Adjournment Debate.

Health Services.

Caoimhghín Ó Caoláin

The news that came with the leaking of the Health Service Executive report that the HSE north-east region is contemplating cuts in services to offset an overrun of almost €10 million in the current fiscal year has come as a grievous blow to the people of counties Cavan, Monaghan, Louth and Meath, the greater number of whom live under a daily dark cloud as a result of the loss of critical services at a number of those hospitals, not least in Monaghan and Dundalk.

People in the region I represent are absolutely outraged and cannot understand that at a time when the economy is, for all intents and purposes, awash with money, the Government is presiding over cutbacks in health, which has made a serious and negative difference in the daily life condition of ordinary people. In the area where I live in County Monaghan, there have been upwards of 20 avoidable deaths as a result of the contraction in service delivery at the acute hospital site in Monaghan in recent years. That is a terrible statistic, a terrible reality and a terrible indictment of Government policy in this regard.

People have a right to ask why, after nine years in government, the coalition has got our health services so disastrously wrong. While it is acknowledged that more money is going into the health services than at any time previously, the reality is that we are not receiving the service delivery we once enjoyed and have every right to expect in future.

The Government is more keen to give tax breaks and land to developers of private hospitals than it appears to be committed to the public hospitals of Monaghan, Cavan and Dundalk, each of which has long records of excellent care for patients and is again being deprived of services. Almost incredibly, the contemplated cuts in the north east will have an effect on some of the most vulnerable of patients, those with cancer and those requiring renal dialysis, among other service user needs.

If these cuts go ahead, long-promised and long-needed improvements in oncology and dialysis services will be blocked as an exercise in a so-called money-saving endeavour. It may save money in the long term, but at what price? What price will people pay over the remainder of this year?

The focus of these cuts is incredible. There is a bounden duty and responsibility on Government to recognise that the per capita allocation of funding in the north east falls well below the average per capita allocation right across the different HSE areas throughout the State. It is now a requirement of the Minister for Health and Children, Deputy Harney, to ensure the HSE properly funds services in the north east rather than employs the exercise mooted in this report, that is, a curtailment of promised developments and improvements and a further contraction in service to allegedly save almost €10 million in the remainder of this year.

There is no doubt that diktat ending accident and emergency services in Monaghan has already contributed to the loss of lives. In respect of what other area of the country could a Deputy stand up and say what the names of Bronagh Livingstone, Pat Joe Walsh and Frances Sheridan mean to the House? I could go on and on and the truth is that each name means something to the Minister. He recognises them and he knows that their deaths occurred in tragic circumstances. No Deputy from any other part of the country could stand up and refer to the hospital services in his or her hospital area and expect such instant, national recognition of those names. There is no better way than that to explain the sad reality of the situation in Monaghan.

I hope the Minister recognises that a special situation applies here. It is not acceptable that we will have further misery heaped on the suffering, fear and concern that is prevalent in the community that I am proud to represent.

Minister for Justice, Equality and Law Reform (Mr. McDowell)

I am taking this matter on behalf of the Tánaiste and Minister for Health and Children.

Under the Health Act 2004, the Health Service Executive has responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. The Department has been advised by the HSE that the allocation in 2006 for the north-east hospital network is €216 million. This is approximately €15 million more than was provided in 2005, representing an increase of over 7%. Management at the hospitals in the north east are examining options to assist in meeting the requirement to operate within the approved funding allocation in the current year. The purpose of the reviews under way is to identify options that can assist with breaking even financially without impacting existing services. A number of budgetary measures have already been put in place within the HSE hospital network in the north east. The HSE has assured the Department that these budgetary control measures will not have an adverse impact on patient care, including cancer and dialysis services. The aim is to obtain best value for money and to maximise efficiencies where possible.

Staffing levels in the north-east hospital network increased from 3,091 at the end of 2004 to 3,238 at the end of 2005 and 3,301 at the end of the first quarter of 2006. This represents an increase of 210 since the end of 2004. Since 1997, cumulative funding totalling more than €36 million has been allocated to the Health Service Executive north-eastern area for the development of appropriate treatment and care services for people with cancer. This investment has enabled the funding of eight additional consultant posts and support staff in key areas of cancer care and 41 cancer care nurse specialists across the region. The HSE has assured the Department of Health and Children that an additional €600,000 will be invested in the further development of cancer services in the region this year. There are currently two consultant medical oncologists with sessional commitments in the region. The appointment of an additional consultant medical oncologist between the Mater Hospital and Our Lady of Lourdes Hospital in Drogheda is currently being processed and is a priority post for the HSE.

The HSE expects that by reviewing expenditure and applying available resources, including money put aside for contingencies, it will manage the provision of services as set out in its 2006 service plan.

Mental Health Services.

Mr. Wall

I thank the Leas-Cheann Comhairle for the opportunity to discuss this very important matter. I raise it because I received letters from the very concerned parents of residents at Clonree House on foot of newspaper reports that the centre there is to close.

To close a centre after a six-month period is a very worrying aspect of this proposal. The families of the loved ones being cared for in this centre, like all families with children suffering from mental illness, see the care and facilities as having a stabilising effect on those seeking such care. The families also understood in this instance that a new rehabilitation group was to be established. However, instead of the good news of advancing the care of their loved ones through the proposed group, the families are being told that the facility is to close for financial reasons. One reason mentioned is that the staffing levels could not be maintained at the centre and because of this, overtime had to be paid on all night-shift work. It is this aspect that is causing the financial problems leading to the threat of closure.

Families also see bonds of friendship develop between all of the residents and this loss of friendship will also affect each of the residents. If the residents are moved to another centre, it will take a great deal of time for them to develop new friendships, acquaint themselves with new surroundings and so on. These difficulties lead to a fear within the person and a further worry for the family concerned.

I need only quote from a letter, sent to the Tánaiste, that I received from a family member with a loved one in the centre, to understand the worry and concern that this uncertainty is causing for the families concerned:

I have now been made aware that this hostel is being closed down for mainly financial reasons. I am one of many families who has someone in the service. To have someone you love develop a psychiatric illness is horrendous. Mostly it is such a slow process that you are not aware it is happening. When you have someone admitted to Lake view unit, the psychiatric section in Naas General Hospital, they usually remain there for a few weeks until they are returned to their families. The effect this has on the family is frightening. The family are left to deal with a stranger with no training and very little support. If every family gave in and left their loved ones in hospital it would cause chaos. We as families need help. This hostel was to be our saving grace we felt. It would be somewhere our loved ones would get the help coping with their illness and maybe families would get the help needed to understand. When someone develops a physiatric illness their personality can change hugely. In a way you end up grieving for the child you lost and have to learn to accept the person they become.

That statement speaks for itself and underlines the threat that the families involved fear at this very moment.

What is going to happen? When will it happen? In what way will it affect their loved ones and in what way will it affect the home? Will any facilities be put in place to assist them with the burden that they have to bear? These very relevant questions must be answered by the HSE before any action is taken in regard to the possible closure of the centre. The families of those involved must be consulted and agreement reached on the means of addressing a problem that has great personal effects for the families involved. It affects them to the point that they are being split down the middle as to what they can further accept.

I ask the Minister that this decision be re-examined and that every effort be made to maintain the centre that the families have come to trust and believe in. I also ask that the proposal on the provision of a rehabilitation group at the centre be considered, as the families believe that this is the way forward for their loved ones.

I will conclude with another quote from the same letter to the Tánaiste:

There is no one fighting solely for the patients or families like me. So for them I ask you to re-think the closure of this centre. I feel you are a straight person and if you can help, you will. I feel so sad because I know what is ahead for anyone who has a loved one enter the service. The only way I can describe it is a life sentence for all of us, patients and families.

I ask that this be brought to the attention of the Tánaiste and Minister for Health and Children and that the appropriate action be taken to keep the centre open.

Mr. McDowell

I thank Deputy Wall for raising the issue and I assure him I will bring his remarks to the attention of the Tánaiste.

The management and delivery of services at Clonree House is primarily a matter for the Health Service Executive. The HSE has informed the Department of Health and Children that Clonree House opened in December 2005 to facilitate the refurbishment of another residential facility in the mental health services for Kildare and west Wicklow. I am advised that six residents live in Clonree House and all residents have been assessed by the mental health services rehabilitation staff. The plan is to transfer them in the near future to community residences which are deemed to be more appropriate to their needs. This will be carried out in consultation with the individuals concerned and their families. The HSE is examining proposals for the most efficient and effective use of Clonree House for the patients of the Kildare adult mental health services.

As the Deputy may be aware, the report of the expert group on mental health policy, A Vision for Change, was published by my colleague the Minister for State, Deputy Tim O'Malley, in January this year. This report has been accepted by Government as the basis for the future development of mental health policy. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984.

Recent years have seen dramatic changes in both the concept and innovative practice of mental health care delivery. These changes have been very much in line with the model of service provision now recommended by the expert group. The focus of mental health service provision is to work towards a community-based model of supporting, caring for and treating people with mental illness who live in their own communities. This is achieved through a range of services, which includes outpatient clinics, day hospitals, home visits, community residences and supported accommodation as well as working in collaboration with voluntary organisations.

A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. The report recommends that a programme of capital and non-capital investment in mental health services adjusted in line with inflation should be implemented in a phased basis over the next seven to ten years. The proposals in that document will allow for further significant expansion in community services and in specialised services for groups such as children, older people and those with particular needs.

The programme of further investment began this year, with an additional €25 million allocated to the HSE for the development of mental health services. This brings to €835 million the estimated non-capital expenditure on our mental health services in 2006. The Minister of State, Deputy Tim O'Malley, who has special responsibility for mental health will seek the active support of all involved in the mental health services so that together we can bring about the far-reaching improvements contained in A Vision for Change. l assure Deputy Wall that decisions in regard to the future use of Clonree House will be made in accordance with the recommendations in that document. I thank the Deputy for raising this matter.

Graffiti Offences.

Mr. Gormley

I thank the Ceann Comhairle for giving me the opportunity to raise the issue of graffiti vandalism, a problem which is becoming worse by the day in Dublin city and elsewhere. From previous parliamentary questions I put down on this issue, it appears the Government does not have a coherent strategy to deal with this issue. Local authorities are only now becoming aware that there is a serious problem. However, they simply do not have the resources or legislation to tackle it properly.

Anyone who has visited capital cities throughout Europe knows that graffiti vandalism is a major problem in Paris, Berlin and Rome. These beautiful cities have been defaced by these graffiti vandals. Interestingly, London does not appear to have the same problem, nor does New York, a city I visited last week for the UN conference on AIDS. Surely it would not be too much for this Government to examine how the New York authorities, or the authorities in New South Wales in Australia, dealt with the graffiti problem.

The US is one of the most progressive countries when it comes to anti-graffiti measures. Its innovative approaches include providing incentives for citizens to use protective coatings to minimise the damage caused by graffiti, revoking the driving licences of graffiti offenders, banning the sale of spray paint to minors, banning the possession of spray paint in public places and the rapid removal or painting over of graffiti once it is discovered. Its graffiti solutions programme builds on deterrents and law enforcement and focuses on prevention, harm minimisation and the removal of graffiti.

It appears we have no specific graffiti offence in Irish law, nor has the Minister any intention to introduce specific legislation. We were informed by the Minister for Justice, Equality and Law Reform that the Criminal Damage Act 1991 and the Litter Pollution Act 1997 cover the offence of graffiti. However, it is not at all clear how many people were convicted for graffiti vandalism last year. The Minister for Justice, Equality and Law Reform informed the House that there were 1,702 convictions for damaging or defacing property. How many were for graffiti vandalism? We were also told there was one conviction under the Litter Pollution Act 1997. Again, was this for graffiti vandalism?

The Minister for the Environment, Heritage and Local Government, Deputy Roche, in reply to a parliamentary question stated he considers this legislation adequate. If this is so, why have we seen an upsurge in graffiti throughout Dublin? We cannot afford to underestimate the extent of this problem. This is not a harmless activity. Householders and shopkeepers must remove the graffiti and this costs a considerable amount of money. I know the owner of the pen shop on Dame Street had to remove graffiti from his windows and stonework on at least three occasions. Not only that, but graffiti gives rise to a sense of urban blight and lawlessness.

Although New South Wales had legislation dealing with property offences, it was felt necessary to introduce specific graffiti offences. These include damaging and defacing property by means of spray paint without reasonable excuse, the proof of which lies with the person. It attracts a maximum fine of 2,200 Australian dollars or imprisonment for six months or a period of community service work. It is also an offence for a person to have spray paint in his or her possession, with the intention that it should be used to damage or deface premises or other property.

Graffiti removal costs money. Approximately $17 billion a year is spent in the United States on the removal of graffiti. I suspect if we calculated the costs here, it would be considerable. It is often borne by the individual householder or shopkeeper. It is not good enough for the Government to continue to put its head in the sand on this issue.

I will suggest a number of steps we could use to deal with graffiti vandalism. The Government must introduce specific legislation to deal with the offence of graffiti vandalism. The Garda must have a special unit, as do many police forces in the United States, to deal with graffiti vandalism. New York city has GHOST, the graffiti habitual offenders suppression team, which gathers information using digital cameras. Rewards should also be offered, as in the United States, for tip-offs on "taggers" as they are known there.

Community service orders for individuals caught defacing property with graffiti should include provision that they remove the graffiti themselves in certain areas. Local authorities must be allocated sufficient resources and a system put in place for the quick removal of graffiti on public and private property. There should be a graffiti hotline to report graffiti immediately so it can be dealt with quickly. We need a graffiti strategy which includes the Garda, Dublin City Council, the Chamber of Commerce and residents' associations.

People suggest that certain graffiti amounts to artistic expression. If this is so, we can always make available blank walls in certain parts of the city to those who want to express themselves. However, much of what I witness does not amount to artistic expression. It is, quite simply, vandalism.

Mr. McDowell

I am standing in for my colleague the Minister for the Environment, Heritage and Local Government, Deputy Roche, but I agree with every word the Deputy stated. Our response to graffiti has not been adequate to date and serious action must be taken on it. The constituency Deputy Gormley and I share has been under sustained attack in recent times. It seems to be spreading everywhere. I will return to that issue if I can.

Under the Litter Pollution Act, primary responsibility lies with local authorities. It is their function and we cannot establish a national body. I understand what the Deputy stated on Garda involvement and I will return to that issue. Gardaí have a great deal to do, but waiting and hoping that someone will produce a spray can and deface a wall in their presence is not productive.

The Minister for the Environment, Heritage and Local Government, Deputy Roche, is satisfied that local authorities have adequate power under sections 19 and 20 to tackle the problem of defacement of property that is in, or visible from, a public place. Section 19 makes it an offence to deface property without the written authority of the relevant owner, occupier or person in charge. A local authority or its agents may enter and take the necessary remedial action.

Section 20 is a complementary provision which enables a local authority in the interests of amenity or of the environment to take remedial action on graffiti, even if it has been put up with the consent of the owner, which I imagine is extremely rare. The local authority may serve a notice on the occupier requiring steps to be taken to remove or otherwise remedy the defacement within a specified period of not less than seven days. Failure to comply with such a notice is an offence and, in the case of an offence, the local authority may give effect to the notice and recover costs. The local authority may also by arrangement with the occupier take steps to remedy the defacement. The local authority or its agents may by agreement enter and remedy the defacement themselves. It is also an offence to obstruct or impede a local authority in these actions under sections 19 and 20. Penalties under the litter Acts range from an on-the-spot fine of €125 to a fine, on summary conviction, not exceeding €3,000 or, on indictment, a fine not exceeding €130,000.

In addition to the Litter Pollution Acts, the Criminal Damage Act 1991 provides for the offences of damaging or defacing property. The Garda authorities take these very seriously. The Garda has put Operation Encounter and Operation Assist in place to focus on anti-social behaviour, including offences of criminal damage and defacing property. When gardaí detect such offences, culprits are processed through the courts or via the juvenile liaison system, as appropriate.

The Department of the Environment, Heritage and Local Government, in conjunction with the Department of Justice, Equality and Law Reform and the Department of Community, Rural and Gaeltacht Affairs has embarked on a pilot project to tackle graffiti specifically. It was originally proposed to operate in RAPID areas only but this did not occur. The obvious danger was that the activities in question would be displaced to non-RAPID areas, in which case the project would have achieved nothing.

I agree with the Deputy it is important for local authorities to provide a service enabling the rapid removal of graffiti. If one spends half an hour putting it up and it is gone the next day, one will not be so keen to do so again. That is the best way to curtail the activity rather than hoping a garda will find a graffiti artist in the act, given that the latter will obviously have a look-out to watch out for gardaí.

Each of Deputy Gormley's suggestions is constructive. Some €3 million has been provided this year for the pilot programme, which I want to see work. I was unhappy with the RAPID-based criterion and we will now operate on the basis of Garda districts instead.

Some national authorities take this matter very seriously and I notice that the NRA tries to paint out graffiti on motorways. The best deterrent is simply to eliminate it as rapidly as possible. In other areas, there is less progress.

Property owners must keep their premises clean. Even if they are vandalised they cannot say somebody else is responsible and that it is therefore somebody else's problem to solve. If one owns property, one's duty is to keep it clear of graffiti. Small shop owners and others whose lives would be made impossible by constant graffiti attacks should be assisted and I agree with the Deputy in this regard. However, it is a different matter in the case of large property development companies that have not got around to cleaning up their properties. It is no more acceptable for them to allow graffiti to be on their premises than to allow their sewers to be cracked. Graffiti is anti-social and degrades the whole community.

It will be interesting to see how the pilot programme works out this year. I agree very strongly with the Deputy that local authorities must raise their game to solve the problem and join in a partnership approach with the Garda to gain intelligence on who is responsible.

The Deputy made a good point on one's being in possession of spray paints without a reasonable excuse in circumstances giving rise to the inference that one might be a graffiti artist. We should include a provision that takes this into account in our law. Somebody, on doing a little research, should be able to track down where the major sales of spray paint are taking place and to whom it is being sold. Even if it can be ordered over the Internet, thus making it difficult to prevent, as was put to me, we must constantly make life difficult rather than easy for vandals.

I am grateful that the Deputy has raised this issue and I hope he will be glad that one of the pilot schemes is based in his and my constituency. We should see some of its benefits in the very near future.

The Dáil adjourned at 5.15 p.m. until 2.30 p.m. on Tuesday, 13 June 2006.

Dáil Éireann díospóireacht - Thursday, 8 Jun 2006