Dáil Éireann díospóireacht -
Tuesday, 21 Mar 2006

Vol. 616 No. 4

Adjournment Debate.

Hospitals Building Programme.

Mr. Ferris

A community hospital for Tralee has been promised since 1999. Since that time, Tralee senior citizens, campaigning for the hospital, have met with three different Ministers, all of whom have given their word that the project will go ahead. The last meeting was as recently as May with the Tánaiste and Minister for Health and Children, Deputy Harney. Many of the senior citizens who initiated the campaign in the mid-1990s have since passed away.

Despite the undertakings given by Ministers and the high status of the proposed hospital in the Health Service Executive, HSE, capital programme, it is feared the project will be further delayed. The HSE has informed the campaign of unresolved revenue costs implications of the project. It is feared this may be used by the HSE as an excuse to abandon or further delay the project.

Given the ongoing crisis afflicting Tralee General Hospital, any further delay in the building of a community hospital will place further strains and pressures on the provision of health care in Kerry. Many in the county are unable to access care, particularly in emergencies.

Tralee General Hospital is the second largest of the southern region's seven acute hospitals and provides services to County Kerry, as well as a proportion of people in west Limerick and north Cork. Statistics have shown a marked increase in demand, yet the hospital is forced to get by with the same number of medical staff as 20 years ago. Facilities are stretched beyond limit with an unsustainable nurse to patient ratio. I commend the staff and physicians who are doing fantastic work in spite of these factors.

A full-time consultant cardiologist with necessary support services is urgently needed in the area. A long-promised consultant cardiologist was appointed in March 2005 and shared with the Bon Secours Hospital in Tralee but has since resigned. A replacement is being sought but again that consultant will have to be shared with the Bon Secours Hospital. County Kerry has the highest rate of coronary diseases in proportion to its population. The 2003 national cardiovascular strategy report recommended the appointment of a full-time cardiologist for the county. The strong support for such a provision was proved by over 30,000 signatures on a petition that a cardiologist be appointed.

Tralee General Hospital services a large catchment area of north Kerry, parts of west Limerick and into east Kerry as far as Killarney. However, it has no public community service for elderly people in need of full-time care. This week, a 72-year-old woman attended my constituency office. For the past ten years she has minded her husband, who suffered a stroke, at home in north Kerry. He was recently moved to a community hospital in Killarney. If she wanted to visit him, she would have to drive 75 miles on a round trip. Due to her health and age, she is not in a position to do so. Instead, she is dependent on family members and neighbours to take her to visit the husband with whom she has shared 40 years of her life.

This is the situation across north Kerry where there is no facility for elderly people in need of full-time care. Anyone in that situation will find themselves located to St. Columbanus's Hospital in Killarney. People living as far away as Tarbert must drive to Killarney to visit their loved ones. It is an intolerable situation. I appeal to the Minister of State at the Department of Health and Children, Deputy Seán Power, to make the funding available for a community hospital to be built In Tralee to allow elderly people live their lives in dignity and security.

Minister of State at the Department of Health and Children (Mr. S. Power)

It is the policy of the Department of Health and Children to maintain older people in dignity and independence at home in accordance with their wishes, and at the same time to provide high quality residential care for older people when living at home is no longer possible.

The Government's commitment to the development of a comprehensive range of services for older people has been demonstrated by the significantly increased resources made available in recent years. From 1997 to 2005 inclusive, additional spending on services for older people is in excess of €302 million. In the budget package announced for 2006, additional revenue funding of €150 million in full year costs was allocated, that is €110 million in 2006 and a further €40 million in 2007, for services for older people and palliative care.

The proposed development in Tralee is a 50-bed unit to be built on a greenfield site located off the Killerisk Road, Tralee. The facility will comprise two modules of 25 beds each, plus ancillary facilities providing continuing care, respite and convalescent care to dependent older people.

The prioritisation of all health capital developments is a matter for the HSE under the Health Act 2004. The capital plan has been approved by the HSE board and was recently submitted to the Tánaiste for consideration. The plan, which includes the proposed development at Tralee Community Hospital, is being considered by the Department of Health and Children in conjunction with the Department of Finance. I expect to be in a position to revert to the HSE in the near future about the plan.

Health Services.

Mr. Crawford

I thank the Ceann Comhairle for allowing me the opportunity to raise the important issue of funding for the Health Service Executive, HSE, in the north east.

The population of counties Cavan, Monaghan, Louth and Meath, in what was then the north-eastern health board region, has increased more than in any other region between 1971 and 2002. The most recent figures available show that between 1996 and 2002 there was an increase of 12.7% as against an 8% rise in the overall population. From 1971 to 2002 the population increased from 250,000 to almost 345,000 in the north-east region and that trend has continued at a significant rate to date.

Unfortunately funding for health services in the north east, even this year under the new HSE, has not taken into account the massive population increase. The most dramatic increase is in the 25 to 44 year age group. There is also a massive increase in the number of persons aged 65 years and over, many whom have to be dealt with by the HSE through home help or home care and nursing home structures with the support of subvention. The demand for the services provided by the HSE continues but unfortunately funding does not match. Funding is based on the funds supplied when the health boards were established in 1971. It was not adjusted to take account of the massive increases in population in the region. Having raised the issue before, I appreciate arguments will be made that the north east benefits from the services provided by hospitals in the Dublin region. However, the same can be argued regarding the midlands, the west or any other region.

My problem and that of the people I represent is that we find out the services available in other areas are completely different. For instance, only recently I came across a seriously handicapped person having to use a wheelchair. She had lived in Donegal were she was receiving 12 hours home care per week, yet because her husband's involvement brought him to Monaghan she now receives only two hours.

In another case I dealt with, a constituent from Cavan-Monaghan was put into full-time care in the western region to be near some of her family members. However, the owner of the home could not believe the difficulties he had in getting the subvention agreed initially and then getting payment of that subvention from the time the person entered the nursing home. He told me that there would not be the same financial pressure in his region.

Another issue of serious concern is the fact that almost 10,000 people in the constituency of Cavan-Monaghan have lost their medical cards since 1997. That figure is out of a population of 109,000 people with an average income, according to Government statistics, of approximately €14,500. By comparison, only 8,000 people lost medical cards in the county and city of Cork, with a population of 550,000, although the figures suggest the average income there is around €16,000.

Out of a national population of 4 million, 100,000 medical cards were lost. This clearly shows a totally unacceptable and uneven distribution of access to free medical care, with Cavan-Monaghan at a serious loss. This loss was even more clearly highlighted to Oireachtas Members from Monaghan who, with the deputation from the VEC, met the Minister for Education and Science, Deputy Hanafin. They were advised that the only reason Ballybay College in County Monaghan was not classified as disadvantaged was the fact that parents of the children did not have medical cards. That means they would have to pay for bus services, if such were made available. In addition, they do not benefit from the free book scheme or the back to school clothing allowance.

This is the reason I am not just asking but begging the Minister and the Health Service Executive to treat the people of the north east on equal terms, like everyone else, for funding. They are not seeking better terms or asking for any advantage. Wherever they live, elderly persons should have the same services available to them. A low-income couple with a young family should have the same right to a medical card as those elsewhere. I urge the Minister to ensure that a per capita sum is made available nationally, rather than being based on some historical and irrelevant numbers that bear no relation to the current situation.

Mr. S. Power

I thank Deputy Crawford for raising this matter on the Adjournment and I wish to reply on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney.

The aim of the home help service is to enable people, who might otherwise need to be cared for in residential care, to remain at home where appropriate. It is recognised that the home help service is an essential support to family and informal carers. In line with the Government's continued commitment to community support for our older people, an additional €33 million was allocated in the budget to the home help service —€30 million for 2006 and €3 million for 2007. The additional investment will provide 1.75 million home help hours this year and is being implemented in a flexible way by the HSE.

By its nature, the home help service is a flexible service which responds to clients' needs. As a result, therefore, the level of service required in individual cases will fluctuate from time to time. To ensure effective prioritisation of the service, assessments are undertaken at local sector level and carried out in all cases by the Health Service Executive's public health nursing services. The service is targeted at high and medium dependency clients in accordance with their assessed needs. The Health Service Executive is responsible for the implementation of the home help service on a national basis. The HSE has advised the Department that it is currently implementing the national rollout of the additional €30 million allocated to the service for this year.

In addition, €55 million was also allocated in budget 2006 for home care packages. It is planned to have an extra 2,000 packages in place by the end of 2006, almost trebling of the current service. Home care packages will deliver a wide range of services and in many cases these will also include an element of home help.

In the case of the particular example cited by the Deputy, the HSE has indicated to my Department that it would be happy to review this case if requested.

Under the Health Act 2004, the determination of eligibility for medical cards is the responsibility of the Health Service Executive. Persons aged 70 and over are automatically eligible for a medical card without reference to their means. Assessment guidelines, having account of both income and allowable outgoings, are used by the HSE to assist in the determination of a person's eligibility. These guidelines are not statutorily binding and in cases where a person's income exceeds the guidelines, a medical card may still be awarded if the HSE considers that his other medical needs or other circumstances would justify this.

Information supplied to my Department by the HSE's primary care reimbursement service for March 2006 indicates that there are 1,168,273 persons covered for services under the general medical services scheme. This is 23,190 more than the comparative figure for January 2005. A further 10,034 people hold GP visit cards.

Funding of €60 million was provided in 2005 to the HSE to provide an additional 30,000 traditional medical cards and a further 200,000 persons with GP visit cards. Since the beginning of 2005, significant improvements have been made to the way in which eligibility for medical cards and GP visit cards is assessed. In January 2005, the income guidelines were increased by 7.5%. In June 2005, the means test for both medical cards and GP visit cards was simplified. It is now based on an applicant's and spouse's income after tax and PRSI, and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work costs. This is much fairer to applicants.

In October 2005, the income guidelines for both medical cards and GP visit cards were increased by an additional 20%. This means the income guidelines are now approximately 29% higher than they were at the end of 2004. It will be noted that the income assessment guidelines used for GP visit cards are 25% higher than those used for medical cards. The HSE has publicised these changes to encourage people to apply and has made the application process as simple as possible. The HSE has also provided a national information helpline. My Department and the HSE will continue to monitor the number of cards issued and will examine any further changes to ensure the targets of an additional 30,000 medical cards and the provision of 200,000 GP visit cards are met.

Records show that between June 1997 and March 2006 the number of medical card holders recorded by the HSE has reduced by approximately 76,000 — that is, from 1,244,459 to 1,168,273. However, these changes may largely be attributed to the increased number of people in employment and the improved economic situation nationally with people on higher wages. The ongoing management and review of medical card databases has also been a factor which has improved data quality in the HSE's databases.

Regarding counties Cavan and Monaghan, current information for March 2006, provided by the HSE, shows that there are 35,540 people with medical cards compared to 34,752 in March 2005. Thus, over the last year, the number of people with medical cards has increased by 788. Furthermore, including GP visit card holders, there are 1,191 more people in counties Cavan and Monaghan who now have free access to GP services under the general medical services scheme than this time last year.

Decentralisation Programme.

Mr. Kirk

I thank you, a Leas-Cheann Comhairle, for the opportunity to raise this issue which is important both to my constituency and the east coast generally. I refer to the decentralisation plans for Drogheda and south Louth. Some time ago, many parts of the country welcomed the Government's decision to decentralise significant portions of the public service. People recognised the significant economic impact that decentralisation would have in the target locations.

Being situated in the North-South corridor, Drogheda was one of the prime locations to be considered as part of the decentralisation programme. The decision to relocate a significant number of public service employees to Drogheda was welcomed. In recent years, the town has been one of the most rapidly growing areas on the east coast and some may say in western Europe. The number of housing units built in the town has grown phenomenally and a significant dormitory population live in Drogheda and work in Dublin. That they can live in Drogheda and commute on a daily basis to Dublin is a tribute to the positive and worthwhile investment in road infrastructure by way of the M1 from Dublin to the Border. It illustrates the importance of investment in our road network for the development of towns such as Drogheda in County Louth.

People in the public service have significant and understandable interest in coming to Drogheda. I am sure it will be much easier for public servants who live on the north side of Dublin to turn the car northwards towards Drogheda than to face the traffic problems they may encounter in going to work in various Government Departments around the city.

It goes without saying that people with an interest in the completion of this project are anxious to see the timescale for locating the offices in Drogheda and for public servants to begin to come to the town in greater numbers than previously. I look forward to the Minister of State's reply on this subject.

Mr. S. Power

I thank Deputy Kirk for raising this matter. On behalf of my colleague, the Minister of State at the Department of Finance, Deputy Parlon, I wish to reply. The Government's decentralisation programme envisages that the headquarters of the Department of Social and Family Affairs will be relocated to Drogheda, County Louth, together with a number of other public service operations, including, inter alia, Comhairle, Reach, the social and family affairs appeals office and certain maritime elements of the Department of Transport. All told, the total number of posts to be decentralised to Drogheda is approximately 700. These numbers will provide a significant and welcome economic boost to the town of Drogheda.

The Office of Public Works has the task of sourcing suitable property solutions to meet the requirements of the decentralising Departments and agencies throughout the country. The office has made good progress in this regard. To date it has completed or significantly advanced property acquisition negotiations in 23 of the more than 50 locations targeted under the decentralisation programme. Sites for the balance of the decentralisation locations are also being actively pursued by the Office of Public Works.

In the case of Drogheda, the Office of Public Works has identified a number of centrally located sites which meet the criteria of the decentralisation implementation group together with those of the relevant decentralising bodies. These sites are in the ownership of the local authority. Agreement in principle has been reached with the local authority officials for the sale of these sites to the OPW for decentralisation purposes.

Detailed site investigations and archaeological assessments are under way and are expected to be completed shortly. In tandem with the ongoing technical assessments, negotiations on the terms and conditions of sale have commenced with the local authority. Subject to satisfactory terms being agreed and satisfactory outcomes to the technical assessments, the Office of Public Works hopes to be in a position to complete the purchase of the selected sites in the near future. The decentralisation implementation group has set out indicative timescales for the completion of the construction of decentralised offices in the "early mover" locations, which include Drogheda.

The indicative timescale for construction completion in the case of the Department of Social and Family Affairs offices is the first quarter of 2009. For the maritime related bodies, the indicative timescale is the first quarter of 2007. It is important to remember that these timescales are indicative. This reflects the fact that many unforeseen circumstances could impact on these timeframes. However, the Office of Public Works will continue to strive to ensure that the decentralisation plans for Drogheda are implemented within the indicative timescales set out by the decentralisation group.

Fire Stations.

Mr. Ring

I wish to raise the situation regarding the Westport fire station. In 2003, details of the fire service capital programme were announced, which included the construction of a new replacement fire station in Westport. Approximately €445,700 was recouped by Mayo County Council to meet expenditure already incurred in respect of the site and fees for the Westport project. On 26 October 2005, the Department authorised Mayo County Council to invite tenders for the construction. The tenders have come back to the council and the Department. However, to date an announcement on the fire station has not been made.

I wish to outline how serious the situation is in Westport, a town that has almost doubled in population during recent years. It has 12 hotels and in the summer months the population trebles. Last night, the fire service had to travel as far as Leenaun to deal with a serious fire and tonight it has been called out to another fire.

I compliment and congratulate the station officer, Noel Duffy, and his staff for the excellent job they have done over the years on behalf of Mayo County Council and the people of Westport and surrounding areas. They have been in rented accommodation for a number of years and it is time the Minister made the announcement and provided the necessary funding, which is the problem.

I believe €4 million has been allocated for the construction of the station, the cost of which has increased to €4.4 million. If that is the problem, I ask the Government and the Department to sanction the extra €400,000. However, they should first appoint a contractor and start building as soon as possible. A site has been chosen, planning permission has been received and everybody is ready for the development.

During the local elections last year, I thought the former Minister for the Environment, Heritage and Local Government, Deputy Cullen, would dig the foundations and put down the blocks when he was in Westport because announcements had been made. I thought it was ready for off and that the roof would be on the building before he left the town that evening. That has not happened.

I hope the Minister of State will have good news for the fire station staff, that the project will be sanctioned, that we will have the tender out next week and that the operation will be up and running as soon as possible. The staff are in rented accommodation, which costs a small fortune. Westport is an expensive town and it would be better to put the money into a project to get their own building up and running and to give that staff the building they need to provide their service. It is not fair that staff work in rented accommodation unsuitable for the job they do.

Everything is in order and I hope the Department and the Minister will sanction the project within the coming days. The tender has gone in and it is a matter for the Government to select a builder, announce that funding has been approved and get the project up and running.

Mr. S. Power

I thank Deputy Ring for raising this matter. I wish to reply on behalf of the Minister for the Environment, Heritage and Local Government. The Minister is aware of Deputy Ring's interest in the provision of a new fire station at Westport and he shares his desire to have this project completed as quickly as possible. There has been no delay in dealing with this proposal since the Department approved the contract documents for the project on 26 October 2005. Mayo County Council advertised for tenders on 25 November with a closing date of 30 December.

Following examination of the tenders by the county council's technical advisers, a proposal for the acceptance of a tender was submitted to the Department, where it was received yesterday. This proposal must now be examined in the Department before a decision can be notified to the county council. This is likely to be within a number of weeks unless queries give rise to further correspondence between the Department and the county council. Assuming that everything is in order a decision will be announced within a couple of weeks. Funding will be available for the project as expenditure arises and a sum of €445,700 has already been paid to the local authority in respect of site costs and fees.

The Dáil adjourned at 9 p.m. until 10.30 a.m. on Wednesday, 22 March 2006.