I welcome the Minister of State, Deputy Butler, to the House and now call on Senator Flynn.
Nithe i dtosach suíonna - Commencement Matters
Traveller Community
I thank the Cathaoirleach and I thank the Minister of State for personally attending the House this morning. It means a great deal because the last time I did this Commencement matter, the Minister of State, unfortunately, could not make it. In April 2022, a year and a few months ago, I stood in this House to raise the exact same Commencement matter with the exact same questions. Obviously, I will change it around a little bit. I say to the Minister of State that we are failing Travellers when it comes to mental health. The Traveller community has asked for a ring-fenced budget and a stand-alone national Traveller strategy. I know that there are six stand-alone actions for the Traveller community. The Minister of State knows as well as I do the level of the crisis within our community. The response, unfortunately, is not enough.
One of the recommendations of the Traveller committee around mental health is to have that stand-alone strategy and to have the ring-fenced budget for the Traveller community around mental health. Since I did this Commencement matter I know on a personal level of five members of the Traveller community who have died by suicide. We need support for the Traveller community which is focused and will have outcomes for our community. I know that in budget 2023, €300,000 was allocated from the Minister of State's Department to Traveller mental health services. While we welcome it and it was the first time in history for us to get money for Traveller mental health, that will not cover two good counsellors for mental health within the Traveller community.
Again, we are not asking for special treatment. I see this on the ground and I am standing here today coming from a meeting which the Minister of State had with the National Traveller Mental Health Network. While we welcome that meeting, the network came away feeling very disheartened and that the political will was not there. We know from years of campaigning that we are recognised as an ethnic minority group and that was not something that was handed to us easily. We had to work for that for at least 30 years in order to be recognised in our own country as a minority group, which we are, and as an indigenous group of this country.
Keeping the focus on mental health, I know the Minister of State is trying her best. However, it is not enough. Next Monday the National Traveller Mental Health Network is launching a report around the need for a mental health phone line for members of the community which they can call because of the need for an out-of-hours service.
My questions to the Minister of State is very simple. What are the updates on Traveller mental health, how was the €300,000 which was allocated in the last budget spent, and what is next? Can we please have what we were promised, which is our Traveller national mental health strategy?
I thank Senator Flynn for raising this matter. I also thank her for all of the advocacy work she does on Traveller health and mental health.
As the Senator will be aware, the National Traveller Health Action Plan 2022-2027 was launched in November 2022 and was informed by the results from the All-Ireland Traveller Health Study and other official reports, including the report of the Joint Committee on Key Issues Affecting the Traveller Community. The plan was developed following consultation with representatives of the Traveller Community.
The Department of Health and the HSE are committed to developing priorities, strategies and actions on Traveller mental health within the framework of the national Traveller Health Action Plan 2022-2027. These will respond to the crisis in Traveller mental health and address the social determinants of Traveller mental health through targeted and mainstreaming measures.
As a first step, the Traveller health action plan contains six actions on Traveller mental health. These are being delivered through the HSE national service plan for 2023, supported by an additional ring-fenced budget of €300,000 to which the Senator referred. Our national mental health policy, Sharing the Vision, and our national suicide reduction strategy, Connecting for Life, all recognise this community’s specific mental health needs. My aim is to work in partnership with the Traveller community and representative groups across the country to improve the standard of services Travellers receive and to ensure more adequate mental health interventions which are rooted in cultural appropriateness and equitable care. The Department and the HSE will also engage with the Traveller community and representative organisations to develop and expand the actions as part of a mental health priority plan within the framework of the Traveller health action plan.
The newly-established HSE steering group on Traveller mental health will continue to consult with the Traveller mental health network on this task and Traveller representatives have been invited to be part of the group.
In 2022 the mental health service co-ordinators for Travellers received a significant grant through this collaboration from the Department of Health to support Traveller organisations across the country in promoting access to mental health recovery with the Traveller community at local level.
I know that the Senator spoke about the €300,000 not being enough but that was new additional funding. There are existing ring-fenced resources. There are nine Traveller mental health co-ordinators; €365,000 was allocated for Traveller mental health engagement in 2022 and further funding of €55,000 was awarded for a peer-led research project to develop a Traveller mental wellness framework in 2022. In addition, the National Office for Suicide Prevention provides annual funding for the Traveller mental health services in Exchange House Ireland National Travellers Service, as the Senator is aware, and also supports and funds for Pavee Point to also support Travellers.
In 2022 the mental health service co-ordinators for Travellers received a significant grant. This has meant we are making progress in the ability of our health service to provide appropriate care to Traveller patients to meet Traveller-specific social and cultural needs. This work focuses on supporting and motivating the health service to engage in a more meaningful way with the Traveller community. I was delighted to meet with the group two weeks ago and we had a robust discussion. I am always open to meeting with the group to discuss what more we need to do. I accept we need to do more. As Members might have noticed, in budget 2024 I did not receive much funding for new developments but I ring-fenced specific funding to provide national coverage for the Traveller counselling service. For the first time ever, in 2024 there will be national coverage for Traveller counselling especially in relation to self harm, suicide ideation and people bereaved by suicide.
For the three and a half years I have been in this House I have worked with the National Traveller Mental Health Network, NTMHN, and with the community on the ground. We are no longer ashamed of mental health issues. That is good to see in Ireland as a whole. However, there are 27 primary healthcare services within Ireland in which the Traveller community works. While we welcome the newly allocated €300,000, genuinely it would not cover two good workers in the year. If the Minister of State walked onto any halting site in the country and spoke to families, they would tell her about the struggle. To a certain extent you really have to live and breathe within the community. There are 13- and 14-year-olds, young women, dying by suicide within our community. We must and should do more. I will talk to the NTMHN about its plans going forward. We were promised a national mental health strategy for the Traveller community. We feel let down as a community.
I thank the Senator. As she knows, there is a strategy for health for the Traveller community which includes the mental health strategy. To be fair, the €300,000 is in addition to the other money being provided. This €300,000 for budget 2024 will have agreed funding. The Traveller mental health working group has agreed funding for one mental health community worker in each of the seven national Traveller health units. That is what the €300,000 is for. Recruitment is starting now. These posts will be based within the Traveller organisations and will be trained by and work closely with the existing HSE Traveller mental health co-ordinators. There are already nine co-ordinators for Traveller mental health within the nine CHOs. This represents a further seven. In what I achieved in budget 2024, there are not a lot of new developments. A great deal of the money is for the existing level of services because there is high demand on the services. I secured funding for counselling nationwide and I will continue to work with the Senator.
Dental Services
I welcome the Minister of State. I thank the Cathaoirleach for selecting this Commencement debate this morning on the issue of dental services. I am a member of the Joint Committee on Health. The Irish Dental Association came before the Joint Committee on Health on 5 July regarding issues within the dental service. The chief executive of the association, Fintan Hourihan, and others have expressed on the record their concern about the medical card scheme and the chronic delays in delivering the school screening programme. They are concerned about the staffing and resourcing of the dental sector, based on research in September 2022 which showed that the majority of vacancies in the dental sector cannot be filled. At that time two thirds of practices that had tried to recruit dentists in the previous 12 months could not fill the vacancies, and neither could half of the practices that attempted to recruit nurses or hygienists. Mr. Hourihan went on to say that the situation is stark, more so in the public sector where the HSE is obliged to provide care for children and for special care patients, including an orthodontic services for children with severe orthodontic needs.
I acknowledge that the budget announced last year provided funding of €4.75 million to support the development of a new prevention-focused oral healthcare system for children from birth to the age of seven. Obviously children are the most vulnerable people in our society. Unfortunately, they will continue to fall behind with their oral health, according to Mr. Hourihan, and will shoulder the burden of a system that has been underfunded for some time. The analysis shows that an extra 500 dentists throughout the public and private sectors are required to adequately meet the needs of the rising population and to replace retiring dentists. He recommends various measures to improve the supply of dentists, including significant investment in and expansion of the two dental schools in Cork and Dublin because Ireland does not produce enough dentists. He was cautiously optimistic about the recent announcement of increased college places by the Minister, Deputy Harris. I certainly welcome that.
At that committee I asked whether, given that numbers are ramping up and investment is being made in the colleges, there could be a role for retired dentists in ensuring the school screening programme is taken up and all the necessary checks are done for all our primary school children throughout the country. Unfortunately, based on the evidence, that is not happening. Some schools or classes have been skipped. Mr. Hourihan said that as long as dentists are registered to practice with the Dental Council of Ireland, they are entitled to see patients. He said that although there would be no reason due to age that they could not contribute to the school screening service, flexibility within the employment rules and policies of the HSE would be needed to allow that to happen. However, it is possible and could happen. He said it would require the HSE to revisit some of its employment practices. A person's entitlement to practise as a dentist is not linked to age but to whether they have a license from the Dental Council of Ireland.
I am calling for an examination of whether there is a basis for a short-term intervention to use dentists who have retired but would be in a position to work in the school screening service and would be happy to do so, on a part-time basis if preferred. This would not be actual dental work but school screening work to allow students and children to be assessed for ongoing developmental issues of their teeth. I look forward to the Minister of State's reply.
I am taking this debate on behalf of the Minister for Health, Deputy Stephen Donnelly. I thank the Senator for the opportunity to address the issue of capacity in the HSE’s public dental service to provide care, particularly to children in primary school. The salaried HSE public dental service provides care to several groups of patients, including those with complex and additional needs. In addition, the public dental service also provides a programme which includes screening and necessary treatment for children at ages corresponding to second class, sixth class and, subject to capacity, fourth class. Emergency care is also provided for children up to 16 years of age and those with complex and additional needs. This service provides care to many children and adults who would not otherwise have access to oral healthcare services. The Minister for Health is aware that, coming out of the pandemic, there are backlogs in the targeted primary school screening programme in particular, leading to delays in children receiving their first appointment. Officials in the Department of Health engage with the HSE on an ongoing basis to understand and address any challenges arising in the provision of public dental services. The Minister has been assured by the HSE that it is continuing to restore dental screening and treatment to children up to 16 years of age through recruitment initiatives to fill vacancies that have arisen or may arise, prioritising clinical treatment in patient groups and reallocating clinical resources according to greatest need.
Regarding capacity and recruitment, it is extremely heartening to note that we currently have more registered dentists in Ireland than ever before, with 3,581 at present, which represents an additional 109 registered dentists since March 2023. This reflects positive trends with the comparative figure being 3,217 in 2018. However, I accept that our population is growing every day. The Minister for Health supports the creation of additional capacity in higher education, including in oral healthcare, to which the Senator referred in regard to the Minister, Deputy Harris. The Higher Education Authority, HEA, is undertaking a process to identify a set of options to achieve this important step towards health workforce sustainability for Ireland.
The HSE has confirmed that for August 2023, 802 whole-time equivalents were working in the public dental service across all grades, including 244 dentist whole-time equivalents. Concerted efforts are ongoing within the HSE to address any current vacancies. A number of community healthcare organisations, CHOs, have run competitions for dentists, dental nurses and dental hygienists to fill vacancies, with panels created from the recruitment competitions. These positions are available for any person who meets the required eligibility criteria to apply. That comes back to the point raised by the Senator, which is a very fair and reasonable ask he has made regarding retired dentists, a short-term intervention and a school screening programme.
As the Senator will know, we require a sufficient number of appropriately trained oral healthcare professionals, including dentists, hygienists, clinical dental technicians, orthodontic therapists, dental nurses and other supporting oral healthcare workers. The Department of Health has commenced work on a workforce census across the oral healthcare sector with a view to ascertaining the current skill mix within our workforce so that we can support future training needs.
I thank the Minister of State for the response. I am heartened that she believes there is merit in the suggestion and I hope she will be able to bring it back to the Minister, Deputy Donnelly.
As the Minister of State said in her response, the public dental service provides a programme for second class, sixth class and, subject to capacity, fourth class. There is a capacity issue, and therefore, thinking of schoolchildren in Galway and every county, I am asking whether this short-term intervention using retired dentists would allow for an improvement in capacity and in the number of pupils being assessed in that critical period of fourth class, for example, to identify any problems that are developing in children's oral health and allow them to be assessed.
I welcome the investment by the Government and that the Minister, Deputy Harris, is looking at the number of places, but this will take time to get through the system. Therefore, I ask again that the Minster of State bring this back to the Minister in terms of a short-term intervention.
I will take it back. As we have said, we require a sufficient number of appropriately trained oral healthcare professionals, including dentists, hygienists, clinical dental technicians, orthodontic therapists, dental nurses and other supporting oral healthcare workers. The Senator mentioned employment rules and flexibility. The HSE national oral health office works with the HSE national HR, recruitment reform and resourcing programme on identifying and resourcing challenges that may be experienced by the dental and oral health professions. As I have said, I think the Senator's ask is fair the way he has set it out regarding screening programmes. I will certainly bring it back. Given the Department of Health has commenced work on a workforce census across the oral healthcare sector, I think that is an area it could look at as well.
Third Level Staff
I welcome the Minister of State to the House. She may or may not be aware that the governing authority of the University of Limerick at a recent meeting failed to appoint a chancellor as set out in legislation. That is a pretty serious situation. To the best of my knowledge it is the first time it has happened in the history of the State and certainly under the new legislation.
There is a requirement in law that two thirds of the governing authority voting must ratify a name that is put forward. It is not as if a number of names are put forward. Only one name is put forward but it requires a two thirds majority of the authority. The candidate put forward failed to reach the two thirds majority. That leaves the university without a chancellor. It is a really important university in the region I come from. About 1,800 people work there and it has more than 17,000 students. It is a university that has grown in stature internationally and in its capacity to meet the needs of students not just in the region but throughout the country. The university has had its issues and difficulties over the years but it has been operating really well. This issue I raise is a blight and stain on the character of the university and is something which needs to be resolved quickly.
I am concerned, based on conversations I have had with people in the university, that there is an effort now being made, which would seem bizarre in the extreme, to revisit the decision that was made by the governing authority, that somehow the same name may be put back before the committee, and that a level of intense lobbying will begin to try to browbeat people who made, in good judgment, a decision not to appoint the individual concerned. There is some history that has been alluded to by a former Member of this House, Shane Ross, about the appointment of the same individual to another board of the State where there was intense lobbying, up to and including telephone calls to the Taoiseach at the time, Leo Varadkar, to secure a particular position for that individual. There is real concern among members of the authority and staff of the university that the same will apply here, that a level of behind-the-scenes lobbying, cajoling and jostling will be deployed to achieve this position for the individual concerned. That would be wrong.
The concern at the moment is that there is still one individual to be appointed externally by the Minister for Further and Higher Education, Research, Innovation and Science. I understand there is a process under way through the Public Appointments Service, PAS, but the Minister will be the final arbiter of that. The concern of some within the university is that the Minister and Government will be lobbied to appoint somebody who will be favourably disposed towards the person who has already been rejected. That would be wrong. I want an assurance from the Minister of State that will not happen.
A decision has been taken by the governing authority not to appoint the individual concerned. In my view, it would be appropriate that all sides would move on and accept the wishes of the people concerned, and that there would be no attempt to cajole, jostle or try to find another way around this. That would not be in the best interests of the university or of a cohesive approach at board level. The board needs to come together around an individual in whom it has faith and trust for the benefit of the university. The sooner that happens, the better, and I am interested in hearing what the Minister for Further and Higher Education, Research, Innovation and Science has to say on this matter.
I thank the Senator for raising this issue and for his contribution. Both the Minister, Deputy Harris, and the Minister of State, Deputy Collins, are in the Dáil Chamber this morning for oral questions and have asked me to take this matter on their behalf.
The University of Limerick advised the Department of Further and Higher Education, Research, Innovation and Science that the university's new governing authority took office on 1 October in compliance with the Higher Education Authority Act 2022. The university further advised that the governing authority held its first meeting on 8 October and, under the terms of the legislation, appointed an external member as interim chairperson pending the appointment of the chairperson.
Under the Universities Act 1997, there is a requirement for a majority vote of at least two thirds of the members of the governing authority to elect the chairperson. The Department understands that the required two thirds majority was not attained. In accordance with legislative provisions, it is a matter for the University of Limerick to appoint the chancellor of the university. The Minister of Further and Higher Education, Research, Innovation and Science has no role in the appointment of the chairperson of a governing authority in a university.
The University of Limerick has corresponded with the Minister to advise that the interim chairperson remains in position and that the governing authority will continue to exercise its statutory and governance functions regarding the university pending the appointment of the chairperson. It is really important to state again that the Minister has no role whatsoever in this process. The Minister is legally prohibited from intervening.
The Department understands the University of Limerick has appointed 18 of the 19 governing authority members. A Public Appointments Service process is currently in progress for the selection of the vacant ministerial nominee.
I thank the Minister of State for the comprehensive response, but I am concerned about one line, which says it is really important to state the Minister has no role whatsoever in this process. The Minister has a role in appointing three people who are being assessed by the Public Appointments Service.
The Minister will select those nominees. One of them will be appointed immediately and two will be appointed at a later stage. The person he appoints could ultimately be the decider of that battle.
I want the Minister to confirm he will appoint an entirely independent person and will not be open to external interference or lobbying of the kind that went on in the past in respect of the same individual and another board, up to and including calls to the then Taoiseach. Shane Ross alludes to it in his recently published book. He alludes to the pressure he was put under to appoint this individual to another State board. People from the university have expressed to me their deep concerns regarding the potential for external interference in the process of appointing the next individual to the board, in the knowledge that the person in question would come with riding instructions. That is a real fear that is not based on superstition but, rather, on recent facts relating to another board but the same individual. I accept that the Minister of State is not in a position to give this commitment, but I want the Minister and the Minister of State, Deputy Collins, to outline a clear and direct position to the effect that they will not be open to external interference in the appointment of an independent person to the board and will not countenance any level of interference that might materialise.
I thank the Senator for raising this matter. In accordance with legislative provisions, it is a matter for the University of Limerick to appoint its chancellor. That is not the main issue the Senator is raising. The requirement for a majority vote of at least two thirds of the members of the governing authority to elect the chairperson is not new. It has been in place since 1997 under the Universities Act, with no previous issues identified. The legislation also sets out that a governing authority shall regulate, by standing orders or otherwise, its procedure and business. The Government cannot and would not wish to intervene in such matters. The legislation is clear on this matter. The Minister expects an update from the university in due course.
On the point raised by the Senator in respect of nine other external members, three of whom are to be nominated by the Minister, a Public Appointments Service process is currently in progress for the selection of ministerial nominees. One nominee will fill the immediate vacancy and the two remaining nominees will be appointed when the term of office of the current nominees ends on 31 March 2024. The assessment meeting is scheduled for next week.
Housing Schemes
The Minister of State is welcome.
I apologise for being late.
No problem.
I thank the Minister of State for coming to the House to respond on this matter. I have experience, as, I am sure, have the Minister of State, the Acting Chairperson and many other Members, of dealing with older people and people with disabilities who apply for housing aid for older people and housing adaptation grants through local authorities. The amounts being given to people under these grants have not increased in recent years yet construction inflation has been off the Richter scale. The grants have remained static for several years but the cost of doing the work has increased dramatically.
During the summer, I dealt with a gentleman who uses a wheelchair. He got a housing adaptation grant of €20,000 to build a wheelchair-accessible extension to his house. As the quote he got when he initially applied for the grant was €32,000, the grant would have covered approximately two thirds of the cost. It took several months for the grant to be processed, however, and when he went to get the work done he was issued with a new quote that was 25% higher than the original. I approached the local authority to see if I could get the grant increased. I was told that sum was the maximum that could be given in the context of that particular grant. I dealt with another person, who was building an accessible bathroom at the back of his or her house. The maximum grant for that work was €8,500. The situation there mirrored what happened in the previous case.
The quotations that were given during the application process were for a certain amount and when the grant was approved and it actually came to doing the job, the person was given a revised estimate about 30% higher. When the local authorities in question were approached, they had given the maximum they could give.
I am looking for the amounts to be increased and the budget to be increased, given that we are dealing with enormous construction inflation. It is just unfair because people who have been allocated money are in a position where they cannot go ahead and do the very necessary works simply because they cannot afford it due to the spiralling cost of construction.
I thank the Senator for raising this important matter. It is one he has consistently raised with me, my predecessors and the Government. To give the background, the Senator rightly referenced housing adaptation for older people and people with disabilities where there are three areas, namely, the mobility aids grant, the housing adaptation grant for older people and people with disabilities and the disabled persons' grant. These grants are to assist people in private houses to make their accommodation more suitable to their needs and are available to those with an enduring physical, sensory, mental health or intellectual disability and to older people who experience mobility issues or who require essential repairs to their homes in order that they can continue to live independently there. As the Senator is aware, the grants are 80% funded by the Department, with a 20% matching contribution from the local authority. Schemes are means-tested and are on a sliding scale with the highest percentage grant available to those with the lowest income, and vice versa. Obviously, the upper limit is income of €60,000. Detailed administration of these three schemes is the responsibility of the local authorities.
In 2022, extra funding of €65 million was made available for the payment of 12,000 grants, which compared favourably with a target of 10,700. The Exchequer funding of grants in 2023 was increased to €66.5 million. Each local authority received an increase on the 2022 allocation, continuing the year-on-year increases since 2014. The Senator is probably aware that I have secured an increase of €8 million for the current year, bringing the total allocation to deliver more than 13,000 grants up to €74.5 million. Thirteen local authorities have applied for increased funding this year and, to date, ten have had their applications approved. We are looking at the other three applications.
This is a scheme I very much believe in. As the Senator is probably aware, Housing for All contains a commitment to undertaking a review of the range of housing grants available to assist with meeting specific housing needs both for our ageing population and people with disabilities. A report on the review of the housing adaptation grants for older people and people with a disability has been prepared by the Department. I have gone through it in depth with the officials. On foot of that, we are engaging with the Department of Public Expenditure, National Development Plan Delivery and Reform on the recommendations in the review report. The objective of this engagement is to deliver on the emerging recommendations and ensure continued enhancement of this successful grant scheme. Any changes to the current scheme will be dependent on that engagement and on funding being made available for the scheme. It is a hugely important scheme. We also want to see the existing grants continuing.
The Senator made reference to construction inflation. In the review that was carried out we looked at thresholds around income and the level of the grant in terms of costs. This is something of which I am very conscious.
The scheme has been beneficial its introduction in 2007, supporting the delivery of over 136,000 grants up to the end of 2022. As of now we have a submission with the Department of Public Expenditure, National Development Plan Delivery and Reform following the review by my Department. I have looked at that review in great depth with my officials and we are in discussions with the Department of Public Expenditure, National Development Plan Delivery and Reform on foot of those recommendations. In the Estimates process, I secured an increase of €8 million, which is about 12% on top of the existing level of funding. It is important to note we have issued additional funding this year above the €66.5 million that was granted for the year 2023 to ten local authorities to date and we are looking to approve applications from a further three as well.
That is absolutely fantastic. I thank the Minister of State for his response, but I am looking for a circular to go from his office to the local authorities telling them to be a little more flexible and take construction inflation into consideration. Take a situation where somebody applied for a grant in 2022 that is only processed in quarter 4 of 2023, by which time he or she is getting a revised quotation that is 20% or 30% higher. If an application goes in for increased funding or an additional piece of funding given the fact the quotations have gone from say, €8,000 to €12,000, maybe the authorities could be a little more flexible and look at maybe facilitating such a top-up.
I understand the point the Senator is making. It is something we are looking at in the specific context of circumstances where people may have applied over a year ago and grant aid is only being provided at the moment. It is certainly something we will look at and take up with the local authorities. There are, as the Senator will appreciate, defined rules under the scheme. However, the point he makes is a reasonable one and something I very much taken on board. I give him a commitment we will look at it and follow up with the local authorities on it.
Excellent. I thank the Minister of State.
Cuireadh an Seanad ar fionraí ar 9.47 a.m. agus cuireadh tús leis arís ar 10.05 a.m.
Sitting suspended at 9.47 a.m. and resumed at 10.05 a.m.