Dáil Éireann díospóireacht -
Tuesday, 5 Oct 2010

Vol. 717 No. 2

Adjournment Debate

Infectious Disease Screening Service

Deputy Deirdre Clune

I am glad to have the opportunity to raise this issue and to get a response from the Government on possible changes to TB services, particularly in the Cork region and particularly in regard to screening and the administration of the BCG vaccine. I raise this issue because towards the end of August there was an outbreak of TB at Crab Lane national school, Ballintemple, which resulted in the return to school being postponed for a week while the HSE notified parents, children and staff. There are 220 children in the school and the HSE initiated a screening process, the end result of which was that 31 pupils and three staff tested positive for latent TB and six pupils tested positive for active TB. Anyone who knows someone who has been diagnosed with TB in even its latent form will know it requires a dose of antibiotics for a minimum of six months, and we are talking about children in this case.

This is the second outbreak in Cork in recent history. In 2008 there were two outbreaks in crèches when 15 children and two adults were affected, and hundreds of children required X-rays and antibiotics.

While I have never received a definitive answer as to whether it was a policy decision based on prevention or for a financial reason, the administration of BCG vaccines to newborn children was discontinued in the 1970s. My children, many children of their age and many children currently of school-going age did not receive the BCG vaccine as a routine act when they were infants. In 2008, however, the BCG vaccine was reintroduced and the result is that we now have lengthy waiting lists. I have asked the Minister, Deputy Harney, the number of children awaiting the BCG vaccine, which is provided to newborns in the maternity hospital at present, and she has forwarded the question to the HSE. The figures for the Cork region are above average. Does the Minister believe this is because the BCG vaccine was not available?

There is also the issue of whether the screening process should be extended. Revised guidelines which recommended the extension of screening were proposed to the HSE. I would like to hear from the Minister of State whether there is any intention to revise and expand the screening process. The chief medical officer has requested that the HSE would provide information to him regarding the routine administration of the BCG vaccine.

There is concern among parents, not just those of children in this school and their community but in the wider Cork community, that TB services have not been up to the same standard provided throughout the rest of the country. A consultant, Dr. Cathal Bredin, was quoted in the media as stating he believed there were still hidden reservoirs of TB in the Cork region which would account for the kind of sudden outbreak that occurred in August. I wish to express the concern of parents and the community in Cork that services would be provided to prevent TB outbreaks and to ensure that children are immunised against TB. The BCG vaccine has proven effective against 70% to 80% of TB strains, so it is very important. It is also national immunisation policy that the vaccination would be provided as a matter of course.

There was no recent outbreak of TB prior to 2008. I would like the Minister of State to address that issue and also the issue of whether screening for TB is to be extended.

Minister of State at the Department of the Taoiseach (Deputy Dara Calleary)

I am taking the Adjournment on behalf of the Minister for Health and Children, Deputy Harney. I thank Deputy Clune for raising this matter as it provides an opportunity to outline to the House a number of issues in this area.

As the House is aware, TB remains a significant cause of morbidity and mortality worldwide. An estimated 9.3 million new cases were reported in 2007, of which 7.8 million were detected in Asia and Africa. The first national survey of TB in Ireland in 1952 gave a notification rate of 230 cases per 100,000 population. A downward trend was sustained until 2001, with a rate of 9.7 per 100,000 population, after which cases remained stable with minor fluctuations in annual figures thereafter.

The National Immunisation Advisory Committee recommends that BCG for newborns be continued. The Deputy will be aware that in Cork for a number of years the BCG vaccine was offered to newborns who were at risk of developing TB, namely, babies whose parents or siblings have a history of TB, whose parents work in a health care setting with patients affected by TB, whose parents come from countries where there is a high incidence of TB and children intending to visit high incidence countries for more than one month. The BCG vaccine was also given to the child contacts of confirmed TB cases.

In recent years, the practice in Cork was reviewed and a commitment was given by HSE South that all newborn babies in Cork would, from October 2007, be routinely offered the BCG vaccine against TB. Due to the increase in demand for BCG vaccination in 2007, HSE South as an interim measure ran a number of additional clinics during the summer period. In parallel with this interim measure, plans had been put in place in regard to the commencement of offering routine neo-natal BCG vaccinations in conjunction with Cork University Maternity Hospital.

A difficulty with the supply of vaccine in Ireland and across Europe emerged in October 2007. The supply shortage was due to technical difficulties at the manufacturer's laboratory and resulted in a European-wide shortage of this vaccine. This manufacturer was the only company which supplied the vaccine to the European market. While some vaccine was in stock, the shortage in supply meant that clinics were not held in HSE South during November or December of 2007. The issue was subsequently resolved in April and May of 2008 and the supply of vaccine recommenced in the Irish market.

On 13 October 2008, the HSE proceeded with the commencement of the neo-natal BCG programme in Cork University Maternity Hospital. Protocols with regard to the availability of information leaflets and the issuing of consent forms have been agreed with Cork University Maternity Hospital staff. This has enabled the HSE to introduce a BCG vaccination programme as a routine measure to newborn babies whose parents request it. In addition to the above clinics, the HSE will continue to provide vaccinations to deal with older children on a priority basis.

The Minister is very concerned about the recent outbreak of TB in the HSE South area. The HSE established an outbreak control team to manage the situation in accordance with the guidance report of the National Immunisation Advisory Committee. Cases of active and latent TB found have been referred for appropriate treatment and follow-up care. All involved with the school have been reassured that, first, the children with active TB are on treatment and are not currently infectious; second, children or staff with latent TB infection are not infectious and, third, other children or staff are not at risk from contact with either the cases of active TB or of latent TB.

In order to assess the position fully, the chief medical officer of the Department of Health and Children immediately requested the HSE to provide clarification and information regarding the routine administration of BCG in all regions of the country. It also requested it to identify areas where this is not the case and specify what arrangements are being made to deliver these services with a timescale for implementation. The HSE has also been requested to plan for the undertaking of an ongoing audit of the delivery of BCG and TB services throughout the country.

Health Services

Deputy Joe Costello

That a budget should introduce a 50 cent levy on every item prescribed for medical card holders is the unkindest cut of all. The danger is not the quantity of money involved, but the category of patient covered. Many of the people who fall into such categories could easily find their situations deteriorating because of the bureaucratic process envisaged in the system. This provision covers a range of seriously ill, mentally ill and physically challenged people, including the terminally ill, those in nursing homes, recovering addicts, people in receipt of palliative care, diabetics, old age pensioners, Alzheimer's sufferers, the homeless and so on.

The category about which I am especially concerned is psychiatric patients. Clearly, this is an erratic category and such patients find dealing with change difficult. The greater burden of requirement placed on them by the new system will make ensuring they get and take their medicine more difficult. The idea that psychiatric patients must attend a general practitioner before a chemist seems outrageous. It inserts an extra layer of bureaucracy and is an obstacle to them. Apparently, the reason is that the GP must put a description on itemised General Medical Services, GMS, scheme paper. This is done for the purpose of dealing with the matter officially. I see no reason to bring the GP into the scenario. Why could this not be done in the chemist? There is no such thing as a standard, but going to the chemist is part and parcel of the well-worn path towards getting medicine to which mentally challenged patients are used. Sticking the GP in the middle of the process means many patients will not do it. Add to this the burden of a 50 cent levy and they will be confused and frustrated. Obstacles are being placed in their way. The danger is that many people who are seriously psychiatrically challenged will not take their medicine. This will also be the case with homeless people, alcoholics and drug addicts. Many categories of people will find taking the extra steps prescribed by the 50 cent levy difficult.

The Minister is expecting to get €25 million out of the levy and there is a cap of €10, but more than €25 million will accrue because there are many prescriptions being handed out that should not be. I am most concerned about the layer of bureaucracy being placed in front of medical card holders. Will the Minister review the levy to determine whether people could avoid the extra visit to the GP and whether the levy is appropriate to people who have difficulty dealing with the basics of getting their medicine without needing to jump through hoops?

Many carers were involved in the GMS scheme but no one who applies for carer's allowance will get the scheme. The caring side is deteriorating, as are the respite care and home help sides. The level of support is reducing constantly. We will find that people will not be able to meet the requirements and this will have serious implications for their health. Will the Minister of State review the 50 cent levy, particularly in respect of the categories to which I referred?

Deputy Dara Calleary

As the House knows, the Minister has introduced a prescription charge of 50 cent for prescribed items dispensed to medical card holders subject to no person or family paying more than €10 per month. The prescription charge seeks to influence demand and prescribing patterns in the GMS scheme in a modest way. Prescription charges do not apply to children in the care of the HSE who have their own medical card, to the long-term illness or drugs payment scheme, to those who receive services under the Health (Amendment) Act 1996 or to methadone supplied to patients participating in the methadone treatment scheme.

Approximately 1.6 million people have medical cards. HSE data for 2008 indicate that only 2% of families with a medical card had 20 or more items per month prescribed to them. Therefore, the Minister expects that only a small minority of families with a medical card will need to pay the €10 per month maximum charge.

Prescription charges are part of a set of key actions to achieve greater value for money in pharmaceutical expenditure. These include off-patent price cuts, reductions in wholesale and retail mark-ups that have been introduced and the preparation of legislation on reference pricing and generic substitution, which is under way.

The cost of the GMS scheme, including payments to pharmacists and GPs, is projected to be more than €2 billion in 2010. The number of items dispensed to medical card holders increased between 2004 and 2009 by more than 15 million to slightly more than 50 million items. This rate of increase, an average of 12.5% each year over six years, in the cost of supplying drugs and medicines is not sustainable. Based on trends in previous years, it is expected that the prescription charges will yield €24 million in a full year or approximately €2 million per month. Every saving achieved by the HSE will reduce pressure on funding for front-line services, including hospitals, home help and home care packages and mental health and services for people with disabilities and their families. It is important in our current financial situation that we take every step possible to provide public services efficiently, limit costs to the greatest extent possible and involve the users of resources in understanding better the value of those resources and their appropriate use. The Minister has committed to keeping the implementation and impact of the charges under constant review. I will refer the Deputy's specific concerns regarding psychiatric patients to her for a direct response.

State Airports

Deputy Timmy Dooley

I thank the Acting Chairman for the opportunity to share time with Deputy Joe Carey. I also welcome the opportunity to contribute to this debate. Shannon Airport is a vital cog in the infrastructure of County Clare, the mid-west and west. It has provided employment for many families throughout the region and created the conditions for the development of the Shannon free zone as a base of foreign investment that has created and retained many jobs in Shannon, Limerick, Galway, Ennis and further afield. Shannon Airport has opened the region to tourism, which created jobs and allowed people to find gainful employment in many rural communities. In particular, it has protected employment in villages and our county's population.

Shannon has faced many challenges in its long history. Aviation has changed and so has the airport. It now faces a new challenge brought about by the recession. Passenger numbers have dropped to 1999 levels to approximately 1.7 million. In 2006 and 2007, Ryanair services drove passenger numbers above 3 million, much of it based on Irish people travelling abroad. Routes have been cut, impacting tourism and business interests in the region.

Taking everything into account, I am not sure whether the response from the Shannon Airport board to increase charges was the best option. We need fresh thinking. We must address the situation rapidly if we are to protect what we have built up. There are governance issues at Shannon and Cork. Airport separation as outlined in the State Airports Act 2004 has not occurred. I never believed in the plan and it was not to the benefit of the airports. Shannon Airport needs more autonomy. It must be in control of its own business plan and asset base. It must be able to compete effectively with Dublin and Cork while relying on subvention from Dublin. It cannot be viewed in terms of profits and losses. It is key infrastructure — not a corner shop. We need a sustainable business plan that is not plot driven. The Shannon Airport Authority has much to do in this regard.

The State Airports Act 2004 has not worked and was a mistake. Shannon Airport is in a worse position than it was under the Aer Rianta structure. We must accept this mistake and move on. Shannon has a board that has neither assets nor power. We need change and we need it quickly. Shannon Airport will need ongoing support and subvention if it is to provide a centre for growth and balanced regional development in tourism and business activity. The solution is based on taking Shannon Airport from the perceived stranglehold of the DAA, keeping it in State ownership and giving day to day responsibility to the Shannon Airport Authority. We can do this with the establishment of an umbrella organisation that has supervisory control over the three airports and the capacity to ensure that Shannon Airport receives the kind of ongoing support which is such a vital part of its future.

Deputy Joe Carey

The present business model as operated by the Dublin Airport Authority is sucking the life out of Shannon Airport. We have witnessed a sharp decline in passenger numbers, airline carriers and destinations available through the airport. Ryanair, which once accounted for 1.9 million passengers and offered 53 routes, now bases just a single aircraft in Shannon Airport. Aer Lingus has withdrawn all its transatlantic flights for January, February and March of next year. The empty car-park and lack of activity at Shannon Airport highlights the low political priority given to the airport by successive Fianna Fáil Governments. There is a sense of utter hopelessness among business people, tourism interests, job creators, airport workers and the general population in County Clare. In response to this crisis the sole initiative of the Shannon Airport Authority in conjunction with the DAA has been to increase its airport charges. To add insult to injury, the only action offered by Government was to impose a €10 travel tax on passengers.

What Shannon Airport offers to the mid west and the western seaboard from an economic point of view in terms of jobs, connectivity for companies and a gateway to the west of Ireland is in real danger of being totally eroded unless a new model of governance is created. That the DAA continues to call the shots on Shannon Airport is no longer sustainable. We need a new beginning, a fresh start with a new business model. Any new structures will need to have adequate resources and strong political and financial support from Government.

The initial major challenge for any new airport authority is to put in place a five-year plan with realistic growth expectations. It also needs to engage with all current carriers who utilise the airport, including Ryanair. Any European airport would welcome such an airline yet Ryanair claims that it has been hindered repeatedly in its development at Shannon Airport because of Government-DAA policy. The challenge for the present Government and any new administration will be to respond to the needs of any such new authority and to reasonable requirements from carriers which want to do business in Shannon.

For an island nation it is a fallacy to tax people who want to travel here. This fallacy should be comfortably exchanged for increased employment and the knock-on revenue and taxes that could be generated from such passengers. The dead hand of the DAA must be removed from Shannon Airport before it is too late.

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

The State Airports Act 2004 provides for the separation of Cork and Shannon Airports into independent autonomous airports and Dublin, Cork and Shannon airport authorities submitted business plans on this objective in 2008. Following consideration of these plans and the recommendations of the boards of the three airport authorities, in late 2008 the Minister announced the deferral until 2011 of a decision on the separation of the airports given the current very difficult circumstances in the aviation sector. In the meantime, new governance arrangements were agreed by the boards and have since been put in place. The new arrangements provide for appropriate delegation of responsibility for the management and promotion of the airports, subject to the necessary accountability to the DAA board in respect of annual budgets, airport charges policy and capital expenditure. The arrangements also provide for reciprocal membership of the boards of the Dublin Airport Authority, DAA, the Cork Airport Authority, CAA, and the Shannon Airport Authority, SAA, whereby the chairman of the CAA and SAA are members of the DAA board and the DAA has a senior executive nominee on the boards of the CAA and SAA.

In recent years, passenger traffic at Shannon Airport has fallen significantly. In 2009 it totalled just under 2.8 million, a reduction of 12% on 2008. Most medium-sized European airports reported a reduction in passenger numbers of between 10% and 20% in 2009 owing to the economic downturn and its effect on airline travel. In 2009 Ryanair stated that it was unwilling to provide the level of services agreed under a five-year arrangement with the Shannon Airport Authority. As a result it withdrew a number of its aircraft and routes from Shannon which directly led to the loss of approximately 600,000 passengers in 2009. That loss was partly offset by the restoration of the London Heathrow service by Aer Lingus.

However, the full annual impact of the reduction in Ryanair services has only begun to be seen in 2010. In addition, traffic this year has been adversely impacted by generally weak demand resulting from the prevailing economic conditions worldwide and by exceptional circumstances such as the volcanic ash disruption. On an ongoing basis, the airport management is in discussions with airlines to encourage the introduction of new services from Shannon. Already this year, services to four UK cities were introduced from July 2010 by the Aer Lingus regional-Aer Arann franchise. Marketing efforts are continuing with a number of airlines on other short haul routes.

In addition I expect both the DAA and the Shannon Airport Authority to exploit the opportunities available with the US preclearance facility at Shannon to increase passenger traffic through Shannon Airport. Currently, Shannon Airport is the only airport in the world outside the Americas which offers full preclearance services. US preclearance has the potential to deliver significant new business for Shannon Airport.

Afforestation Programme

Deputy Andrew Doyle

Deputy Carey mentioned the five-year plan which is necessary in any kind of industry especially in one such as forestry. I tried to bring this matter into focus and to the attention of the Government because the planting season and the preparation for 2011 starts now for many in the forestry sector. It begins in the nursery where over the past three years more than 60 million seedlings have been nurtured and prepared.

The commitment in the current programme for Government envisaged 10,000 hectares of afforestation per year or 17% cover by 2030. I keep that in mind and in good faith, having seen it referred to at least twice in the 2020 Vision document in which forestry was depicted as paying a key role in greenhouse gas mitigation and biomass and biofuel production. It is also a primary source of supply to the construction industry and other sectors by way of saw logs and saw mills. Forestry probably employs 6,000 people directly.

The forestry Bill states its aim as follows: "To reform and update the legislative framework relating to forestry in order to support the development of a modern forestry sector which enshrines the principles of sustainable forestry management and protection of the environment." Given all that, one would think the forestry sector had nothing to worry about but instead there is uncertainty. Between now and 2016 the capital investment programme actually cuts forestry to a level where 2,000 hectares per annum is considered to be a realistic amount with the level of funding that can be achieved.

I hate to use the term "no-brainer" but this is the case. The forestry sector has a critical role to play. It drives and supports an entire industry. It is not something that can be turned around in a year or two years. If we do not plan now we will pay the price in 15, 20 or 25 years time. If we have to start to import raw material for own industry, this will have a negative impact on our balance of payments, as opposed to exporting it. We will be paying for greenhouse gas carbon emissions. It is estimated that the programme for Government target of 10,000 hectares would actually save the State some €46 million a year. If 6,000 people are put on the unemployment register, by 2020 that would amount to about €12 million, so this is the level of cost benefit to be achieved.

However, cost benefit analysis shows that for every euro spent on forestry there is a yield of €1.59 back to the State. This proves that when we are looking for value for money in the context of limited resources we have to target areas that give a better yield and show a return down the line. One has to speculate to accumulate and we have to invest wisely.

Of all the sectors this is crucial, and should be of particular interest to the Green Party members. This was one of their trophy successes in last year's renewed programme for Government, and yet while it received a good soundbite at the time, it seems to have merited token gesture status since. The summer was taken up with the introduction of legislation to ban stag hunting. I might have comments to make regarding horse welfare, etc., that seem to have been neglected but that is a matter for another night.

I cannot overemphasise the urgency with which this issue needs to be addressed by the Minister of State. I know he is not long in the job but I ask him to bring this back to Government. It embraces many contexts and even Commissioner Dacian Ciolos last Friday alluded to the fact that in the revised CAP, forestry could be part of the rural development programme, Pillar 2, which allows some co-funding of the obligations. If the carbon offsets we could attain are factored in, then perhaps that could represent our co-funding obligations. We could drive on an industry, it would create jobs, as already justified under serious cost benefit analysis. What is more, the benefits would disperse into rural communities around the country, with the money staying local and keeping those communities sustainable as well.

I urge the Minister of State to bring this to attention of the Cabinet.

Deputy Seán Connick

I thank Deputy Doyle for raising this matter as it gives me the opportunity to address concerns about the future funding for forestry and to reiterate the Government's commitment to forestry in Ireland.

I am well aware of the national importance of investment in forestry. Since 2000, the State has invested €1.25 billion in forestry enabling the development of an industry that now plays a significant role in the export market to Britain. The investment in forestry represents a substantial share of the agricultural budget reflecting the Government's commitment to and recognition of this important indigenous industry. I have met with a number of representative bodies, all of which have briefed me on the issues and concerns in their sector of the industry.

The benefits of the Government's investment in forestry is not confined to industry. We have also enjoyed significant benefits in terms of the provision of a source of renewable energy, the essential contribution that forestry makes to carbon sequestration in furtherance of the national climate change strategy. Benefits have also been derived from income derived from tourism associated with the use of forestry recreational amenities.

The primary objective of the forestry programme is to increase the level of afforestation in Ireland, which is among the lowest in Europe, in order to continue to derive all of these benefits from the natural resource. The Government is committed to ensuring the continuation of the afforestation programme at a rate that maximises the use of available financial resources.

The renewed programme for Government commits to an increase in the annual planting of 10,000 hectares per annum. In order to make progress towards that objective, provision was made in 2010 for 7,000 hectares of new planting and I am glad to say that this target is on course to be met.

Forestry premiums, paid in recognition of the creation of a long-term asset which provides major benefits beyond its immediate hinterland, account for over €73 million this year. As the Deputy will appreciate, forestry premium payments are a substantial commitment being carried forward each year and account for a large proportion of the eventual allocation.

A review of State forestry policy, also provided for in the renewed programme for Government, is currently being undertaken, part of which is assessing the effectiveness of current forestry grant schemes. This review will make recommendations on how best to deliver supports in the future. While the afforestation programme is an important component of the forestry programme, we also have to bear in mind the ongoing management of the existing forestry resource.

Concern has been expressed to me by farming and industry sources about the adequacy of the capital allocation of €89 million for the forestry programme in Capital Review — Infrastructure Investment Priorities 2010-2016, published in the summer. As part of the Estimates process, my Department will be reviewing its available capital resources, which are capped at €350 million for 2011, to ensure that priority needs and commitments are met.

I can assure the Deputy that I am fully aware of the need to maximise funding for forestry in what we all know are exceptionally difficult times for the public finances. I will be making every effort on behalf of the forestry industry to get a fair share of the limited resources available.

The Dáil adjourned at 10.40 p.m. until 10.30 a.m. on Wednesday, 6 October 2010.