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Dáil Éireann díospóireacht -
Wednesday, 11 Feb 2009

Vol. 674 No. 2

Adjournment Debate.

Hospital Services.

I thank the Leas-Cheann Comhairle for allowing me to raise this serious matter. I believe a death notice for South Tipperary General Hospital has appeared in the form of an information document dated 29 January 2009 on the modernisation of acute services for the hospital group south-east. A short few years ago, St Joseph's County Medical and Maternity Hospital, Clonmel was renamed South Tipperary General Hospital at great expense and inconvenience to take account of the amalgamation with Our Lady's County Surgical Hospital, Cashel.

South Tipperary General Hospital under the new guise of modernisation of acute services will lose its identity and become part of a recognised, or possibly unrecognised, group — it will become a statistic in the HSE plan. Lest anyone forget or needs reminding, the HSE is about saving lives, not saving money. The situation in regard to South Tipperary General Hospital and the proposed reconfiguration of hospital services within the south-east, and its impact, is a matter of grave concern to the constituents of Tipperary South and to myself.

The implementation of the transformation programme as required by the national services plan will commence, we are told, in March 2009 with the development of a steering group for the modernisation of acute hospital services for the HSE group south-east. The steering group will have a membership initially comprised of four clinical directors — one from each hospital — and a hospital manager. The role of the steering group will be to supposedly agree and plan for a re-configuration model of acute hospital care for the hospital group south-east, make recommendations on service delivery issues and oversee the implementation of the modernisation programme. A project manager will support the planning and implementation phases of the programme and the planning phase will be completed by September 2009.

I am concerned that we have too many programme managers within the HSE and too few frontline staff. Under the HSE plan for the modernisation of services, the so-called aims of discussion are as follows: understanding and clarification of challenges, as if we did not know already; having a shared understanding of the need for change; a shared understanding of what we must do and how we should go about it; and timelines — all fancy jargon adopted by the HSE. However, what we have is no two-way dialogue, completely one-way traffic, a tunnel vision on behalf of the HSE and its management and no proper, meaningful consultations with the extremely hard-working and dedicated staff at Clonmel.

As I said, the death notice for South Tipperary General Hospital has appeared in the form of this information document, dated 29 January 2009, with its fancy title concerning the modernisation of acute services for the hospital group. I am totally opposed to these new plans to remove out-of-hours services or accident and emergency services after 7 p.m., as well as the removal of maternity services and all acute hospital services. This would mean that never again would a child be born in Tipperary, which is unacceptable, particularly when we have a top quality maternity service with large numbers of deliveries each year.

While I have no issue with centres of excellence, as with speakers on another debate today, I believe we must have centres of excellence in place before we attempt to remove services. A radical change in the direction of health care policy is needed in the Department of Health and Children and the Health Service Executive. Democratic accountability must return to the Minister and services must return to our local hospitals. There must be a health care system which truly places the patient first and which is capable of meeting the needs of our communities. I remain committed to fight might and main to keep all services in South Tipperary General Hospital.

I thank Deputy Mattie McGrath for raising this important issue. The Government is committed to ensuring the delivery of the best quality health services possible, in an effective and efficient way. Ensuring patient safety is of paramount importance, such that people can have confidence in the care they receive and can expect the best possible outcomes. Patient safety and quality must be prioritised and services organised and managed from that perspective. In addition, services should be available, as far as possible, close to where people live.

Currently, South Tipperary General Hospital provides acute services for a catchment population of some 135,000 people in South Tipperary and the bordering areas of North Tipperary and west County Waterford. Since acute hospital services in South Tipperary were amalgamated in South Tipperary General Hospital in January 2007, following the transfer of accident and emergency, general surgery and oncology services from Our Lady's Hospital, Cashel, service delivery arrangements have been much enhanced and have proved beneficial for both patients and health service staff in the area.

We are all now familiar with the expert advice that, where the delivery of complex care is concerned, better outcomes for patients are achieved if this takes places where the necessary staff and equipment is all to hand and sufficient volumes of activity take place. The available evidence also emphasises the need to provide timely emergency care to patients in an appropriate setting and that this leads to lower rates of death, fewer complications and longer life.

It is important to appreciate that the nature of health service delivery is changing and that the direction of future development is towards an increased proportion of diagnosis and treatment taking place on a day or outpatient basis. For example, much computerised tomography, CT, scanning and endoscopy work can be undertaken in local hospitals. This is a good deal more convenient for patients and their families, as well as being much more cost-effective.

The HSE's national service plan for 2009 contains a commitment to develop in the south east an overall framework for reconfiguration of all services in the hospital network. The HSE is at present developing its plans to advance this work. This task is at a relatively early stage. The Government is committed to a process of change which is incremental, involving appropriate consultation and discussion with health professionals, service users and other interests.

I assure Deputy Mattie McGrath and the House that any proposed changes emerging from the process in the south east will be the subject of consultation. The HSE has already prepared the information document to which Deputy McGrath referred dealing with the modernisation of acute services in the region which will be a helpful input to the work ahead.

Whatever configuration of services is ultimately decided upon, the Minister is confident that South Tipperary General Hospital and each of the other acute hospitals in the region will continue to play a valuable and significant role in the delivery of an integrated regional health service. I thank Deputy Mattie McGrath for raising this important issue.

Visa Applications.

I wish to share time with Deputy Noel O'Flynn. I welcome the opportunity to raise an issue of some practical significance to the country and the economy. Ireland has a practical and developing relationship with Taiwan within the framework of its overall policy position on relations with countries in the region. Many European countries have established a well-staffed representative office in Taiwan as a fundamental part of the policy to develop economic trade there, while also developing a relationship with China. The staffing of these offices ranges from five people for Austria and Belgium, to 29 for Germany and as many as 53 for the United Kingdom and 55 for France. In addition, the European Union has a large office in Taiwan with more than 50 staff.

Ireland should upgrade the scale and scope of its presence in Taiwan as the foundation stone upon which better economic and social relations can be built. Taiwan encourages freedom of movement internationally. Based on the spirit of the 1944 Chicago convention on international civil aviation, Taiwan has granted visa exemption to 38 countries, including 24 of 27 EU member states. Ireland is one of 27 European countries currently enjoying a 30-day visa-exempt entry arrangement into Taiwan, a privilege it has enjoyed since 2003.

Visa exemption is a powerful means to enhance trade relations. Total annual trade between Ireland and Taiwan stands at approximately €1 billion, of which almost €250 million is accounted for by Taiwan's imports from Ireland. Taiwan is one of the world's most robust economies and is the world's sixteenth largest economy. Its trade surplus is quite substantial and its foreign reserves are among the world's largest. Ireland is not reaching its potential for trade with Taiwan. In the current international economic climate and at a time when our economy is in decline and needs all the support and stimulus available, the impetus must surely be for Ireland to take the initiative and further develop trade links.

Visa exemption is a powerful means by which to enhance the tourism trade. Some 260,000 Taiwanese travel to Europe each year. Surveys in Taiwan indicate this number would be considerably higher were it not for prohibitive visa regimes. Following the introduction of a visa waiver scheme for Taiwan nationals visiting Japan in 2005, tourist numbers visiting Japan rose by 30%. Taiwan people that travel overseas are generally quite wealthy and have proven to be valuable tourists who contribute strongly to the host country. Visa-free entry to Ireland would attract an increasing number of Taiwan tourists visiting Europe and the UK. If Ireland lifted its visa barrier and could attract a small percentage of visitors to Europe, it would be a substantial gain for the tourist industry in view of visitor purchasing power.

Now is the time to take the initiative on the tourism front. Following the UK announcement of a six-month visa-free entry system, Taiwanese interest in visiting the UK has soared. Tour operators are now introducing a whole range of new travel packages. This is a great potential source of new and immediate revenue. A visa waiver to visit Ireland would certainly attract a proportion of Taiwanese visitors to the UK to also visit Ireland.

In the area of education the difficulties for students attaining an entry visa imposes a particular handicap on any student considering visiting Ireland. That the existing entry requirements into the UK are a good deal easier than attaining a visa to come to Ireland is evident from the fact that some 8,500 students from Taiwan travel to the UK every year, and make a contribution of more than £1 billion to the UK economy. Increasing the international student market should be a key short-term objective for the educational sector. Travelling Taiwanese students are well educated, highly motivated and adequately financed. They should become a key market for our educational institutions. However, we are a good deal behind our main competitors in this market, and with the introduction of a new six-month visa-free entry in the UK, Ireland is now in danger of being completely excluded from this market. Time is of the essence in this issue. We must avail of the window of opportunity and act now.

The cold war is over between the People's Republic of China and the Republic of China, Taiwan. The political question has been put aside, as President Ma stated during a visit by Deputies to Taiwan last August. Taiwan is investing heavily in The People's Republic of China in such areas as tourism. As Deputy Perry stated, we seem to be falling behind other EU countries. Some €40 billion in goods and services is exported from the EU to Taiwan each year. Germany is the largest exporter and we export €250 million. As Deputy Perry indicated, we import €750 million which is an imbalance.

It is time to organise an official trade mission to Taiwan. I call on the Minister of State at the Department of Enterprise, Trade and Employment, Deputy John McGuinness, to consider putting this proposal to the Government. We should explain to the Chinese ambassador that we subscribe to the one China policy. However, it should be possible to have Taiwan as one of our trading partners, as is the case in all other EU countries. We should carry on more business in Taiwan. We should beef up the number of staff from the Department of Foreign Affairs staff in Taiwan; at present, there is only one staff member in place. I support the visa proposal. Some nine students from Taiwan are studying in Ireland. It is almost impossible to get a visa, but there are just less than 7,132 studying in England. English is our second language. Taiwanese people seek to come to Ireland, but we must make it easier to do so. I welcome the move in the UK this week of providing a clear visa with no restrictions for people travelling to Taiwan for six months.

All universities in the country are open for business. I recently brought Representative Lee to University College Cork where the president of the college said that it was open for business and wanted the students because they are worth €35,000 each to this economy every year.

In March 2007 the UK introduced a visa waiver test to assess the effectiveness of its visa regime. Travel to the UK from every country outside of the EEA and Switzerland was measured against a range of criteria, including illegal immigration, crime and security concerns. In July 2008 the results of this test were assessed and the UK then entered into a six month period of dialogue with the countries concerned to consider what steps might be taken to address the issues arising.

Following the end of that period, the Home Office announced on Monday 9 February 2009 that the UK had decided to impose a visa requirement on nationals of Bolivia, Lesotho, South Africa, Swaziland and Venezuela and had decided to lift the visa requirement for Taiwanese passport holders for short visits of less than six months. This waiver is due to take effect from 3 March 2009.

It is worth noting that the visa regime in the UK operates differently from the Irish regime in so far as all persons other than EU, EEA and Swiss nationals are required to obtain an entry visa or pre-entry clearance for stays in the UK for periods in excess of six months, regardless of the purpose of journey. This will continue to be the case for Taiwan even after the visa waiver is introduced. In contrast, the Irish system operates on the basis that, depending of his or her nationality, the visitor is either visa required or not, irrespective of the length of his or her stay or its purpose.

The net result of the change in the UK is that students coming for university courses or other educational programmes lasting more than six months will continue to require visas but those coming for shorter periods will not. Tourists and others coming on short visits will also be exempted.

The existence of a visa requirement should not be a significant impediment to genuine visitors. On the contrary its purpose is to separate the credible applications from the rest and the establishment of dedicated Irish visa offices in a number of countries has yielded significant benefits in this regard.

In the light of the common travel area, however, it is important that the Irish and British visa lists cohere in all practical respects to the extent warranted by immigration concerns. To this end, Ireland must take serious account of any alterations in the UK regime. The implications of the UK decision to introduce new visa requirements for nationals of Bolivia, Lesotho, South Africa, Swaziland and Venezuela are being examined particularly in the light of the likelihood of persons who would fail the UK test seeking to enter via Ireland. On the other side, full and immediate consideration will be given the issue of Taiwan and to whether a relaxation of the current regime is desirable based on the approach now being followed by our UK colleagues.

I understand that this process will be completed before the coming into force of the new UK arrangements. Section 17 of the Immigration Act 2004 sets out the purposes for which the Minister can make a visa order, inter alia, ensuring the integrity of the immigration system and for reciprocal immigration arrangements with other states.

Private Rented Accommodation.

I thank the Minister for Social and Family Affairs for coming to the House this evening. I accept that rent supplement can be beneficial to people who are living in private rented accommodation and cannot provide for the full cost out of their own pocket. I question, however, the quality of accommodation provided in the private rented sector.

I have seen many properties in Dublin South-Central, where people are receiving rent supplement but are forced to live in totally sub-standard flats and houses. Many landlords receive large sums of money but do not maintain their properties properly.

I recently visited a flat in Inchicore where a young mother is living with her three young children. As soon as the door opened I met a strong damp smell. There was mould growing on the wall, and even though the woman has three children she has no access to a back garden. I insisted that the local authority inspect the flat, which it did but following receipt of the report the landlord carried out only minor repairs after many weeks of requests. This landlord is not answerable for the state of the inadequate accommodation for which he receives more than €1,000 per month.

It has also come to my attention that it is over five years since some private rented accommodation in my area was last inspected. There are many landlords with more than one property. In one case in my area the landlord receives on average €10,000 per week from the Department of Social and Family Affairs for properties which are in an appalling condition.

Rent supplement is allocated by the Minister's Department but is paid out by the community welfare officer. The officer, however, is not obliged to check out the accommodation before granting rent allowance. I cannot comprehend how money is being handed over without anyone in authority knowing what they are paying for.

The Department of Social and Family Affairs has stated in the past that accommodation occupied by rent supplement tenants should at least meet minimum housing standards but this is not being enforced. The Department has also stated that responsibility for setting and enforcing housing standards rests with the local authorities.

It is about time that people came into the real world and did something to make landlords accountable for the standard of housing they put up for rent. There must be regular inspections and the blame cannot and should not be shifted from one Department to the next. It is simply not acceptable that neither the Department nor the Health Service Executive, HSE, carries out inspections before substantial sums of money are handed over to landlords.

Many tenants are so desperate to find accommodation that they do not see the hidden problem until they move in. Some are afraid to complain to their local authority. In many cases their landlords evict them if they do.

In these challenging economic times the Minister needs to look for value for money. The Department of Social and Family Affairs should enforce its rules and require full accountability for the millions of euro being paid out on rent supplement each year. The Government must put in place a new system to require landlords who rent out private accommodation to meet basic hygiene and housing standards.

The average weekly rent supplement payment at the end of 2007 was €128.43, and €125.87 at the end of 2008. In 2008, the Department of Social and Family Affairs spent €441 million on rent supplement for 74,000, up from 60,000 in 2007, 20,000 of whom reside in Dublin, which cost €392 million. At the end of 2008, 31,343 households were in receipt of rent supplement for 18 months or more. Is it not true that rent supplement is designed to be a short-term income support scheme? Keeping people on rent supplement long term does not make much sense.

There has to be a better way to channel State funds into helping people live in acceptable conditions. The rental accommodation scheme, RAS, which Dublin City Council introduced is moving along quickly and helps the long-term needs of those moving on from rent supplement. More than 780 landlords in Dublin have signed up to the scheme but this is only a drop in the ocean. The restrictions of the scheme make them reluctant to sign up.

There are thousands of vacant apartments in Dublin city. It is time for the local authorities, together with the relevant Ministers, to examine the possibility of making some of these vacant units available to people who need them.

There are 327,000 people on the live register and we hear of more redundancies each day. With such a dramatic increase in numbers on the dole, the demand for social and affordable housing, and rent supplement is going to sky-rocket. That is why it is so important for the Minister for Social and Family Affairs to act now to address the rent and housing crisis and prevent thousands of euro of taxpayers' money being handed over to line the pockets of many greedy landlords, and to facilitate the many young people living in poor sub-standard conditions with young families and no access to decent accommodation.

I thank Deputy Byrne for raising this issue and for acknowledging the importance of the scheme, the amount of money spent on it and the people who benefit from it. It is administered on behalf of the Department of Social and Family Affairs by the community welfare service of the Health Service Executive, HSE. It is expected that accommodation occupied by rent supplement tenants should at least meet minimum housing standards. Given the availability of much more rented accommodation now tenants have much more flexibility in moving and finding better accommodation. That should challenge landlords to ensure that they are meeting the relevant standards.

Responsibility for setting and enforcing housing standards rests with the local authorities. Under legislative provisions introduced by the Department in 2006 and 2007, the HSE can decide that a rent supplement may not be payable where it has been notified by a housing authority regarding non-compliance with housing standards. Where a notification of non-compliance with standards is received from a housing authority in respect of an existing tenant, guidelines recommend that a community welfare officer discuss the situation with the tenant and take whatever action he or she decides is necessary in the best interests of the tenant. The objective is to ensure that substandard accommodation does not come within rent supplement.

The purpose of rent supplement is to provide short-term income support to eligible tenants living in private rented accommodation, whose means are insufficient to meet their accommodation costs and who do not have accommodation available to them from any other source. The HSE must be satisfied that accommodation funded under the rent supplement scheme is reasonably suited to the residential and other needs of the claimant. Where the HSE becomes aware of accommodation or blocks of accommodation which appear to be sub-standard, it notifies the local authority and it may advise prospective tenants at those premises that rent supplement will not be paid in respect of those tenancies. Details of rent supplement tenancies are provided to local authorities via the Department of the Environment, Heritage and Local Government on a quarterly basis, and this information sharing assists in enforcing housing standards.

The arrangements are aimed at improving the standards of accommodation which rent supplement tenants occupy and support the local authority in meeting their responsibilities on housing standards. The HSE has indicated that notifications of substandard accommodation received from local authorities have resulted in rent supplement being terminated or the refusal of rent supplement where it was not already in payment.

The Government has approved measures to update minimum standards regulations for rental accommodation. The new regulations took effect from 1 February 2009 and apply in their entirety to all new, first time lettings. There is a four year phasing-in period for existing properties to allow time to comply with some of the more onerous provisions, such as the installation of dedicated sanitary facilities in each rental unit. Successful enforcement of the regulations is critical and this responsibility rests with local authorities. Local authority inspectors inspect rental properties for the purpose of ensuring they comply with the regulations. Where a property does not comply, they engage in a series of sanctions against a landlord, up to and including prosecution in the District Court.

The Department is committed to working with and supporting the Department of the Environment, Heritage and Local Government and local authorities in meeting their responsibilities for enforcing housing standards.

Special Educational Needs.

It would have been far more appropriate if the Minister for Education and Science were here to take this matter on the Adjournment, because it is such a serious issue. I was glad to see the Minister for Social and Family Affairs take Deputy Catherine Byrne's matter. However, I know that the Minister of State, Deputy Wallace, has much experience in this area and I appreciate her coming here tonight.

During the debate on class sizes a few months ago, virtually every Deputy from the Government side began by saying that they came from classes with more than 30 pupils, and that it did them no harm. In fact, one Member stated that he came from a class of 42 pupils. We all know people who came out of those classes who did not quite make it because the type of supports were not there to ensure that they performed to the best of their ability. Today's announcement by the Minister for Education and Science — who considers himself to be one of the tough guys in the Cabinet — against a group of defenceless, vulnerable children is the most despicable cut of all. These children have a learning disability. This means that they cannot learn at the same rate as other children in school for which reason support teachers and special classes are put in place. We all know the children involved, because we meet them every day on the street, they are our neighbours' children, they are in school with our children or grandchildren. For an hour a day or an hour a week, they go to a class where they get intensive personalised teaching.

By giving these children support, it will ensure they at least have a chance to learn to read, write and be numerate. If that special support is removed, we will ensure they come out of school without any of those skills. These skills are necessary to survive in today's world.

We did not always have these children in mainstream schools. We used to have a bus that came into the community every morning, picked them up on each street and went to a special school when it was full. Those children were not seen anymore until they came back that night. The parents of those children campaigned, walked the streets and lobbied us until they got the type of support that was necessary in order to ensure their children could go into mainstream education. They knew what they were talking about, because it was not just about education, but about the socialisation of children with a learning disability. It was about ensuring that they made friends in school that lasted them through their lives. It was about ensuring that they mixed with their peers and that they were not ghettoised into special schools.

When these children moved into mainstream education, the structure of special schools was dismantled, because there no longer was any need for it. Therefore, there is no choice for these children. They are in mainstream education without the supports they need to stay there, but there is no way back for them because the special schools no longer exist. It is outrageous that this attack is occurring on the most vulnerable of our people. A republic is not about fine speeches, but about actions. If this action is what the Government will be judged on, it is an appalling action. The National Council for Special Education has commissioned a report on special classes, and it has not yet come back with it, but the structure has been destroyed. These children will now be left floundering next September. I am seriously disturbed at this action, and I hope that it can be overturned by next September. It is an appalling decision for any Government to make.

I am glad the Deputy has raised this matter, because it provides us with an opportunity to clarify a few issues. I will take the Adjournment matter this evening on behalf of the Minister for Education and Science, which is about the decision of the Department to suppress a number of mild general learning disability classes in primary schools.

A total of 128 classes are being suppressed in 119 schools, and a total of 534 children are enrolled in these classes at the moment. Allocations to schools typically increase or decrease depending on pupil enrolment. In the case of classes for mild general learning disability, the normal pupil-teacher ratio that applies is 11 to one. However, the Department allows for a small reduction in this number and permits schools to retain a teaching post where it has a minimum of nine pupils in the class. In the case of 128 classes in 119 schools, the number of pupils dropped below this minimum. Therefore, these schools are no longer entitled to the teaching posts in these classes. The 119 schools from whom the teaching posts are now being removed received allocations under the general allocation model of teaching support. These schools have therefore been resourced for the categories of pupils in question. I must point out that eight of these classes had no such pupils, ten had only one and more than half of them had five pupils or fewer.

Some 3,000 schools that do not have special classes for pupils with mild general learning disability still meet the needs of these children through mainstream classes and the use of their general allocation teaching resources. Furthermore, some schools in recent years voluntarily disbanded such classes and mainstreamed the pupils with the associated loss of the mild special class post. Some 80 of the 119 schools already have reduced class sizes under DEIS or previous disadvantage schemes. Some 17 of those schools will get an additional post when the pupils in question are divided among mainstream classes. Essentially, the loss of a teaching post from the mild class will be offset by the addition of a post to maintain the lower class size to which such schools are entitled as a consequence of their disadvantage categorisation. The pupils from the 128 classes in question will be placed in mainstream classes and will receive support from their class teacher. Those in disadvantaged schools with reduced pupil-teacher ratios will benefit from small class sizes. As Deputy Lynch suggested, all schools will benefit from the support that is available to them through the schools general allocation model. As I have already said, primary schools that do not have classes for children with mild general learning disabilities cater for such pupils from within the general allocation model.

In recent years, there has been an unprecedented investment in the provision of supports to children with special needs. In our schools, approximately 19,000 adults are working solely with children with special needs. There are over 8,000 resource and learning support teachers in our schools. There were just 2,000 such teachers in 1998. Over 1,000 other teachers support children in the special schools that continue to operate throughout the country. The 76 classes for children with mild general learning disabilities in which there are nine or more children are to be retained. I emphasise that priority will continue to be given to provision for children with special educational needs. As I said earlier, the establishment of classes for children with mild general learning disabilities predates many of the developments in special education policy over recent years. The general allocation model now offers us a system for supporting schools that have children with high incidence special needs. I hope my clarification has been of assistance to Deputy Lynch. I thank her for raising this issue on the Adjournment tonight.

I thank the Minister of State.

The Dáil adjourned at 9.40 p.m. until 10.30 a.m. on Thursday, 12 February 2009.
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