Dáil Éireann díospóireacht -
Tuesday, 1 Jun 2004

Vol. 586 No. 5

Adjournment Debate.

Health Board Services.

Mr. Connolly

I am grateful for the opportunity to discuss the impact of under funding in the North Eastern Health Board area. In recent days, a report on deficiencies in services and infrastructure was presented to the Minister for Health and Children by the executive of the North Eastern Health Board. It is as if the executive has suddenly realised that the under funding which has obtained for years is a major matter of concern now that the boards are being dissolved. I have proposed the rejection of service plans for years on the basis that we were not receiving enough money to run an adequate service in the north east. This was having a negative impact on services across the board.

Ours is the most under funded health board in the country and must make do with 79% of the national average. The North Eastern Health Board receives €1,590per capita whereas the national average is €2,020. The board’s total budget is approximately €550 million per annum. To bring this up to the national average, the North Eastern Health Board would have to receive a further €137 million per year. One can imagine the effect that would have on the delivery of services. The current funding equates to a gross under spending per person in the north east.

The response of the board's executive to the shortfall in funding has been to cut services at Monaghan General Hospital, Cavan General Hospital and Louth County Hospital and to cut back on medical cards. The executive cut wherever it could think of cutting. Regrettably, every possible cut was made including the closure of maternity units. The executive was supported in this by a Fianna Fáil dominated health board which supported it through thick and thin. I would have preferred to see the executive come knocking on the door of the Minister for Health and Children to demand extra funding. That never happened as the executive knew it was being shielded by the Fianna Fáil dominated board. When one looks at the newspapers, one sees that it is always the north east where troubles arise. That is the result of poor management.

Traditionally, Dublin hospitals treated people from the north east. While they tell us now that we should treat people in our own communities, they have held on to the budget for the treatment they used to provide. The cuts are having an impact right across health services. They are affecting mental health, acute hospital, disability and community services. The north east has an increasing population which has grown by 13% since 1996. There has been a 29% increase in child birth since 1999, our reaction to which was to close two maternity units at Monaghan and Dundalk respectively. We have seen a 32% increase in cardiac admissions, quite of number of which originate in Monaghan. Our reaction to that was to close the accident and emergency unit in Monaghan. Of all road traffic accidents, 25% occur in the North Eastern Health Board area. A large percentage of those occur near Monaghan area which is crossed by four major routes leading to an increased demand for services.

Recent reports identified a need to fill 85 consultant posts to achieve regional self sufficiency, of which 60 remain vacant. The money is not there and we cannot attract the consultants needed to make the north east self sufficient. There are also deficiencies in specialist surgical services including ear, nose and throat, ophthalmology and urology. There are medical deficiencies in cardiology, nephrology and dermatology. A total of 23 major projects are still outstanding in the North Eastern Health Board and I see no possibility that they will be tackled in the near future. The North Eastern Health Board must make do with one member of staff per 100 of population whereas the national average is one per 70. I call on the Minister for Health and Children to take some form of action to address this inequality. With the disbandment of the health boards, we will not know what level of funding is being provided in different areas and it will take a genius to work out the extent to which we are being under funded.

At the moment at least we can identify clearly why and how we are being under funded in the North Eastern Health Board area. There are great needs. There is a 44% shortage of in-patient beds and we need a 90% increase in day places in the North Eastern Health Board area. We also need a 150% increase in day procedure rooms. These are services for which funding is necessary to avoid a scenario in which every time one looks at a newspaper one sees that the north east is the area which appears to be suffering.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I reply on behalf of the Minister for Health and Children who strongly rejects the suggestion that the North Eastern Health Board has been under funded in the year 2004. The House will recall that overall funding for health and children's services in 2004 was the largest level of funding provided to any Department. Approximately €926 million was provided representing a 10.7% increase over 2003 in day-to-day spending. The level of funding provided in 2004 for the North Eastern Health Board is €548.784 million which is an increase of €65.7 million or 13.6%.

Mr. Connolly

It is the lowest level of funding per capita.

Mr. B. Lenihan

This increase was above average. The Deputy refers to cutbacks in the context of a budget which was increased by 13.6%. The chief executive officer's introduction to the board's 2004 service plan acknowledges that the increased funding is substantial. He is correct. The increase represents the third highest increase provided in 2004. The Minister recognises the pressures on the board due to demographic shifts, maternity service demands and the increase in the numbers of non-nationals receiving services. Nevertheless, the increase in the board's funding base since 1997 has been significant by any measurement. The overall increase in funding for all health boards between 1997 and 2004 was €5.2 billion or 196%. The comparative figure for the North Eastern Health Board was €383 million or 231% which has been the largest increase in day-to-day funding of any health board. The next highest increase was219%. In part, the increase represents an acknowledgement of the Deputy's point concerning the lower base level of funding in the North Eastern Health Board in 1997.

It is generally recognised that a major reason for the low funding base has been the board's rate of referral to acute hospitals in the Eastern Regional Health Authority area. This is the highest rate of any board for in-patients, elective in-patients only and day cases. In the case of day patients, the referral rate from the North Eastern Health Board is twice as high as that of the next highest, the South Eastern Health Board. This statistic has an obvious impact on the allocation of funding to the board. The Eastern Regional Health Authority's hospitals carry a significant financial burden for the treatment of patients from the North Eastern Health Board.

I wish to outline some of the service issues addressed by Ministers since 1997. Acute hospital funding has allowed for a 26% increase in patient discharges, more than 10% of which relate to in-patients. Day cases recorded an increase of 86%. This compares with a national average increase of 23% in discharges overall, with 4% in-patients and 64% day cases. Additional funding of more than €24 million has been provided for services for older people including in particular provision for nursing home subventions and home-help services. Cancer services received increased funding of more than €9 million to support the 130% increase in admissions since 1997. Cardiovascular services have received additional funding of almost €5 million to support a 32% increase in admissions since 1997. The North Eastern Health Board's employment numbers increased considerably in recent years. Between 2002 and 2003, an additional 1,782 posts were approved giving a staffing complement of almost 7,000 posts at end of 2003. Some 780 additional staff have been approved for the region's acute hospitals since 1997, of which more than 100 were consultant posts.

These are some of the more significant issues addressed over the past years. It remains the position that the board has been more than fairly treated in the period in which this Government has had responsibility. The Minister and his officials have always and will continue to work with the board to seek solutions to emerging problems. A record of increased services supported by a now significant funding base is testimony to this. The objective for 2004 is to again work with the board to achieve a quality service for its clients while utilising the funding base efficiently and effectively.

Mr. Connolly

The board is still short €137 million.

Natural Heritage Areas.

Caoimhghín Ó Caoláin

I wish to address the need for the Minister for the Environment, Heritage and Local Government to liaise urgently with his ministerial counterpart in the Six Counties and with the relevant local authorities North and South to carry out an immediate assessment of the environmental damage to flora, fauna and landscape in the extensive fires which broke out on 23 May at Bragan, County Monaghan, and to take all necessary measures to ensure the most effective possible restoration of this key amenity area straddling the Monaghan-Tyrone border.

Between Sunday 23 May and Tuesday 25 May, a fire raged across thousands of acres of bogland and forestry in the Bragan and Knockatallon areas on the Monaghan-Tyrone border. The fire was first reported on Sunday evening and fire units attended from Monaghan, Castleblayney and Ballybay. They were joined on the Monday by a unit from Clones.

Having heard firsthand accounts of their experience, I want to pay tribute to the firefighters and members of the Civil Defence who battled to contain the conflagration at great risk to themselves. This fire was very difficult to get under control because of bad lighting circumstances. There were obvious dangers in upland bog.

The Bragan area is a wild, rare space in our increasingly over-developed countryside. It has been a haven for wildlife and its flora and fauna have been cherished by people throughout the county and Border areas, and by visitors who appreciate the area's unique landscape. Thankfully no human life was lost or injured, but in every other way the fire was devastating. Thousands of acres of vegetation, both trees and bogland plants, were destroyed. We do not yet know the full extent of the damage to the environment, including damage to wildlife. There were rare visiting species in the area, as there have been over the years.

Many questions need to be posed and answered. What means would best address such fires in the future? Are there lessons to be learned in cross-Border co-ordination and co-operation in tackling such conflagrations? Not least, were these fires started maliciously? Their causes need to be established. It is reported to be highly unlikely that a multiple of fires would have broken out some distance apart. Who would involve themselves in such outright devastation, and why? It is unforgivable.

We need also to examine the adequacy of fire prevention measures in such vulnerable wild areas during the summer months. More can be done on a voluntary basis and I would like to see a system of firewatchers in all our vulnerable landscapes. That should be considered. I echo the appeal of Monaghan's chief fire officer for vigilance on the part of the public who use and enjoy our wild areas, especially our woodlands.

I urge the Minister for the Environment, Heritage and Local Government to liaise with his ministerial counterpart in the Six Counties because the fire raged on both sides of the Border. He should liaise too with the relevant local authorities North and South to carry out an immediate assessment of the environmental damage to flora, fauna and landscape in the area of the fire. The advice and expertise of various people should be sought. We need to see this area restored as quickly and effectively as possible. I appreciate that we will have to depend in great measure on nature itself to take hold again of this landscape and it is to be hoped that we will see the fruits of that in the coming months and years. I urge everyone to give all possible assistance in addressing the need of this area. I hope that the Minister will facilitate this urgent task in every way he can. The fire was ultimately overcome by means of helicopters which lifted and dropped water from lakes. This was organised by Coillte. I want to pay tribute to the people involved in all that.

Was the Minister of State familiar with the detail of these events before they were raised by colleagues in the House last week? I sought an Adjournment debate on the matter last week and raise it again now. The issue highlights the fact that we in the Border counties are often overlooked by what are sometimes described as the national media. If this fire and the devastation it wreaked on this 4,000 acre area happened in any other part of this State, I have no doubt it would have topped our national broadcasting media news. That it did not is something which annoys, upsets and should be of concern to all of us.

Mr. B. Lenihan

I make this reply on behalf of the Minister for the Environment, Heritage and Local Government. I thank Deputy Ó Caoláin for raising this issue on the Adjournment. It is an important matter when a major stretch of land of high amenity value is destroyed in this way.

The Department of the Environment, Heritage and Local Government understands that the fire in this mountain range, which is located in County Tyrone and County Monaghan, started in the County Tyrone part of the area on the afternoon of Sunday, 23 May. Unfortunately, it then spread across the border to County Monaghan. The fire affected a large area of open mountain moorland as well as 8.5 hectares of Coillte plantation and also private conifer plantations. According to the observations of the Department's conservation ranger at the location, the site is still smouldering in Northern Ireland today.

The main nature conservation interest in the area is the open mountain habitat and rare species occurring there. The habitat types form a complex of blanket bog, dry and wet heaths, upland grasslands and natural acidic and nutrient-poor lakes and ponds. Some of these habitats are of European importance, for example, in the case of blanket bog. Part of the mountain range is a proposed natural heritage area under the wildlife legislation. This is Eshbrack Mountain, site code 001603. Another part of it, over the land frontier, is designated as a candidate special area of conservation. This is Slieve Beagh, EC site code UK0016622.

The Eshbrack Mountain proposed natural heritage area is a large area of blanket bog complex occurring at an altitude range of 200 to 250 metres on the southern side of Slieve Beagh. Part of it has already been impacted upon by turbary, mostly arising from machine cutting, while smaller areas have been afforested. The site contains some areas of unmodified mountain blanket bog dominated by ling heather, cranberry, deergrass and bog mosses. Areas of species-rich wet grasslands, flushes and wet and dry heaths also occur. The area is without doubt one of the most scenic areas of County Monaghan and it is also one of the few wilderness landscapes of the county.

The mountain range is also an important area for birds, and it is under consideration for European designation as a special protection area, SPA, for species such as the hen harrier, which has a stronghold in this area. There are some seven pairs breeding in this mountain range across both counties. This species is using open heathlands or young conifer plantations for nesting and it is foraging over open moorland. The mountain range is also used by Greenland white-fronted geese, red grouse, merlin and golden plover.

The wildlife of the open mountain can be seriously damaged by burning. The fire can cause the loss of nests, eggs and young of the bird species mentioned and can seriously damage the foraging area of these birds. Regional staff of the Department's national parks and wildlife service will continue to monitor the impact of the fire on the proposed natural heritage area and the mountain range. The conservation ranger who visited the site today estimates that about 10% of the area is affected.

To gain a more accurate picture of the damage and to draw up the most suitable action plan for the area, an aerial patrol is planned within the present month. Following this survey, a suitable monitoring regime can be designed by the staff in liaison with Monaghan County Council, landowners and other interested parties for the County Monaghan part of the site. Advice on best restorative measures will be provided by national parks and wildlife service personnel. Initial contact has been made with the environment and heritage service of the Department of the Environment in Northern Ireland, as the mountain range is an ecological unit. I anticipate that further contacts will facilitate the co-ordination of ecological monitoring and restorative actions on both sides of the Border.

Social Welfare Benefits.

Mr. M. Higgins

While I welcome the opportunity to raise this issue, it gives me no pleasure to do so. It is an instance of the abuse of the social welfare system to implement a contorted view of an immigration policy. I have supplied the details of the family in question to the Department. The circumstances are as follows. They are a Romanian family with two teenage children, aged 16 and 14. The mother was heavily pregnant when she first came to me and she had a difficult obstetric history. The family was in direct provision accommodation in Galway city. They had supplied information to the Department, the Western Health Board and other bodies. For example, on 16 January 2004, their doctor provided details of a miscarriage the woman had suffered on 8 February 2002 which suggested she had been exposed to chickenpox. This information was submitted to the relevant authorities.

The family left direct provision and went into private accommodation. Since then, they have not received assistance by way of rent allowance, food allowance or otherwise. They sell flowers to live, making approximately €120 per week. They are allocated a €25 food voucher from the Society of St. Vincent de Paul, have borrowed €6,000 from friends and have sold personal items, including jewellery. When they came to me, they were worried about the 16 year old girl in particular. A social worker who was familiar with the case had drawn my attention to the fact that she was interested in discontinuing school to be of assistance to the family, as was her younger brother of 14.

The family recently received a letter which suggested that in accordance with supplementary welfare allowance procedures, verified evidence of unemployment, such as a P45 or a letter from an employer, and verified evidence of means in the period prior to their claim would be required to make a determination on the claim. The letter suggested that if they were dissatisfied with the decision, they should appeal. I understand that their appeal has been turned down. Further correspondence to the family suggested that they apply to the refugee integration agency for direct provision accommodation despite the mother having a proven obstetric history of three miscarriages — despite this history, I am happy to record that her baby Patrick was born safely on 17 March last.

As I wish to be fair and I note that the Western Health Board is the only health board acting in this manner. I exhausted all the board's procedures by way of advice to the family in regard to appeals. The family have been awaiting a decision since 27 March 2002 on humanitarian grounds. While I accept that many cases must be processed, it is extraordinary that they are not entitled to the normal benefits during this period. I am shocked that the practice of assistance through a health board or the Department of Social and Family Affairs would be used as an instrument to force people into direct provision accommodation. It is particularly shocking in this case as the family left direct provision accommodation because the woman had a miscarriage in 2002 and had been exposed to chickenpox, as attested by the notes of doctors O'Beirne and Whyte dated 14 January 2004.What would any of us do in such circumstances?

In the most recent correspondence I have read, it is suggested that if the family survived for so long without visible means, they must have had means from somewhere. When I last spoke to a family spokesperson, it was suggested that they are perfectly willing to supply the names of the relatives and members of the community from whom they have borrowed money — I have permission to state the amount, which is €6,000. It is extraordinary that this can go on. They have received nothing from the State by way of sustenance since last November. From my checks at the regional hospital and the testimony of the woman, I found that she is a diabetic who administers insulin to herself four times a day.

It has been suggested that the family go back into direct provision accommodation or get nothing, a suggestion made by the health board and the social welfare system, which should have no role in implementing this kind of treatment for a family who are at considerable risk.

Mr. B. Lenihan

I reply on behalf of the Minister for Social and Family Affairs, Deputy Coughlan. The supplementary welfare allowance scheme, which is administered on behalf of the Department by the health boards, provides assistance to eligible people in the State whose means are insufficient to meet their basic needs. The supplementary welfare allowance scheme is subject to a means test and, accordingly, where a person has access to resources in kind or in cash, the relevant legislation requires that these be taken into account in determining the amount of assistance payable.

The Western Health Board was contacted regarding the family in question and has advised that they arrived in Ireland in August 2000 and submitted an application for asylum. The Reception and Integration Agency of the Department of Justice, Equality and Law Reform caters for the needs of asylum seekers through its system of direct provision. Under the direct provision system, asylum seekers are provided with full board accommodation and other services such as laundry and leisure facilities. In addition, they receive a weekly allowance of €19.10 per adult and €9.60 per child.

The agency initially referred the family to one of its direct provision accommodation centres in the Southern Health Board area. The family later transferred to direct provision accommodation in the Mid-Western Health Board area and in July 2001 transferred to direct provision accommodation in Galway. The family applied for rent supplement under the supplementary welfare allowance scheme in August 2001 on the basis that they had to move to private rented accommodation on medical grounds. Details of the medical evidence provided was forwarded by the health board to the Reception and Integration Agency which, having examined the circumstances of the case, advised the health board that the family's existing direct provision accommodation was suitable for their needs. In the circumstances, the application for rent supplement was refused. The family appealed this decision but their appeal was not upheld.

In May 2002, the family's application for asylum was refused. They applied for permission to remain in the State on humanitarian grounds and continued to reside in direct provision accommodation. A further application for rent supplement was made in 2003. The application was again refused on the ground that their existing direct provision accommodation was suitable for their needs. No appeal was made on this occasion.

In April 2003 payment of the weekly allowance was terminated as the family had vacated their direct provision accommodation and had failed to make contact with the health board. The board had no further dealings with the family until early 2004 when they applied for assistance under the supplementary welfare allowance scheme claiming that they had no means with to which to provide for their basic needs or rent costs. They were asked to provide details regarding their financial circumstances. In particular they were asked how they have been able to provide for their needs since they vacated their direct provision accommodation nine months previously. Despite being offered several opportunities to provide the necessary information, the family have failed to satisfy the board regarding their past and present financial circumstances.

Mr. M. Higgins

I can give the Minister of State the details now if he will just re-examine the case.

Mr. B. Lenihan

I am not sure that I have a function in that because there are appeals procedures in place and if they furnish those materials by way of a fresh application, that may resolve the matter. Accordingly, the family have not established as of the time of the preparation of this reply that they have an entitlement to assistance under the terms of the supplementary welfare allowance scheme.

The issue of medical benefits referred to by the Deputy relates to an application for a medical card. The health board has advised that it is awaiting the return of a completed application before a decision can be made in that regard.

Mr. M. Higgins

Is it not disgraceful, starving them out of the country and putting a child at risk?

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 2 June 2004.