Hospital Services.

Deputy Timmy Dooley

I welcome the Minister of State to the House. I seek the assistance of the Minister on behalf of patients in the mid-west region in freeing up what appears to be a logjam in the roll-out of services for patients with cystic fibrosis, CF, in particular at Limerick Regional Hospital.

The Minister will be aware that the recommendations of the national working group on CF services were accepted. I understand €559,000 was set aside to upgrade services for CF patients. The Minister may be aware that 77 children and 46 adults are currently being treated at the Limerick Regional Hospital. Funding for CF services was allocated by the Health Service Executive following the Pollock report on CF services in 2006. Nationally, €4.8 million was provided, of which €2,072 million has been set aside.

As I stated, €559,000 was allocated directly to Limerick Regional Hospital to fund a number of positions. Two of the urgently required positions have not yet been filled, namely, an adult respiratory consultant with an interest in CF and a paediatric respiratory consultant with an interest in CF. The concern of patients in the region is to identify where that funding is and why these services have not been rolled out. The funding, as I understand it, was to support the cost of an additional eight staff, identified for the adult and paediatric CF services at the Dooradoyle facility. Included in the eight additional staff were two consultant posts, a consultant physician for adult services with a special interest in cystic fibrosis and a consultant paediatrician with a special interest in cystic fibrosis. That is the minimum required to provide the type of services needed for patients in the region.

There has been a considerable outcry during the past couple of years in regard to the treatment of individuals with cystic fibrosis and there was some movement by Government in this regard, in particular in regard to services to be delivered at St. Vincent's Hospital on the east coast. It is only right and fitting — I know the Government and Minister is committed to this — that the type of facilities available on the east coast are made available to people from the mid-west region who have cystic fibrosis. While the money for this has been set aside, services have not to date been rolled out. It is incumbent on the Minister and her Department to use their good offices, taking into account the assistance from the HSE, to move this forward without any further procrastination or delay.

While a relatively good service is provided in the paediatric area, there is need for an extra consultant. There is little service available to adults suffering from CF, which is a progressive illness. Clearly, there is a requirement to ensure continuity of service in respect of children moving from the paediatric service to the adult service. I understand also that a physiotherapist is required in the adult section. Anybody who understands CF knows that physio is the cornerstone of therapy to be delivered to patients suffering from that condition. It is absolutely necessary that these services are rolled out without delay, that the positions are advertised and that appointments are made as quickly as possible so that the same degree of service as is available on the east coast can be delivered in the mid-west region.

Minister of State at the Department of Health and Children (Deputy Mary Wallace)

I thank Deputy Dooley for raising this important issue.

The Cystic Fibrosis Association of Ireland commissioned Dr. Ronnie Pollock to review existing hospital services for cystic fibrosis in the context of accepted international standards. The report, which was published in 2005, provided an assessment of need for current and future cystic fibrosis patients. Following publication of the Pollock report, the Health Service Executive established a working group to undertake a detailed review of cystic fibrosis services. The remit of the group, which was multi-disciplinary in its composition, was to review the configuration and delivery of services to persons with cystic fibrosis in Ireland.

In recognition of the need to improve services for these patients, the Minister for Health and Children identified the development of cystic fibrosis services as a policy priority. As Deputy Dooley stated, additional funding of €6.78 million was provided to the Health Service Executive in 2006 and 2007 to develop these services. The HSE has advised that 44 additional staff dealing with cystic fibrosis have been appointed to date across a number of hospitals, including Limerick Regional Hospital and eight other hospitals. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally, including staff for the mid-west region. The services in place for cystic fibrosis patients in the mid-west region were built up over a number of years, as acknowledged in the Pollock report.

The current adult cystic fibrosis service for the mid-western region is provided at the Mid-Western Regional Hospital Limerick by two consultant respiratory physicians providing inpatient and outpatient services. The cystic fibrosis service for children is provided by a consultant paediatrician and involves both inpatient and outpatient services. Two nurse specialists currently cover both the paediatric and adult cystic fibrosis services. Adult and paediatric cystic fibrosis services are also supported by a dedicated team, which includes a social worker, a dietician, a physiotherapist and a pharmacist.

The Mid-Western Regional Hospital, Limerick, provides three dedicated rooms for adult cystic fibrosis patients. These rooms may be used for other patients if not required for cystic fibrosis patients. Paediatric cystic fibrosis patients are accommodated in the paediatric unit.

With regard to additional clinical posts mentioned by Deputy Dooley, eight and a half additional clinical posts have been approved to enhance the adult and paediatric cystic fibrosis service in the mid-west. Four of these posts are now in place and recruitment arrangements for the remainder are in train. This includes the two additional consultant appointments the Deputy referred to, which are proceeding through the recruitment stages. Subject to a satisfactory outcome to the recruitment process, the remaining appointees for the mid-west are expected to take up posts in 2009.

I thank the Deputy for raising this important matter. The Minister is confident that these developments will significantly enhance the level of service provided for persons with cystic fibrosis in the HSE mid-western area.

Services for People with Disabilities.

Deputy Deirdre Clune

I thank the Ceann Comhairle's office for allowing me to raise this issue again, having had the opportunity to raise it during the past 12 months. It is an extremely important issue to a number of people. I have given a commitment to a number of mothers in particular who have adult children over 16 years of age with an intellectual disability who cannot get routine dental treatment because it is required under general anaesthetic. This issue is particular to the Cork region. It is a distressing situation that has arisen for the parents, who are the carers of these adult children, and for the adult children.

The problem is that for a simple procedure such as a filling or for even a scale and polish adults with intellectual disabilities in some cases require a general anaesthetic. It is a day procedure but it must be done under strict criteria, which we all accept. They have been referred by their dentist or general practitioner to the Cork University Dental Hospital for these procedures, the waiting list for which is mounting and is now more than two years. In the period I have been raising this issue, one or two of these adults have been dealt with as an emergency case in Tralee, but that is not satisfactory. It does not address the ongoing problem and the fact that the waiting list for these procedures is mounting.

I tabled a question on this issue to the Minister in June of this year to which I received a reply from the HSE. I was told in June that the HSE has made provisional agreement with the Cork University Hospital anaesthesia and day treatment departments to commence an additional two treatment sessions per month for adults with special needs beginning in September 2008. This will be provided by HSE staff in collaboration with the dental school and the service will increase capacity, reduce existing waiting lists and manage referrals. That reply in June was welcome news.

In November I again raised this question and was told that progress had been made, nevertheless, no service has been provided. The HSE in north Cork recruited a senior dentist in July 2008. He commenced in September and is skilled and experienced in the delivery of dental services to adults with an intellectual disability under general anaesthetic. He is currently working on preparing the protocols, policies and procedures to commence this service and discussions are ongoing with Cork University Hospital with an anticipated starting date of early December 2008, which is this week. I was contacted yesterday by two parents of adult children who are in this position and no service has been provided for them. The dentist and anaesthetist are in place but there are no beds available. Therefore, there is no provision again in December for these adults.

I cried with a parent as she told me on the telephone of her daughter who needs a filling in her front tooth. Her tooth is deteriorating and it will get to the stage where she will push her tongue against her broken tooth and get a crack in her tongue and will end up with untold problems. That is a small issue, but it must be dealt with. It is only one of the stories of all these adults provision for whom is being neglected.

The Minister of State will probably tell me this is a matter for the HSE, but it is matter for this House and for those of us who have been elected to represent these people. It is a matter for the Department of Health and Children which has decided policy in this area, namely, that these people will be given the necessary dental treatment, yet it is not happening on the ground. It is a tragic situation that needs to be addressed. We are getting there slowly, but we cannot close the circle to ensure that these people receive the necessary dental treatments that should be available to them.

Deputy Mary Wallace

I am happy to have the opportunity to address the issue raised by Deputy Clune. My ministerial colleague, Deputy Haughey provided the Deputy with information on this issue earlier this year and I am happy to be to a position to update this information.

I would like to explain the current position. In January 2007 a decision was taken by Cork University Dental School not to accept any further referrals to its existing waiting list for adult special needs patients who required treatment under general anaesthetic. The services in question in the Cork University Dental School were provided under an arrangement with the HSE. This decision was taken after considering a number of factors, including the length of time for patients on the current waiting list and the capacity of the current services at Cork University Dental School.

In addition to these factors, there were also concerns regarding the appropriateness of the facilities in regard to the treatment of both adult and child patients in a shared treatment environment and the lack of a consultant specialist for adults within the dental school. After considering all these factors, a decision was taken to cease services and no new referrals were added to the list from January 2007. I would like to point out that patients who were already on the waiting list continue to be treated and will receive all the dental treatment involving general anaesthetic that has been prescribed for them.

The Minister is now informed by the HSE in Cork that it has recruited a dentist with experience in the delivery of dental services to adults with special needs who require general anaesthetic. This dentist will also provide a service to all clients referred from both voluntary and statutory sources in the greater Cork area, including the city and county. As this service needs to be provided in an acute hospital setting, the HSE is currently negotiating with Cork University Hospital and the dental school to reconfigure existing theatre sessions in order to accommodate this new service development. Discussions in regard to these theatre sessions are ongoing and the HSE anticipates that it will be in a position to commence services as soon as the theatre capacity is made available.

The HSE is aware of those patients who have been unable since January 2007 to access services at the Cork University Dental School and will contact them in due course regarding treatment when the new arrangements are in place. In the interim period while these arrangements are being finalised, the UCC Dental School will continue to provide emergency dental care to adults with special needs and a limited service is also provided to adults with special needs by HSE dental staff.

On a broader issue, I wish to inform the House that the Minister for Health and Children is in the final stages of developing a new national oral health policy. This new policy, the first such policy in 13 years, has been undertaken by the Department of Health and Children in conjunction with the HSE. Among the matters that have been examined are service delivery issues such as the availability of dental and oral health care services for people with special needs. In this regard, officials in the Department of Health and Children have met a number of groups who work in the area of special needs dentistry to ascertain their views on recommendations for improving oral health services to people with disabilities. These groups include the Irish Society for Disability and Oral Health and a group of principal dental surgeons in the HSE who have responsibility for special needs dentistry.

In addition to meeting these groups, the Department of Health and Children has also sought the views of various organisations who work with people with disabilities. As a result of these meetings and consultations, the Department of Health and Children intends to bring forward a series of recommendations to improve the position of dental and oral health services to people with special needs in its forthcoming national oral health policy report, which will be available shortly.

Pension Provisions.

Deputy Joan Burton

Last Sunday's edition of The Sunday Tribune carried a front page story of a leaked memo from the Minister for Social and Family Affairs, Deputy Hanafin, to Government that there is a potential deficit on certain private sector pension funds of between €20 billion and €30 billion; that the majority of defined benefit pension schemes are probably in deficit because of the fall in the value of equities and that many pension schemes are at risk of being wound up.

As there are approximately 250,000 employees and 90,000 pensioners in defined pension schemes, it is understandable that the leaking of the memo caused grave concern to workers and pensioners in such schemes. The subsequent statements by the Minister, Deputy Hanafin, in media interviews did little to allay fears. The Minister's suggestion that people would always have the State pension to fall back on anyway was insensitive to say the least. During its 11-year reign in power, Fianna Fáil has continually talked about pension reform but done nothing.

In terms of the immediate crisis facing pension schemes, a number of suggestions have been made by the Minister and some of her colleagues, among others. One suggestion was to extend the period by up to two years on the requirement to purchase an annuity for people about to retire. The second was a relaxation of the current rules governing defined benefit schemes to allow a breathing space in the context of depressed equity markets. Is it the Government's intention to implement either of those two proposals to give some relief and space for people coming of pension age at present and funds that may have particular short-term difficulties?

The Government's failure to reform pensions is on a par with the model of regulation that it chose for the banks — regulation with a light touch, which has left many workers dangerously exposed to their pensions losing value. The Government has offered generous tax breaks for investments in pensions. However, for many ordinary workers on modest wages in the private sector, much of the tax relief has been eaten up by the high level of charges the Government has allowed for pension schemes in Ireland, unlike in other European countries. Prudent fund management would dictate that as workers approach retirement age, their funds should be invested in less risky investments such as Government-backed bonds. However, since Charlie McCreevy's time, the Government has been encouraging and permitting pension funds to invest more and more in equities. While this was a way of boosting profits while stock markets were running high, it now leaves many coming up to retirement age perilously exposed to the collapse in stock market prices.

The Government can be accused of encouraging both pensioners and pension funds, through the attractiveness of tax breaks, to take unnecessary risks. Now that, unfortunately, those risks have materialised, it is extraordinarily high handed of the Minister for Social and Family Affairs to wash her hands of the issue and casually remark that "most of these people would have a State pension — €230.30 per week — and the State pension is a good guarantee to fall back on". That smacks of Marie Antoinette and her advice to the peasantry of pre-revolutionary France, "Let them eat cake".

I want the Government to put on record tonight what concrete proposals it has to protect the tens of thousands of workers affected. We need a national solution to the problem. People need a pension for their retirement. It is right for the Government to encourage people to save and invest wisely for their retirement but the Government has created extraordinarily attractive schemes for the high rollers and the multimillionaires to invest in pension funds but, unfortunately, many middle income workers have been left far behind the high rollers.

The time for Government PR, Green Papers, discussion documents and task forces is long past. We need a Pensions Ombudsman with much greater powers to protect workers in schemes. We need an immediate response from Government to address the difficult issues facing people due to retire in the short term, and those pension funds that the Minister has indicated in her memo are at risk.

I welcome the fact that the Minister is in the House tonight because it is important that she put some positive statements on the record and tell us whether the Government will permit the extra two years for the purchase of annuities. Will the Minister provide an active mechanism for pension funds to vary some of the conditions in the context of the current depressed equities market?

Minister for Social and Family Affairs (Deputy Mary Hanafin)

I welcome the opportunity to discuss the issue in the House because the memo that was leaked and covered in the newspapers on Sunday did have the effect of causing unease among a huge number of people even though many would have known that pension funds are investment funds and the way the markets have gone would affect the financial status of the funds. I set out to allay people's fears in subsequent media interviews by pointing out that no pension fund has gone bust and no pensioner has been left without a pension. However, we know there are some who are bound to experience difficulties given the current state of the market. It is true that those people who are many years away from receiving a pension will have an opportunity to allow their funds to build back up when the markets turn, as they will. I appreciate the fact that many people are in pension schemes and those coming close to retirement feel somewhat uneasy about the information that was leaked.

The overall number of active defined benefit schemes registered with the Pensions Board at the end of 2007 was 1,319. The number of active defined contribution schemes was 98,483. The active membership of those schemes at that time was 530,933 and 269,465, respectively. That is a total of approximately 800,000 people who are involved in pension funds of one kind or another.

The Pensions Act provides for a minimum funding standard which defined benefit pension schemes must meet on an ongoing basis. Generally speaking, the standard requires that schemes maintain sufficient assets to enable them to discharge accrued liabilities in the event of a scheme winding up. Where schemes do not satisfy the funding standard the sponsors-trustees must submit a funding proposal to the Pensions Board to restore full funding within three years. In certain circumstances the Pensions Board can allow a scheme up to ten years to meet the standard.

In 2007, 81% of defined benefit schemes reporting to the Pensions Board passed the funding standard. Most of those schemes that failed the test had a funding proposal in place. It is expected that the number of schemes failing the funding standard will increase significantly in the coming year.

Estimates suggest that defined benefit pension schemes have sustained approximately €20 billion of investment losses this year. While it is expected that the number of schemes failing the standard will increase sharply as a result of current market conditions, the extent of the problem will not be fully apparent until schemes carry out end of year actuarial assessments and report the results to the Pensions Board, as required under the Pensions Act.

In recognition of the current market difficulties and the difficult decisions that pension schemes will face, the Government has put in place a number of short-term measures to ease the pressure on schemes. It has been agreed with the Pensions Board that an additional six months will be allowed for trustees to prepare funding proposals. That will mean schemes will have 18 months to review the situation with sponsoring employers and formulate proposals for recovery. Those actions are being taken to alleviate the current situation.

Members of defined contribution schemes have also been exposed to investment losses. In such schemes the risk is borne in full by the member. Many of those schemes are relatively immature and for many people there will be adequate time to recoup some or all of the losses that have occurred.

There are particular concerns for those who may be at, or close to, retirement. Good practice would suggest a conservative approach to investments in the last number of years before retirement but anecdotal evidence suggests that may not have been applied in some cases. Members of defined contribution schemes are required to purchase an annuity at the point of retirement. In the current environment, those scheme members could realise a significant loss in the value of their pension fund. In the circumstances, the Department of Finance is currently working out the details on how such scheme members could avail of a period of up to two years to purchase an annuity. There is, of course, the risk that those availing of the deferment option could sustain further losses and that will be clearly outlined in guidance notes.

The Government is working with the Pensions Board, representative organisations and the social partners to find ways to ease the pressure on schemes by striking a balance between the long-term nature of pension savings and the need to ensure short-term security of accrued benefits. As outlined, it has taken some short-term measures in this area. The long-term response is being considered in the context of the Green Paper on pensions and any changes proposed will be announced in the context of the overall framework for pensions which the Government has indicated it will announce in the near future.

While appreciating the concern people have about their pension funds, we recognise funds can be in difficulty because of the markets. We are working closely with the Pensions Board and have no hard factual information to the effect that any scheme is in difficulty. No scheme has run into difficulty to date and no one responsible therefor has indicated that this is the case. No pensioner or prospective pensioner has lost out. Where there were difficulties with schemes in the past, the employers made them good. They are very willing to support those who are dependent on pensions. We are certainly working on this issue and very much on top of it. I allay any fears that the unfortunate leak might have aroused.

Deputy Joan Burton

When will the arrangement for the annuity be introduced?

Flood Relief.

Deputy Seán Sherlock

I raise this issue because there is deep concern in Fermoy about proposals made by the OPW to replace the weir in the town with a rock ramp pass. People fear for their rowing club which some argue has been in existence since Adam was a boy. They fear that if the weir is replaced by a rock ramp, it will have untold consequences for the water level in the River Blackwater, thus negating the amenity value of the rowing club.

Why is the Government proceeding with this folly? There is no justification for the project. The OPW's flood alleviation works were sanctioned and welcomed but it is now seeking to change the weir, to which there seems to be no logic. When I put a question to the Minister on the issue on 4 November, I was told the direction had been issued in the interests of conserving wild salmon resources and avoiding the initiation of infringement proceedings by the European Commission under the habitats directive on foot of a complaint lodged with the Environment Directorate-General of the Commission.

Given that the Government is seeking to adhere to the habitats directive, the people of Fermoy and I would like to know the nature of the complaint and who lodged it. We want to know the justification for it. If it is to ensure enough salmon can get up the river, plenty of salmon are being caught by rod on the river. It does not require the destruction of the weir to ensure more salmon can get up the river because there is a much cheaper solution that would ensure the continuation of a fish pass without compromising the valuable amenity constituted by the rowing club in Fermoy.

We want to ensure the future viability of the rowing club. We do not see the economic justification for the proposal in the current climate. If the Minister of State tells me that the project is being carried out by the OPW because Fermoy Town Council cannot afford to do so, she should note that the former Minister of State, Deputy John Browne, visited the town in 2006. Two years have passed since his visit and the project is to be hitched to an OPW flood alleviation plan, to which there is no logic to whatsoever. The people of Fermoy cannot comprehend it.

The EU habitats directive is being used as a battering ram to carry out the project. There is no justification for this. If there was a complaint lodged to the Environment Directorate-General of the Commission, will the Minister of State make a copy of it available to the House in order that Members will know exactly who is behind the works? I do not believe for one moment that the OPW is fully responsible and believe there are other mechanisms at play. I would go so far as to say the Southern Regional Fisheries Board is the main instigator and that it is seeking to justify its position. It will gladly sacrifice a rowing club to this end but should realise that, ultimately, as many salmon will get up the river without a rock ramp as they would if one were installed. Hiding behind the fallacy of a habitats directive is typical of a Government which has used the European Union when it wants to push through some bad proposals. This project will have an adverse effect on the community in Fermoy. I ask the Government to rethink its strategy, particularly in the current economic climate.

Deputy Mary Wallace

The proposed works at Fermoy do not involve the removal or replacement of the weir but rather the essential replacement of the fish pass to permit the unheeded passage of migratory fish, as required under the habitats directive.

The background to the current proposals on works at Fermoy weir is that a complaint was made to the European Commission alleging that the weir was acting as a barrier to migrating salmon which are being injured in their attempts to migrate for spawning purposes. Salmon is one of a number of species in the River Blackwater that are protected species under the habitats directive. The river also happens to be a designated special area of conservation

The Commission has indicated to officials that failure to rectify the position will result in infringement proceedings being initiated against Ireland. This could result in very substantial fines being imposed by the European Court of Justice. In these circumstances, the engineering section of the Department of Communications, Energy and Natural Resources investigated the matter. Its report of July 2006 indicated that the weir acted as a barrier not only to salmon but also to other protected species, namely, lamprey and shad.

In the light of the findings of the report and the complaint to the Commission, a direction under section 116 of the Fisheries (Consolidation) Act 1959 was issued by the Minister to Fermoy Town Council, as owner of the weir. The council is required to lower part of the weir, consistent with retaining sufficient depth for rowing in recognition of the amenity enjoyed by Fermoy Rowing Club, and to install a rock ramp pass in the lowered weir to facilitate fish passage. While the optimal solution to barriers to migrating fish, purely from a fisheries conservation perspective, is to remove them, at no time was it proposed to remove the weir, nor is removal part of the current proposals. This approach was adopted in order to protect the recognised amenity enjoyed by Fermoy Rowing Club on the River Blackwater.

An opportunity has arisen to have the works on the weir completed alongside the first phase of a flood relief scheme for the area to be carried out by the OPW. There are obvious efficiencies and economies associated with pursuing this course of action. I advise the Deputy that departmental officials, at the request of Fermoy Town Council, held a public consultation in the town recently to explain the nature and purpose of the proposed works. The Department also met representatives of Fermoy Rowing Club and its engineering adviser to discuss the proposals. Concerns were expressed during the consultation about aspects of the proposal and a number of measures to alleviate these concerns have now been proposed. Under the revised proposal the width of the fish pass would be decreased. This will reduce further the extent to which upstream water levels will drop below the existing weir crest, in low flow periods to 85 millimetres, or 3.4 inches. That is in the normal flow of a dry summer. In a severe drought period, the drop in water levels below the existing weir crest will not exceed 175 millimetres, or 7 inches, according to the engineers. I am advised there is deep water upstream of the weir and these projected water levels during low flow should not give rise to any interference with the activities of the rowing club.

The additional proposals to be designed as part of the project include the installation of a pontoon slipway, pending the building of a new slipway by the OPW, as part of phase 2 of its flood relief scheme; the removal of gravel from the river bed at the strand area where it has naturally silted up and limits rowing; with the consent of the owner the cutting back of weeds and foliage that limit the width of the river available for rowing. These works are to be carried out by the Southern Regional Fisheries Board.

I am advised that the Minister of State at the Department of Communications, Energy and Natural Resources, Deputy Seán Power, hopes to hold a number of meetings to clarify whether there are any issues that have not been addressed in the revised proposals before he decides whether to proceed with the necessary works, in compliance with domestic and European law.

The Dáil adjourned at 9.55 p.m. until 10.30 a.m. on Thursday, 4 December 2008.

Dáil Éireann díospóireacht - Wednesday, 3 Dec 2008