Adjournment Debate.

Hospital Services.

Deputy James Bannon

I thank the Office of the Ceann Comhairle for allowing me time to raise this urgent matter, namely, the need for the Minister for Health and Children to clarify her position on the Midlands Regional Hospital, Mullingar. I would like her to assure me this evening that the withdrawal of services from the hospital and the refusal of scan and X-ray services to public patients are not indicative of the closure of the hospital by stealth. The hospital is a valuable and much-needed health facility for the midlands.

What exactly are the Minister's plans for the hospital? The completion of phase 2B at the hospital must be one of the longest sagas of inefficiency on the part of her Department, despite the ring-fencing of €57 million for the hospital 12 years ago. This sum has ended up being drip fed over the past 12 years and work has not been completed to date. Longford-Westmeath was assured services in the area would be fully supplied and remain at the hospital. However, among other cutbacks, the breast cancer unit was withdrawn in November 2007, 25 beds have been closed at the hospital, front-line staff numbers have been reduced, budgets have been cut, transport vouchers have been withdrawn and now post mortem services are to be redirected to Tullamore hospital. Scans and X-rays are apparently unavailable for public patients and lives are being put at risk.

Last September, the HSE supported the issuing of bogus appointments for a consultant dermatologist in a department that did not exist at the hospital. This meant seriously ill patients were being given appointments for a consultant who had left the hospital six months previously. A new consultant had not been appointed and the department was effectively closed. Appointments were cancelled at the last moment and patients were strung along in a blatant cover-up.

I draw the attention of the Minister of State, Deputy Connick, to the latest health-threatening cutback at Mullingar hospital. I ask that a full investigation be carried out by the Minister for Health and Children in regard to it. Public patients are being refused scans and X-rays at the hospital and it is alleged that general practitioners are being forced to refer patients to Dublin hospitals on a private basis. This is putting the gun to the heads of vulnerable patients, who are, once again, being forced to put their hands into their own pockets to avail of necessary procedures.

It is scandalous that the Department of Health and Children is putting in place measures to ensure patients must either go without investigative procedures or pay privately for scans or X-rays. If this is a deliberately orchestrated response to general practitioners' referrals, the Minister should consider her position. If it is the case, I will accept nothing less than a resignation from her because she is totally incompetent and inefficient in her administration of the health service.

Irrespective of whether this scandal is geared to close the hospital by stealth or not, it should be thoroughly investigated. If this is happening in Mullingar Regional Hospital, then the chances are that this directive is in place around the country. Longford lost its hospital, which was closed in 1986. Guarantees were given that a full service would be available to all in Mullingar. This is not proving to be the case. Longford-Westmeath relies on this valuable hospital, which is one of the top performing hospitals in the country. It must be supported by the HSE in an open and fully transparent manner, with all the necessary services being provided.

I stress that a deliberate and cold-hearted campaign of axing services in Mullingar Regional Hospital, to the detriment of the health of the people of Longford-Westmeath will not be tolerated and questions must be answered by the Minister.

Why are patients being denied life-saving procedures? Why is it that under this Minister's watch patients' lives are continually being put at risk in this hospital? I demand answers here this evening.

Minister of State at the Department of Agriculture, Fisheries and Food (Deputy Seán Connick)

I thank the Deputy for raising the question which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Midland Regional Hospital at Mullingar, MRHM, is part of the Dublin Midlands Hospital Group. The aim of the hospital is to deliver a quality-driven, people-centred service to the population of Dublin-Midlands and in particular the Longford-Westmeath area.

The Deputy's question assumes there has been a withdrawal of services at Mullingar Hospital and also a refusal to provide scan and X-ray facilities to public patients. The HSE has confirmed that there has been no withdrawal of such services at Mullingar. On the provision of scan and X-ray facilities, a recent nationwide survey conducted by HSE HealthStat revealed that access to radiology for urgent cases in the MRHM catchment area is the best in the country. This is achieved through the diligence of the radiologists in the Department reviewing individually every request for CT, MRI and ultrasound, and prioritising them. While this can be a very time-consuming process, it is considered to be an efficient and effective process by the consultant radiologists at Mullingar hospital.

The trend in modern medicine practice is to use more and more investigation. From a clinical perspective, not all of this is considered to be helpful. However, a consultant radiologist at Mullingar has indicated that in many cases GPs' requests can be unnecessary, resulting in the waiting times for more appropriate examinations taking longer than necessary. Consultant radiologists at Mullingar hospital return a number of requests to the referring doctor for various reasons, usually because the test requested is inappropriate for the clinical problem. This practice applies to requests from both general practitioners and internal requests from doctors in the hospital.

I am informed that, for example, international evidence shows that in the case of back and neck injury presentations, unless there is evidence of neurological damage, the use of imaging is not indicated. Inappropriate requests are not accepted for scans on any patient, whether public or private, at the hospital. The HSE has categorically confirmed to the Department that all patients, both public and private, are treated equally for the purposes of radiology requirements at Mullingar Hospital.

Where scans are available from private providers, the criteria used to decide whether they are required may be different. This could give the mistaken impression that these private patients are getting a better service.

The activity and volume through the radiology department at Mullingar hospital is constantly increasing year on year. The position on radiological tests at the hospital during 2008 and 2009 is an increase of 2.5%. I am confident that services at the Midland Regional Hospital Mullingar are designed to deliver the best and most appropriate services to all of its patients and will continue to do so into the future.

Deputy Seán Sherlock

I should say at the outset that Cobh community hospital is a facility that is very well-regarded by the people of Cobh. I have been asked by my Labour Party colleagues on Cobh Town Council to raise this issue as a matter of urgency because there is a situation whereby the National Treatment Purchase Fund has taken over the fair deal scheme as it relates to Cobh hospital. That will have serious permutations for the cost per patient per week in that it is stated that the possible drop in fees from €1,200 to €800 per bed per week could result in a serious deficit. Obviously a deficit in funding would have an impact on the ability of the patients to remain within the hospital in the first instance, but also severely impact on the hospital's ability to take in new patients.

It is a 38-bed hospital and there are approximately 40 staff. What goes to the heart of this is the issue whereby care for our older people who are in community-based facilities is being eroded by this Government through a process of stealth. The Government's model of health care is about rolling back the State and these wonderful community-based facilities so that they may be completely and utterly subsumed into a private nursing home model, thereby rolling back the stakesholdings that communities have within these hospitals which make them the excellent facilities they are. It is all being done under the wonderful guise of HIQA rules and the fact that these institutions are older. Anything that is deemed to be older in this new paradigm we have with this Government is deemed not to be of sufficient standard.

I want to speak for hospitals such as Cobh, the welfare home in Youghal and Nazareth House in Mallow, all of which provide an excellent standard of care, but are now under threat because of the new rules that have come into play through the fair deal scheme and the new punishing HIQA standards. All I want to do here is make the case for Cobh community hospital, in that it is an excellent facility. There is a significant buy-in from the people of Cobh into this hospital. The staff coterie is very loyal to the hospital. The patients there are happy, and I would hope the Government ensures the continuation of this hospital in perpetuity, especially for the older people of Cobh who will use it, hopefully, into the future.

Deputy Seán Connick

I thank Deputy Sherlock for raising this issue which relates to the nursing home support scheme, a fair deal. The scheme commenced on 27 October 2009 and the HSE is now processing applications.

The scheme was introduced in order to address the fundamental inequity in the treatment of public and private long-term nursing home residents and in order to alleviate the financial hardship being experienced by long-term residents in private nursing homes. Prior to the introduction of the scheme, many people in long-term nursing home care experienced unaffordable care costs over periods of many years. The result was that many people had to sell or remortgage their houses or had to turn to family and friends in order to find the money to meet their care costs.

A fundamental purpose of the new scheme, therefore, was to offer assurance to one of the most vulnerable groups in society — those in need of long-term nursing home care — that such care will be affordable and will remain affordable for as long as they need it. In order to achieve these objectives of equity and affordability, the new scheme involves a fundamental change in the way in which long-term nursing home care is funded and, consequently, the way in which nursing homes and community hospitals are funded. In the past, many of these facilities were allocated a lump sum annually. In contrast, the new scheme supports the individuals in need of long-term residential care, not the facilities providing the care. This means that funding follows the patients, regardless of whether they choose a public, private or voluntary nursing home, and ensures that these facilities are not being funded for empty beds.

In order to qualify for the scheme, all private nursing homes, including Cobh community hospital, must negotiate and agree a price for the cost of care with the National Treatment Purchase Fund. This is a necessary feature of the scheme due to the commitment by the State to meet the full balance of the cost of care over and above a person's contribution. As stated above, the nursing homes support scheme only applies to long-term nursing home care. Nursing homes and community hospitals can continue to have separate agreements with the HSE for the provision of other services, for example, day care, respite and convalescence.

Finally, the Government is committed to developing a financially sustainable funding model to support all long-term care services, both community and residential care services. It is envisaged that this work would also encompass short-term residential care such as respite and convalescence care. This commitment by Government was made in the social partnership agreement, Towards 2016, and preliminary work has commenced within the Department of Health and Children on the analysis of funding models.

Human Rights Issues.

Deputy Joe Costello

I am pleased to have an opportunity to raise this issue on the Adjournment.

I understand the OECD is planning to confer member status on Israel at its next meeting on 10 May, and that our Government will be supporting this move. I already raised this matter with the Minister at the Joint Committee on European Affairs, and the committee, at my request, wrote yesterday to the Minister protesting against Ireland's support, as a member of the OECD, for Israel's becoming a full member in the present circumstances. The road map for the accession of Israel to the OECD Convention, which was adopted in November 2007, states:

The Council reaffirms that OECD Membership is committed to fundamental values, which candidate countries are expected to share. These fundamental values serve as the foundation of the like-mindedness of OECD Members and have been expressed in various OECD Ministerial Communiques. [. . .]

These fundamental values include a commitment to pluralist democracy based on the rule of law and the respect of human rights, adherence to open and transparent market economy principles and a shared goal of sustainable development.

The key phrases here are "pluralist democracy" and "respect for human rights". If we now give our imprimatur to Israel’s accession, we are effectively saying that we acknowledge that Israel is not in breach of human rights in its relations with the Palestinian people and that it is a pluralist democracy.

I will quote one or two things the Minister for Foreign Affairs, Deputy Martin, has said in this regard. He wrote in The New York Times on 5 March this year:

I view the current conditions prevailing for the ordinary population [in Gaza] as inhumane and utterly unacceptable, in terms of accepted international standards of human rights. . . . I genuinely believe that the medieval siege conditions being imposed on the people of Gaza are unacceptable.

In December 2009, the Minister described Gaza as "an open prison". If that is the view of the Minister — which presumably reflects the view of the Irish Government — how can he back Israel's OECD membership? The decision is to be made on 10 May. The only way to address this would be for the Minister to raise at that meeting the issues and concerns that have been expressed throughout Ireland, including the invasion of the Gaza strip in December 2008, which continued into January 2009, and the fact that since then Gaza has effectively been an open prison, as the Minister said — actually, a closed prison. A total of €4.5 billion in funding has been collected from the international community, including the Quartet. Israel will not allow people to move freely from Gaza; nor will it allow any repairs, development or construction work to take place. The proper response would be for the Minister to argue, on Ireland's behalf, that this matter should be postponed and no decision should be taken until there is clear, demonstrable proof that Israel will fulfil its human rights obligations under international law — obligations that are part and parcel of the accession process to the OECD. Failing that, Ireland should dissent from the decision on Israel's accession to the OECD.

Deputy Seán Connick

I thank the Deputy for raising this matter on the Adjournment. The Minister for Foreign Affairs appreciates the opportunity afforded by this debate to address on the floor of the House these matters, to which the Minister has replied in several parliamentary questions over the last week or so, including a reply issued today to a written parliamentary question tabled by Deputy Costello. The Minister welcomes the engagement of the Oireachtas on this matter as well as that of civil society organisations, several of which met with our ambassador to the OECD in Paris last week, and others who will meet officials from the Department of Foreign Affairs during the course of next week.

In June 2008, at the annual Association Council meeting with Israel, the EU agreed in principle to further enhance its relationship with Israel. The EU restated this agreement in principle at its December 2008 External Relations Council. Ireland agreed with this decision, but acted with other member states to ensure that the decision of the External Relations Council included a clear linkage to the EU's political concerns in the region, especially progress on the peace process.

Following the Gaza conflict, Ireland and other member states argued that for the EU to proceed at this time with the proposed upgrade would be open to misinterpretation, both in the wider Middle East region and in Israel itself. In June 2009 the Council agreed that the time was not right to proceed with the upgrade. This remains the position for now. It is the Government's view that nothing has happened to alter that decision. For practical purposes, co-operation with Israel continues to be guided by the existing action plan.

With regard to the proposed accession of Israel to the OECD, it should be recalled that the OECD has periodically enlarged its membership since its foundation in 1961 with 20 members, including Ireland, to its current membership of 30. In 2007, the OECD ministerial council meeting decided, by consensus, to open accession discussions with five countries, including two EU partners: Estonia, Slovenia, Chile, Israel and the Russian Federation. The OECD accession process involves submission of an initial memorandum which sets out the country's position on more than 200 OECD legal instruments, and technical accession reviews by 22 OECD committees assessing the country's compliance with the OECD acquis — that is, the organisation’s standards for multilateral co-operation. These obligations include liberalisation commitments under the OECD investment instruments, adoption of national laws which comply with the requirements of the OECD anti-bribery convention, and commitments related to environmental policy. A final decision is made by the Council of the OECD to invite the candidate country to accede.

An invitation to accede to the OECD is based upon the applicant country's compliance with the organisation's acquis and does not relate to or imply approval for other actions or policies of that state. This is a very important point, which must be emphasised. Agreeing to an application from a particular state to accede to the OECD does not in any way indicate the OECD’s approval of other policies or practices of the country concerned. What the 30 members of the OECD are acknowledging is that a successful applicant is in compliance with the organisation’s acquis.

An accession agreement with Chile was signed on 11 January of this year and it will accede formally to the organisation once ratification procedures are completed. It is expected that Slovenia, Estonia and Israel will complete their accession procedures this year. The accession process for Russia is moving at a slower pace and there is currently no predicted date for completion. In the case of Israel, on the basis of formal opinions and all other relevant technical information, the Secretary-General of the OECD has recommended to the OECD council that Israel be invited to accede to the organisation. It is expected that the OECD council will address this matter over the weeks ahead.

Throughout the Israeli accession negotiations, the EU has adopted a cohesive approach. It plans to issue a common statement at the OECD council when a decision to formally invite Israel to become a member is taken in the coming weeks. It is anticipated that the EU will note that Israel has taken a number of important steps forward through the adoption of new legislation, regulations and policy directions in many areas, including anti-corruption measures, the environment, competition and intellectual property rights. It is also likely to state that Israel is expected to demonstrate readiness for compliance with the recommendations made by OECD bodies in the accession process and to pursue reforms, especially in areas in which implementation periods were granted or commitments have been undertaken.

On one issue of particular sensitivity — that of statistics on Israel — the following footnote will appear in all OECD documents which include statistical data on Israel:

The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.

The use of this footnote will be formally agreed in an exchange of letters between the OECD and Israel which will be signed this evening in Paris. Taking all requirements of the accession process into consideration, the Minister for Foreign Affairs expects that Ireland will join the other 29 members of the OECD in formally inviting Israel to become a member. Upon acceding to the OECD, Israel, like all new members, will be subject to vigorous and objective peer review processes across a range of areas, including potentially sensitive ones such as labour standards and issues relating to income inequality and discrimination. We will work with partners in ensuring that Israel fully complies with all the obligations arising from OECD membership.

Schools Building Projects.

Deputy Joan Burton

Tyrellstown in Dublin 15 is a vibrant community of over 2,000 houses and apartments built over the past eight years. It now has a population in excess of 5,000, many of them children. Many people will only have heard of Tyrellstown as a consequence of the tragic recent killing of one of its young residents, Toyosi Shittabey, a Nigerian born 15 year-old who was raised in Ireland and had promise as a footballer and athlete.

For the past eight years, successive Fianna Fáil Ministers for Education and Science have promised that significant new developments like Tyrellstown would get primary and secondary schools. After seven years, a permanent site for two primary schools was acquired in January 2010 at a cost of over €4 million. This seven acre site is intended to house Tyrellstown Educate Together and Mulhuddart national school. When will permanent buildings for these primary schools be built? These fine primary schools are in many ways the soul of their communities. It is a false economy to accommodate students in temporary buildings paid for by the Department of Education and Science.

A permanent secondary school building is also urgently needed for this community. The Department does not seem to have considered providing a new secondary school even though approximately 150 children graduate local primary schools every year and are dispersed widely across Dublin 7 and Dublin 15.

Tyrellstown is a fine, multicultural community and it is in shock at the killing of Toyosi. The lack of a second level school means that pupils who have been educated together in their local primary schools are dispersed when they go to secondary school. At a time when integration is really important, it is an appalling commentary on the Government and the Department that the community has no permanent primary school, secondary school, community facility or playing fields. This is a community full of soccer and GAA mad children. If we want a genuinely integrated community of Irish people and new Irish people, it is critically important that we educate children of diverse backgrounds together. Facilitating children growing up and playing sports together is the best way of ensuring integration for children and their parents.

A secondary school with a gym, sports hall and playing fields is taken for granted in many smaller communities. When will Tyrellstown get the resources it needs and deserves? Ireland was shocked by the death of Toyosi. There was a huge outpouring of support and sympathy for his family and friends. GAA and other sports clubs are working on the ground without facilities.

Many people in Tyrellstown bought their houses at the height of the Celtic tiger and are paying huge mortgages as well as their taxes. They deserve to see their tax money spent on much needed facilities for their children at primary and secondary level. Millions of euro in development levies were paid by people who bought their houses in Tyrellstown, yet this Government cannot provide the basic community facilities these levies were supposed to fund.

I seek a clear timetable for the construction of these schools. I see no reason that work cannot commence on these schools or steps taken to acquire a site for a secondary school and associated playing fields. The secondary school could be started on a temporary basis in the vacated prefab primary schools while the permanent building is being constructed.

The Minister of State at the Department of Education and Science, Deputy Mary White, and her ministerial colleagues expressed sympathy for the community after the death of Toyosi. These expressions were well meant but how can a community of 2,000 houses and 5,000 people be left without permanent facilities or opportunities for teenagers to play sports and attend school together? That is not a recipe for integration.

Deputy Seán Connick

I am replying to this matter on behalf of my colleague, the Tánaiste and Minister for Education and Science, Deputy Mary Coughlan. I thank Deputy Burton for raising this matter as it affords me the opportunity to outline to the Dáil the process being utilised to ensure that there will be adequate accommodation in schools at primary and post-primary levels in all parts of the country.

The forward planning section of the Department of Education and Science utilises the latest in geographical information system, GIS, technology to assist in planning school requirements in the future. The GIS contains geo-coded information on all schools in the country at primary and post-primary level. This information is linked to the relevant demographic information for those areas, which typically is supplied from the Central Statistics Office's census data, the general registrar of births, the Department of Social and Family Affairs, An Post's geo-directory and information supplied by local authorities through development plans. Growth projection figures are applied to the existing population with a view to assessing future requirements and identifying the areas experiencing highest growth at primary and post-primary level. In addition, there is ongoing liaison between the Department and local authorities to establish the location, scale and pace of major developments and their possible implications for school provision.

The forward planning section of the Department is in the process of carrying out detailed analysis of over 40 locations of highest population growth in order to identify the school accommodation requirements up to and including the school year 2014-15. Given the increase in the birth rate in recent years, the initial focus of this analysis is on primary accommodation requirements and this will be followed by a more detailed analysis of post-primary accommodation requirements. Overall school accommodation requirements in the Tyrellstown and Mulhuddart areas, including requirements for additional post-primary accommodation, are being considered as part of this process. However, the Deputy will be aware that a new post-primary school with capacity to accommodate 1,000 pupils is currently under construction in Phibblestown and this should assist in easing accommodation pressures at post-primary level in the Tyrellstown-Mulhuddart area in the short term.

Deputy Joan Burton

That is a completely different area.

Deputy Seán Connick

The Deputy will be aware that the Department, under the terms of the Fingal model agreement, requested Fingal County Council to acquire a number of sites in the council's administrative area, including a site for Tyrellstown Educate Together and Mulhuddart national school. Following the recent acquisition of a site by the county council, the previous Minister included both schools in the announcement of 16 February 2010 on the appointment of a design team. Since February, departmental officials have held preliminary discussions with the local authority in regard to the schools. Template drawings for the project have also been prepared and a tender competition for the appointment of a project manager and design team is under way. Following completion of this competition, a contract will be awarded and it is anticipated that the project will progress through the design and construction phase as soon as possible thereafter.

Any further proposed building projects required arising from the forward planning section's analysis will be considered in the context of the Department's multi-annual school building and modernisation programme for 2010 and subsequent years. However, the House can rest assured that the Department is fully aware of the rapidly developing nature of the Dublin 15 area, including Tyrellstown, and the associated demands for school places.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Wednesday, 5 May 2010.

Dáil Éireann díospóireacht - Thursday, 29 Apr 2010