The House will now hear two-minute statements on measures appropriate to the Minister for the Environment and to the Minister for Health. I propose to call on the Deputies I have selected in the following order: Deputy Finucane, Deputy Flanagan, Deputy Lowry, Deputy Deenihan and Deputy J. Higgins. Each Deputy is entitled to two minutes in respect of each matter and each statement will be followed immediately by a two-minute reply from the appropriate Minister. I now call on Deputy Finucane to make his statement.
Environment and Health Matters.
The only orthopaedic hospital in the mid-west region is St. Nessans, Croom, which caters for a population of about 315,000. Of that population more than 35,000 persons are over 65 years of age and are, therefore, in the high risk category for fracture injuries. Since 1987 one ward has been closed, thus reducing the effective bed complement to fewer than 100 beds. Each year during the summer months one ward is closed down, so the average bed occupancy is reduced even further.
Comhairle na Ospidéal recommend a target ratio of one orthopaedic surgeon per 70,000 population. An extra orthopaedic surgeon was appointed in November last, bringing the staff complement of orthopaedic surgeons to four.
The Mid-Western Health Board have failed to appoint extra nursing staff to fully support the orthopaedic staff, and I have received complaints that the shortage of nursing staff has put a lot of stress and strain on nurses. As the Minister knows, older patients place extra demands on the nursing staff, and in that hospital two-thirds of the patients fall into this category. For example, one ward has 28 male patients and one nurse and a night porter, and one relief nurse for two wards. On occasions one older patient could demand most of the attention of one nurse. Other aspects in relation to the lack of nurses have been brought to my attention, but time constraints prevent me from now informing the Minister of them.
I compliment the staff of Croom Orthopaedic Hospital, who carry out great work under difficult circumstances. I now call on the Minister to provide extra nursing staff. In conclusion, I very much appreciate the Minister's being present here tonight to respond.
The provision of nursing staff at Croom orthopaedic hospital is a matter for the Mid-Western Health Board in the first instance. My Department approved a fourth consultant orthopaedic surgeon for Croom hospital last year. The Department are currently examining the question of approving additional nursing staff at the hospital to support the increased activity due to the appointment of the fourth consultant. That matter will be discussed between officers of my Department and the Mid-Western Health Board in the near future in the context of the board's allocation for 1991 and my commitment to maintain activity levels during this year at the approved 1990 levels.
I assure the Deputy that I am most concerned to improve orthopaedic services throughout the country, particularly in centres with long waiting lists for these services. Deputy Finucane would be interested to learn that there was an 18 per cent increase in the number of orthopaedic operations at the orthopaedic hospital in Croom in 1990 as compared to 1989, and I am confident that activity will be maintained at least at the 1990 levels during the current year.
I rise to inform the House of a very serious position in the Midland Health Board area following the butchering of the budget by £1.4 million by the present Minister.
Many people are suffering severe hardship because of the huge waiting lists for orthopaedic surgery at Tullamore General Hospital. The situation is intolerable. Urgent action is needed to increase the staff in the Midland Health Board area. The orthopaedic surgery department at Tullamore Hospital is working round the clock, but the lists and applications for treatment are just too long.
An interesting statistic reinforces my argument. The Minister might consider the following figures relating to the ratio between population and orthopaedic surgeons throughout the world: in Sweden the figures are 20,000:1; in the USA, 20,000:1; Canada, 30,000:1; Australia, 32,000:1; New Zealand, 36,000:1; the Netherlands, 42,000:1; Scotland, 48,000:1; and England and Wales, 66,000:1. In Ireland, as Deputy Finucane said, the recommended figure by Comhairle na Ospidéal — which has almost reached its target — is 70,000:1. If the figures in Ireland are broken down, the ratio for the Eastern Health Board stands at 56,000:1; the North-Western Health Board, 53,000:1; the recommended ratio of the Irish Orthopaedic Institute is 50,000:1. The Midland Health Board have a population to surgeon ratio of 103,800:1. That is a damnable disgrace. I ask the Minister to take on board that statistic. He should be ashamed of himself. He should immediately instruct the Midland Health Board to make the appropriate appointment. There can be no doubt that the Midland Health Board area has been selected to bear the brunt of ministerial cuts.
People want to be treated locally. It is not sufficient for the Minister to say that a certain amount of operations were performed in Cappagh or in Dublin. People in the Midland Health Board area deserve a team of surgeons who can perform orthopaedic operations within the Midland Health Board area. God knows, on the figures I have produced, one surgeon for 103,800 people, having regard to the waiting lists and the severe hardship caused to elderly people in particular throughout County Laois and County Offaly, I urge the Minister to act, and to act immediately.
In Tullamore there are two consultant orthopaedic surgeons employed in the unit, which has 49 beds. In 1990, 1,134 orthopaedic operations were performed, 121 of those being hip replacement operations. At present the average waiting time for the hip replacement operation is six to seven months in the Midland Health Board area. I should like Deputy Flanagan to go to England, Sweden, and every other country he talked about, and see the waiting lists of those who need hip replacement operations. Urgent cases are admitted much more quickly than the six or seven months I mentioned — usually within one to two months. Deputy Flanagan did not tell the House that. That compares reasonably well with the waiting time for hip replacement operations nationally.
I should also welcome that some orthopaedic operations are carried out elsewhere on patients from the Midland Health Board area. In 1990 Cappagh Hospital, for example, performed 30 such hip replacement operations. A total of 859 new out-patients were seen by the Tullamore orthopaedic hospital during 1990. I might add that patients do not object to going to Cappagh Hospital. There was a 40 per cent increase in the number of hip replacement operations performed at Cappagh Hospital last year over the previous year.
Close it down and let Cappagh take over. That seems to be the policy.
The Deputy talks about cutbacks, but there are no cutbacks on the orthopaedic services which are improving all the time.
My Department are currently considering an application from the Midland Health Board to appoint an additional orthopaedic surgeon at Tullamore General Hospital. That request will be considered as sympathetically as possible in the context of the many competing demands for resources and the board's own priorities for new development. At present my Department are considering an application also from the Midland Health Board for a capital grant to provide a temporary theatre at Tullamore General Hospital.
The vexed question of traffic flow and pedestrian movement in Littleton is of long standing. The village is situated on the heavily trafficked Dublin to Cork main road, and is highly dangerous for pedestrians and drivers. Since 1985 there have been more than 50 serious accidents at this junction. Several proposals were put forward and rejected by the Department of the Environment. Remedial works carried out have, according to residents, intensified the problems, involving car parking difficulties, poor and inadequate sightline, diminished public accessibility to business premises and extensive flooding of the village.
Numerous reports and studies have been commissioned during the past eight years at considerable cost, yet agreement on an appropriate course of action cannot be achieved between the council and the Department. It is irresponsible and a downright scandal to allow the death trap situation to prevail. The local community are frustrated and angry with inept, faceless bureaucrats who are opposed to all proposals while not having the capacity to put forward their own plans to resolve the problems. The aggrieved public are jaded with misleading, empty ministerial promises of action and demand that immediate and positive steps be taken.
Following representations, the council were informed by letter of 5 April 1991 from the Department of the Environment that the Department did not see any useful purpose being achieved by the attendance of their inspectorate at an on-site meeting to discuss traffic control measures for Littleton village. The letter also stated that the Department did not favour the use of "rumble strips" and that it was a matter for the gardaí to enforce the speed limits that applied to this location. This response is an insult to local residents who must live with this daily nightmare. I call on the Minister to exercise his ministerial authority and to instruct his officials to implement a satisfactory proposal without further delay.
Traffic control measures at Littleton are primarily a matter for Tipperary (North Riding) County Council who, over the last two years, have put in place a number of measures to improve road safety. These measures, which were financed from State road grants, include the provision and marking of kerbs to narrow and mark out the carriageway; a pedestrian hand rail near shops; double white lines to prevent overtaking; oversized speed limit signs and repeater signs through the village. I am satisfied that these measures provide a good level of safety, provided road users comply with the law and observe the speed limit.
The county council have sought approval to have "rumble strips" on the Dublin-Cork road through Littleton. I am advised that Littleton would not be a suitable location for the use of these facilities. The council were advised accordingly in October 1990.
The county council have requested a major extension of the 40 mph speed limit and this is being considered. Enforcement of the speed limit is, of course, a matter for the Garda.
Deputy Deenihan will now make a two minute statement.
I am speaking on behalf of the people of Dirrha, Listowel, and wish to voice my disapproval at the failure of the Minister to provide a sewerage scheme for that area. Over 250 people are affected, a total of 40 houses. There is an unacceptably high concentration of septic tanks in a restricted area, which is an obvious health hazard. The residents informed me recently that there has been an alarming increase in vermin in the area, which was very much in evidence during the fine weather of the past two summers.
The residents are very concerned about the health of their families and the community. They feel abandoned by the Minister as the tender has been with the Department of the Environment since December 1987. The people of Dirrha have waited since their estate was built in 1954 for a sewerage scheme. There was a severe outbreak of typhoid in the Dirrha estate and there is always a danger that this could recur. The residents are very frustrated and militant at present. They feel, with justification, that they have been forgotten by the Department. They have to travel to Listowel along the most dangerous stretch of road in the country, a point which I raised here some time ago. They have lived without proper sanitary conditions for the past 57 years and it is now time to give them their rights.
Will the Minister please take these people out of their misery and give them access to the funds available to his Department from the Structural Funds, which will solve the problem once and for all?
This proposed extension to the Listowel sewerage scheme would serve about 50 houses along the Ballybunion road. Sewage from these houses is disposed of by means of septic tanks and I understand that these arrangements have not been fully effective. Kerry County Council have examined a number of options to serve the area and concluded that it should be connected to the main drainage scheme.
I appreciate the Deputy's concern in this matter but, due to the high level of existing commitments on the water and sanitary services programme, I cannot indicate when I will be in a position to finance this scheme. Deputy Deenihan will appreciate that significant funds are already being provided for high priority schemes in Kerry, including water supply schemes at Dingle, Firies, Scartaglen, Scart reservoir, Dromin water treatment works, Brosna, and sewerage schemes for Dingle, Tralee, Ballybunion, Kenmare, Killorglin, Caherciveen and Knightstown.
Water and sanitary service grants totalling £4.4 million have already been allocated to schemes in Kerry in the current year. This compares to £3.8 million which I provided in 1990 and demonstrates a continuing high level of commitment to water and sewerage schemes in the county. These allocations show that Kerry is receiving its fair share of the overall capital available. Nevertheless, I will consider the Deputy's comments in relation to this particular scheme in the light of developments on the implementation and financing of the programme as a whole. I am conscious of the need in this case.
Any promises?
Read my lips.
The House will now hear a two minute statement from Deputy Jim Higgins.
The Minister knows from his days in Mayo County Council, when the original Coalition were in power, that we were building 250 houses per annum; we had a proud housing record. Today there is a national crisis in housing and the general impression in many counties is that Mayo has been the beneficiary of the Minister's largesse. Unfortunately, the figures divulged last Monday at a meeting of Mayo County Council set the record straight. The housing waiting list is as follows: Achill 15; Balla six; Ballina nine; Ballindine one; Ballinrobe 12; Ballycastle ten; Ballycroy 12; Ballyhaunis 23; Bangor Erris nine; Belmullet 17; Castlebar ten; Charlestown five; Claremorris 19; Crossmolina 16; Foxford 23; Geesala two; Kilkelly seven; Killala 15; Kilmaine two; Kiltimagh four; Knock three; Newport eight; Swinford 22 and Tourmakeady one. In the rural electoral areas the numbers are as follows: Ballina 40; Castlebar 19; Claremorris 57; Killala 31; Swinford 27 and Westport 39. The numbers in regard to urban councils are; Ballina 120; Westport 113 last week and 11 this week and 55 in Castlebar, 14 of them for unmarried mothers.
The Minister is aware that there is a major cirsis in Mayo as there are 900 people on the waiting list. We have a social and moral obligation to provide houses. Unfortunately, millions have gone elsewhere for less worthy projects. It is an indictment of the Government's social policy and of the Minister as a Mayo man. Beidh lá eile ag an bPaorach.
The capital allocation for the traditional local authority housing construction programme in 1991 totalled £45.6 million, an increase of £11.7 million or 35 per cent over the final allocation in 1990. These allocations will finance the commencement of 1,500 houses and the completion of 1,300 houses in 1991, with a further 1,300 houses in progress at the end of the year.
The capital allocation for each housing authority was determined on the basis of the competing needs of housing authorities and the total capital available nationally for the programme. On this basis, the four housing authorities in Mayo received an allocation of £2.08 million for their 1991 programmes. This is not an unreasonable figure, having regard to all the circumstances. Of course, needs are not met only by the construction of new local authority houses. The vacancies which arise in the housing stock must also be taken into account as these add to the number of lettings which are possible. The Mayo housing authorities had about 70 vacancies in 1990 and, when added to new house completions, allowed for total lettings of about 130 for the year.
This year the local authority housing construction programme has been complemented by the measures set out in a plan for social housing. These include a new scheme of assistance for the repair of private houses owned and occupied by persons accepted as being in need of local authority housing. They also include a scheme under which the housing authority may make a site available, at a nominal price, to certain persons who are prepared to build for themselves.
The measures in the plan are a comprehensive response to social housing needs and, when fully operational, will result in the provision of about 5,000 units of accommodation each year in addition to the traditional local authority housing programme. Mayo, in common with the rest of the country, will share in the benefits from these new initiatives.
The Dáil adjourned at 11.30 p.m. until 10.30 a.m. on Thursday, 23 May 1991.