Dáil Éireann díospóireacht -
Wednesday, 20 Feb 2008

Vol. 647 No. 4

Adjournment Debate.

Disabled Drivers.

Deputy Tom Sheahan

Will the Tánaiste and Minister for Finance consider awarding primary medical certificates to persons with mentally disabilities and Down's syndrome under the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994? I put this question to the Minister some weeks ago. I dislike categorising any individual but there are six categories under which one may qualify for a primary medical certificate whereby one can avail of a concession on vehicle registration tax, VRT, and motor tax. I ask the Minister to include in this categorisation the parents or guardians of persons with mental disabilities and sufferers of Down's syndrome. While such persons are entitled to drive when they become adults, they will never be able to do so and are entirely dependent on their parents or guardians for transportation.

Under the current regime, only persons who are missing at least one limb or have the medical condition of dwarfism qualify for the disabled drivers grant. Mentally disabled persons and those with Down's syndrome are entitled to this benefit. In Northern Ireland and Britain, for example, people with Down's syndrome qualify for the primary medical certificate whereby their parents or guardians can avail of exemptions on VAT and VRT on the purchase of a car. It would be a progressive step on the part of the Government to provide this benefit to parents who are primary carers of their mentally disabled or Down's syndrome children. Their lives are dedicated to providing for those children.

I understand the disabled drivers grant represents a significant expenditure for the State. The majority of people availing of the grant change their cars every two years. I accept that there are limited resources and that the cake is already divided among many beneficiaries. However, a legislative provision whereby recipients of the grant could change their cars only every four years rather than every two years would halve the cost to the State and facilitate the inclusion of the parents or guardians of persons with mental disabilities or Down's syndrome within the scheme. I strongly urge the Minister to consider such an amendment. Such persons are unlikely ever to be able to drive and are entirely dependent on their parents or guardians in this regard.

This would be a positive initiative on the part of the Government. I have seen parents dedicate their lives to their children with mental disabilities or Down's syndrome. Their inclusion in this scheme would provide support of which they are entirely deserving. Nobody would wish to see a return to previous times when children with mental disabilities and Down's syndrome were sent to mental institutions. The parents of these children want to care for them themselves and provide an important service to society in so doing. The State should support them where possible. They do everything for their children, bringing them to and from school, leisure activities and so on.

I applaud the work being done on behalf of people with Down's syndrome and other mental handicaps. I refer to sporting organisations like Special Olympics Ireland, for example. The proposal I have made, which would help to lift the burden on parents, would be a positive thing for the Government to do and would greatly help families. I accept that a limited amount of funding is available, although it could be divided better. People who are availing of the disabled drivers scheme will probably contact me in the morning to complain about what I am saying tonight. I feel very strongly that many more people could be accommodated under the scheme. It would be a positive step if the Government were to adopt the approach being taken in Britain and Northern Ireland.

Minister of State at the Department of Finance (Deputy Noel Ahern)

The disabled drivers scheme was established in 1968. Under section 43 of the Finance Act of that year, relief from road tax is offered to people with a disability who meet specific medical criteria. The scheme has been extended and amended on a number of occasions since then. The benefits of the scheme for those who qualify are set out in the 1968 Act. Such people are entitled to full vehicle registration tax and VAT relief in the relevant tax year when they purchase an adapted vehicle, 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. Those who avail of the scheme are also entitled to an 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 and road tax. In the other years, the benefits received relate solely to road tax. The regulations also provide for the inclusion in the scheme of non-profit organisations involved in the transport of people with a disability. The most recent data available from the Revenue Commissioners for the overall scale and scope of the scheme show that the total number of claimants in the system in 2007 was approximately 12,500 — some 4,750 drivers and 7,750 passengers. The total cost of the scheme in 2007, excluding road tax, was €66 million. That figure increases to €74 million when road tax is included.

All Deputies come across genuine cases. This issue has been discussed on several occasions since I was first elected to this House. The regulations governing the scheme have been amended and adjusted. I accept that the reply that has been circulated is a standard one. It might not seem to get to the core of the case made by Deputy Sheahan. Strict medical criteria are set for qualification for this generous scheme, which is not open to all people with a disability. It is available to those who have certain serious permanent physical disabilities which result in considerable mobility difficulty. The Deputy has outlined broadly the six categories of disability which are covered in the scheme. A fundamental requirement for admission to the scheme is 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 given a certificate by the senior medical officer of the local HSE area. Possession of a certificate qualifies the holder to claim the benefits of the scheme as a qualifying driver or passenger.

In some cases, those who apply do not appear to the senior medical officer to meet the criteria and the certificate is therefore refused. The legislation provides for an appeals procedure, operated by the disabled drivers medical board of appeal, when a certificate is not granted. The board is an independent body and its decision is final. Its 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 offered when appeals are made. Further work is needed in this regard. Following a period of difficulty in organising sufficient meetings of the medical board of appeal, the board was reconstituted in early 2005. The number of people on the panel of doctors has been incrementally expanded from three to 15 since that date. This has facilitated more frequent meetings of the board.

I was not aware until Deputy Sheahan mentioned it that children and adults with Down's syndrome are covered by the schemes which operate in Northern Ireland and England. I will bring that to the attention of the Minister. This country's scheme is very generous for people in the six categories who qualify for it. Those who benefit from the scheme can change their cars every two years. This generous scheme costs quite a bit. It is very helpful for those who qualify. I accept that it may seem to those who do not qualify that the scheme is mean, miserable and tight. I will bring the point made by the Deputy about Down's syndrome to the personal attention of the Minister for Finance, who will see if changes can be made.

Deputy Tom Sheahan

Given that the scheme is 40 years old, it is time to update it.

Deputy Noel Ahern

It has been updated several times.

An Ceann Comhairle

Supplementary remarks are never allowed at this stage of the Adjournment debate.

Ambulance Service.

Deputy Pat Breen

I welcome the opportunity to raise the urgent need to review the provision of an ambulance service in County Clare 24 hours a day, seven days a week. There needs to be a specific emphasis on the provision of such a service to areas like west Clare. Three special deliveries in recent weeks, when three women gave birth in separate incidents, brought this issue to the fore. The common denominator in the three cases was that no ambulance was available to transfer the expectant mother to hospital. All three mothers and their families live in west Clare — two in Kilrush and one in Kilbaha, which is approximately 100 km from Limerick. Coincidentally, the women went into labour within hours of one another on 4 and 5 February last. One woman waited for an ambulance for over an hour before her father drove her to hospital. Another woman had to wait three hours before she arrived at the maternity hospital in Limerick. The third woman gave birth on the side of the road. All three mothers and babies are well in spite of their ordeal, thank God.

Since the withdrawal of maternity services from County Clare, it is common for expectant mothers in west Clare to have to make a pilgrimage of this nature. It is of concern that in all three cases, no ambulance service was available when telephone calls were made to the 999 service. The organisation of the ambulance service in the outlying areas of County Clare is putting the lives of people at risk. Ambulance service personnel in the county are to be commended for the excellent service they provide in trying circumstances. However, their work needs to be complemented by a review of the organisation of the entire service. We need to eliminate the dependence on "on-call" services. Rather than all ambulance personnel being in the ambulance centre, some of them are on call from their homes, which can add a minimum of 20 minutes to the call-out time. Such a delay in the start of the ambulance's journey to the person in need can be vital.

The ambulance service in County Clare is clearly under-resourced and under-staffed. In this case, no staff were available in Kilrush to work on the ambulance due to sick leave, etc., and an ambulance had to be dispatched from the Ennis centre. This is not an isolated case, sadly. It is common practice for ambulance crews in Ennis, Ennistymon, Kilrush and Scarriff to be dispatched to the four corners of the county. They also have to provide a back-up service for the regional hospital in Limerick. As staffing numbers are at a minimum — some workers are on sick leave etc. — there is extreme pressure on the delivery of the service. For example, there was a 25-minute delay in responding to a recent incident in Ennis town centre because the ambulances at the Ennis station were out on other calls. A private ambulance had to be called in to assist in that case.

The Labour Court recently recommended that an additional 180 emergency medical technicians be recruited to the service throughout the country. That recruitment and training should not be delayed or postponed. A review of the ambulance service should also consider the provision of advanced paramedics as part of a special response unit, which could be made available throughout the county for emergencies. Kilrush would be an ideal location for a permanent advanced paramedic posting because it is 44 km from the nearest hospital. Such highly trained personnel are currently under-utilised. They should not be seen as additional staff in their centres, but as part of the centres' crewing numbers.

Despite the Minister's commitment to provide a 24-hour accident and emergency service at Ennis General Hospital, there is huge apprehension in west Clare that the situation will get significantly worse for those who have the misfortune to get sick. Recent incidents do little to dispel this fear. The people of west Clare do not have access to a first-class ambulance service, never mind a first-class health service. They deserve better.

The HSE recently launched a hospital hygiene campaign, Wash Your Hands. If the executive is serious about hygiene, it should immediately address the scenario in Ennis ambulance station. It is an absolute disgrace that staff are expected to clean out ambulances with nothing more than a mop and bucket. I recently visited the ambulance centre and I was appalled to witness at first hand how the ambulance personnel clean their vehicles. They must clean out coagulated blood in a public car park, which is a hygiene scandal. These are Third World conditions in a first world economy. Staff have been waiting more than three years for a new wash unit. How long more must they wait? I appeal to the Minister of State to bring the matter to the attention of the HSE immediately. Perhaps he will get back to me in regard to same because it is a total disgrace.

Our excellent medical personnel are continuously fighting to give their patients the best medical help in a system in which penny pinching practices are increasing. I urge the Minister of State to request the HSE to undertake immediately a review of the ambulance service in County Clare. The review should focus on the provision of a 24-7 service in isolated rural areas, particularly in west Clare, to extend the operation of the Scarriff station to 24 hours and to revisit the provision of an ambulance centre in Shannon, the second largest town in the county.

If efforts are not made to address and reorganise the ambulance service in County Clare, more incidents will happen and people's lives will be lost. Having visited the ambulance centre a few days ago, I ask the Minister of State to contact the HSE regarding the primitive working conditions of staff cleaning out their ambulances and to come back to me about it.

Minister of State at the Department of Health and Children (Deputy Pat The Cope Gallagher)

I thank the Deputy for raising the matter. I am pleased to have the opportunity to respond on behalf of my colleague, the Minister for Health and Children.

It is regrettable that the mothers referred to by the Deputy should have suffered undue distress, particularly as the birth of a child should take place in a safe, secure environment. I have been advised that while, thankfully, such incidents are rare, the HSE will examine the circumstances which culminated in the unfortunate events. The HSE apologises unreservedly to the three mothers. Both the Minister and myself hope that the events leading up to the birth of these babies have not taken from the joy which the birth of a child brings to parents.

A number of objectives were identified in the Strategic Review of the Ambulance Service 2001, which were to lead to an improvement in response times and, ultimately, more effective responses to emergency calls. In recent years, substantial additional funds have been invested to develop the ambulance service along the lines identified in the strategic review and this work will continue into the future. Since the publication of the review, as part of the revised organisational framework developed under the Health Service Executive, a national ambulance service has been established to replace the eight ambulance services that operated under the former health board structure.

The HSE has advised that, within the greater mid-western area, resources are deployed from nine ambulance stations based on the policy to dispatch the nearest available ambulance to respond to emergency calls. While the location of the ambulance station may be important, it is not the only factor, as resources and skill mix can be tactically deployed based on priority and demand. For example, the ambulance may be diverted, while en route to a routine call, to an emergency call.

County Clare is 3438 sq. km. and has a total population of 110,000. The county is serviced by ambulance stations in Ennis, Ennistymon, Kilrush and Scarriff with 24-hour services in all but Scarriff, which provides 19 hours of cover per day. Part of County Clare is also serviced by Limerick ambulance station. Since the inception of the HSE's national ambulance service, there has been significant investment in ambulance services in terms of estate facilities, education, training, fleet and equipment. To ensure optimum use of the Government's investment, one of the critical objectives of the service is to develop models of pre-hospital emergency care that will meet existing and future demands.

In conjunction with the Pre-Hospital Emergency Care Council, PHECC, a statutory agency that has responsibility for clinical education and training standards as well as response time standards, the national ambulance service is researching the demand for emergency services and associated ambulance services in the context of the developing the optimum deployment of resources. This research is being undertaken by way of a national spatial analysis study. The outcome of this study will be used for the development of pre-hospital emergency services and, in particular, for tactical deployment of resources and future planning of services in terms of models of care, skill mix of staff, ambulance response points and fleet configuration. This study will form the bedrock for pre-hospital emergency care development in the future. It will then be possible to ensure that available resources are targeted to the best advantage in terms of response times.

The Deputy raised a number of specific questions and, as requested, I will ask the HSE's parliamentary affairs division to correspond with him in this regard.

Deputy Pat Breen

I thank the Minister of State.

Hospital Staffing.

Deputy Seán Sherlock

The people of Mallow, north Cork, south Tipperary and east Limerick fear for the future of Mallow General Hospital, MGH. The 100 general practitioners who wrote to the Minister in September stated they are in despair and that "a blinkered vision of health delivery is slavishly following foreign models without taking into account the existing nature and makeup of the Irish Health Service". They contend, as do I, that all patient contact should be in centres of excellence, be it in primary, secondary or tertiary care. MGH is a primary example of a secondary facility that has punched above its weight, in spite of concerted efforts to downgrade it.

The Government, by reducing the hospital's budget by more than €500,000, did not take into account the fact that the information being supplied to warrant a cut is at best misleading and does not take into account certain factors. The hospital networks section of the HSE south, when asked to provide specifics in reply to questions I have posed to the Minister, responded with generalities which leave us none the wiser. I have tabled numerous questions to the Minister on the future of the hospital, the appointment of an executive management structure, the appointment of a radiologist, casemix, and the appointment of a radiographer to oversee the CT scanner that has been sitting in an empty room for years.

On the issue of casemix, I refer to Parliamentary Question No. 400 on 30 January 2008, where the HSE in response to my question on the €500,000 cut to the hospitals budget stated:

Mallow General Hospital has received a negative casemix adjustment of €571,233 for 2008 (which is based on 2006 activity). Management at the hospital are examining the underlying causes of the negative casemix adjustment for 2008 and a rigorous scrutiny of the hospital's base costs will be carried out.

MGH's budget had been cut because the workload of the hospital had been under measured through casemix because of a lack of clerical staff, but it does not suit the HSE to admit this. I have it on good authority that only 95% of MGH's workload was captured. The HSE's official line is that the budget was cut because of "inefficiencies". Nobody disputes that MGH's budget is the lowest in the country or that its workload is greater than many comparable hospitals. How is it then that its budget is cut?

I refer to the appointment of an executive management board. Why has Bantry hospital, with a smaller catchment area than Mallow, an EMB? I applaud Bantry hospital in this regard but it is lucky. The answers I received are an insult to the people I represent. I refer to Parliamentary Question No. 119 of 31 January 2008, in which I asked about the make up and reintroduction of the executive management structure. In its reply, the HSE stated that management of both the Cork University Hospital group and Mallow General Hospital are keen to enhance the management structures at the hospital and have over the past several months been working with the HSE's performance and development unit to facilitate the process of establishing an executive management board at Mallow hospital. It continued that key stakeholders have been met on a one-to-one basis to explore concerns, expectations, visions for the future and development needs, that discussions are ongoing and that a proposal to re-establish the executive management board at the hospital is currently being finalised.

According to the HSE, the review has taken slightly longer than anticipated because its scope was broadened to incorporate community-based services and to allow wider consultation with key stakeholders, including medical staff from the Mallow catchment area. Again, the HSE speaks in generalities but is short on specifics. It fails to acknowledge that an executive management board was in place Mallow General Hospital which ceased to operate and was never replaced. As for its assertion that there was a consultation with key stakeholders, this is stretching the truth. I can name 95 GPs who are key stakeholders in the area but were never consulted. I know of nobody in community-based services who was consulted. Which key stakeholders and medical staff from the Mallow catchment area were consulted? What does the HSE regard as the Mallow catchment area?

In the same reply, the HSE states that the acute hospital services review in HSE south will determine overall governance arrangements. To whom has the proposal for an executive management board for Mallow General Hospital been sent? On the issue of the CT scanner, which is also addressed in the reply, if the HSE see the benefits of the scanner, why did it not put a proper management plan in place in 2005?

We are concerned for the future of the hospital and that the acute hospitals review will seek to downgrade our accident and emergency services, postpone further appointments when current surgical terms of employment end and further delay the building of a day procedures unit. We want to see the appointment of a radiographer because we have waited too long for one. We want Mallow General Hospital to be a centre of excellence for secondary care. We are proud of our Hospital. If the HSE persists in downgrading the hospital by stealth, we will protest vigorously.

Deputy Pat The Cope Gallagher

I thank Deputy Sherlock for giving me the opportunity to reply on behalf of the Minister for Health and Children, Deputy Harney.

I am advised that capital funding of €1.5 million was sanctioned by the Department of Health and Children for the installation and dedicated accommodation of a CT scanner at Mallow General Hospital in October 2004. Following receipt of fire certification and planning approvals, tendering arrangements for the entire project were put in place and work on the premises commenced in late 2005. In the meantime, tendering arrangements for the purchase of the scanner were also put in place. The scanner was delivered in December 2006 and the necessary commissioning works were undertaken by the supplier and completed in August 2007.

In regard to staffing, formal sanction for the posts was received by the HSE in September 2007 and the necessary arrangements to commence the recruitment and appointment of the appropriate staff were put in place without delay. Interviews for the clinical specialist radiographer, CT technician and senior radiographer were held during November 2007 and suitable candidates were identified. I understand that the HSE will be in a position to progress these appointments in the coming weeks.

Mallow General Hospital and Mercy University Hospital have approval for two consultant radiologist posts in a reciprocal sessional arrangement between the hospitals. The filling of these posts has been held up due to the consultants talks. The management of Mallow General Hospital, Mercy University Hospital and the southern hospital group are now in discussion on the timeframe for the filling of these posts. Subject to the staff being in place, it is expected that the CT scanner should be operational by May.

In regard to the budget, Mallow General Hospital has received a negative casemix adjustment of €571,233, based on 2006 activity. Casemix was introduced in an effort to collect, categorise and interpret hospital patient data related to the type of cases treated to assist managers define their services, measure productivity and assess quality. Casemix contributes towards equity, efficiency and transparency by clarifying and categorising hospital throughput. By allowing peer group comparisons, it creates an incentive for better performance. Management at Mallow General Hospital is currently examining the underlying causes of the negative casemix adjustment for 2008 and a rigorous scrutiny of the hospital's base costs is being carried out.

In regard to the other issues raised by the Deputy, I will obtain a copy of the report and request the parliamentary affairs division of the HSE to correspond directly with him.

Schools Building Projects.

Deputy John O’Mahony

I protest in the strongest possible terms at the unacceptable treatment of three applications for new school buildings in County Mayo.

The principal and board of management of Midfield national school, Swinford, have been pursuing building extension and renovation works for over ten years. The Department of Education and Science's consultants acknowledged the school's urgent need in 1998 and €30,000 was spent on professional fees. The project went to the costing stage but was then shelved.

In 2006 the school authorities were advised to re-apply under the small schools scheme and an architect was commissioned to carry out a report. He noted that other businesses would be shut down under health and safety regulations as the classrooms, heating system, sewerage system, roof, windows, toilets and play areas were all substandard. The septic tank is seeping sewage near the play areas. This application will become an emergency in September 2008 when projected numbers will necessitate the employment of an extra teacher. The school is trying to function under Third World conditions while coping with the increasing numbers of children being enrolled. One parent asked me in the context of the Taoiseach's announcement last December of €5 million for shanty towns in Cape Town how the school could be treated so badly.

Gaelscoil Uileog De Búrca in Claremorris opened in 1989 with an enrolment of eight children. Attendance is currently 109 children and the projected enrolment for next year is 120. In 1998 the then Minister for Education and Science, Deputy Martin, promised a new school if a site was agreed. The site was purchased in 2005 and further land was acquired in 2007. The Department has promised a new eight-classroom school and the sanction of the current Minister, Deputy Hanafin, is awaited. The school has operated for ten years out of an old, dilapidated two-teacher premises with four prefabs at an annual rent of €70,000. The school could have been built for the amount of money that had to be spent leasing prefabs.

St. Joseph's national school, Bonniconlon, is another project which has been ongoing for more than 10 years, causing frustration for teachers, pupils, parents and the board of management. In 2000 the local community began fundraising for the local contribution and accessed alternative accommodation to have everything in readiness when the application passed through the various planning stages. The Minister sanctioned the building of the new school at a meeting in Knock in 2006. The board of management was told on umpteen occasions that the building would go to tender in January 2008 only to get the dreaded phone call from the Department in the week before Christmas. The board of management is now totally frustrated and feels isolated, particularly following the emergence of the recent list of school building projects in respect of which the go-ahead was announced at the end of January.

The Minister and the Department have assured us that resources are not solely going into rapidly developing areas but the evidence points to the contrary. The three schools to which I refer are situated in areas of developing population and the teachers, parents and boards of management are very angry at the lack of transparency in the system which gave the go-ahead to the recently announced projects and left those to which I refer, which are long awaited and much needed, in limbo.

Under previous Administrations, the school building programme was considered slow but fair and schools knew their place in the queue. However, school boards of management throughout the country are now questioning the transparency of a programme that is excluding previously approved schools without explanation. There is genuine anger in those schools that have waited years for projects involving renovations, extensions or the construction of new school buildings to commence and in respect of which progress is yet to be made. In the meantime, other schools appear to be getting the go-ahead to proceed to construction and this is leading to complaints about the lack of transparency in the process.

I call on the Minister to include the schools to which I refer in the next round of announcements in order that the communities they serve can have access, in appropriate school buildings, to the high standard of education they richly deserve.

Deputy Pat The Cope Gallagher

I thank Deputy O'Mahony for raising this matter. I welcome the opportunity to outline to the House the Department of Education and Science's position regarding the provision of new school buildings for Bonniconlon national school, Gaelscoil Uileog De Búrca and St. Joseph's national school, Midfield, Swinford.

In the lifetime of the national development plan, almost €4.5 billion will be invested in schools. Approximately €600 million of this will be spent this year on school buildings. This is an unprecedented level of capital investment which reflects the commitment of the Government to continue its programme of sustained investment in primary and post-primary schools. This investment will facilitate the provision of new schools and extensions in developing areas and the improvement of existing schools through the provision of replacement schools, extensions or large-scale refurbishments in the coming years. The progression of all large-scale building projects from initial design stage through to construction phase is considered on an ongoing basis in the context of the national development plan and the Department's multi-annual school building and modernisation programme.

As regards the position of the three schools to which Deputy O'Mahony refers, the project relating to Bonniconlon national school is currently at an advanced stage of architectural planning in respect of the provision of a new three-classroom school. I understand the tender documentation for this project is nearing completion. The Minister for Education and Science intends to announce projects that will proceed to construction during the year and Bonniconlon will be considered in this context.

A site for a proposed new school building for Gaelscoil Uileog De Búrca was acquired last year and an assessment of projected enrolment trends, demographic trends and housing developments in the area will be required in order to determine the long-term projected staffing figure on which the school's accommodation needs will be based. It is heartening to note that a school established in 1989 with eight pupils now has an enrolment of 109. The latter is expected to rise to 120 next year. I am a great supporter of gaelscoileanna, which offer an opportunity for children in schools outside the Gaeltacht to pursue their studies through the medium of Irish.

St. Joseph's national school, Midfield, previously applied for an extension and refurbishment to provide for improved ancillary accommodation, such as a general purpose room, a multipurpose or staff room, a remedial room and a general office. The proposed project did not include additional mainstream classrooms. However, in January of this year the Department of Education and Science received a new application in respect of additional accommodation. This will be considered in the context of the multi-annual school building and modernisation programme.

On behalf of the Minister, I wish to assure the Deputy that she and her Department are committed to providing high-quality accommodation for Bonniconlon national school, Gaelscoil Uileog De Búrca and St. Joseph's national school, Midfield, at the earliest possible date. I will communicate to her the strong view expressed by Deputy O'Mahony.

The Dáil adjourned at 9.35 p.m. until 10.30 a.m. on Thursday, 21 February 2008.