I welcome the Minister of State, Deputy Byrne, to the House.
Nithe i dtosach suíonna - Commencement Matters
Higher Education
I thank the Cathaoirleach for selecting this matter. I welcome from the National College of Ireland, Ms Gina Quin, president, and Dr. Deirdre Giblin who are here for this issue. I appreciate the Minister of State, Deputy Byrne, is taking this on behalf of another Department. However, as a former education spokesperson, he is familiar with the work of the National College of Ireland, NCI. It was founded in 1951 and at present has 6,500 students. It has a strong commitment to the access agenda in Ireland. On access to higher education, the National College of Ireland is one of our leading institutions. As the Minister of State is aware, it is an independent, not-for-profit institution. As a provider of higher education it offers a wide range of courses, based in the city centre of Dublin. It attracts students from more than 80 countries. It is one of the biggest providers of Springboard courses. The Minister of State is very familiar with the work it does.
I seek an update on the designation of NCI as an institution under the Higher Education Authority Act 2022. When we were debating the Bill in this Chamber in July last year, the Minister, Deputy Harris, said that it was very simple and that this legislation allowed colleges for the first time to put their hands up to say they wish to be designated. The Minister was very open at the time. My question today is very simple. When will the National College of Ireland be designated? What is the process to allow the NCI to be designated? When will that process commence? Will the Minister signal as to when we are going to move on this? The Minister was open to it, both in private discussion and when we were debating the legislation. Everybody agrees that the NCI is a core part of the higher education framework in Ireland. It is something that the institution itself wants to see happen. It wants whatever process needs to commence, to begin. However, we need to know what that process is. Now that the Act is well embedded, we need to know and we need a signal from the Minister as to what is the process. As the Minister himself said, if the hand is up, how can one go towards designation? I would be grateful were the Minister of State to outline today what the Department is saying about that process and a potential timeline.
I thank the Senator for raising this matter. I am pleased to have the opportunity to provide, on behalf of the Minister for Further and Higher Education, Research, Innovation and Science, an update on the Higher Education Authority Act 2022 which was only signed by the President on 10 October 2022. The majority of the sections of the Act were commenced on 10 November via SI 554 of 2022. The Higher Education Authority Act 2022 provides for the designation of institutions of higher education where the purpose and intent of this designation system is to protect the reputation and integrity of the higher education sector by bringing together all reputable, high quality higher education providers under the oversight of the Higher Education Authority, HEA. The designation provisions in the Act first set out the automatic designation of institutions that are currently established or recognised under legislation and which were designated under the Higher Education Authority Act 1971. Therefore, those automatically designated are the universities, technological universities, institutes of technology, the National College of Art and Design and the Royal College of Surgeons in Ireland.
The legislation also provides for an application process to the HEA by not-for-profit or private higher education providers for designation by order of the Minister. These sections in the Act have not yet been commenced as the legislation requires this application process to have regulations in place detailing the conditions to be complied with by a higher education provider before a designation order can be made. The Department of Further and Higher Education, Research, Innovation and Science has started work on the development of these regulations. The completion of the designation regulations and the establishment of a process for designation by order will take further consideration, including consultation with the HEA. Once the regulations are prescribed and the process is fully developed, the relevant provisions of the Higher Education Authority Act will be commenced. It will then be open to the National College of Ireland to apply for designation by order under the legislation.
Institutions, including the National College of Ireland, will be informed once the designation by order process is open for applications by the Department of Further and Higher Education, Research, Innovation and Science.
I thank the Minister of State. I appreciate he is taking this matter on behalf of another Department. However, it is almost a case of “tell me something that we do not know” because this is very clearly what is laid out within the legislation. What I am asking, and I would ask the Minister of State to take it back to the Minister, Deputy Harris, is that we need to know the timeline for when this will happen. We know what needs to happen. We know that the Minister is committed to it but in that answer, we do not have a clear timeline in place. What the Minister of State is saying is that once the regulations are prescribed and the process is fully developed the relevant provisions will be commenced. The question that I have, which the Minister of State needs to bring back to the Minister, is when will the regulations be prescribed? When will the process be developed? When will the provisions then be commenced? When, as the Minister, Deputy Harris said, can the National College of Ireland hold up its hand and say “we wish to be designated”?
I thank the Senator for raising this issue and for his contribution. I assure him that departmental officials are working, as I said, and the work has already started to develop the regulations and the process in regard to the designation by order provisions in the Higher Education Authority Act 2022. Once the designation by order regulations and the process are both approved, the designation by order sections of the Higher Education Authority Act will be commenced.
The regulations are being written. Once they are finalised the legislation can be commenced, and then those regulations can come into effect by ministerial order.
The National College of Ireland and other institutions will be informed at that time of the application process relating to designation. It will be open to them to apply for designation under the legislation. Any application received by the National College of Ireland will be assessed in accordance with the designation-by-order regulations and the process.
Healthcare Infrastructure Provision
I thank the Cathaoirleach for accepting this matter, which relates to an issue that is very important to us in Tipperary. It is particularly important to Councillor Declan Burgess, who has been working with the HSE for a number of years to try to push this project along in his home town of Cashel. It is infuriating because the process is stuck at a particular stage. St. Patrick's Hospital in Cashel in County Tipperary provides residential rehabilitation and respite care to older adults in the south Tipperary area. It provides a top-class service and is considered a very strong example of how to do community healthcare right. The national capital plan includes the new build for St. Patrick's Hospital in Cashel. It will be a 60-bed unit that will replace the current St. Anne's, St. Bernadette's and St. Benedict's wards. It has survived the review of the capital plan on numerous occasions and remains committed to by the HSE.
Councillor Burgess has been advised on numerous occasions that a design team has been appointed, and that a pre-planning meeting was conducted with Tipperary County Council. Members of the HSE design team have visited several sites as part of the process of agreeing the overall layout and design of the premises. It was planned to submit for planning permission by August 2019, and then subsequently in early 2020. We are very concerned that the delay in submission for planning permission is not a good indicator to the future development of this project. Time and again the HSE has said to us that they are at stage 2, which is the detailed design and planning application. It is imperative that planning permission would be submitted as soon as possible. There were significant delays due to Covid 19 and the complicated site investigations that have to be carried out in respect of historical locations. Despite several motions and questions tabled by him at the HSE health forum, Councillor Burgess is none the wiser as to the reasoning behind the delay in submitting the application to the planning section of Tipperary County Council. They were ready for submitting in August 2019 and early 2020 but it just never materialised.
We want to get to the bottom of the situation here. We made a commitment to develop this 60-bed unit. We have announced to the people in Cashel. The people in south Tipperary want this project delivered. It is very frustrating when, as a local councillor in your home town, you see people every day who know that the Government you represent announced a project in respect of which nothing has happened and which is stuck in the planning process. That is just not acceptable. Our representatives on the ground need answers when something like this happens. I really hope that the Minister of State will be able to provide some extra information for me and for Councillor Burgess.
I am taking this matter on behalf of the Minister for Health, Deputy Donnelly, who is in the Dáil taking parliamentary questions on health. The Minister thanks the Senator for raising this issue and providing the opportunity to update the House on the position relating to St. Patrick’s Hospital in Cashel.
In early 2016, a capital programme for older persons residential centres was developed in response to the introduction of HIQA’s national residential care standards for older people and the requirement that all facilities providing long-stay beds be registered by HIQA. This is a programme to replace, upgrade and refurbish care facilities, as appropriate, at 90 locations. The vast majority of projects are replacement capacity. The emergence of the Covid 19 pandemic in March 2020 interrupted work on St. Patrick's Hospital. As a response to Covid-19 risks, upgrade works were carried out to make facilities located on the campus of the nearby Our Lady’s Hospital, Cashel - now called the Cashel Residential Older Persons Services - suitable for long-stay residential use. Residents from St. Patrick’s Hospital were moved to this facility, which was registered under HIQA for three years from June 2020. The three-year registration is due for renewal and the HSE is engaged with HIQA regarding registration.
The Minister, the Minister of State, Deputy Butler, the Department and the HSE are committed to the development of a new community nursing unit for older persons for Cashel. The HSE advises that the existing site is not suitable for the new 60-bed community nursing unit, CNU. The HSE also advises that the site is very limited in size. Challenges regarding the amount of parking space and access to the building have been identified. A site in Cashel town is currently being reviewed by HSE for suitability for a new CNU. In line with project guidelines and best practice, an options appraisal will be completed to review all options for delivering the required CNU accommodation. This review is expected to be completed in quarter 2 of 2023. An assessment and rehabilitation unit, and a day hospital for older persons services, continue to operate at St. Patrick’s Hospital.
Specialist renovation works have been carried out on some of the vacated space at St. Patrick’s Hospital for the development of new facilities for the children’s disability network team for Cashel, Tipperary and surrounding areas. This will also accommodate children’s disability services originally based at Our Lady’s Hospital. Other available space at St. Patrick’s Hospital is being considered for the development of facilities for the HSE’s roll out of the enhanced community care programme. In addition, the public private partnership build in Clonmel, with a completion date of quarter 4 of 2024, has started. This will provide a 50-bed CNU.
All capital development proposals must progress through a number of approval stages, in line with the public spending code, including detailed appraisal, planning, design and procurement before funding for each stage can be confirmed. The successful completion of the various approval stages will determine the timeline for delivery of this project. It is not possible to provide a timeline for construction or operation of the facility at this point.
I thank the Minister of State for his response. In fairness, I understand that the Minister for Health and the Minister of State, Deputy Butler, are in the Dáil taking questions. I welcome the fact that they are committed to the development of a new CNU for older persons in Cashel. That is the most important thing. It is important that there is a commitment in this regard. Investment has been made in Tipperary in other areas and there is future investment planned also. The Minister of State, Deputy Byrne, will understand that from a local perspective it is incredibly frustrating when projects are being delayed and when we as public representatives cannot get the answers on when the projects will move forward.
I welcome that there will be a bit of movement in quarter 2 of 2023. I ask that there be as much communication as possible with councillors, particularly as this matter relates to their home town where a big development is going to happen. They are the ones who will be asked the questions about why the project has been delayed and when it will be completed. Will the Minister of State, Deputy Byrne, contact the Minister of State, Deputy Butler, to ask if she would meet with me and Councillor Burgess to discuss the project? It is a really positive story that will be a huge benefit for the area. We just need to make sure that it keeps moving along and progressing, in a timely and speedy manner.
I will certainly communicate that to the Minister of State, Deputy Butler. I reiterate that the Department of Health, the HSE, the Minister for Health and the Minister of State, Deputy Butler, are all committed to the development of a new CNU for Cashel. Provision has been made in this year's capital programme to progress a 60-bed CNU for Cashel. A site in Cashel town is currently being reviewed by the HSE for suitability for the new CNU.
Services are still being provided at St. Patrick's Hospital in Cashel. An assessment and rehabilitation unit and a day hospital for older persons services continue to operate, and will continue. I will bring the concerns raised by Senator Ahearn to the Minister and the Minister of State, Deputy Butler. There is a commitment there and there is funding in the HSE capital plan. Work is under way to review a particular site and let us hope that this is successful.
Health Services
This matter relates to out-of-hours services at St. Joseph's Hospital, Longford. I will give the Minister of State a little background. In December 2022, the old MIDOC service that was there went into receivership and it left no permanent contract in place for the out-of-hours service, or the red-eye service, for evening and weekend services in Longford. To date, a permanent contract has not been put in place. There were times when the service was not available and people had to travel to Mullingar hospital.
We have seen the opening of a minor injury clinic at St. Francis's hospital in Ballinderry, which is on the edge of Mullingar as well, without any investment in the campus at St. Joseph's hospital.
I put on the record my thanks to the Minister, Deputy Harris, when he was Minister for Health. He allocated a multimillion euro fund to upgrade the care centre for the elderly, but the people of Longford want a permanent out-of-hours service contract put in place. We feel not enough investment is going into the centre there. We have been looking for additional palliative beds. We have a fantastic X-ray facility, which needs a significant upgrade, but that investment does not seem to be put in place. My colleague, Councillor Peggy Nolan, has probably been one of the strongest advocates for the staff and, indeed, the service there. I will also highlight this issue. We want a permanent contract put in place, to take away that fear that if an issue arises with regard to the availability of a doctor, we will be left without that service in our county town which means, yet again, we have to travel three quarters of an hour to get that service. I want a commitment from the HSE that service will be in place immediately to serve the people of County Longford.
A robust general practice and GP out-of-hours service is essential to the delivery of our primary care health service. GP out-of-hours co-operatives are largely private organisations. However, since MIDOC out-of-hours ceased operations on 31 December last, the urgent out-of-hours GP service in the area, which was previously run by MIDOC, has been run by the HSE. The service provides out-of-hours GP care for counties Laois, Offaly, Longford and Westmeath. MIDOC GP CLG, a private company, previously co-ordinated the rotas and payments for GPs who worked in the MIDOC out-of-hours service. However, MIDOC made the decision to cease trading on the 31 December 2022. This was despite a long period of prior engagement with the HSE to help address the financial challenges the company faced and financial support to the company provided by the HSE, to allow for the completion of an independent financial review. It was disappointing that despite this ongoing engagement and support, the company ceased trading.
Since December, there has been no change to or cessation of services, as the HSE put in place interim arrangements to provide urgent out-of-hours GP services, including the out-of-hours service at St. Joseph’s hospital in Longford. Since the decision by MIDOC to cease trading, the HSE has been engaging with the Irish Medical Organisation, IMO, and continues to communicate with GPs. The HSE has ensured and will continue to ensure the provision of out-of-hours services until such time as an alternative provider is in place.
It is important to note, however, that the provision of out-of-hours services is a contractual obligation under the general medical scheme contract and, therefore, the decision on who provides the service rests with the GPs. The HSE will support and facilitate this process. The current interim arrangements will continue until at least 2 July 2023, allowing the necessary time for GPs to agree on a preferred out-of-hours provider and to implement the service, which is a contractual obligation under the general medical scheme.
The terms of reference for a strategic review of general practice have recently been published. This review will commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including the out-of-hours services and will set out the measures necessary to deliver a more sustainable general practice.
The one line that stands out to me again is that the "interim arrangements will continue until at least 2 July". The interim arrangements to get a contract were meant to be until the end of January; then the end of April and now they are until 2 July. I acknowledge the agreement has to come from the doctors, but that is in conjunction with the HSE. This is a priority for us in Longford. It is not good enough for the constituents in my local area to know this is an interim arrangement. It is the only interim arrangement anywhere in the country. We need a permanent arrangement in place. I ask that this be a priority for the senior staff within the HSE and within the community healthcare organisation, CHO. I also highlight a lack of funding for some of the services on that campus. Some of the queues in Mullingar hospital could be alleviated by upgrading, at least, the X-ray service and giving consideration to what is a successful minor injury clinic, based only two or three miles from Mullingar hospital and yet some people in County Longford are more than an hour away from it. Some consideration should be given to a minor injury clinic based at St. Joseph's hospital. It would cut down on the number of people who are going in to the emergency department in Mullingar hospital.
I will take all of that back to the Minister, who is in the Dáil at present. I apologise for that. He is answering questions. A key sentence from what I have already said is that "the HSE has ensured and will continue to ensure the provision of out-of-hours services until such time as an alternative provider is in place". That is very important. It is reassurance for the Senator's constituents in Longford. Despite the decision of the private company MIDOC to cease trading, there has been no disruption to the urgent out-of-hours GP services in the midlands. The HSE has been managing and will continue to manage the provision of out-of-hours urgent GP care in the area previously served by MIDOC. This arrangement will remain in place until an alternative provider is agreed by local GPs and is put in place. The HSE continues to support out-of-hours services throughout the country and provide significant financial supports towards service delivery. It regularly engages with all providers and recently increased the funding and supports available to them over the busy winter period, to allow the rostering of more doctors in order that more patients are seen. Senator Carrigy can be assured that quality and patient safety in the delivery of out-of-hours GP care remains paramount for the HSE.
Defibrillators Provision
Tá fáilte roimh an Aire Stáit go dtí an Teach seo ar maidin. I am here this morning to seek an update on the out-of-hospital cardiac arrest strategy that we are beginning to roll out throughout the length and breadth of the country. As the Minister of State knows, many community groups across the length and breadth of the land have worked and fundraised hard to ensure that their communities have access to defibrillators or automated external defibrillators, AEDs, in the instance of cardiac arrest. AEDs are portable, life-saving devices designed to treat people experiencing sudden cardiac arrest, a medical condition in which the heart stops beating suddenly and unexpectedly.
The National Ambulance Service has a list of locations of more than 2,000 AEDs on its national computer-aided dispatch system, which it can use to advise emergency callers, although this is in its infancy. Sudden cardiac arrest is among the world's leading causes of death. Having access in the community to such devices is vital. For each minute defibrillation is delayed, the odds of survival are reduced by approximately 10%. Thus, having access to an AED and, more importantly, knowing how to use one is critical. As the Minister of State said here the last time I raised this issue, "Research has shown us it takes an entire system to save a life, which is why a strategic whole-nation approach is planned. Improving out-of-hospital cardiac arrest survival is essential". The national out-of-hospital cardiac arrest steering group was established to develop and implement a strategy to improve out-of-hospital cardiac arrest outcomes in Ireland. A strategy is very much needed because out-of-hospital cardiac arrest is a significant source of mortality and morbidity, with wide variation in reported incidence and outcomes globally. The voluntary efforts by communities deserve great credit, but they need to be backed up by a strategic system rather than an ad hoc affair. A nationwide approach to improving the strategy is absolutely essential.
I spoke the last time in the House about Buncrana Garda station, with which the Acting Chair will be very familiar, in Buncrana Garda district. The National Ambulance Service provided cardiac first response training to members of that Garda district. All of the members took it up and, as a result, the National Ambulance Service installed a defibrillator in every single Garda vehicle, including a motorcycle, in that district.
Many schools have also installed AEDs and have trained their staff in first aid. There is a clear ambition in the community to be able to respond to emergency situations. We need a culture right across the board, that is, in the community; schools; businesses; transport; and hospitality. There are plenty of examples of excellent resuscitation practice across the country that should be looked at with regard to national implementation, with the ultimate aim of improving survival outcomes nationwide.
I mentioned how in Buncrana district, An Garda Síochána has rolled out defibrillators in all of its vehicles, including motorcycles. I hope the Minister of State will have an update as to where that is at countrywide, not just regarding the Garda fleet but also fire stations and their vehicles. They should also be equipped. In many instances in rural Ireland, there are, unfortunately, delays with ambulance response times. These Garda vehicles and fire personnel are in every community and each county throughout the country. It is important this strategy is progressed as quickly as possible because every second counts when it comes to trying to save a life.
The Minister for Health, Deputy Donnelly, would like to thank Senator Gallagher for facilitating this chance to update the House on this important matter. The Minister is in the Dáil this morning answering health questions, so that is why he is not here.
Enhanced community response is critical to improving cardiac arrest survival rates, and this is wholly recognised in the national out-of-hospital cardiac arrest strategy, OHCA, from 2019, which is called Putting Survival at the Heart of the Community, from 2019. The National Ambulance Service, for example, has a network of more than 250 community first responder schemes supported by a community engagement team. In the event of a cardiac arrest, automated text messages direct community first responders to the scene of a cardiac arrest that occurs in the catchment area. The role is to help stabilise the patient by providing CPR and defibrillation while awaiting an ambulance crew. The evidence clarifies the significance of this role, as this time from collapse intervention is a direct determinant of cardiac arrest survival.
The strategy clearly sets out that improving survival from out-of-hospital cardiac arrest involves a number of initiatives. In 2021, percentage survival from out-of-hospital cardiac arrest was reported as 6.1%, with 178 people returning home to their families. One important aim of the out-of-hospital cardiac arrest strategy is to support Ireland to achieve similar survival rates to the best-performing European countries who, more consistently, achieve rates exceeding 10%.
Implementation of the national out-of-hospital cardiac arrest strategy is managed by the National Ambulance Service, with a multi-agency governance group drawn from the HSE, the national directorate for fire and emergency management, An Garda Síochána, the Pre-Hospital Emergency Care Council, the Irish Heart Foundation, Community First Responders Ireland, Dublin Fire Brigade and the Red Cross, as well as national and international academic expertise.
In countries that have achieved improved out-of-hospital cardiac arrest survival rates, police and the fire service are routinely dispatched in tandem with ambulance services. In line with this, the out-of-hospital cardiac arrest strategy recommends opportunities to involve An Garda Síochána and the fire services. The strategy and recommendations are endorsed by Government and are currently being developed and implemented.
Firefighters and gardaí from a small number of retained fire stations and Garda units, and Senator Gallagher has mentioned some of them, currently provide a response to cardiac arrest in their communities. Support for this is provided by the National Ambulance Service community engagement team, which manages and co-ordinates the community responses. Support includes provision of information sessions to firefighters and gardaí who are interested in providing an out-of-hospital cardiac arrest response, training days and follow-up meetings to participating services. Instructor training is also provided to enable each participating service to train its members to the appropriate responder level. Individualised post-call follow-up for difficult situations is also provided.
In common with other responders in the community, An Garda Síochána members and fire services personnel are provided with clinical governance through the National Ambulance Service clinical director, with co-ordination through the National Ambulance Service community engagement team. The out-of-hospital cardiac arrest strategy does not include a specific recommendation to equip gardaí, emergency services and fire service vehicles with automated external defibrillators, AEDs. The focus is on building the capacity, through teams, to respond quickly in the community.
I thank the Minister of State for the response. The statistic he gave about the current rate of survival in this country was 6.1%. As the Minister of State said himself, 178 people were able to return to their families, which is a very positive development. He also said that the European norm is slightly over 10%, which shows we have a way to go.
I very much welcome the strategy. It is an excellent idea. We have a resource within each community throughout the country in both the Garda fleet and the fire service vehicles as well. That should be utilised to its absolute maximum. We are talking here about saving lives, and it is to be hoped the next time this issue is raised in the House, that 6.1% will be closer to or even greater than the European norm of 10% and that more people will return home safely to their families.
I thank Senator Gallagher. The Government is committed to ensuring Ireland continues to improve out-of-hospital cardiac arrest survival rates through supporting the strategy and all the work towards achieving a target of greater than 10% survival, as the Senator just said. To do this, there is a commitment to work with the National Ambulance Service in pursuing and endorsing opportunities to involve An Garda Síochána and the fire services. The strategy governance implementation group will continue its work to strengthen further the involvement of retained fire services in community first response to cardiac arrest.
Improving survival from an out-of-hospital cardiac arrest involves a number of initiatives. One of these is a specific aim to implement a National Ambulance Service national AED or defibrillator registry, which will be mapped on the National Ambulance Service dispatch system, and a supporting app for dispatching first responders. Work has already begun on developing this registry.
It is a good opportunity for all of us to thank all of our emergency services who are part of the public service: An Garda Síochána, the fire services, the National Ambulance Service, mountain rescue, coastal rescue, and all of these people who do fantastic work. We should also thank our volunteer community first responders as well. It is an initiative that has grown up in recent years, and it is tremendous to see the commitment right across the country from ordinary people who have effectively trained themselves up, with assistance from the National Ambulance Service, etc., to be available within their community as first responders to keep people alive. Our thanks goes to them.
Absolutely, Minister of State. We can all agree with that.
Cuireadh an Seanad ar fionraí ar 10.07 a.m. agus cuireadh tús leis arís ar 10.30 a.m.
Sitting suspended at 10.07 a.m. and resumed at 10.30 a.m.