Dáil Éireann díospóireacht -
Tuesday, 28 Apr 2009

Vol. 681 No. 1

Adjournment Debate.

Health Services.

Deputy Pat Rabbitte

I thank the Ceann Comhairle and his office for calling this important matter. This concerns two secondary school students in my constituency aged 15 and 17 years respectively who suffer with a condition known as scoliosis, in which the spine grows inwards and from side to side causing pain, deformity or even breathing problems in the late stages. The condition in its severest form causes curvature of the spine and visible deformity. Both girls require specialist operations to correct the curvature. There is no connection between the two cases except that neither has been able to get the necessary medical and surgical procedure done.

These young women are due to sit their leaving certificate examinations in 2010 and were happy to be advised by Our Lady's Hospital for Sick Children in Crumlin that their operations would take place in April and June of this year which would give them time to recover and enable them to study for their examinations without pain or the distraction that their illness causes. One young girl has been on the waiting list for three and a half years. Due to cutbacks and ward closures imposed by the Health Service Executive, HSE, however, one student has had her operation cancelled and no alternative date has been given. The other student has been given a provisional date for June of this year but with no guarantee that the operation will be done then. If either family could afford it, their respective daughters would be attended to almost immediately as private patients for €85,000 each. As a matter of urgency I request the Minister to ensure that both these girls have their operations carried out before the new school term in September 2009.

One of these young women might have been spared this trauma if screening for this disease was available as promised when she was a first year pupil. She must now look forward to enduring a severe operation but is uncertain when it will take place. The other young woman has been told by her consultant that at her age if the operation is not done quickly she may require a subsequent operation down the line. It is heartbreaking for a young woman in these circumstances to be given a date for such an operation only to find it cancelled at short notice. There is something seriously wrong with our health services when the system cannot meet the medical needs of two bright girls who only want to get on with their lives.

I regret to say that I have been unable to get a meaningful response from the Minister, who is normally very understanding of these matters, and it goes without saying that I have been completely unable to extract any meaningful reply from the HSE, which really is shameful.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I apologise to Deputy Rabbitte for the fact that the Minister, Deputy Harney, cannot be available to respond to this Adjournment matter. I am therefore taking it on behalf of the Minister.

Our Lady's Hospital for Sick Children, Crumlin is Ireland's largest paediatric hospital and provides a wide range of secondary and tertiary paediatric care. A significant portion of paediatric orthopaedic practice at Crumlin involves evaluation and management of children and adolescents with spinal deformity. The condition presents when children and adolescents are growing rapidly and may be progressive in childhood. The progression relates to growth and is particularly seen in early childhood, one to five years, and during rapid adolescent growth.

The hospital has a long-established programme for casting and bracing children less than five to eight years of age, as spinal deformity may be a major challenge when their lungs and chest organs are going through a critical phase in development. In older children and adolescents, the optimal treatment is often one operation called "instrumented deformity correction and fusion". Patients suitable for this operation are prioritised for surgery based on clinical need.

I understand that it would not be appropriate to discuss the specific circumstances of individual cases, such as those raised by Deputy Rabbitte. However, I understand that the authorities at Crumlin are seeking to agree arrangements with the National Treatment Purchase Fund for a number of patients to be treated as soon as possible. I would hope that early progress can be made in this regard. The HSE and the three Dublin paediatric hospitals are also having discussions with a view to establishing the potential to improve the existing arrangements for the provision of paediatric orthopaedic services generally.

I thank the Deputy for raising the matter and I wish I could be more forthcoming in my response.

Special Educational Needs.

Deputy David Stanton

I thank the Ceann Comhairle for allowing me to raise this matter and I also thank the Minister of State for dealing with it. I am raising the issue on behalf of school leavers with autism and special needs, who typically attend special schools or special classes in mainstream schools. As the Minister of State is aware, these are very special young people. They are aged about 17 or 18 and are among the most vulnerable in our country. The Minister for Finance vowed to protect them in his Budget Statement of 14 October 2008.

I have been approached by a number of parents who are very concerned about the availability of places in day service provision from next September. I have a letter from one of the service providers, which states that having attended a meeting with HSE south in April, they were informed that there may not be any new moneys available for day service places this year. Essentially, HSE south is requesting that, where possible, any new individuals requiring a day service this year should be accommodated within existing resources. Unfortunately, this is not possible as it will lead to an inferior quality of service with a much higher staff-to-client ratio that may not meet a child's needs. HSE south is still awaiting clarification — I assume from the Department — as to whether any moneys will be made available in the months ahead. However, there is now a strong likelihood that nationally many individuals will be left either without any day service at all, or perhaps one that is limited to two or three days a week. Parents tell me that would be very disruptive to their children who need a routine.

I am asking the Minister of State to give a commitment that resources will be provided so that every young person can be accommodated. Towards 2016 does give commitments in this regard, so I would ask the Minister of State to ensure that they are met. A key focus under the life cycle framework in Towards 2016 is activating people to take up employment or other activities. One of the long-term goals in section 33 states that "every person with a disability will be supported to enable them, as far as possible, to lead full and independent lives, to participate in work and in society, and to maximise their potential". For day services this implies both a fulfilling environment and developmental possibilities for those participants who want to become more independent. This in turn means that a person-centered approach and linking day services and providers into the world of wider opportunities.

While we are in challenging economic and fiscal times, we must not lose sight of where we want to get concerning the long-term goals and the development of services for people with disabilities. The need to harness all resources to achieve common ends that respond to the health, personal and social services, as well as the education, training and employment needs of people with disabilities, must be a priority.

In mid-2007, the HSE established a national review group to carry out a strategic review of HSE-funded adult day services for people with disabilities. I understand this was supposed to be completed in 12 months. Can the Minister of State tell me what is the current status of this review? I have been unable to ascertain this information.

I have been speaking to parents who are extremely worried. They say that children with autism and special needs require a routine and need to be challenged. If they are home they will be very anxious. They are young adults of 18 or 19 years, who have an intellectual level or mental age of a five year old. They cannot be left on their own but they can be helped and trained to do certain things.

I am told that about €20,000 per annum would provide a service for each of these children. At the moment, I am aware of at least seven or eight such children who are waiting to get into at least one service provider in the Cork region. I am told that this could become a national problem, but before it does I ask the Minister of State to intervene.

At this time of the year, the service providers and the special schools often enter into a transitional process whereby children can go to the service providers one or two days a week and get used to the routine. That is not happening now, however, which puts them back even further. This matter is serious and urgent because those concerned are the most vulnerable. I hope the Minister of State has good news and will act on this. I am sure he will because I have faith in him.

Deputy John Moloney

I am taking this Adjournment matter on behalf of my colleague the Minister for Health and Children, Deputy Mary Harney. I am pleased to take this opportunity to address the issues raised by Deputy Stanton. At the outset, I would like to reaffirm the Government's steadfast commitment to people with disabilities in Ireland and to the national disability strategy and its long-term goals and objectives, which we will continue to pursue in the coming years in partnership with all the key stakeholders.

As Deputy Stanton will be aware, a range of training, health and personal social day services are provided by several State agencies, including the HSE, non-statutory agencies funded by the HSE, and specialist training providers funded by and on behalf of FÁS to young people with disabilities when they leave school. A national review of all health funded day services for people with disabilities is currently being completed. This review indicates that a total of 25,302 people with intellectual disabilities, physical and sensory disabilities, and-or long-term mental health difficulties attend day services either provided by the HSE or provided by non-statutory agencies funded by the HSE. These figures include a total of 2,178.05 day places in intellectual disability services comprising 1,967.55 new places and 210.50 enhanced places funded under the multi annual investment programme 2005 to 2008.

With regard to the areas of training and, in particular, the provision of life skills training, otherwise referred to as rehabilitative training, the HSE and HSE-funded agencies provide such training services for persons with disabilities to enhance their individual level of skill, which will focus on the enhancement of an individual's care, fundamental skills, life skills and social skills. The level of outcome from rehabilitative training is not pre-determined but is dependent on the level of the development capacity of each individual. Consequently, it is important that training services are matched to the person's need. In meeting this need the HSE employs guidance officers at local level to assist in the profiling of young school leavers with disabilities to appropriate training and day services. The guidance officers work with the school leaver, their family, school authorities and service providers to ensure that school leavers with disabilities have access to appropriate services.

The co-ordination and planning of services to meet the needs of people with disabilities form a central tenet to the national disability strategy. A critical element of such co-ordination and planning is the requirement to provide financial support for the development and implementation of services.

In recent years, the Government has provided significant additional resources for services and supports for effecting real change in the development of services for people with disabilities. The multi-annual investment programme, which was a key component of the Government's disability strategy, had by the end of 2008 provided for the intellectual disability services: 980 new residential places, 313 new respite places, and 2,505 new day places. In terms of services for people with physical and sensory disabilities, 300 new residential places and 950,000 extra home care-personal assistance hours have been provided for.

As part of the national disability strategy's multi-annual investment programme, the HSE has increased the number of day places for people with intellectual disability by almost 1,500 since 2005. In addition, nearly 150 day places have had their services enhanced with the provision of additional supports to allow the places deal with school leavers or other adults with significant disabilities.

The increase in new and enhanced health and personal social services in recent years has ensured that young people with intellectual disabilities have appropriate services in place to ensure a smooth transition from secondary school. In some cases, the funding provided supported the school leavers to access appropriate day services in line with a person centred plan. Due to the current economic situation, it has not been possible to provide development funding for additional services in 2009.

Deputy David Stanton

The Minister of State is surely not being serious.

Deputy John Moloney

I am being serious. The HSE and voluntary disability service providers are working together to ensure that of the existing resources available for specialist disability, services are used in the most effective manner possible. In the current challenging economic environment, there is a responsibility on all publicly funded services to review the way in which services are delivered and ensure resources are used to maximum effect. This also applies to disability service providers in the non-statutory sector.

The aim should be to ensure that the needs of as many individuals as possible are catered for within the resources available. Voluntary agencies within the disability sector are working with the HSE to ensure plans are in place in each area to respond to the needs of individuals with disabilities in 2009. While this will be challenging in the absence of significant funding for new developments, the voluntary sector and HSE are committed to the best use of available resources in a creative and flexible manner to be as responsive as possible to the needs that present.

On the specific issue of availability of day places, the Department of Health and Children and HSE are aware of the particular needs of school leavers in September 2009. The HSE is reviewing, with service providers, whether capacity exists within current day services to accommodate the needs of some of the individuals in question.

Deputy David Stanton

Only some of them.

Deputy John Moloney

Yes, some of them. Some funding may be available within the context of the HSE's service plan to provide additional capacity in the event that existing services are not in a position to accommodate an individual's service requirements. This will be examined on a local and regional level.

The sustained enhancement of service delivery to people with disabilities, as I have outlined, is confirmation of the Government's objective to progress the disability agenda. Working together with all stakeholders in a spirit of partnership, we will continue to build on what has been achieved in terms of this Government's commitment to achieving the common goal of building a true and inclusive society.

Designated Areas.

Deputy Catherine Byrne

I thank the Ceann Comhairle for allowing me to raise this issue on the Adjournment. I wish the Acting Chairman, Deputy Charlie O'Connor, and the Minister of State, Deputy Moloney, good morning. For many people living in the Kimmage, Walkinstown, Crumlin, Drimnagh, Terenure — KWCDT — Partnership area, this is not a good morning, particularly for the 50 people whose jobs will probably be lost in the coming weeks.

This is the sad result of Pobal's decision to withdraw funding from the KWCDT Partnership. Since its inception in 1994, the partnership has worked closely with many small organisations in the community, including child care, community and women's action groups, many of which would not secure funding in normal circumstances. For many of these groups, the withdrawal of the partnership from the area will make their success stories a dream of the past. Sadly, the future of the partnership and many groups working in the area is under threat. Many of these small organisations have developed over the years through funding from the KWCDT Partnership and Pobal. The news in the past couple of days that the Minister has decided to liquidate the partnership and assume responsibility for funding partnership areas is a major blow to the community of Dublin 12, in which the Acting Chairman has a strong interest.

Despite many appeals from action groups and politicians, including members of the Fianna Fáil Party, little was done in the appeal process to enable the KWCDT Partnership to remain in place. What will happen to many of the small groups working in the area? How will they be able to continue to serve the community as they have done for the past 15 years? These vital groups, which have developed in the community, include organisations involved in child care and women's groups working with young people.

A dark cloud hangs over Dublin 12 as a result of the withdrawal of funding for the partnership. While I have had issues with many of the partnerships in the community in which I have served and worked, there is a real need for partnership, especially in the severely deprived areas of Crumlin and Drimnagh. The House has discussed cases of violence and intimidation in the Dublin 12 area on many occasions. The Minister must consider that the disbandment of the KWCDT Partnership will mean that many small groups with which it is currently associated will no longer have opportunities to facilitate young people.

I appeal to the Minister of State to give me the answers I have sought unsuccessfully for the past couple of weeks in order that I can inform people in the Crumlin, Drimnagh and Walkinstown areas about what will happen to many small groups and the 50 people they employ in the coming weeks and how we will be able to sustain some community benefits in the Dublin 12 area in the coming months.

Deputy John Moloney

I thank Deputy Byrne for raising this matter on the Adjournment. I will respond on behalf of my colleague, the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy John Curran. The local development social inclusion programme, LDSIP, is a series of measures that are designed to counter disadvantage and promote equality and social and economic inclusion. It is funded by the Department of Community, Rural and Gaeltacht Affairs and managed by Pobal on the Department's behalf.

Since January 2009, the local development social inclusion programme has been implemented locally by 37 integrated local development companies, 17 urban partnerships and two employment pacts. The integrated local development companies were formed as a result of the cohesion process where organisations delivering local development social inclusion programmes and the rural development programme merged to form single entities.

Until the end of 2008, the local development social inclusion programme was implemented by area and community partnerships. KWCDT — Kimmage, Walkinstown, Crumlin, Drimnagh and Terenure — Partnership delivered the programme in the Dublin 12 area. There have been a number of significant concerns over a period of years relating to the operation, impact and effectiveness of KWCDT's contract to deliver the LDSIP in the catchment area. Recent audits and programme reviews found significant flaws in the management of the LDSIP resources and the implementation of the programme, including financial management, governance issues, general performance of management functions and the effectiveness of the work on the ground.

Since August 2008, with the co-operation and agreement of the KWCDT board, an executive facilitator with substantial experience and expertise to undertake this work was engaged to enable the partnership address and rectify these serious issues. KWCDT was funded on a core cost basis only and was given a six month period to make satisfactory progress on the problems and issues identified.

The KWCDT board representatives met with Pobal in early March 2009 to discuss the remedial action to be taken by the company based on the audit findings and other governance issues highlighted and to discuss progress made, if any. Following this meeting, the board of KWCDT wrote to Pobal stating it was withdrawing from the local development social inclusion programme and the partnership would cease its operations and wind up the company. Following this correspondence, the Pobal board made a formal decision to discontinue the local development social inclusion programme contract with KWCDT. At the end of March the board of KWCDT wrote to Pobal appealing the decision to terminate the contract. The appeal has been brought before the Pobal board, which, on 21 April 2009, upheld the original decision to discontinue the contract. While the Minister of State, Deputy Curran, has met with the board of KWCDT, he sees no reason to intervene in the original decision taken.

The Department of Community, Rural and Gaeltacht Affairs is committed to the provision of full county coverage of the LDSIP, through targeting the most deprived communities and is preparing plans for the continuation of services to the KWCDT geographic location to ensure the front-line services previously provided by KWCDT Partnership and Drimnagh CDP, its hosted project, are protected. The Minister of State has been informed that Pobal is in discussions with his departmental officials to progress matters in this regard.

Urban Renewal Schemes.

Deputy Aengus Ó Snodaigh

Ba mhaith liom buíochas a ghabháil leis an gCeann Comhairle as ucht na ceiste seo a roghnú. Dolphin House in my constituency is in the news in recent days for all the wrong reasons. What has been in the news is a slight on the good people of Dolphin House who are normal people struggling to live normal lives but, because of neglect by the State over many years, have many things to cope with, not just the problems of the past two days. There are many problems such as sewage, drug problems, poor housing and the siege of the area, not only in the past two days but for quite a long time, by drug dealers who have made their community a misery.

This area and the people living there had built up their hopes in recent years. They reorganised the community and much good work was done to try to ensure when regeneration occurred, everyone in the community would benefit. Such was the enthusiasm for the planned regeneration that people in the community were involved in a door-to-door canvass of every household to find out what people's preferred options were and ask them for ideas. There was a significant response which was much higher than in many other areas which have been socially disadvantaged. Most people said they would prefer the complex be demolished and a new Dolphin House or community be rebuilt on the site. Other issues raised in the canvass were the protection of the community and the need to tackle the increasing anti-social behaviour in the complexes, especially in block 2 and subsequently in block 4. There was a need, in the meantime, for Dublin City Council to increase its repair and maintenance work in the area.

Such was the scale of the changes, anyone visiting Dolphin House now would not recognise it from the late 1980s or early 1990s. The community has reorganised and there is much work being done for young people. Despite this, hopes have been dashed because the regeneration programme, given the current economic circumstances, seems to have been stalled. My appeal is for those hopes to be regenerated and for some message from the Government to say it has not forgotten the community and is still on track with the regeneration of Dolphin House.

As a symbol of the stalled process, if one goes into Dolphin House there are brand new portakabins where the old community centre was and they have been there for a number of months waiting on Dublin City Council to connect them to the sewage system. Months have passed and it has not happened. A simple thing such as that would mean the community could use the brand new facilities it has.

I urge the Minister of State, Deputy Moloney to send out a message of hope to the community so it does not feel isolated and totally under siege by the thugs who have tried over recent nights to destroy the reputation and good work in the area. Some 30 cars were damaged one night with a riot the following night and subsequent disturbances. It is not a positive message of regeneration. I appeal to the Minister of State to work with the Minister for Justice, Equality and Law Reform, Deputy Dermot Ahern, to send out a message that the community will be protected because in recent nights the thugs have specifically targeted those who have been working to build up the community and ensure young people in Dolphin House have hope.

Only two days ago I attended the launch of a report on the health of the community and, again, it reflected what we already knew. Those who are disadvantaged have major health problems which are exacerbated by poor living conditions and anti-social behaviour. There is an opportunity for the Minister of State, elected representatives and Dublin City Council to send a message out that they will stand by the community and ensure the good work that has been carried out in recent years will not be left to go to rack and ruin, that there is potential in the area, they will help re-start the regeneration project and work will take place.

Deputy John Moloney

The Minister for the Environment, Heritage and Local Government, Deputy John Gormley, understands from inquiries made that increased Garda activity in the vicinity of Dolphin House has led to a serious and quite sinister spate of anti-social behaviour and criminal activity, including vandalism of cars, daubing of graffiti and threatening behaviour. The Minister commends the members of the Garda Síochána on their diligence in carrying out their duties and the members of the general community in the Dolphin's Barn area who rightly support the Garda in its efforts to address anti-social behaviour and criminal activity engaged in by very small numbers of people in the area. Furthermore, he wishes to record his condemnation of those involved in this sort of activity who, purely for their own capital gain, seek to undermine the Dolphin's Barn community.

Community is and always has been the bedrock of society and its development, encouragement and protection are paramount in this Government's policy of sustainable communities. There is a very clear objective to ensure communities in all parts of the country are afforded the opportunity to grow and develop in a safe environment and to enjoy the protections afforded by the laws of the land. The Housing (Miscellaneous Provisions) Bill 2008, which has been passed by the Seanad and is on Second Stage in this House, is an important legislative milestone in the ongoing development and implementation of housing policy and in progressing the sustainable communities agenda.

Of particular importance are the new provisions in the Bill relating to anti-social behaviour in the social housing stock. There is a new requirement that the elected members of each authority must adopt a strategy for the prevention and reduction of anti-social behaviour in its housing estates and complexes. The strategy must set out measures to promote good estate management and co-operation with other bodies, such as the Garda, that have a role to play in combating anti-social behaviour. The new strategies, combined with statutory initiatives to promote consultation between the Garda and local authorities, will help secure a multifaceted approach to dealing with instances of anti-social behaviour in local authority housing estates.

The definition of anti-social behaviour in the Bill is also being extended to cover graffiti and damage to property to bring it more into line with the approach in recent legislation relating to behaviour orders that may be sought by the Garda. Furthermore, the Bill extends the existing anti-social behaviour powers of housing authorities to cover a broader range of accommodation, including accommodation provided through rental or leasing arrangements.

In conjunction with the Office of the Attorney General, the Minister is also looking at the scope for further changes to existing legislation that will enhance the role of housing authorities in addressing anti-social behaviour. He will incorporate any further measures that he possibly can arising from this examination when the Bill reaches Committee Stage in the Dáil.

Regarding the issue of a regeneration programme for Dolphin House, the Department of the Environment, Heritage and Local Government has not yet received a proposal in this regard from Dublin City Council. However, the Minister understands proposals are being developed and the project is at an early stage in the process, with initial consultations between the city council and community nearing completion. It will then be up to Dublin City Council to decide on the type of regeneration process most appropriate for the area and decide by which means the project should be delivered. However, it is open to the council to prioritise the project in terms of its social housing investment programme and submit a report in the usual way to the Department for project approval and funding from the within the authority's annual funding allocation.

I emphasise to the House that the Department of the Environment, Heritage and Local Government continues to work actively with Dublin City Council in connection with its broad range of housing programmes. In that context, the Minister looks forward to continued engagement with the council as it develops and implements its ambitious programme of regeneration. I thank Deputy Ó Snodaigh for raising the issue.

The Dáil adjourned at 12.50 a.m. until 10.30 a.m. on Wednesday, 29 May 2009.