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Dáil Éireann díospóireacht -
Thursday, 22 Nov 2007

Vol. 642 No. 2

Adjournment Debate.

Health Services.

I am grateful for the opportunity to raise this matter and thank the Minister of State, Deputy Brendan Smith, for coming to the House to reply.

The Leas-Cheann Comhairle and the Minister of State will be familiar with this case. In the past ten or 15 years I have repeatedly raised the issue of primary medical certificates and the qualification they entitle to the bearer. There are considerable discrepancies with regard to those who qualify and those who do not. The rules are extraordinarily rigid, yet constituents will on occasion point out that they know somebody who has a primary medical certificate but is in a position better than or equal to the position of the constituent. I wish to raise one such case.

The qualifying guidelines state applicants must be wholly or almost without the use of both legs; wholly without the use of one of their legs and almost wholly without the use of the other leg such that they are severely restricted as to movement; or without both hands or without both arms. We do not have be medical experts to work out that persons would qualify in such extreme circumstances. However, it is extraordinary the guidelines do not refer to persons with the use of one arm and one leg.

In the case to which I refer, the applicant, who was an athletics coach, had a severe stroke. He is not in the business of exaggerating his condition but his brain is working perfectly, he has a functioning role in society and wants to travel to work but cannot afford to do so. The stroke severely restricted the use of one side of his body, as often happens in such cases. As a result, he has had to stop work.

I raised this issue on the Adjournment in June last. The person wrote a plaintive letter to me on 5 November in which he referred to the number of occasions on which he had been examined. In each case the examination consisted of a chat and a kind of walkabout, followed by a medical conclusion — I cannot understand how it works in this fashion. He appealed his case and was called to the health centre on 28 August last and was again unsuccessful, despite the fact that the community health doctor did not physically examine him in any way.

The applicant knows a number of other people in the area who have qualified for such certificates who are no worse or better off than he, although he has had to come to that conclusion without a medical examination. Let us not forget he is an athletics coach and has some knowledge on these matters. He would like to return to work and continue to make a contribution to society. He can do so but he has repeatedly been refused a certificate.

I do not blame the Minister of State for this situation. Will he contact whatever bureaucrat is in control? Once and for all, we need to liberalise the system, let a little clarity into the arena and allow the decision to be made that where persons are severely restricted on one side of the body, the certificate will be awarded. There are countless similar cases.

I thank the Deputy for raising this important matter. It is not the first time I have heard him speak on this issue and the need to improve the scheme.

The disabled drivers scheme dates back to 1968, when relief from road tax was made available under section 43 of the Finance Act of that year for persons with a disability meeting specific medical criteria. Since then, the scheme has been extended and amended on a number of occasions.

The benefits of the scheme for qualifying persons are set out in the legislation. They consist of full relief in the year of purchase of an adapted vehicle of vehicle registration tax, and VAT subject to limits of €9,525 for a qualifying driver and €15,875 for a qualifying passenger or organisation. In the case of passengers, there is a requirement that the adaptation to the car must amount to at least 10% of the cost of the car. In the case of both drivers and passengers, the vehicle must be retained for at least two years. Second, there is relief from excise duty up to a maximum of 600 gallons per year, or 900 gallons in the case of an organisation; and third, exemption from road tax.

The average total annualised value of these benefits is estimated at around €5,500 per claimant. In the year of purchase of a car, a claimant receives benefits relating to the purchase of the car, fuel relief and road tax. In the other years, the benefits received are fuel relief and road tax. Regulations also provide for the inclusion in the scheme of non-profit organisations involved in the transport of persons with a disability.

In terms of the overall scale and scope of the scheme, the most recent data available from the Revenue Commissioners shows that the total number of claimants in the system in 2006 was around 11,000. This was made up of approximately 4,500 drivers and 6,500 passengers. In 2006, the total cost of the scheme, excluding road tax, was €59 million — an increase of some €9 million on 2005. When road tax is included, the total cost in 2006 is estimated at over €67 million.

The statutory basis for the current scheme is section 92 of Finance Act 1989. The 1994 Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations, made under the 1989 Act, set out the medical criteria, certification procedures, reliefs available to eligible persons, appeal procedures, and other matters. Given the generosity of the scheme, strict medical criteria are set down for qualification. The scheme is not open to all people with a disability. It is available only to people with certain serious permanent physical disabilities, which result in considerable mobility difficulty.

Deputy Durkan has already referred to the medical eligibility criteria for the scheme, as set out in the legislation. It is a fundamental requirement for admission to the scheme that the applicant meets the specified medical criteria and is in possession of a primary medical certificate to that effect. A person who is deemed to satisfy the criteria is issued with a primary medical certificate by the senior medical officer of that HSE administrative area. Possession of this certificate qualifies the holder to claim the benefits of the scheme either as a qualifying driver or a qualifying passenger.

In some cases, the persons concerned do not appear to the senior medical officer to meet the criteria and so the relevant certificate is refused. Where the medical certificate is not granted, the legislation provides for an appeal procedure operated by the Disabled Drivers Medical Board of Appeal. The board is an independent body whose decision is final. The board's members are appointed by the Minister for Finance on the nomination of the Minister for Health and Children.

Considerable efforts have been made in recent years to improve the level of service concerning appeals. There is still some work needed in this regard, but following a period of difficulty in organising sufficient meetings of the Medical Board of Appeal, the Tánaiste reconstituted the board in early 2005. Since that date, the panel of doctors has been incrementally expanded from three to 15 members. This has facilitated more frequent meetings of the board, thus enabling progress to be made in reducing the backlog of appeals that had arisen.

A special interdepartmental review group has reviewed the operation of the disabled drivers scheme. It examined current benefits, qualifying medical criteria, Exchequer costs, relationship with other schemes and similar schemes in other countries. The report also made a number of recommendations, both immediate and long-term, referring respectively to the operation of the appeals process and to options for the future development of the scheme.

In respect of the long-term recommendations, which included the qualifying disability criteria, the issues raised are complex and difficult, as is clear from the interdepartmental review group's report, and they raise fundamental questions about the scope and purpose of the scheme. However, given the scale and scope of the scheme, any possible changes can only be made after careful consideration and with regard to the existing and prospective cost of the scheme, and available resources. The key challenge is to seek to ensure that the current scheme is managed effectively and efficiently, and that any changes introduced ensure the effective use of resources in promoting access and participation for persons with a disability.

At the outset I should have stated that I am replying on behalf of the Tánaiste and Minister for Finance, Deputy Brian Cowen, who is unavoidably absent.

With regard to the particular case that Deputy Durkan outlined, I ask him to send the details to me and I will forward them to the Tánaiste for his further consideration. We all know of particular cases that seem to meet the criteria, but at times it appears difficult to make progress with them. This can be so with individual cases I have come across. I ask the Deputy to communicate with me in that regard.

Cross-Border Health Services.

I thank you, a Leas-Cheann Comhairle, for affording me the opportunity to raise this important issue. I welcome the Minister of State, Deputy Brendan Smith, who will reply to the matter.

One of the benefits of the peace process has been the growth in co-operation between North and South over the past decade. Co-operation is ongoing and expanding in many areas of economic and social development including trade, education, training, public administration, communications, agriculture, the environment and tourism. There are many benefits associated with investing and developing cross-Border activities. These initiatives receive considerable financial and political support from the Irish and British Governments, the EU and international bodies. Cross-Border co-operation is delivering real and practical benefits to the midland and Border counties. As a Deputy for a Border region himself, I know the Minister of State will fully concur with this point.

We already have some co-operation in the area of health care. Under EU regulations, a cross-Border worker is entitled to sickness and maternity benefits in both states. Other aspects of cross-Border health care co-operation include accident and emergency services, road traffic accident mobilisation and planning for major emergencies, co-operation on the purchase of high technology medical equipment and cancer research. Health promotion is an area of active co-operation involving research projects and joint conferences.

Cross-Border co-operation in the provision of health care services will help strengthen opportunities for people to access quality health care services, especially where people have better geographical access to services on the other side of the Border. Cross-Border health care services that operate on a patient voluntary basis can be budget neutral between the co-operating jurisdictions. That matter should be examined further. Working together to expand the range of co-operation in the health care area will strength the sense of partnership for the mutual benefit of all.

The HSE proposal for eight specialist cancer care centres means that there will be no cancer care north of a line from Dublin to Galway. That is appalling. The front page editorial in last week's Sligo Champion asked: “Did nobody look at the map and ask what’s wrong with that picture?” The proposed removal of cancer care services from the midlands and Border counties runs totally counter to all the Government’s talk of regional development, seeing the region as having an important and interdependent cross-Border dimension. The proposal is further evidence of the Government abandoning the entire midland and Border counties area and the reinforcement of the growing east-west divide.

The Minister for Health and Children spoke in the Dáil of her recent meeting with Northern Ireland's Minister for Health, Social Services and Public Safety, Mr. McGimpsey. She confirmed that she had a good discussion on co-operation in cancer care between Altnagelvin and Donegal. I welcome this proposed co-operation and I can see many advantages in cross-Border co-operation in health care. I call on the Minister for Health and Children to take up the issue of cross-Border co-operation in health care with Mr. McGimpsey, to explore fully the possibilities of extending co-operation to include the provision of the full range of cancer care services covering all midland and Border counties. In particular, she should fully explore the provision of specialist cancer care services from Sligo Hospital to patients from County Fermanagh. This possibility has not been previously analysed. Following such a review, the case for continuing specialist cancer care services in Sligo Hospital will be fully justified.

Pending the outcome of such a review, I ask the Minister to direct the HSE — and especially Professor Keane who has now taken up his appointment — to defer any further planning for the transfer of cancer care services from Sligo Hospital to Galway. There is outrage in the county over this proposal. As a Deputy representing a Border area, I recognise the opportunities for County Fermanagh, which should be considered for inclusion in the scheme. Its population base contributes to the demographic case for a specialist centre in Sligo. I call on the Minister to defer the instruction given to Sligo Hospital to transfer the oncology facility to Galway. I am appealing to the Minister of State to impress upon the Minister, Deputy Harney, the need to take immediate action on this important issue.

I am taking this matter on behalf of my colleague, the Minister for Health and Children. I welcome the opportunity to set out the current position regarding the restructuring of cancer services, with particular reference to Sligo General Hospital. Professor Tom Keane took up his position on Monday as national cancer control director to lead and manage the establishment of the national cancer control programme and I wish him every success in the implementation of the programme. The key objective of the programme is to ensure equity of access to services and equality of patient mortality and survival irrespective of geography. This will involve significant realignment of cancer services to move from the present fragmented system of care to one consistent with international best practice in cancer control. The decisions of the HSE on four managed cancer control networks and eight cancer centres will be implemented on a managed and phased basis.

The HSE has designated University College Hospital Galway, UCHG, and Limerick Regional Hospital as the two cancer centres in the managed cancer control network for the HSE western region, which includes Sligo. The national quality assurance standards for symptomatic breast disease services provide that each specialist unit should manage a minimum number of 150 new breast cancer cases per annum. Sligo General Hospital had 65 such cases in 2005. Many locations will feel they are losing out but we must be clear about the need for this change. People in the west and south have a poorer survival rate for common cancers, including breast cancer, than the remainder of the country. The designation of cancer centres aims to ensure patients receive the highest quality care, while at the same time allowing local access to services, where appropriate.

Sligo General Hospital has a dedicated inpatient oncology unit, comprising 15 beds, and a dedicated day services unit comprising eight beds. Where diagnosis and treatment planning is directed and managed by multidisciplinary teams based at the cancer centres, then much of the treatment, other than surgery, can be delivered in local hospitals such as Sligo. Cancer day care units will continue to have an important role in delivering services to patients close to home. The HSE is putting in place a structured programme of quality assurance, support and information services to underpin the reorganisation of services to ensure cancer patients will receive quality services as close to home as possible.

Patients from Sligo needing radiotherapy continue to be referred to the radiation oncology department at UCHG for treatment. The HSE has informed the Department that, in 2006, UCHG treated almost 1,000 radiation oncology patients, 107 of whom were from counties Sligo and Leitrim. The Minister met Minister Michael McGimpsey of the Department of Health, Social Services and Public Safety, Northern Ireland, on 5 October last. The potential for further cross-Border co-operation and collaboration on cancer care, and specifically provision of a satellite centre for radiation oncology in the north west, linked to Belfast City Hospital, was discussed. Consideration of a satellite centre in the north west will have regard to populations in Border counties such as Donegal, Derry and parts of Fermanagh and Tyrone. It was agreed both Departments would progress this issue through the joint North-South feasibility study on the potential for future co-operation.

The Government is committed to making the full range of cancer services available and accessible to cancer patients throughout Ireland in accordance with best international standards. The developments I outlined will ensure a comprehensive service is available to all patients with cancer in the western and midland regions, including County Sligo.

Local Government Elections.

I am grateful for the opportunity to raise this issue. The need to hold a boundary review of local electoral areas is clear. A review has not been carried out since 1998, which was based on the 1996 census. The boundaries are, therefore, 11 years out of date. Since then two constituency reviews for European elections and two for the Dáil elections have been carried out.

At a recent conference, the Minister for the Environment, Heritage and Local Government suggested such a review would be carried out and completed by spring 2008, while the Taoiseach suggested it might be completed by next May or June. However, in reply to a number of parliamentary questions I have tabled in this regard, I have not received a clear written commitment from the Government to carry out such a review. A boundary commission has not been appointed and time is running out. Local elections are not far away and parties need to organise and hold conventions. I would like a written commitment that the commission will be appointed in the next few days rather than a vague statement about consideration being given to its establishment.

Section 22 of the Local Government Act 1994 provides for the Minister to vary the number of councillors on local authorities. The population has increased dramatically in a large number of local authority areas. For example, in my area, Fingal County Council, the ratio of councillors to people is 1:10,000, which compares with 1:1,000 in County Leitrim. The population has also increased considerably in County Wexford and additional seats are needed in Gorey, but perhaps they should not be provided at the expense of New Ross. Will the boundary commission or another body be given authority to vary boundaries?

What terms of reference will be laid down for rural areas? Currently a significant anti-democratic bias favours such areas. For example, Carrigaline has double the population of Bantry in County Cork but Bantry has five seats compared with six in Carrigaline because, when the previous boundaries were drafted, rural areas were favoured over urban areas. It is unjustified that people who live in suburban Cork should have less representation on Cork County Council than those living in rural Cork.

The key issue in Dublin West is the Mulhuddart ward, which comprises half my constituency. The ward has a population of 58,000 and has four council seats. However, its population is more than that of the Howth, Malahide, Portmarnock wards combined, yet they have seven seats. This is an example of rotten boroughs, which is why a boundary review is needed as soon as possible. Clarity is also needed on whether the number of councillors will be increased, the terms of reference of the commission and whether urban votes will be worth less than rural votes.

I am replying on behalf of the Minister for the Environment, Heritage and Local Government who is away on Government business. I thank Deputy Varadkar for raising this issue and for the opportunity to brief the House on the issue of review of the local electoral area boundaries in advance of the 2009 local elections, which is a matter of interest to many people.

The last review of local electoral areas was carried out in 1998 based on 1996 census data. The recommendations from the two committees that carried out the review were duly implemented and had effect for the local elections held in 1999 and 2004. Prior to that review, local electoral areas were last reviewed in 1985 based on 1981 census data. Unlike for Dáil and European Parliament constituencies, however, there is no statutory or constitutional requirement to review local electoral areas at particular, or any, intervals. The main legal provisions concerning boundary committees are set out in the Local Government Acts 1991 and 1994. Section 24 of the 1994 Act specifies that the Minister may by order, subject to Part V of the 1991 Act, divide a local authority into local electoral areas. Section 32(2) specifies that, before deciding whether to make an order under section 24 of the 1994 Act in relation to a local electoral boundary, the Minister shall request a boundary committee to prepare a report. The committee shall, if so requested, prepare and furnish to the Minister a report in writing which shall include its recommendations and the Minister shall publish the report and shall have regard to it in deciding whether to make the order.

The question of a review of local electoral areas before the next local elections needs to be considered in the context of the recent census results. As the Deputy correctly points out, significant development has occurred in many suburban areas and county towns in recent years. While the population nationally increased by 8.2% from 2002 to 2006, changes in population were much greater in certain areas. For example, in Fingal County Council an increase of 22.2% in population was recorded, while in neighbouring County Meath the increase was 21.5%. It is clear, therefore, that a comprehensive revision of local electoral areas is needed in some parts of the country.

As the House will be aware, a constituency commission to review Dáil and European constituencies was established in April, upon publication of the census results. The commission presented its report to the Ceann Comhairle on 23 October last. It is desirable that the outcome of this review should be available prior to a review of local electoral areas. This is important because boundary committees should take due account of the desirability, where possible, of aligning local electoral area boundaries with Dáil constituency boundaries.

We are all agreed that local electoral areas need to be reviewed. The Minister for the Environment, Heritage and Local Government is putting in place the detailed arrangements for these reviews and will announce details of his intentions in this regard very shortly.

Speaking as a public representative and not on behalf of the Department of the Environment, Heritage and Local Government, there must be a weighting in respect of rural areas in the drawing up of boundaries and the alignment of seats. In my county, which is not the most rural one in the country, it can take an hour to travel by car from one end of an electoral area to another, vast areas of which are not highly populated, and some of the terrain is mountainous and difficult. Perhaps in some of our more urban centres of population, a local councillor could walk around his or her electoral area in a short time. I accept that it is much more difficult to travel around parts of counties Donegal, Mayo, Kerry or Cork than it is to travel around inland Cavan, but nevertheless it could take an hour to travel from one part of an electoral area to another in my county.

The issue is not as simple as considering the population as the sole factor. In fairness to everybody involved, all the issues of the people who deserve representation, the geography of an area and the time factor in the distance to be covered should be taken into consideration in finalising boundaries.

The Dáil adjourned at 5.10 p.m. until 2.30 p.m. on Tuesday, 27 November 2007.
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