming in. I am disappointed again. I have only got him to come in once in all the time I have been calling for him to come in. That is all I can do. I ask the Minister of State, Deputy Catherine Byrne, to come back to me on this. I will give her the details of the seven families I am working with. I ask her to forward those details to Deputy Daly so that I can get supports in place for these families. This is very serious. I thank her again for coming in.

I understand the stress. I deal on a daily basis with many people who need to be taken out of hospital and put into care. They need services in their homes or in facilities. It is becoming challenging because people are getting older. I spent two days in an emergency department over the past couple of weeks. I was conscious that many of those there were older people with respiratory illnesses. As we get older, such illnesses become more prevalent. My daughter, who works in this area, told me that it is very hard to get staff to work in home care packages and home care services. She has said that difficulties arise when these services are loaded with more work and not enough staff are available to do it. It is a very dedicated service. I acknowledge that supports are needed for people. I attended a meeting in St. James's Hospital last week with the CEO. We spoke about people who are in addiction, homeless people and people who are in hospital. We discussed how we need to use the Housing First approach to get them to vacate the beds. It is an issue across the country.

Staff are being put to the pin of their collar. It is important that we recognise the work they do.

I acknowledge that. I have plenty of friends and neighbours who work in St. James's Hospital. I will bring the Senator's concerns about the 152 beds to the attention of the office of the Minister of State, Deputy Jim Daly. I ask her to supply me with the names via email.

Rather than sending those details directly to the Minister of State, the Senator should send them to me in order that I can bring them to his attention.

I will do that. I thank the Minister of State for coming in. I appreciate it.

Hospital Accommodation Provision

We are approaching next Tuesday's budget. The day after last year's budget, our local Minister in County Donegal, Deputy Joe McHugh, told the people of Donegal on Highland Radio that all 20 beds in a short-stay ward that had been closed would be reopened. He said that recruitment was commencing that day and that he had spoken to the manager of the hospital. We were worried that this commitment was not going to be honoured, but shortly afterwards, the Minister for Health promised the people of Donegal that these beds would be reopened. Since that promise was made by the two Ministers, funding has been received for the reopening of five beds. Thanks to the efforts of the Saolta University Health Care Group, which oversees Letterkenny University Hospital and has been working with public representatives in Donegal, we managed to get funding to increase the number of beds to be reopened to ten. While it has been helpful that half of the beds have been reopened, we still have a serious crisis at Letterkenny University Hospital. It is reported on local radio every day that large numbers of people are on trolleys. Yesterday, 38 people were waiting for beds in the hospital. I find it unfathomable that the Minister has not kept his promise.

Here we are again at budget time. I am led to understand clearly that the recruitment embargo is the only reason we do not have the 20 beds. The management team at the hospital has attempted to put in place a range of people across the hospital spectrum, including cleaners, porters, nurses, doctors and consultants. They are being prevented from appointing new personnel. The embargo has to be waived in Letterkenny. The Minister is watching as large numbers of people, many of whom are elderly, have to wait in the emergency department for long periods before being placed on trolleys. There is a wider issue in the county. Over the past ten years, our community hospitals have lost one in four of their beds and one in four of their nurses. The Government has cut the number of beds in our community hospitals and in our major hospital in Letterkenny. It has also cut home care packages. There are blockages in the entire system. I intend to hold the Minister for Health to account for the key issue in this regard, which is his promise that all 20 beds closed in the short-stay ward would be reopened. I call on him to keep his word and to stand by his promise to the people of Donegal. The recruitment embargo should be lifted to allow the hospital to recruit the necessary nurses to get the beds opened and to try to take the pressure off the entire hospital, particularly the nurses, doctors and staff in the emergency department, who are doing impossible work every day under impossible circumstances.

I thank the Senator. I apologise to him on the basis that this is probably the third time I have been here to deal with the same issue. I acknowledge that he has raised it on a few occasions. I have been reminding the Minister of the situation constantly. I am responding once more today on behalf of Deputy Harris. He acknowledges the distress that overcrowding in emergency departments causes to patients and their families and to front-line staff who work in challenging conditions in hospitals throughout the country. The number of patients attending emergency units continues to increase each year. In the first eight months of 2019, the number of patients attending increased by 2.9% and the number of admissions increased by 1.7% compared with the same period last year. During the same period, attendances at the emergency department in Letterkenny University Hospital increased by 4.5% and admissions increased by 6.1% compared with the same period in 2018. According to provisional TrolleyGAR figures, some 3,025 patients waited on trolleys in the emergency unit in Letterkenny University Hospital between January and the end of September this year. This represented a 32% increase on the same period last year. This is an average of 11 people waiting on trolleys each morning so far in 2019.

The health service capacity review, which was published last year, made it clear that a major investment in additional capacity in hospital and community settings is needed. It also spoke of the need for wide-scale reform of the manner and location of the provision of health services. An additional 267 beds have been opened since 2017. The capacity programme for 2019 provides for increases in capacity, as set out in the 2019 national service plan. Some 75 acute beds and 70 community beds were provided for under the 2018-19 winter plan, including five beds that opened in Letterkenny University Hospital in June 2019 under that plan. Some 47 additional beds, including a 40-bed modular build in South Tipperary General Hospital, three high-dependency unit beds in the Mater Hospital and four high-dependency unit beds in Cork University Hospital, were also provided for. The capacity programme also provides for the preparation of 202 beds during 2019, including 15 in Letterkenny University Hospital, with a view to bringing this additional capacity into operation in the first quarter of 2020. The programme also provides for the commencement of works on a 60-bed modular ward at University Hospital Limerick. In its most recent update to the Department, the HSE advised that ten short-stay ward beds at Letterkenny University Hospital opened in June 2019 and the opening of nine further beds at the hospital is under consideration. To date, no timeline has been provided for the opening of these beds. I will come back to some of the issues raised by the Senator in my concluding remarks.

When one reads the response drafted by departmental officials on behalf of the Minister, one gets to the core of the issue. The response confirms that five beds have been provided. I remind the House that the Ministers for Health and Education and Skills said that all 20 beds would reopen. They said a year ago that they had contacted the manager of the hospital and that the recruitment process had commenced. It has been confirmed in the response that just five beds have been funded. The response also refers to plans for another 15 beds, "with a view" to having them opened in the first quarter of 2020. There is a further reference in the response to the opening of ten beds. The Department is admitting that it funded five beds, but ten beds have been opened. I can inform the Minister of State and the departmental officials that the Saolta University Health Care Group, working with public representatives in Donegal, provided funding to get the number up to ten because of the urgent crisis and the failure of the Government. I am asking the Ministers to keep their promise and their word. The Minister of State has told us that it is "under consideration". That is just not good enough.

The Minister for Health is only superseded by the Taoiseach. In recent days, the Taoiseach apologised to all the people in the emergency department. Apologies are no longer any good. People need hope; they need to believe it is going to change. Whatever about the reform of the wider health system, 20 beds were closed and we were promised they would be reopened. It is very simple. The Government was to provide the funding for the nurses and the beds to get it reopened and it has not done so. It broke its promise and its word. I am holding the Government to account. I am not going to go away. We need to see all 20 beds.

I ask that the Minister of State would send the transcript to the Ministers for Education and Skills and Health. I will get the transcript from Highland Radio, if need be, and remind them of the words they uttered. They need to keep their promise and their word, get those beds reopened and give the people of Donegal, and the nurses and doctors in that hospital, some hope. Stop the apologies, give us some hope and give us some solutions.

I acknowledge it is not the first time I have heard the Senator's concerns and anger. I can understand his frustration. It must be acknowledged that attendances at emergency departments are increasing on a yearly basis and the health service capacity review indicates that Ireland has among the highest acute bed occupancy rate in the developed world. Against that backdrop, the HSE capacity review recommended an increase in acute beds to more than 2,600 by 2031 to support the projected increase in demand for the service.

I acknowledge that the Senator has spoken out so strongly regarding the expressions of support from the Ministers for Education and Skills and Health on the additional beds. I assure the Senator I will make it my business, as I always do, to send a transcript to their offices when I receive it later, and I will highlight the concerns that have been raised, not only by the Senator today but by other Senators in the past. Although I cannot speak on behalf of the two Ministers in regard to what they said on radio, I assure the Senator that both of them will receive a copy of the transcript later today. It is up to him after that as to what he wants to do about the local radio interviews. I acknowledge the fact there is much frustration and that beds were promised, as he said. If we are going to promise to do something, I acknowledge that, somewhere along the line, it has to be done. I will convey his concerns to both Ministers.

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