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Seanad Éireann debate -
Tuesday, 21 Jun 2022

Vol. 286 No. 5

Nithe i dtosach suíonna - Commencement Matters

Mental Health Services

I welcome the Minister, Deputy O'Gorman, to the Chamber.

I know this is an issue that the Minister is deeply committed to addressing as well. He will be aware that within the programme for Government there is a very clear commitment to provide for therapeutic services, particularly for children in the care of Tusla. The Government is developing its plans about expanding and developing the child and adolescent mental health services, CAMHS, and it is increasing the number of medical and other interventions for young people and, indeed, support for their families. I commend the Minister on his work.

However, we need to look at that question of the broader range of therapies that are available, and particularly for children in care, many of whom who may have complex needs. It is about ensuring they have access to appropriate counselling and therapy. Those services are essential.

A quite successful programme has been operated by Tusla in the north inner city in Dublin, as the Minister will be aware. The child art psychotherapy programme allows children and young people, through use of creative means, such as art, painting and drawing, to express themselves. It has worked quite well. The Minister will be aware of the recent Growing Up in Ireland survey, the latest iteration of which was just published by the ESRI, which reported the impact that the past two years have had on children and young people. There are increasing numbers of young people reporting poor mental health. The Minister will also be aware that last week Women’s Aid reported on what has happened during the Covid period in terms of the number of reports it received, and particularly the impact on children and young people. There were a number of frightening statistics, however, one stands out. Women’s Aid reported that over the Covid period, 5,400 child abuse or suspected child abuse reports were made. It is important that we provide, as much as possible, the broadest range of supports. We have a very clear commitment within the programme for Government to do that. I hope that the Minister will be able to outline what progress has been made in that regard.

Tusla's in-house therapeutic model aims to support and inform front-line practitioners in their day-to-day work with children and families, as well as providing multidisciplinary therapeutic services that can address more complex needs. It is essential, therefore, that any expansion of this service must have regard to the provision of related services offered by other State agencies. In that regard, I highlight that overall responsibility for mental health services lies with the Department of Health, through the HSE.

Tusla, therefore, funds the HSE to supply psychology services on its behalf to children in care. Under existing agreements with the HSE, Tusla pays approximately €7 million annually for psychology services provided by the HSE. Where these services cannot meet a particularly crucial and essential therapeutic need that has been identified, Tusla also purchases additional private therapy sessions. I have been informed that these therapeutic services are accessed based on the unique needs of each child and delivered as part of their care plan.

As the Senator is probably aware, my Department funds the Child Care Law Reporting Project, CCLRP, which reports on child care court proceedings and engages in research on child law. In its most recent report, Ripe for Reform, the CCLRP identified issues regarding the provision of mental health services to children as a theme in a number of the child care proceedings it had observed, particularly in terms of CAMHS, which the Senator mentioned.

In September 2020, officials from my Department and the Department of Health agreed a revised joint protocol to be adopted by Tusla and the HSE regarding the management and funding of disability placements for children in care, or those transitioning out of State care.

The agreement relates to individuals displaying complex disability, including mental health. Crucially, this revised joint protocol ensures that the needs of the child or young person are central to all deliberations about them.

On a separate but related point, Tusla has advised me that in order to enhance the quality and consistency of care to children, it is actively investing in enhancing therapeutic services across the system. Senator Byrne spoke of the commitment in that regard set out in the programme for Government.

Action 1.4 of the Tusla business plan for 2022 commits Tusla to work collaboratively with other agencies to investigate, assess and support children, young people and adults who have been abused. There are also related business plan action points which are relevant to the Senator's query. These include the mapping of all existing Tusla and Tusla-commissioned therapeutic services completed; finalising a revised integrated framework for therapeutic services for children who have been harmed or abused; and, from the third quarter of this year, all children and young people newly admitted to care will have a multidisciplinary assessment and care plan completed.

I had the opportunity early this year to visit the north Dublin hub to see the services. My colleague, Deputy Costello, has always been a strong advocate for these services. I met the service providers in the Tusla hub and also some of the community services linked to that. Some €700,000 has been allocated in the financial framework of the business plan for 2022 to roll out the objectives I have just outlined.

I also welcome Tusla's strategic approach to deliver an integrated framework for therapeutic services. This includes a three-year plan to establish a high-level framework and operating model for Tusla therapeutic services within each of its six regions with clear pathways of responses based on the assessed need of each child in care. I welcome this strategic approach adopted by Tusla, which includes a commitment to establish multidisciplinary teams in each area with clear governance and supervision arrangements.

Tusla has informed me that it has adopted a project management approach to the development and implementation of the revised integrated framework for therapeutic services for children in care. This has been progressed with the establishment of a project working group with key stakeholders being brought in.

I thank the Minister for his comprehensive response. In particular I welcome the clear commitment that from the third quarter of this year, all children and young people newly admitted to care will have a multidisciplinary assessment and care plan completed. It is not only important that a care plan is completed but also that it is implemented and that the supports are put in place. Coming out of the Covid pandemic period, we do not know what its full impact will be and how that may manifest itself in certain areas. However, we must make sure that every child is allowed to have as full a childhood as possible and where children face difficulties or have complex needs, the State will step in and support them, including through the provision of counselling and therapeutic services. It is not only that a care plan is provided but that it is also followed through and the necessary supports are put in place. I know the Minister is committed to doing that but if we were to give that guarantee to every child, it would be very welcome.

The Senator is absolutely right about the need to follow through. The crucial work that Tusla has done has been backed up by my Department with significant additional funding of €66 million in 2021. I think that is the highest ever annual increase in funding and €41 million was provided last year in budget 2022. We are investing in Tusla to give it the resources to be able to undertake the kinds of innovative approaches we are seeing in the therapeutic hub in north Dublin. It will take a little while before this approach can be rolled out across the country.

The Senator mentioned multidisciplinary work and it is an issue I have raised with Bernard Gloster and his team several times. We recognise the importance of having these interlinked and wide-ranging therapies available for the children who need them most. As Senator Byrne said, that need is particularly great coming out of Covid. I will be happy to engage with the Senator and other Senators and to provide updates on the roll-out.

Hospital Services

I thank the Cathaoirleach's office for choosing this issue for debate. I welcome the Minister of State, Deputy Feighan, to the Chamber to discuss, once again, healthcare matters in the west of Ireland. As I always say, it is great to have a Minister of State from the west, who has an interest in this particular area, answering the questions. As he knows, the national development plan, NDP, under Project Ireland 2040 objectives, states: "In accordance with balanced regional development, a cancer care network for the Saolta region (West, North West) with a Cancer Centre at Galway University Hospital with appropriate infrastructure will be delivered." This is a welcome commitment for which many people fought, including politicians, practitioners and those with expertise in the field of cancer care in the west. Those people do a tremendous job in the region with the resources and facilities they have.

Unfortunately, as the Minister of State knows, cancer care outcomes in the west of Ireland are not as good as elsewhere in the country. That is the unfortunate reality. The survival rates from cancers are lower in the region than they are in other parts of Ireland. It is not acceptable that any part of the country would be left behind in this fashion. That is why I welcome the commitment in this regard in the NDP. One in two of us will get cancer during our lifetime. This is a frightening statistic but it reflects the reality. It is the reality because we have an ageing population and people who live longer are more likely to suffer from a number of illnesses.

We need to get the best results we can in the west of Ireland. Unfortunately, the survival rates for such conditions as lung and colorectal cancer are lower than the average for the country. This is not good enough. Figures from HSE west show that for breast cancer, there is a cumulative five-year standardised average net survival rate of 80%, compared with the average for Ireland of 85%. In the case of lung cancer, the survival rate in the HSE west area is 16.7%, compared with the national average of 19.5%. For colorectal cancers, the survival rate in the west of 62.6% is just below the national average of 63.1%. The survival rates in the region are worse than the average for the whole country. These statistics are no reflection of the wonderful work consultants and staff do, but it is a wake-up call on the need for a cancer care strategy and facilities in the west.

I welcome the commitment in the NDP but we need to see progress on it. It is a long way out to 2040, under Project Ireland 2040, and a long way out, under the NDP, to 2030. We have seen with other projects that actions are put down on paper but their progress and delivery through all the various stages is very slow. It is incumbent on all politicians in the west of Ireland to drive and push this project forward. As I understand it, following a great deal of deliberation, it has been agreed that the site will be located at University Hospital Galway, UHG, as stated in the NDP. There have been larger debates for years on the best use of appropriate sites and, in this instance, whether UHG or Merlin Park University Hospital should be used. The commitment is now in place for the development of the centre in the grounds of UHG. We need to see progress and we need timelines that can be adhered to and achieved in order to ensure delivery.

I thank the Senator for raising this important issue. The model of care for hospital cancer treatment is centred on eight designated cancer centres, each serving a defined population and geographic area.

University Hospital Galway, UHG, is one of the eight designated cancer centres. The centralisation of specialist services into designated cancer centres aims to optimise patient outcomes through case volume, multidisciplinary working and infrastructural supports. As part of the Saolta University Health Care Group, UHG is the Saolta model 4 hospital delivering 24 hours a day, seven days a week emergency medicine, acute medicine, acute surgery, critical care, maternity, neonatal, paediatric, cancer, laboratory and radiology, alongside a wide range of tertiary referral services for the Saolta Group.

Recommendation 15 of the National Cancer Strategy 2017-2026 sets a goal of ultimately developing at least one comprehensive cancer care centre in Ireland that will optimise cancer prevention, treatment, education and research during the strategy period. It was always envisaged the development of such a centre could only be achieved towards the latter part of the strategy period. The Department of Health and the national cancer control programme, NCCP, have had preliminary discussions on the best way forward, including the possibilities for comprehensive cancer networks across regions or internationally. These issues are also the subject of much debate in other EU countries in the context of the Europe's Beating Cancer plan. It is envisaged that proposals on a way forward in Ireland will be defined shortly, at which stage the matter will submitted to Government for approval.

With regard to the development of a comprehensive cancer centre at University Hospital Galway, the National Development Plan 2021-2030 sets out, "In accordance with balanced regional development, a cancer care network for the Saolta region (West, North West) with a Cancer Centre at Galway University Hospital with appropriate infrastructure will be delivered." The Saolta cancer managed clinical and academic network, MCAN, has been formulating proposals for the development of the cancer infrastructure at UHG, with the goal of becoming a comprehensive cancer centre, along with a network of enhanced ambulatory cancer services at Letterkenny, Sligo, Castlebar and Portiuncula. Both the NCCP and the Department acknowledge the work that has been initiated in this regard. However, the national policy in regard to a comprehensive cancer centre and cancer structures nationally has yet to be worked up and agreed. It is most important that developments in UHG and Saolta fit in with the national approach and take realistic account of the overall limitation on resources.

Furthermore, a new €56 million radiation oncology facility is under construction at UHG under the national programme for radiation oncology, NPRO. The facility will include seven radiotherapy treatment vaults, a brachytherapy suite, two CT rooms, MRI, on-treatment support and ancillary physics, treatment planning and administration facilities. Construction of this new facility is expected to be completed in 2023.

The Department of Health and the NCCP continue to work closely with UHG on short-term actions to continue to support the delivery of cancer services through UHG and the Saolta hospital group.

I thank the Minister of State for the reply. I acknowledge and welcome that there are plans and a commitment to develop this very important centre, although the timeline is not spelled out. According to the experts, what is urgently needed is the functional cancer centre at University Hospital Galway, including inpatient beds, operating theatres, cancer ICU, an ambulatory rapid access diagnostic centre, a haematology oncology day ward and outpatients department, and modern laboratories, as well as functional regional cancer infrastructure, including ambulatory cancer centres at regional Saolta hospitals, supporting diagnostics, imaging pathology and multidisciplinary teams across the network, supported by a regional network of GP and primary care facilities.

I welcome the response the Minister of State has given but, as I said, we need to progress this and ensure there are no undue delays. Obviously, when the time comes, funding will be an issue but it is committed to and contained within the national development plan and Project Ireland 2040. We need to see progress in regard to the site, the various strategic assessment reports and preliminary business cases, all of the various stages of the spending code of the Department of Public Expenditure and Reform and the lodging of the planning application.

I thank Senator Kyne for his contribution on this matter. Galway University Hospital provides diagnostic services for breast, lung and prostate tumours, with a satellite service for breast cancer at Letterkenny University Hospital. The hospital has a reputation for the delivery of high-quality, innovative and safe care for patients, particularly through the provision of medical, surgical and radiation oncology services.

As the Senator knows, over the past two years more than €40 million in new development funding has been secured for the ongoing implementation of the national cancer strategy. It is the largest investment in the strategy since its launch in 2017. The funding is also being used to increase and bolster existing services, including those delivered through University Hospital Galway, while also facilitating the development and implementation of new services in all cancer clinical programmes. Furthermore, a new €56 million radiation oncology facility is under construction at the hospital. This facility will include all of the various services. I believe it will be completed in 2023.

While no decision has yet been made on the development of a comprehensive cancer centre as outlined in the national cancer strategy, the Department of Health and the national cancer control programme continue to engage with University Hospital Galway to ensure it continues to deliver high-quality cancer services to patients in the west and north west.

Legislative Measures

The Minister of State is very welcome. This matter is with regard to the Public Health (Tobacco and Nicotine Inhaling Products) Bill. I thank Grace Kearney from the Bridgeway Family Resource Centre in Ballymahon whom I met recently on a visit to Ballymahon Vocational School. She highlighted this serious issue and the epidemic among children as young as 12 years of age who vape on a regular basis. It is seen as cool. The reality is that teenagers do not know what they are putting into their bodies. It is seen as cheap, accessible and acceptable in society. Many parents allow the activity unaware of the consequences or unaware that their children are vaping. People can hide the fact they are vaping due to the fact the smoke disappears. The smells and the tastes are like bonbons in a shop with flavours such as mango, bubblegum and strawberry. There are 40 or 50 different versions.

People can buy disposable vapes for as little as €5. These can give up to 10 to 20 mg of nicotine. People can buy vapes with up to 50 mg, which is the equivalent of 50 cigarettes. Some children are inhaling these to get a buzz instead of using drugs. This is what they can do apart from putting nicotine into their system. I have heard stories of shops delivering these products to children at certain venues such are the profits that can be made from them.

What is this doing to the health of our children? What is it doing to their lungs? Children are pulling out of sports because of the reduction in their fitness. They are not fit to play football or take part in sport because of this. We need to license these products properly as we do with cigarettes. We need to introduce a ban on the use of vaping in sports grounds. The reality is that it is cheap and cool and people are uneducated about it. We need strong robust legislation to help us police it. We need this immediately prior to the summer recess.

I thank Senator Carrigy for sharing time with me on this very important issue. As we are aware, these shops are springing up all over our towns. They are located in prime locations with very expensive rents. They seem to be open on a daily basis. I have never come across a shop that just sells cigarettes because it would not be financially viable to do so. Something needs to be done on the regulation of these shops. I am aware that the committee on health has had a number of pre-legislative scrutiny discussions regarding the Public Health (Tobacco and Nicotine Inhaling Products) Bill.

We must try to strike a balance between the potential benefits of e-cigarettes for adult smokers trying to quit and the risks that more non-smokers, particularly children and especially young children, will start vaping.

As Senator Carrigy said, there is evidence that children aged as young as ten and upwards are vaping. The ban on sales of e-cigarettes to minors and the sales licensing system are measures that are needed, and a ban on cigarette flavours, which are believed to appeal largely to children and young adults, should be adopted. I understand there is a consensus among those selling these products that an age limit of 18 should be reduced, but that they disagree with a ban on the flavours. While e-cigarettes face fewer restrictions than the sale of tobacco cigarettes, as they are considered consumer products, the EU tobacco products directive does regulate some aspects of e-cigarettes, including: minimum standards of safety and quality; notification of ingredients; packaging and labelling, including health warnings; and a ban on advertising in print, broadcast, online and other electronic media, although outdoor advertising is allowed on buses and billboards, for example.

It is worth noting that the Irish Cancer Society and the Irish Heart Foundation are concerned that the number of young people vaping is increasing. In 2015, 23% of young teenagers used these e-cigarettes. By 2019, this had increased to 37% and I suggest it is even more now. Therefore, in October 2020, the Health Research Board, HRB, published a report that stated that adolescents who used an e-cigarette were three to five times more likely to start smoking than those who did not. This is an important issue. It is as important as when we had to consider legislation to address the head shops in 2009. After much work by the late Senator Nicky McFadden, me and others, those shops were banned in the Criminal Justice (Psychoactive Substances) Act 2010, which stemmed from the so-called "party Bill". Those shops were closed. This issue is just as important.

I thank Senators Carrigy and Wilson for raising this issue. The Public Health (Tobacco and Nicotine Inhaling Products) Bill 2019, which deals with these matters, is a legislative priority for this Government. Nicotine inhaling products, such as electronic or e-cigarettes, are relatively new and the science concerning their public health effects is continuously evolving. Analysis in this regard is made more difficult by the rapid and continuing evolution of the products themselves. For example, an e-cigarette from ten years ago is nothing like the products currently on the market. Important questions exist around the use of these products and there is no scientific consensus on their harms or benefits.

On one side of the argument is the risk of possible long-term health effects from e-cigarette use and the question as to whether they may act as a gateway for young people to smoking tobacco products. Against this, there are the possibilities that e-cigarettes could act as a substitute for combustible tobacco products for smokers and assist some smokers to quit and therefore reduce the enormous levels of disease and death caused by smoking tobacco products.

In 2019, the HRB was asked to carry out evidence reviews on electronic cigarettes and heated tobacco products on behalf of the then Minister for Health. The HRB was asked to examine the available evidence on three topics: the effectiveness of electronic cigarettes as a cessation aid for smokers; the relative health harms and benefits of electronic cigarettes and heated tobacco products; and what association, if any, could be found between the use of electronic cigarettes among adolescents and the subsequent initiation of smoking tobacco products.

In 2020, the findings of these evidence reviews were published. On the effectiveness of e-cigarettes in helping smokers to quit, the HRB review found that e-cigarettes are as effective as nicotine replacement therapy as an aid to smoking cessation for observed periods of up to six months. On the relevant health harms and benefits of e-cigarettes, the research found they are less harmful than tobacco cigarettes but that further research was needed. On heated tobacco products, the review found that there was insufficient evidence from which to draw conclusions.

On whether e-cigarettes used by adolescents increased the likelihood of smoking, the review found a strong association in the majority of examined studies between the use of e-cigarettes and a subsequent uptake in smoking. While the likelihood of smoking initiation varied across the studies, the conclusion was there was a higher likelihood among adolescents who used e-cigarettes.

Taken together, these findings underscore the importance of many of the measures contained within the public health (tobacco and nicotine inhaling products) Bill that is currently in development. We do not want our children to vape and the Bill will prohibit the sale of these products to or by anyone under the age of 18. The Bill will also introduce a licensing system for the retail sale of nicotine inhaling products such as e-cigarettes. A separate licence for each premises that sells these products will be required and an annual fee will apply. The creation of a comprehensive list of retail outlets where these products are sold will also assist the HSE in its enforcement of existing legislation on e-cigarettes under European Union law.

The Bill is currently being drafted by the Office of Parliamentary Counsel and the intention is that it will proceed to enactment as soon as possible. The draft law will require submission at EU level to assess its alignment with Single Market principles and, subject to this process, it will be brought before the Oireachtas as soon as possible. Pre-legislative scrutiny of the general scheme of the Bill began on 3 November 2021 and the report of the Oireachtas Joint Committee on Health on that process is awaited. Once again, I thank the Senators for raising this important public health issue.

I thank the Minister of State for his comments. I also thank Senator Wilson for sharing this Commencement matter with me and I support his comments.

The Minister of State in his reply said the review found a strong association in the majority of the examined studies between the use of e-cigarettes and a subsequent uptake in smoking. That is a key point. If we want to stop young people from smoking, we need to ban these substances. We do not know what this can lead to. We are allowing people to be addicted at 12 years of age. How are they going to be able to fund this addiction other than turning to crime? The legislation needs to be implemented before the summer recess.

At the outset, I should have welcomed the Minister of State, Deputy Feighan, to the House earlier. I thank him for his comprehensive reply. I welcome that this Bill is progressing and I would like if it could be speeded up as soon as possible. This is very necessary legislation and it is important it is brought in as a matter of urgency. More importantly, when it is brought in, it is important it is enforced because these shops are springing up daily in our towns and villages. Anything we can do to discourage that should be done.

As well the measure proposed under the public health (tobacco and nicotine inhaling products) Bill, it is important to recognise that electronic cigarettes are also regulated under EU legislation. A tobacco products directive that was published in 2014 was transposed into Irish law following the EU legislation. Under the regulations, health warnings that advise consumers that electronic cigarettes contain nicotine are mandatory on packaging. The regulations also provide for mandatory safety and quality requirements for electronic cigarettes and refill containers, including maximum nicotine concentrations and maximum volumes for cartridges, tanks and nicotine liquid containers. E-cigarette manufacturers or importers are required to notify the HSE of all products they place on the market, and if a manufacturer, importer or distributor has a reason to believe the product is not safe, they are required to notify the HSE immediately and to explain what corrective action has been taken.

Advertising for e-cigarettes is also prohibited on television, radio, online and in printed publications. The tobacco products directive is currently being reviewed as part of the EU's Europe's Beating Cancer Plan, and it is very likely this will result in proposals for further regulation of electronic cigarettes.

The measures contained in the public health (tobacco and nicotine inhaling products) Bill, together with the existing regulations provided by the tobacco product directive, will create a comprehensive regulatory system for electronic cigarettes in Ireland. Taken together, these laws will ensure e-cigarettes and related products and those businesses that operate in this market are appropriately regulated and will act, as the Senators have said, to prevent young people from accessing and using these products.

Regeneration Projects

I welcome the Minister for Housing, Local Government and Heritage to the House.

I thank the Minister for coming to the Seanad. Last year, he included the wholesale fruit and vegetable market in Dublin 7 in the more than €121 million allocated funding for urban regeneration in the north inner city of Dublin. We greatly appreciate the funding. I have asked him to update the House on the progress that has been made by Dublin City Council, DCC, in using the funding to reopen the fruit and vegetable market. Please advise the House on how his Department can support DCC to achieve an early re-opening of the market.

As the Minister will be aware, the market is housed in an iconic Victorian building located behind the Four Courts in one of the oldest parts of this city where the streets date back to medieval times. The distance from the Spire to Smithfield is 1 km and, therefore, the market is in the middle of the city and is served by the Luas transport system. In addition, the market is located within walking distance of all of the major attractions in the city centre. The Victorian building is iconic with its facade of red bricks, wrought iron, wood and steel. The building was purpose-built in 1892 by Dublin Corporation to allow local producers to sell their fruit and vegetables to residents and businesses. For generations, and for most of my life, the market bustled with activity and I am sure that the Minister will be aware of that himself. The market is a quintessential and unique Dublin institution with its building, the activity there and the generations of families who traded at the market.

As far back as 2001, DCC came up with a framework to redevelop the market. In 2005, the adjacent fish market was demolished and that has been replaced by a car park. In 2004, when I was elected to the council, I worked with the traders and officials to upgrade the market building by rewiring it, and replacing and repainting the roof. Significant funding went into it at that time but, sadly, since 2019, the site has lain vacant. The council said that it needed vacant possession and the market is lying vacant, which is a shame. One pop-up Chinese New Year festival took place at the venue but otherwise it has been rented out as a builder's yard. The building is now empty and that is shameful. The design of the building is spectacular and, therefore, it has enormous potential to act as a culinary, cultural, commercial and community point in the city centre.

I hope that the Minister can advise the House on what progress has been made by Dublin City Council because the latest report from the local authority has indicated it will be another two years. Another two years does not sound like a long time but in the context of more than 20 years already talking about this, it is unacceptable. It is de-motivating for other businesses in the area, for the local community and for the wider city.

I hope the Minister can advise the House on what actions his Department can support Dublin City Council with to reopen it. Ideally, it should be opened, at least on a pilot basis, once a week. It is a huge space. Conservation works could take place in parallel.

I look forward to the Minister's reply.

I thank the Acting Chairperson, Senator Boyhan.

I thank Senator Fitzpatrick for her ongoing interest in this issue and, indeed, for tabling this important Commencement matter.

I visited the markets with Senator Fitzpatrick not so long ago. I am acutely aware of them. I visited them when I was much younger when they were a bustling place that was full of life, full of enterprise and an important part of the north inner city.

By way of a little background, the Urban Regeneration and Development Fund is a cornerstone of the Government's response to ensure that right across the country, no less so than here in Dublin, we are providing funding to the local authorities directly to regenerate and rejuvenate areas such as the Victorian fruit and vegetable markets in St. Mary's Lane.

To date, the Government has committed €1.7 billion of Exchequer funding to move forward with projects. I have had the pleasure of seeing in a number of areas right across the country, such as in Kilkenny, Tralee and Limerick, where this funding is already being drawn down and used to deliver significant regeneration works that are driving enterprise in those areas. In Kilkenny, for example, in the Abbey quarter, there will be 450 new jobs in that space. I want to see Dublin City Council, DCC, do the same.

We have allocated to DCC in call 1 approximately €190 million for projects in the north inner city. I have sought an update from Dublin City Council, which informs me that it is developing the preliminary business case for the north inner city concept area 1 project in line with requirements. I am being told I will receive that in the coming weeks. I want that in the coming weeks. The "coming weeks" should be by the end of July. If I need to sit down and meet the city council in this regard with Senator Fitzpatrick, I will certainly do that.

St. Mary's Lane in Dublin 7 is a sub-project of the larger urban regeneration project providing significant investment in the rejuvenation of Dublin's north inner city. With Senator Fitzpatrick's support, and insistence, and rightly so, we allocated €5.625 million specifically for the Victorian fruit and vegetable market sub-project.

I am informed that the local authority has now appointed a conservation specialist who will identify works, methodology and specifications for refurbishment and conservation works because it is an important building. That will ensure the highest standard of protection for the structure. I am being told that this report is also due in the coming weeks. I want to see definitive timelines on this, not ones that are open to interpretation. On completion of the report, the local authority will procure a design team and contractor to complete the conservation works.

I am strongly encouraging Dublin City Council to expedite the process here. It has appointed a conservation specialist. Let us see how quickly that work can be done. There have been previous plans. We do not need to reinvent the wheel on this issue.

I want to see that area of Dublin, in particular, the markets, being a living and working space that is full of life and that will breathe life into that area. I am taking a personal interest in this particular project. With the significant moneys that we have allocated, I want to see those moneys drawn down by DCC and being put to active use, as I am seeing in other parts of the country.

Gabhaim buíochas leis an Aire. The Minister's commitment to the north inner city is unquestionable.

It is spectacular that since he took office he has dedicated more than €120 million to just this part of the north inner city. Those funds will be used not just for the fruit and vegetable market but for Moore Street, Wolfe Tone Square where DCC has done a fantastic job, Mountjoy Square and the city library we need to see delivered as well. I hear the Minister's frustration and I share it.

Locally people are really at their wit's end because DCC has been bringing forward plans for what to the naked eye is a purpose-built building that is fit for use for more than 20 years. I appreciate the council has given the Minister a commitment that he will get a report within the coming weeks but I would welcome a meeting on-site with the council. I have to believe with the collective will and energy and the resources that have been applied to this we have an opportunity to reopen it early. Maybe it will not be open fully seven days a week but let us aim to have it open at least once a week and start it as a pilot. We have to make people believe DCC is serious about reopening it. At this point, after more than 20 years, there is not that confidence. It hurts me to say this but there is not the confidence DCC is serious about delivering it. We know that is not the case so let us make it real.

I thank the Senator. Just before I call the Minister, I have been to Limerick and have seen it and I look at Covent Garden in London and see the potential, so I thank him for this very detailed response.

I thank the Cathaoirleach Gníomhach. He is 100% correct. I have been in the buildings with Senator Fitzpatrick and, fortunately, they are in good shape. I remain to be convinced of the level of restoration work required to bring the market back into use. We can look to the English Market in Cork, El Nacional in Barcelona and others. We can see what they add to their areas. I have no doubt whatsoever the fruit and vegetable market will be incredibly popular with people and will be a hub for enterprise but also for community.

Following the Senator's intervention, I am going to seek a more detailed, concise report from DCC with specific dates in it. I will absolutely commit to a meeting on-site with her and senior officials to move this forward because we know what needs to be done here. If we can, even on a temporary basis and provided it does not impinge on the works that need to be done, look at opening it up at various times, I want to see this work start. I am aware there is a process to follow through and commend DCC on the work it has done heretofore but I share the frustration of the Senator and residents of the area. With my Department working with DCC and the Senator we can look to expedite this process.

Following this debate I will write to the city manager to seek a meeting on-site in the coming weeks. I will seek a more concise report with specific timelines on delivery. I do not want to see the opening of the market delayed until 2024, so we need to be able to do everything we can to shorten that timeframe. That is what I want to do. I again thank the Senator for her continued support for this project on behalf of Dublin and residents of the north inner city as well. We will follow up with those meetings in the coming weeks.

I thank the Minister for that comprehensive response and thank the Senator for raising the issue.

Wind Energy Generation

I welcome the Minister of State, Deputy Ossian Smyth, to the Chamber. We are entering a quite exciting renewables phase. The technology is advancing and the opportunity to generate renewable electricity, particularly off the west coast, is evident to everybody. In recent weeks, the Taoiseach referred to the cost-of-living crisis, particularly the energy crisis we now face, and acknowledged what we all know is a fact, that is, that we are in for a difficult seven or eight years ahead. This will mean the decarbonisation of our energy production when there is energy price inflation. One solution, as advocated by the Government, is to become more self-sufficient and produce more of our own energy, and to do so through renewables such as offshore wind. This will be the key to generating more electricity domestically and having a more sustainable supply for ourselves that we can say is green and decarbonises the economy.

Many people, following the Taoiseach's comments and others by the Government, were asking where the Government's strategy on offshore wind energy is. They were asking about our plan of action for the rest of this year, next year, the short term, the medium term and the long term. We realise there is a technological challenge but we also know the technology exists. Other countries are already using it, so there is no reason we cannot do the same. We can become a net exporter of energy if we do the right thing and put the right investment and infrastructure in place. We need to manage the environmental impacts of putting wind turbines in the sea, and we also need to work with our fishermen, fisherwomen and fishing communities to make sure they are not negatively impacted. I am sure we can achieve the right balance in this regard, working closely with them. People are now looking for hope. They are looking to see what the Government is doing to deal with the energy crisis at a time when energy costs are rising. We know we are too vulnerable when it comes to sources of energy from outside our own country, and we also know we burn too much fossil fuel in this country to generate electricity.

With these two points in mind, it would be welcome to hear about the Government's strategy and what we aspire to achieve as a country in the coming years, particularly along the west coast. I am from County Mayo. From having lived there, I can attest that it is one of the windiest counties in the country, but the opportunities are immense. We have a vast coastline. The same applies to Clare, Galway, Sligo and Donegal. There are immense opportunities for offshore wind energy generation, but it will be expensive and require a significant State investment to put the infrastructure in place, work with communities and work to ensure we can achieve our goal of being more self-sustaining and self-sufficient in the production of our energy.

I acknowledge that we have particular planning difficulties associated with many of these initiatives. This will have to be addressed. I would welcome the Minister of State's comments on how we are to deal with the planning process for wind turbines, particularly because offshore wind energy will present new challenges that we may not have dealt with in planning for renewable energy sources previously.

I have a question about the grid. There is little point in producing vast amounts of electricity offshore if we cannot transfer it to the national grid. We are aware that we have considerable vulnerabilities in the grid, particularly in the west. I understand and acknowledge that EirGrid has been invested in significantly in recent weeks to increase capacity, but ambition in this regard to match our ambitions for increasing renewable energy seems to be lacking. We have to match our ambitions with investment in the grid so the two can work together.

Could the Minister of State talk about the strategy for the short and medium terms, the level of investment by the State to realise it, the percentage of our energy we expect to derive from offshore wind and how we are going to deal with grid capacity to capitalise on the energy we produce?

I welcome the pupils and teachers in the Visitors Gallery to the Seanad. I do not know what school they are from. We are now dealing with Commencement matters, which are matters raised very briefly by Senators in the House. A relevant Minister comes in to respond and the sessions are very tight. The guests are very welcome and I hope they enjoy their day. I hope we inspire one or two of them to enter politics.

I thank the Senator for asking these important questions about offshore wind policy and how it affects the whole country, including her area, Mayo.

Ireland has one of the best offshore renewable energy resources in the world. We have a sea area of 490,000 sq. km, which is about seven times the size of our land area. Because of Ireland's location at the edge of the Atlantic and the EU, we have more energy potential than most countries in Europe. The climate action plan of 2021 includes a suite of actions to realise the full potential of the totality of Ireland's offshore renewable energy resources, and it also commits to the achievement of 5 GW of offshore wind capacity by 2030.

Our programme for Government sets out a further commitment to develop a long-term plan to harness the estimated potential of at least 30 GW of offshore floating wind power in our Atlantic waters, which could enable Ireland to become a major regional generator and exporter of offshore renewable energy.

The 5 GW target will be primarily met through the development of offshore renewable energy in Ireland's eastern and southern coastal regions. This reflects the suitability of water depths in these regions for the deployment of conventional fixed bottom offshore wind turbines and existing electricity grid infrastructure to connect these projects to the onshore grid. Subsequent cost-effective deployment of renewables in deeper waters off the west coast, in order to take advantage of greater wind resources, should be increasingly feasible through future advances in floating turbine technology.

The national marine planning framework, NMPF, was published in 2021 and brings together all marine-based human activities for the first time, outlining the Government's vision, objectives and marine planning policies for each marine activity, including port activity and offshore renewable energy. The Maritime Area Planning Act was enacted in late 2021 and provides the legal underpinning to an entirely new marine planning system, which will balance harnessing our huge offshore wind potential, while protecting our rich and unique marine environment.

An eight-week MAC application window for the first batch of projects, known as the phase 1 projects, coming in under the new regime was opened on 25 April 2022 and will close on 22 June 2022, with the first MACs expected to be granted in quarter 3 of 2022. The first phase of offshore wind in Ireland will be necessary, but not sufficient, to reach our 2030, 5 GW ambition. An additional phase is required, comprising projects which can deliver by 2030 and before we complete the transition to a plan-led enduring regime.

The Department is currently reviewing submissions on a recent consultation to gather views on the scale, make-up and sequencing of phase 2 of offshore wind deployment. A new offshore renewable energy development plan, OREDP Il, will be published in the first quarter of 2023. It will assess Ireland's offshore energy resource potential, including for floating wind off the west coast, and will provide an evidence base for the identification of the areas most suitable for the sustainable development of fixed and floating wind, wave and tidal technologies in the Irish exclusive economic zone, while also considering other maritime activities and marine biodiversity.

The OREDP Il, along with a planned economic analysis, will set out the pathway for the long-term sustainable development of offshore renewable energy beyond 2030. This plan will provide a framework for the future sustainable development of Ireland's ORE resources.

A cross-departmental offshore wind delivery task force has been established to drive delivery and capture wider and longer-term economic and business opportunities associated with the development of offshore renewables in Ireland. This will include the identification of supporting infrastructure development and supply chain opportunities as Ireland's offshore wind industry is developed. The development of offshore renewable energy in Ireland will bring us closer to achieving our energy and climate goals, reducing our reliance on imported fossil fuels and increasing our security and diversity of energy supply.

I thank the Minister of State for his response. There is some positive stuff in it, but it appears to be lacking in terms of the level of ambition we would like to see for the west of Ireland. I understand the technology is slightly different and is not as easy to install floating, as opposed to fixed bottom, turbines, but the Minister of State acknowledged in his reply that the wind resources off the west coast are far greater than elsewhere. If we are serious about achieving our 2030 targets, which we are currently not on track to meet, and we want to do more than that longer-term, that is where we have to be ambitious and what we should aim for.

I ask for a renewed commitment to advancing projects in the west of Ireland because that is where we will reap the greatest benefit. It should not deter us because it is the more difficult option; if it is the better option it is the one we should pursue now and not wait for ten years when we will have missed our 2030 target.

I also welcome the new development plan, OREDP II. It will consider the possibility of offshore wind for the west coast. We will be waiting with bated breath to read that plan next year. We hope we will deliver it in quarter 1, as the Minister of State promised in his response.

I did not hear anything from the Minister of State about the level of investment the Government is putting into the development of offshore wind. I am not sure if he has any answers to that at the moment. If he does not, his officer might forward that information on at the earliest opportunity. I ask for some more detail on the cross-departmental offshore wind delivery task force. Who is on it? Does the Minister of State sit on it? Are there any Members of the Oireachtas on it? Does it meet in public or in private?

Is there access to the minutes? Is there transparency around the work that the task force does? It sounds interesting and promising. I would love an opportunity as a Member of this House to engage with that task force.

As the Senator pointed out, the west has more wind. It has faster speeds and more regular wind and, therefore, there is more to be harvested. However, it also has deeper waters and a more environmentally sensitive coastline. There are, for example, the Cliffs of Moher and many beauty spots along the west. It is, therefore, harder to develop wind there using the conventional approach, which is to put a wind turbine in the sea and build it onto foundations. That can be done in the shallow waters of the east coast where the wind is not so strong. We are moving towards floating wind turbines, which are a newer technology that is not quite yet commercial. However, I was in Portugal recently. They have a floating turbine there as a pilot and all their water is deep. We are not the only country in the world that is facing this issue. Japan is in the same situation in trying to face this. Our current plan is to not build floating turbines until after 2030. However, there is a war in Ukraine. There is an accelerated need to move towards renewable energy. We know this because long-distance commuters are feeling pain when they have to put petrol in their cars. People are who are on low incomes are finding it hard to heat their homes because the enormous price of fossil fuels.

There is an acceleration across Europe. The European Commission’s REPowerEU plans are all about how we speed up the development of offshore wind and renewables in general, as well as how we can go beyond our current plans. I, therefore, ask the Senator to watch this space.

Hospital Overcrowding

I welcome the Minister of State, Deputy Feighan, back to the Chamber.

I thank the Minister of State for coming back to the Chamber to discuss this all-important issue. I would like him to make a statement regarding the recent HIQA report on University Hospital Limerick. It is a damaging, concerning, disappointing and shocking report. I have been raising the issue of UHL in this House, as well as with the Minister for Health, for a long time. I raise issues every week. While there are positive things that happen there, this report is damaging. It is important that the Minister acknowledges the concerns around the hospital.

I welcome that the visit was unannounced. I had been calling for this, because I believe that in an unannounced visit we can get the true sense of the issues within the hospital. I have written to the Minister seeking the terms of reference of the independent group that he is asking to look at the hospital and the issues present there. I believe that this report should inform what the independent group looks at.

The report outlined many disturbing facts and concluded that UHL was mainly non-compliant with all HIQA standards. That is most frightening. Throughout the report, it can be seen that of the many examinations that took place, none of them concluded that the hospital was compliant. There have been recent reports of patients going missing. There are not enough neurological nurses, which I have highlighted in the House in the past. I was told that three were sufficient but I believe that eight are required.

Some solutions have been suggested, including the provision of 100 beds. However, Professor Lenihan said the other evening that they need more than 200 beds to bring the hospital up to standard. More than 200 patients have been waiting for over four years for appointments for diabetes. These issues are not helping the overcrowding conditions.

During Covid-19, 98 extra beds as well as 11 extra critical care beds were provided but that has not been enough. Improved access to special infection prevention, supporting staff with education and training, improving clinical audits, activity within the emergency department and staffing levels are all issues that were highlighted in the report. I believe the Minister for Health and his Department can no longer bury their heads in the sand and ignore the crisis any further. Doing so will be a reflection of the fact that, at the moment, his concerns do not seem to be around overcrowding in UHL.

I really believe it is the worst hospital in the country in that respect. On one day alone last month, there were 126 people on trolleys. Standard 6.1 states: "Service providers plan, organise and manage their workforce to achieve the service objectives for high quality, safe and reliable healthcare." The report concluded that UHL was non-compliant in this matter as staff shortages were always present and staff deficits varied between 17% and 33%.

With regard to the quality and safety dimension, the report found that UHL was also non-compliant on the two national standards that were assessed. Furthermore, UHL was found to be non-compliant regarding service users' dignity, privacy and autonomy, which is highly disturbing as patient confidentiality is crucial in all healthcare settings. The hospital was also found to be non-compliant in the service provider's ability to protect service users from the risk of harm associated with design and delivery of healthcare services. The conclusion of the report states that while it was the second busiest emergency department in 2021, UHL had the second lowest bed stock compared with other model 4 hospitals in Dublin, Cork and Galway. Another point that was highlighted is that elective hospitals in other areas are being progressed. In Limerick that is certainly not the case.

It is deeply concerning that there has not yet been a single comment from the Minister on the report. Undoubtedly the crisis is dangerous, not only for the people of Limerick and the mid-west but also for the staff. That is the really frightening part. I have been speaking to some of the staff and morale is on the floor. The report from last Friday needs to be considered in a serious light and taken as part of the independent review the Minister is ordering. The issues need to be addressed. Limerick and the mid-west deserve a better standard of healthcare, not only for the patients and their families but for the staff working there as well. I look forward to the Minister of State's reply.

I welcome the opportunity to address the House on this important issue raised by Senator Maria Byrne. I also welcome the publication of HIQA's report of the unannounced inspection of the emergency department at University Hospital Limerick against the national standards for safer better healthcare. Four national standards were assessed as part of the HIQA inspection, two standards in each of the two dimensions of capacity and capability, and quality and safety. HIQA judged that UHL was partially compliant against one standard and non-compliant against the remaining three standards.

The inspection focused particularly on the important issues of patient flow and inpatient bed capacity in the hospital; respect, dignity and privacy for people receiving care in the emergency department; and staffing levels in the ED. As Minister of State, I am concerned about the significant risk to service users identified in the report. I am pleased that the Minister, Deputy Stephen Donnelly, recently requested the HSE to appoint an expert review team to work with hospital management to improve ED performance at UHL. In addition, the Minister also requested the HSE to prepare short-term and longer term unscheduled care performance improvement plans for all our emergency departments, including UHL.

The compliance plan agreed by UHL with HIQA to bring about compliance with the relevant standards contains short-term, within three months, medium-term, within six months, and long-term, within three years, actions. The Department of Health is working with the HSE to ensure the ED performance improvement plan for UHL and the expert team review operate in concert with the compliance plan included in the HIQA report.

In addition, UHL also commissioned Deloitte to review and advise on unscheduled care and patient flow in the hospital. The expert team will consider the outputs of this work in its review. Both Deloitte and the HSE expert review team are due to submit reports which are expected to help identify potential mitigations for the problems outlined in the HIQA report.

It must be recognised that University Hospital Limerick continues to deal with record volumes of patients attending its ED.

There were more than 76,000 attendances at the emergency department in UHL in 2021, up 16% compared with 2020.

There continues to be substantial investment in UHL to address capacity issues, including a 28% increase in the workforce since the end of 2019 and the opening of an additional 98 non-ICU acute beds. To deal with this increased level of presentations, reform of service delivery as outlined in Sláintecare is vital. This includes the expansion of community care and other measures to provide people with the care they need outside emergency departments. We are working to improve patient flow and egress from hospital by providing more home care packages and nursing home supports. Investment of €1.1 billion was allocated in budget 2021 to expand capacity, increase services and support reform. That level of investment has been maintained in budget 2022.

I thank the Minister of State. While I acknowledge there has been significant investment and expansion of services, it is not enough. This report has made that clear. I am disappointed that the Department has not acknowledged that services need to be expanded further. I acknowledge the Department is awaiting the expert report but it is not right that the people of the mid-west are subjected to these conditions. It is the most overcrowded hospital in the country.

There are many good things about the hospital. It has won several awards in different areas. Not all the departments are affected by overcrowding - I do not want the story to go out that they are - but the emergency department is a significant concern and needs to be attended to. The Minister must acknowledge straightaway that these issues need to be dealt with because the situation is at crisis point. It is very deflating for staff, families and patients to hear other patients saying they are afraid to go to the hospital. That is the most frightening statement a person could make. That needs to be acknowledged by the Minister.

The Department and the HSE cannot afford to put their heads in the sand any more. There has been significant investment but there is a need for an independent group to see what is working right and what is not working, bring the two together and deliver a report. Any such report must not sit on a shelf, however; it needs to be implemented.

As I stated, I am concerned by the findings in respect of patient safety in the HIQA report. However, I believe the report provides an important opportunity for a renewed focus on the capacity and capability of UHL and on the quality and safety of the emergency services it delivers to the people of the mid-west. The Senator has articulated those issues extremely well. HIQA reviews are essential in ensuring that the resources required to underpin patient safety are optimised and that learning is shared across all hospitals and the health service generally. A strong quality and safety culture is associated with a responsive health system that listens and learns to improve services.

The Department regularly seeks assurance regarding the appropriate escalation measures for emergency department overcrowding. As I mentioned in my opening statement, significant resources have been invested in UHL in recent years. This has seen an increase in its workforce of 28%, or 796 whole-time equivalents, since the end of 2019. In addition, 98 new beds have been provided since the start of 2020, including a 60-bed modular ward block that was established to provide a rapid-build interim solution to begin to address the bed capacity issue at the hospital and to improve patient flow. A further 96-bed block is currently in planning for the hospital.

The performance of hospital emergency departments is under constant review by the Department through ongoing engagement with the HSE. I assure Members that the Government and the Minister are committed to driving improvement in emergency department performance. I again thank the Senator for raising these concerns. They will be brought back to the Minister and the Department.

Cuireadh an Seanad ar fionraí ar 1.19 p.m. agus cuireadh tús leis arís ar 1.30 p.m.
Sitting suspended at 1.19 p.m. and resumed at 1.30 p.m.