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Dáil Éireann díospóireacht -
Tuesday, 4 Oct 2005

Vol. 606 No. 3

Adjournment Debate.

Services for People with Disabilities.

Is the Minister of State at the Department of Finance, Deputy Parlon, taking the Adjournment Debate?

It must be his week on the stump. The matter I raise is the lack of spaces for people with intellectual disabilities despite increased funding. During the past year, Fine Gael spokesperson, Deputy Stanton, and I spent months debating complicated disability legislation and trying to persuade the Minister for Justice, Equality and Law Reform to amend it. Not only did he show no interest in making changes but he showed no interest in the Bill.

All the points I and my colleagues raised during debate of the Disability Bill on the lack of spaces and services for people who suffer from disability have been borne out by a report published by a Government body, the National Intellectual Disability Database, charged with collecting the type of data which is essential in planning a proper service for people with intellectual disabilities. Its latest report is staggering. It notes, for example, that 2,270 people with intellectual disabilities are still without a day service, full-time care service or both. It also reports that no plans were made to respond to the high birth rate in the 1960s and 1970s and higher life expectancy rates among people with disability. It notes that the proportion of people with a severe disability who are aged 35 years and over increased from 29% in 1974 to 49% in 2005. The report also states that the multiannual funding announced in last year's budget has made no inroads into reducing the number of people with intellectual disabilities requiring a day care or residential place.

It is astonishing that none of the points made by Opposition Deputies during the debate on the Disability Bill, when every nuance of life for people with a physical or intellectual disability was discussed, was taken into account. Despite the fanfare with which the new Bill was introduced, nothing has happened and it has still not been signed into law. The Minister informed us that we must wait until proper services are in place before he will sign the Act section by section. Opposition Deputies specifically asked that he avoid this course of action but he has insisted on pursuing it.

In response to the recent report of the National Intellectual Disability Database, Deirdre Carroll, chief executive of the National Association for People with an Intellectual Disability, NAMHI, stated:

The Government is just throwing money at the situation without looking at the level of need. Some people will spend their lives without a service while others will die in large institutions because there is no money to move them out.

After watching on RTE last night the television documentary, "Asylum", which dealt with the few remaining residents in one of our mental institutions, it is clear the Government must make mental health services a priority. It is, however, so flush with money it no longer cares what it does. As the Private Members' debate demonstrated, a fraction of what the Government has wasted would be sufficient to put in place all the services required for those with intellectual disabilities. It is estimated that a further €400 million is needed to provide a sufficient number of services and residential and day care places for people with an intellectual disability.

While advances have been made in securing additional day care places, progress thus far has come about as a result of continuous pressure from those who have fought on behalf of people with disability. Instead of making a generous gesture, the Government has shown a grudging attitude to providing additional services. According to the report of the National Intellectual Disability Database, 284 day places, in addition to almost 2,500 residential care places, will be required over the next five years. One judges a society by how it deals with its most defenceless citizens. This Government has a very poor record on intellectual disability. The amount of money it has squandered would have gone a long way towards fixing what desperately needs to be put right.

I congratulate the Leas-Cheann Comhairle on his long service in the House and share the sentiments expressed by my colleagues in this regard.

I am taking this Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the matter as it provides me with an opportunity to outline to the House the position regarding the provision of health and personal social services for people with intellectual disabilities. The recently published report of the National Intellectual Disability Database 2005 indicates that 23,914 people with an intellectual disability are registered on the database, 97% of whom are in receipt of a health or personal social service. Despite this record level of service provision and significant investment in services from 2000 to 2002 and again in 2005, it is acknowledged that nationally 2,270 people are without a major element of service, that is, a day service, full-time residential service or both.

In November 2004 the Government announced that disability and mental health services would be prioritised under the Estimates for new health initiatives in 2005. An additional sum of €40 million was allocated to services for people with an intellectual disability and those with autism in 2005 as part of a five year multiannual budget for the sector and is being used for the provision of additional day, residential and respite places for people with an intellectual disability and the transfer of people with an intellectual disability from inappropriate placements. Additional funding of at least €50 million will be allocated each year in the period 2006 to 2009 to disability and mental health services. The new funding will provide additional residential, respite and day places, improve specialist support services and meet costs associated with moving individuals to more appropriate placements. This multiannual approach, with its firm commitment to future funding, is unique to the disability service.

It is anticipated that the additional investment in disability services over the coming years will significantly address the shortfalls in service provision identified by the report of the National Intellectual Disability Database. This is proof of the Government's commitment to the national disability strategy and people with disabilities.

Monaghan General Hospital.

I want to be associated with remarks congratulating the Leas-Cheann Comhairle on his long service.

I thank the Chair for allowing me raise this issue but I am a little amazed and shocked that no Minister with a health portfolio is in the House to discuss this serious matter.

The issue of Monaghan General Hospital has taken on a new urgency over the past few days. A proposal to restructure the male medical unit at the same time as the surgical ward will seriously curtail the ability of the hospital to continue a realistic level of services that would justify the staff and consultant numbers, maintain a hospital on call service and retain junior hospital doctors and anaesthetists.

I ask that both the Taoiseach and the Tánaiste and Minister for Health and Children, Deputy Harney, take the same interest in Monaghan General Hospital as they have taken in hospitals such as those in Nenagh and Ennis, where they have individually committed large sums of money.

On 15 September last the consultant surgeons belonging to the joint departments of surgery of Cavan General Hospital and Monaghan General Hospital unanimously requested that the Health Service Executive bring Monaghan General Hospital back on call for acute surgical emergencies. This followed the unprecedented instance where 30 patients were waiting for treatment on trolleys in Cavan General Hospital's accident and emergency department. On 23 September the board of Monaghan General Hospital supported the same request and asked the HSE — formerly the North Eastern Health Board — to review the wrong decisions and correct them by putting Monaghan General Hospital back on call for acute surgical emergencies as Cavan General Hospital had advised medical practitioners not to send patients to Cavan if at all possible — I have proof of that in writing.

Can the Tánaiste and Minister for Health and Children, Deputy Harney, advise what doctors are to do and, above all, what rights have patients in this position? Can she advise what will happen if two thirds of the beds available in Monaghan are to be closed at one time? Can she further advise what discussions she had — of course she cannot do so because she is not here — with the HSE regarding this project and its implications for long-term care? Does she realise that the proposed programme will do little to restore a proper general hospital service and more to establish a home for the elderly? How can she justify the fact that the treatment room, which was promised for last February and construction of which finished in July, has not yet opened? Can she ignore the statement by the consultants that putting Monaghan General Hospital on call for acute surgical emergencies would alleviate pressure on beds, both at Cavan General Hospital and at Our Lady of Lourdes Hospital in Drogheda? Will she make sure that adequate resources are made available, including providing theatre nurses in Monaghan General Hospital for evening and night duties? Does she realise that many people owe their lives to the service of Monaghan General Hospital? Unfortunately it can be clearly seen that lives were put in danger, if not lost, during the period that the hospital was on call.

The Taoiseach is entitled to get respect and to be thanked for his involvement in the peace process in Northern Ireland. However, no other hospital in Ireland has served a more difficult area or as long a Border region, and it is impossible to understand why he and Deputy Harney have ignored this vital organisation which is based alongside the N2 motorway leading from Dublin to Derry, the fourth largest city in the country. With Dungannon Hospital now closed, and the hospital in Omagh under threat, the services of Monaghan General Hospital are even more crucial. Industry, sport and every other aspect of life depend so much on proper general hospitals. With a permanent peace, Monaghan General Hospital could have a much broader service base and that should be our aim.

How can Deputy Harney stand over the waste of €150 million on computerisation that did not work while funding is curtailed to a few million euro for a hospital as important as that in Monaghan? How can she stand over the minimum use that is being made of a brand new theatre in Monaghan General Hospital as she pours out money to the national treatment purchase fund to do the same job?

Would the Minister of State, Deputy Parlon, who is from a rural constituency, like to stand beside a widow, with her handicapped child, whose husband was only 100 yards from Monaghan General Hospital but was not allowed in because it was off-call? That is the type of occurrence we face on a daily basis. It is impossible to understand how the Taoiseach could come to Cavan to hold a parliamentary party meeting and not mention Cavan General Hospital or Monaghan General Hospital, or how Deputy Harney still has not mentioned the group in charge of trying to restructure Monaghan General Hospital in a positive way. I just want straight answers.

I am taking this Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this matter as it provides an opportunity to outline to this House the position with regard to the provision of surgical services across the Cavan/Monaghan hospital group.

Under the Health Act 2004, the Health Service Executive is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Responsibility for the provision of services at Monaghan General Hospital rests with the HSE.

The Department is advised by the HSE that the policy approach in respect of surgical services for the Cavan/Monaghan hospital group was set-out in the 2004 report of a steering group established by the former North Eastern Health Board. The steering group was representative of all the key stakeholders and included consultant surgeon, radiologist and physician representation from both hospital sites. The Department is further advised that the steering group's recommendations were unanimously approved by its members.

They were not given any choice.

The steering group's recommendations were accepted by the executive board of the former North Eastern Health Board in late 2004. The HSE has informed the Department that it does not intend to review the steering group's recommendations in respect of surgical services.

The steering group recommended that major and emergency surgery should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective elective surgery. The report's recommendations reflect advice from the Royal College of Surgeons in Ireland. In accordance with the recommendations of the steering group, a full surgical team based in Cavan will provide services at Monaghan General Hospital, in the form of selective elective surgery on a Monday to Friday basis.

The HSE has also recently appointed a non-practising lead consultant surgeon at the Cavan-Monaghan department of surgery whose remit is to oversee an implementation plan arising from the RCSI's advice on the future configuration of surgical services in Cavan and Monaghan. Measures to achieve this include the appointment of surgeons to fill existing or forthcoming vacancies. All these posts will be structured, eight sessions at Cavan Hospital and three sessions at Monaghan Hospital.

In accordance with the steering group's recommendations, the hospital returned to 24-hour seven-day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call. The arrangements, which I have outlined and which are being put in place by the HSE, are designed to enhance the overall level of surgical services across the Cavan/Monaghan hospital group.

Ambulance Service.

I am grateful for the opportunity to raise this matter on the Adjournment. There are two matters to mention here, the first of which is to state this is an essential service and make the case for that. The second is the failure of Government to even recognise its responsibility and the utter ease with which it has been able to pass the buck to the HSE. Our worst fears about the Health Act 2004, that there would be no transparency or accountability, have come true. If the funding is not provided, the HSE can do nothing. As long as the money is not provided, the position will remain unacceptable.

The former Western Health Board area is very large. It includes three areas unique in Ireland, in that there is no ambulance base within 20 miles of them. The criteria laid down indicate there should be an ambulance base within 20 miles of all areas so people can get the help they need within the golden hour, a period recognised and laid down in medical circles as the time needed to give a person the best chance at life. Outside of the golden hour the chances of things going wrong are much greater and the chance of recovery less.

The issue for those who protest against the Hanly report and other changes is about getting services within the golden hour and getting essential definitive services that will make the difference between life and death, or life with disability or a cure. We face this difficulty through the lack of an ambulance service in the Mulranny-Achill area, which has a scattered rural hinterland. It takes two hours for an ambulance to come to Achill, never mind the chance of a person getting treatment within the golden hour. This is an utter scandal and has been raised with both the current and the previous Minister.

We put the same questions and get the same answer every time that this is a matter for the HSE and has nothing to do with the Minister who has no responsibility for the people of Mulranny and Achill who are dying. While Nero fiddled, Rome burned. While the Minister for Health and Children evades responsibility patients die. I got involved in helping set up a voluntary ambulance service in our area, but because of legalities etc. this service is no longer available. We are dependent on the State to provide a service. There is an onus on the State to provide an ambulance service that will provide service within the golden hour.

The situation is the same in Roscommon and Tuam, the two other areas that do not have an ambulance base within 20 miles. Four babies were born in my house because mothers could not make it to the hospital in time. People have died because of the distances involved and because of the delay in getting to the services in Mayo General Hospital, a considerable distance away.

We have been getting the same answer from the Minister since I came into the Dáil that the HSE is responsible for this area, not the Minister. For what has the Minister responsibility? What is the point in having a Minister for Health and Children if she will not take an interest in this issue and provide the necessary funding to ensure we get an ambulance service for the Mulranny-Achill area?

I am taking this Adjournment matter on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the matter as it provides me with the opportunity to outline to the House the facts relating to this issue.

The Deputy mistakenly alleges certain failures on the part of the Tánaiste and Minister for Health and Children. It is important, therefore, to clarify for the House the follow-up action taken by the Department and the Health Service Executive pursuant to the particular parliamentary questions which the Deputy tabled and which were replied to by the Tánaiste on the basis that the matter was one for the executive and had been referred to it for direct reply.

The Deputy's question of 14 June was referred to the executive and resulted in it issuing a letter to the Deputy on the matter dated 6 July. The Deputy raised the same matter in a question on 29 June and this was also referred to the executive in accordance with the Tánaiste's reply on that occasion. The executive replied to the Deputy by e-mail on 9 September, reiterating the position as conveyed to him previously. I am advised the Deputy was in telephone contact on the morning of 29 September with the executive to discuss the matter with the person who wrote to him on 9 September.

This sequence of events demonstrates that the Deputy's question to the Tánaiste was promptly referred to the executive and elicited responses to the Deputy setting out its current position on the provision of the particular service concerned. There was no failure on the part of the Tánaiste or her Department in regard to this matter.

Will the Department provide the money?

The Tánaiste's actions were fully in accordance with the provisions of the Health Act 2004, particularly subsection (4) of section 7 which expressed the decision of the Oireachtas that the executive "shall manage and deliver, or arrange to be delivered on its behalf, health and personal social services".

If it gets the resources.

The executive has its own Vote for which its chief executive officer is the Accounting Officer. In that context, it must make its own decisions on the use of resources and the setting of priorities for service development in Mayo or anywhere else in the country.

The Tánaiste has put particular emphasis and importance on the executive providing timely replies and information to Oireachtas Members. This is an initiative on which her Department has been working with the executive and which led to the establishment of the executive's parliamentary affairs division. A primary task of this new division is to ensure questions referred to the executive are responded to as soon as possible and that the issue of replies is monitored and followed up where necessary. The Department continues to work with the executive to develop its parliamentary affairs capability.

I emphasise that while these arrangements facilitate referral of questions to the executive, they do not give a role to the Tánaiste in the decisions which inform the replies provided directly to Deputies, as these are a matter for the executive in accordance with its responsibilities under the Act.

It is no use having priorities if they cannot give the funding.

Schools Building Projects.

I take this opportunity to congratulate the Leas-Cheann Comhairle on the great and singular honour of completing 44 years service to this House.

I speak on behalf of the people of Kanturk and ask the Minister for Education and Science the current position on the amalgamation of the two national schools in Kanturk. This proposal has been ongoing between the Department and the boards of management of the two primary schools since 2001. In many cases amalgamations have been proposed by the Department rather than on the ground, but in Kanturk the boards of management have been willing to ensure the amalgamation between the boys' and girls' national schools takes place. The technical assessments have been carried out on these schools and I understand a further technical assessment took place of the buildings this summer.

I am delighted the Minister of State at the Department of Finance, Deputy Parlon, is here as he has special responsibility for the OPW and I understand the Department is to liaise with it in sourcing a greenfield site. What is the position in that regard? Kanturk is a growing town and it has been shown that the current facilities are on too small a site. Some 200 houses are at construction stage in Kanturk and the extended school is necessary to ensure the proper education of the young people of the town.

Kanturk is signalled as a decentralisation town and the regional office of the OPW, the departmental responsibility of the Minister of State, is earmarked for Kanturk. I believe a site has been earmarked for that office and negotiations are ongoing between the OPW and the site owners to finalise the details on it.

Kanturk is a growing town with a great spirit. It is a local provincial town, the capital town of Duhallow, with a good community spirit. We would not like to see the growth of Kanturk held back in any shape or form as a result of not having proper primary school facilities. As I said at the outset, the boards of management of both schools have been willing to work with the Department of Education and Science on the amalgamation plans. Sadly, the Department has not supplied the desired information in recent years. I ask the Minister of State to outline to the House the detailed proposals which have been made to date. He should emphasise to the Minister and the Department the importance of ensuring that this project goes ahead as a matter of urgency. Many stages of the planning process need to be completed speedily before the amalgamation can take place. A new greenfield site needs to be bought so that the project of constructing a new educational facility in Kanturk can be progressed as soon as possible.

I thank the Leas-Cheann Comhairle for giving me the opportunity to raise this issue. I would like progress to be made in respect of this matter, which is of great importance for Kanturk, as speedily as possible. I congratulate the Leas-Cheann Comhairle on completing a record service in the House.

I thank the Deputy for raising this matter. I am pleased to outline, on behalf of the Department of Education and Science, the position regarding the proposed amalgamation of St. Colman's boys national school and Scoil Náisiúnta Chlochair, which are the two primary schools in Kanturk, County Cork.

St. Colman's boys national school, which had an enrolment of 106 in 2004-05, is staffed by a principal, three mainstream assistants, a permanent learning support teacher and a permanent resource teacher. The enrolment of Scoil Náisiúnta Chlochair, a girls school that enrols boys in junior and senior infants only, has increased in recent years from 156 pupils in 2000-01 to 170 pupils in September 2004. It is staffed by a principal, five mainstream assistants and one permanent learning support and resource teacher.

The authorities in both schools are in favour of the amalgamation and the preferred option locally is for a new school building on a greenfield site. A technical assessment of the existing sites has accepted that there is a need for a new site, as neither of the existing sites lends itself to the development required to facilitate the amalgamation.

The proposed project has been assessed and banded in accordance with the Department's prioritisation criteria, which were revised last year after consultation with the education partners. The provision of the accommodation that is necessary to facilitate agreed amalgamations is assigned a band 1.4 rating, which will positively influence the timescale for the delivery of the project when a site has been acquired.

The long-term projected staffing on which the accommodation needs of the amalgamated schools will be based will be determined by officials from the Department of Education and Science in consultation with the two school boards. A detailed assessment of demographic trends, housing developments and enrolment trends will be undertaken to ensure that the capital funding that is provided will deliver accommodation that is appropriate to the needs of the amalgamated schools into the future. When that has been decided, the appointment of a design team for the project will be considered. The project will then be considered for progression in the context of the school building and modernisation programme 2005-09.

I thank the Deputy again for giving me the opportunity to outline to the House the position on the proposed amalgamation of the two national schools in Kanturk.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 5 October 2005.
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