Dáil Éireann díospóireacht -
Tuesday, 3 Oct 2006

Vol. 624 No. 3

Health Services.

Mr. Ring

I wish the Minister, Deputy Cullen, would wait to listen to what is happening to the health service because I would be able to tell him.

There has been a change in the services bringing elderly people, particularly in the west, to their hospital appointments in Dublin. In the past, when things were bad and we had no money, there was respect and support for the elderly and we were able to bring them to hospital appointments.

I got a letter today from the Health Service Executive, western region, about a woman who had a liver transplant two years ago and who has had a kidney transplant. The HSE could not bring her to the hospital for her appointment because it did not the resources. It stated it did not have enough money in the health budget to do that, which is a disgrace.

This is a very serious issue. I will have to bring a few of my constituents to the House to show the Minister of State the type of people who are not getting the service they deserve. We will shortly march to the HSE offices in Castlebar to show it the type of people concerned. If RTE and the media were doing their jobs, they would come to Mayo to see some of the people who have had to cancel their hospital appointments because the HSE has a new policy in regard to bringing people to their appointments in Dublin.

People in north Mayo due to go into hospital for an operation on a Monday must wait until Sunday evening for a phone call from an executive in a hospital to know whether a bed is available. Then they must make arrangements for transport, which they cannot get in the west. The HSE could not bring this woman I mentioned who has had liver and kidney transplants to her appointment. It wrote a three-page letter explaining why it could not do so. It blamed the Minister of State and the Department and stated that there is no funding in place. It said the ambulance service is not there to bring sick people, such as her, to their hospital appointments.

Do we have any respect for the elderly, sick and the weak? Are we going to continue to push the weak and the sick aside? A Taoiseach on a general election campaign did not realise the health service was so bad. However, the people are waiting for the opportunity to vote on this issue.

I heard today about the amount of revenue collected. Deputy Walsh, a former Minister, is in the House and even in the bad old days when we had nothing, we had respect for the sick and the elderly, but now we cannot even bring them to hospital appointments. There is a row going on between the HSE and the Department that the funding is not in place for this service. The weak and the sick are suffering and people must cancel their hospital appointments in Dublin and Galway.

Somebody living in Blacksod in Belmullet lives 80 miles from Castlebar, 150 miles from Galway and over 200 miles from Dublin. People on disability or social welfare only have €165 per week on which to live, yet they are expected to provide transport to their hospital appointments in Dublin even though they are sick. There are hundreds of such people in my constituency and I will shortly bring some of those who are fit to come out to a protest meeting in Castlebar. I will show the people of this country what is happening and what we are doing to our elderly people.

Acting Chairman (Mr. Carey)

The Deputy has one minute remaining.

Mr. Ring

I would need approximately ten minutes because what is going on is a disgrace. As a Deputy from Dublin, the Acting Chairman would not like to see his constituents wondering how they are going to get to their hospital appointments.

Something must be done and I ask the Minister of State to sit down with officials from the HSE in my region and draw up a policy on who can and cannot be brought to hospital appointments. Let us not have a situation where this poor creature who has had liver and kidney transplants could not make her hospital appointment last week because the HSE would not bring her to it. If that is not cruelty, what is it? We have more respect for the rich flying in for the All-Ireland finals and the Ryder Cup and who will not pay their taxes in this country, but we will not look after our elderly. It is a disgrace.

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

I wish to address this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

The Department has been informed by the national ambulance office of the HSE that, while the statistical information required by the Deputy is not readily available, it will arrange for the collation of the information requested and furnish a reply directly to him. Deputy Ring gave details in regard to a particular case. I was not aware he was going to raise it but I will get further details from him and will take the matter up directly with the HSE on his behalf.

The role and purpose of the ambulance service is to provide a clinically appropriate and timely pre-hospital care and transport service. Pre-hospital emergency care and transportation services are provided as an integral part of the continuum of care for patients.

The primary focus of the ambulance service is on the provision of emergency transport for those patients with an acute medical need. However, the HSE also arranges for the provision of patient transport services and examines all requests for such services on a case by case basis, taking account of individual needs.

The HSE has advised that its national ambulance office, in conjunction with primary community and continuing care in the national hospital office, is currently arranging for a comprehensive review to be undertaken of the non-emergency transport needs of patients attending HSE facilities. This review will include an examination of the service currently delivered nationally and make recommendations that will inform its future development. The HSE has advised that it anticipates that the view will be completed by the end of 2006.

Given what the Deputy said, I am concerned that transport was not available to a person in that situation. I will follow the matter up and get back to the Deputy.

Mr. Ring

There are many more like her.

Mr. Deenihan

I call for immediate action on the development of the sexual assault treatment unit in Kerry General Hospital. The unit in Kerry is in difficulty due to the lack of resources at the hospital. A working group consisting of Kerry General Hospital, Tralee gardaí and the Kerry Rape and Sexual Abuse Centre has come up with proposals to solve this difficulty and has reached an agreement with the hospital. The group needs to raise €47,284 for on-call nursing staff. If this funding can be raised, it will be in a position to offer a 24-hour sexual assault treatment unit in Kerry General Hospital.

Currently, there is only one 24-hour sexual assault unit in the Munster area, which is in Cork. A need was identified in Kerry for a sexual assault unit to ensure that victims of rape could be examined at Kerry General Hospital. A pilot scheme was undertaken in April 2002, which operated very successfully and 60 clients were seen and supported.

A decision was made in September 2004 to contact general practitioners in the Kerry region to provide trained doctors on an on-call rota to undertake the forensic medical examinations. A total of ten GPs were interested in undertaking the training. The Department of Justice, Equality and Law Reform committed funding to the cost incurred in forensic examinations. Unfortunately, due to lack of resources to fund a nursing post and on-call nurses, this initiative could not take place.

The genesis of a service is available but it is functioning at a very low level due entirely to a lack of nursing resources. Even with the existence of a sexual assault unit in Kerry, victims in remote parts of the county will still have to travel for at least an hour. Victims now reporting may have to travel to Cork — a six-hour round trip — for the examination. This is an unacceptable burden on someone who has been subjected to the most traumatic experience of rape. Victims are also required to return to Cork at their own expense for any follow-up treatment, which may involve up to four visits.

Research shows that only one in ten people raped or sexually assaulted reports to the Garda. However, expecting people to travel to another county for the examination will result in even fewer rape victims reporting the crime. Research has also shown that when dedicated services are available an increase in reporting follows. One rape victim who did not want to report to the Garda told a counsellor in the Kerry Rape and Sexual Abuse Centre that she felt very isolated as there was nowhere for her to go for a medical examination if she did not report. Another victim said she felt very uncomfortable having to go to Cork with gardaí.

It is the experience of counsellors in the Kerry Rape and Sexual Abuse Centre that the majority of rape victims who had to travel to Cork for the forensic medical examination did not avail of counselling until months later. It is accepted that most people dealing with the aftermath of a rape want to feel safe, be somewhere familiar and have access to support. It is evident that having to travel to Cork does not meet these requirements. According to the Kerry Rape and Sexual Abuse Centre, the majority of rape victims examined in Kerry avail of counselling immediately after the incident, in stark contrast with rape victims who have to travel to Cork.

The development of the sexual assault unit at Kerry General Hospital ought to achieve an increase in current levels of reporting and an increased sense of safety for those who make the decision to report. There is a framework in place in Kerry for the delivery of a structured response that encompasses all aspects of care for rape victims. Commitment and co-operation is evident between all the agencies and access to training is provided for all personnel involved. The very experienced consultant gynaecologist there is highly skilled and experienced in forensic medical examinations for victims of rape. The Kerry Rape and Sexual Abuse Centre provides an on-call facility. These volunteers are highly trained and available 24 hours a day, seven days a week.

The local Garda has been proactive for many years in developing a professional, sensitive service for rape victims, in keeping with best practice and agreed protocols. Trained female gardaí are available at all times to attend the forensic examination. The hospital has a dedicated space available for the examinations. This space is similar to examination suites used in the UK.

There is a strong commitment from all the agencies involved to have this valuable service available in Kerry. The arguments for the provision of such a service are supported by national and international research. Being supported, informed and kept informed is of critical importance to rape victims and can enhance the healing process.

I thank the Acting Chairman for his patience, as I have exceeded my time. Next weekend, the Kerry Rape and Sexual Abuse Centre will be co-ordinating the collection of signatures supporting its cause in Tralee, Killarney, Listowel and Dingle. The amount of funding requested is minuscule at €47,284. This situation should never have been allowed to arise, given that the amount of money involved is relatively small in the context of the overall health budget. I am asking for this matter to be resolved immediately. I hope the Minister of State, Deputy Seán Power, can make an announcement before Saturday, if possible.

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

I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank Deputy Deenihan for raising this important matter on the Adjournment. In general there is little appreciation of the devastation suffered by victims of sexual assault.

The national steering committee on violence against women was established following the report of the task force on violence against women in 1997. It is chaired by Deputy Fahey, Minister of State at the Department of Justice, Equality and Law Reform. The purpose of the national steering committee is to provide a multidisciplinary, multi-agency and cohesive response to the problem of violence against women and in so doing to progress the recommendations of the task force. The steering committee is representative of a wide range of interests concerned with violence against women. The Department of Health and Children and the Health Service Executive are represented on this committee.

The objectives of the committee include ensuring that regional and local structures are established, developing public awareness campaigns, co-ordinating and advising on the distribution of resources nationally, and co-ordinating and advising on ongoing development of policies including those concerning perpetrators, criminal justice intervention, services and supports.

In June of this year the national steering committee working group published its report entitled, Sexual Assault Treatment Services — A National Review. The report detailed the current level of service provision and also made a number of recommendations for the future provision of services.

The factors that determine the location of sexual assault treatment units include sustainability of services, travel time and previous reporting rates. The sexual assault treatment unit, SATU, for the southern hospitals group catchment area of Cork and Kerry is located in the South Infirmary-Victoria University Hospital, SFVUH, Cork. It is staffed by a nurse manager and a team of nurses providing an out-of-hours, on-call service, while a team of GPs provide medical cover.

The review group recommended that two additional SATUs be established, one in Galway city and the other in the midland region and it is committed to continual review of these services. Both the Minister and I are keen to see the recommendations from this report treated as a priority within the HSE and I anticipate that the HSE funding priorities for 2007 will reflect this.

The Government is committed to working with all interested parties and service providers and has undertaken a range of measures to reduce the incidence of domestic violence, to respond to the needs of both victims and perpetrators and to raise awareness among the public about the dynamics of these crimes. These measures can be seen across a wide range of Government policies and initiatives and include legislative measures, Garda response, health services, the national steering committee on violence against women, national research and treatment programmes for perpetrators.

A key indicator of Government commitment to the issue can be seen in the involvement of many Departments and agencies in the funding and provision of services. These include the Health Service Executive and the Departments of Justice, Equality and Law Reform, Education and Science, Social and Family Affairs and Community, Rural and Gaeltacht Affairs.

Funding in the health sector has risen from approximately €3.8 million in 1997 to approximately €12 million in 2005. The allocation of funding for front-line services is a matter for the Health Service Executive. Many services are provided by non-governmental organisations on behalf of the executive.

I am pleased to acknowledge the valuable work undertaken by the non-governmental organisations, such as women's refuges, rape crisis centres and Women's Aid to mention just some in this area. I also wish to acknowledge the direct supports provided by the HSE through its sexual assault treatment units, counselling services, accident and emergency units, social work services, GP and hospital and community services.

Special Educational Needs.

Dr. Cowley

The intention behind raising this matter is to ensure adequate funding is provided for autism-specific educational training centres in Mayo. At present if one looks at a map of the geographical spread of such centres it is clear that they are all located on the east coast and there is none in the west. It is obvious that children also suffer from autism in the west of Ireland and that autism-specific education or applied behavioural analysis, ABA, offers the best hope for an improvement in the condition to autistic children and their families. It is a terrible scandal that this essential service is not available in the west, specifically in Mayo.

I recently attended a special meeting organised by the Mayo Autism Support Group. People's eyes were opened to the need for and value of autism-specific education. The speakers at the meeting included Dr. Mark de Salvo, the parent of an autistic child. He was inspiring. He outlined how he set up the Saplings school in Celbridge, County Kildare which offers autism-specific education using the ABA system. Dr. de Salvo stated that there is already a waiting list for hundreds of children for that school. The school has a success rate of up to 50% which is a remarkable achievement as autism is a challenging condition that affects the entire family of those who suffer from it.

I am full of admiration for the cogent effort made by the families and carers of autistic children and adults. It is a national scandal that the parents of autistic children have needed to fight tooth and nail for proper education for their loved ones. Recently, I received a reply from the Minister for Education and Science, Deputy Hanafin. Millions of euro of taxpayers' money are being spent by the State to fight parents looking for these services. In other words, it is trying to defend the indefensible. That does not make sense.

Parents set up systems, but unfortunately those systems did not work because the teachers appointed with the help of the Department proved to be untrained in autistic teaching. They had primary degrees and were unsuitable for the job. The children, therefore, did not do well. I am less than impressed by the Department and how it behaved in respect of defending the indefensible and wasting millions in legal fees fighting parents who are looking for these essential services.

The 2001 report of the task force on autism states that the needs of persons with an ASD must be met as a matter of constitutional priority and that the costs associated with meeting the needs of persons with autistic spectrum disorders must be faced by society and by the administrators of the education system. It is a constitutional right of children to receive autism-specific training. Children who are past primary education have the greatest problems as the largest gap in the system is in that area. In 2001, the task force identified that gap, stating:

It is noteworthy that while all pupils with disabilities within the primary school system now have an automatic entitlement to a response to their needs as per Circular 8/99, this automatic entitlement has not yet been extended to pupils at the post-primary stage. In practice, however, provision is made for all identified post-primary pupils with disabilities at the request of the school. However, evidence from submissions indicate that considerable delays in procuring this provision are, in many instances, the norm.

This situation has not changed since 2001 and schools still have difficulties in sourcing staff trained to the appropriate level.

I appeal to the Minister of State to ensure that a school with applied behavioural analysis and autism-specific trained teachers will be set up in County Mayo. Those children matter, but they are currently left with inadequate teaching. A success rate of 50% in the school in Kildare, with the opportunity of entering mainstream education, is remarkable.

Mr. S. Power

I thank the Deputy for raising this matter as it provides me with the opportunity to clarify the position of the Department of Education and Science in respect of the educational provision for pupils with autistic spectrum disorders. The Department has not received any application to expand the pilot scheme to a centre in County Mayo, but as he is aware, the Department is committed to ensuring that all children, including those with ASDs, receive an education appropriate to their needs. In this regard, the Department has established 170 special classes for children with autism attached to special and mainstream schools, six of which are in the Mayo area, five special classes for children with Asperger's syndrome, 16 pre-school classes to facilitate the demand for early intervention provision for children in the autistic spectrum and 12 stand-alone facilities providing an applied behavioural analysis-specific methodology on a pilot basis. Approval has been given for the establishment of a further two such facilities. Saplings Centre in County Kildare is funded under the scheme.

The Department is of the opinion that children with autism, in common with all children, should have access to appropriate provision delivered by suitably qualified teachers within the school system where they can mix with their wider peer groups and have maximum opportunities for integration. Pupils with autism who are fully integrated into mainstream schools receive individual teaching support for a number of hours per week as well as support from special needs assistants and special equipment, if required. Pupils attending these classes benefit from having a wider range of autistic spectrum disorder teaching methodologies open to them, fully qualified national school teachers, a school structure and the option of integration into mainstream classes immediately available depending on each child's ability and progress.

Schools have the support of the special education support service, which is committed to providing continual training as appropriate. Staffing supports for autistic children in special classes in ordinary and special schools have a maximum pupil-teacher ratio of six pupils to every teacher. A minimum of two special needs assistants are provided per class with the possibility of additional special needs assistant posts being made available up to a 1:1 basis where required.

The newly established National Council for Special Education and its team of more than 70 special educational needs organisers is working throughout the country to ensure that the new services are put in place where needed so that children with special needs, including those in the autistic spectrum, have access to appropriate school-based provision. I assure the Deputy that the Department will examine any proposal submitted to expand the pilot scheme to a centre in County Mayo and I thank him for raising this matter.

Social and Affordable Housing.

Mr. Walsh

I thank the Ceann Comhairle for allowing this matter to be discussed. I welcome the Minister of State, Deputy Noel Ahern, who has made himself available to take this debate.

I am raising this matter out of deep frustration with the fact that while 15 hectares of suitable land was made available to Cork County Council for an affordable housing scheme two and a half years ago, little or no progress has since been made. In the meantime, young people, many of whom are on reasonable salaries, cannot afford to acquire houses of their own. In the west Cork region, sites typically cost between €200,000 and €250,000 and houses cost between €450,000 and €750,000. In a recent survey, Clonakilty was deemed to be the most expensive part of the country, including Dublin city and elsewhere.

These young people who want their own homes call to me as their representative and ask me what the Government is doing about the lack of progress, to which I reply that the local authority has a difficulty. In the worst example of rural snobbery I have encountered in 30 years in public life, Fine Gael tried to stymie this development. In June, however, a clear majority of Cork County Council voted in favour of the project notwithstanding a minority of Fine Gael councillors who voted against it out of pure snobbery.

These young people are fine citizens. They work locally and want nothing more than their own homes. The council received the land as a gift from Teagasc, but it is frustrating and reprehensible that, on the face of it, nothing has been done. I have been told by council officials that this matter must go through a section 8 process. The scenic route taken is baffling. After June, there should have been no significant problem. I was told that the matter needed to be advertised in various journals, but I have yet to see any advertisement. We are approaching the middle of October and Christmas advertisements are already in the newspapers.

Fair play to the Minister of State, who went to the trouble of visiting the site on foot of my report that nothing was happening locally. I ask that he instruct the housing authority to take this matter seriously and give it priority. It will be a lovely eco-village of 100 houses with playing pitches and all sorts of amenities. It is a crying shame that it is not currently going ahead. I would appreciate positive news from the Minister of State, who was kind enough to appear in the House in response to my raising this matter.

Minister of State at the Department of the Environment, Heritage and Local Government (Mr. N. Ahern)

I thank Deputy Walsh for his continuing interest in this project.

The site in Clonakilty was one of the sites released to the affordable housing initiative by Deputy Walsh and I acknowledge both this and the other sites released by him to the initiative during his tenure as Minister for Agriculture and Food. While progress on this site may appear to be slow, Cork County Council, whose responsibility it is to plan and develop this project, states it is advancing this project as speedily as possible. Officials in my Department are in constant contact with the council to monitor progress and to ensure that any obstacles to progress are dealt with. I am aware that senior officials of the Department and the county council have met in Cork recently to discuss this and other affordable housing projects throughout County Cork.

I will not go through the detail of the various steps that have taken place to date, although it is important to mention that a feasibility assessment of the site was deemed necessary in the first instance. Following this and the ensuing public consultation on the outcome of the feasibility study, a proposal to amend the local area plan was advertised and at its meeting on 22 May 2006, the council voted after many objections to approve the amended plan.

While the council considered a number of different options in developing the site, in terms of developing it in one phase or a number of phases, I held the view that the site should be developed in one phase and I am happy that the council is proceeding along these lines. The site will comprise a mix of affordable, social, voluntary and private homes, with 74 of the 104 homes being made available under the affordable housing scheme.

The next stage in the process is to apply for Part 8 planning and the council advertised for expressions of interest from consultants on 22 September 2006, for the preparation of the relevant documentation required for the Part 8 process, and for the preparation of cost plans, tender documentation and construction contract.

Due to the size of the project, the advertisement was also placed in the EU Journal. The closing date for expressions of interest is 31 October 2006 at which stage the council will short-list a number of bidders and proceed with the selection process to select the successful bidder. The next stage will be to apply for Part 8 and the outcome of the planning process will determine when construction can commence on the site. The ultimate aim, as with all projects under the affordable housing initiative, is to give people affordable homes as quickly as possible and I look forward to the day when all 104 homes are occupied and a new vibrant and successful community is in place.

I thank Deputy Walsh for the site and for pressing this matter, locally and nationally. I think I have been successful in increasing the output of affordable homes. However, I need the co-operation of local authority officials and elected members in this regard. The help from the elected members on Cork County Council has been reluctantly dragged out of them, and this applies to Fine Gael members in particular. As I see it, Fine Gael does not want these houses to be ready, or even started, by the date of the next election. They probably will be successful because their delaying tactics and snobbish attitude to this idea from the very beginning will probably see that the work will not start by the date of the election. I am trying and I am pressing the officials in the Department to do all they can, but we have lost many months through these delaying tactics. While I will keep up the pressure, it is quite likely at this stage that the delaying tactics by Fine Gael members on the council have been successful.

I note that Deputy Walsh, like me, would very much like to see the bulldozer even going on site the day before the election, but time is quickly running out and the filibustering and delaying tactics by the county council, and by the elected members in particular, has been successful. I promise Deputy Walsh that I will continue to press the matter, through the officials, with the county council as best I can.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 4 October 2006.