Adjournment Debate

Hospital Services

I sincerely thank the Ceann Comhairle for facilitating me in permitting me to raise the ongoing situation at the Midland Regional Hospital in Mullingar. Regretfully, I have to raise it again, particularly the decision to suspend elective procedures at the Longford-Westmeath regional hospital in Mullingar, which is extremely important in terms of its location for the citizens of Longford and Westmeath and as a central and pivotal hospital for that region. Theatres at the hospital will only be staffed with cover for obstetrics for a further three month period for emergencies and for children.

These measures were recently announced at the hospital but, as in the case of many matters concerning the HSE, it is difficult to extract information from it. These measures clearly led to reduced activity at this important, progressive and most efficient hospital. It is one of the most efficient hospitals in the country in terms of all the parameters, output data and case mix assessment that are now used to determine degrees of efficiency and effectiveness.

I raised the issue of the severe bed shortage that has led to record numbers of patients being placed on trolleys in the accident and emergency department of the hospital. In the last few days of October, in excess of 130 patients were on trolleys. This is the position at one of the busiest hospitals and most efficient accident and emergency departments in the country and it arises because up to five wards have been closed in the hospital.

In October 2007, there were only four patients on trolleys; in October 2008, there were 11; in October 2009, there were 70; and in October 2010, there were 132, which represents a 3,200% increase compared to 2007. The number of patients who were on trolleys up to the end of October 2010 was 1,620, which represents a 392% increase compared to the same period in 2009. In the first four days of November, 24 patients have been on trolleys in the hospital.

Staff in the accident and emergency department are working to the very limits of their capacities and endeavours. They are at breaking point and are deeply concerned as they are expected to care for the ever increasing numbers of patients arriving in this department. I am not surprised at the fact that this situation has now arisen at the hospital, as I predicted this would inevitably arise when 41 inpatient beds were removed from the hospital almost two years ago. This has given rise to significant overcrowding in the accident and emergency department in this context. I am talking about the second most efficient hospital in the country in terms of effectiveness, outputs, case mix assessment and other assessment factors.

In recent days management in the hospital made a decision, as far as I can ascertain, to suspend elective procedures and the operating theatres will only be staffed to a level to facilitate obstetrics and emergency cover, scopes and cover for children; in other words, all elective adult surgery will be suspended with only seven of the 18 staff being utilised. As a result, they will only be able to operate one of the theatres effectively and facilitate emergencies as I outlined.

We are lucky to have an excellent surgical staff comprising nurses, anaesthesiologists, surgeons and all the other ancillary staff in this hospital, yet routine adult surgery which these people so effectively perform has now been put on hold. I understand that these wards were closed for a specified period but it now appears that it will be extended, although it is somewhat difficult to ascertain the precise intentions of the HSE as it has the happy knack of being extremely vague as to its intentions when it is questioned. As I understand it, even the trade union representatives have still to be fully informed in respect of these issues.

It is abundantly clear that in respect of a person's health, early investigation and detection is extremely important and that, once a person is diagnosed, early treatment would follow. Thus, it is important that elective procedures take place as quickly as possible after diagnosis. If what I have been informed in regard to elective procedures at Mullingar hospital takes place, all that will happen is that waiting lists will build up and grow longer and people will suffer unnecessarily.

The perception locally is that the hospital is being penalised for its great efficiency. It has been too good, as one nurse said to me. People are concerned that what starts off as temporary measures can be elevated to the status of being permanent after a short period. We want a guarantee that this is not the intention of the HSE and that it has no plans to downgrade the important facility of the Midland Regional Hospital for the citizens of Longford and Westmeath.

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Midland Regional Hospital in Mullingar is part of the Dublin-midlands hospital group. The aim of the hospital is to deliver a quality-driven people-centred service to the public of the Dublin-midlands area and, in particular, the Longford-Westmeath area. The hospital at Mullingar operates on a 24 hour, seven day per week basis.

The HSE advised the Minister that at the end of September the hospital was 7.2% ahead of its service plan target. The primary drivers for the increased activity in the hospital are in the areas of obstetrics, paediatrics and general medicine, all of which are predominately emergency service driven. In addition, the hospital has provided for 4,784 surgical inpatient and day case discharges to the end of September, which again exceeds its service plan target. The hospital is currently meeting its target under HealthStat with regard to waiting lists.

The September financial figures showed an increase in expenditure trend for the first time since May. Having regard to the activity to date when compared to the service plan, the HSE decided to review the level of activity that could be facilitated at the hospital for the remainder of the year.

For the hospital to be able to manage its activity it must examine areas of elective work, in particular the area of general surgery.

Following consultation with relevant stakeholders it was agreed to concentrate on emergency surgical activity and urgent elective activity for the remainder of the year. These areas of service will continue to be provided. Any issue or concern about what would come under the definition of emergency activity and urgent elective activity will be dealt with by the clinical director. The HSE has advised the Minister that all caesarean section activity will be facilitated, as will endoscopy procedures.

This arrangement will reduce overtime and agency costs and assist with bringing the budget of the hospital back in line, while delivering on the services promised in the hospital's service plan. The Minister has asked the HSE to keep the issue of service delivery at the hospital under ongoing review in order that patients who require treatment can receive it as quickly as possible in the appropriate health care setting.

Sports Capital Programme

I thank the Cathaoirleach for allowing me the opportunity to raise an issue of vital importance for Churchtown GAA club in north Cork and many other sporting organisations. The issue is the delay in delivering funding to the club, which has been caused by a problem in the Land Registry. The funding allocation was made two and a half or three years ago and the club has been awaiting a directive from the Land Registry which it could forward to the Office of the Chief State Solicitor to enable the funding to be sanctioned. A number of clubs across the country are in the same position. Industrial action in the first half of 2010 prevented the Land Registry from addressing the matter. Although the industrial action ceased in June, the Chief State Solicitor's office has still not prepared the required paperwork or resolved outstanding issues with the Land Registry to ensure the funding can be drawn down by the club.

Churchtown GAA club has been ready to commence work on the project for which it secured the relevant funding since this time last year. Officials in the Department wish to ensure that every club receives its allocation as quickly as possible. The reason the club has been waiting to draw down the funding for such a long time is the inordinate delay in having the paperwork done on its application.

When the Minister met members of Churchtown GAA club in June last year he indicated that the allocation would be made once the issue causing the delay had been rectified in the Land Registry. Unfortunately, as we approach the middle of November, sanction for the funding is still not forthcoming. I ask the Minister of State to outline what steps have been taken to resolve this issue.

I thank the Deputy for raising this issue which is, I am sure, of great importance to the club concerned. The sports capital programme, which is part funded from the proceeds of the national lottery, is the primary means of granting Government support for the provision of sports facilities at national, regional and local level. It would not be an exaggeration to state that the programme has been of benefit to communities the length and breadth of the country.

Under the sports capital programme, the Department of Tourism, Culture and Sport provides funding to voluntary, sporting and community organisations for the provision of sports and recreational facilities. More than 7,400 projects have benefited from sports capital funding since 1998, bringing the total allocations in that time to more than €738 million. The programme has, in the past ten years, transformed the sporting landscape of Ireland with improvements in the quality and quantity of sporting facilities in every part of the country. The facilities funded range from the smallest clubs to national centres of sporting excellence.

Deputies will be aware of the many benefits that derive from the programme in their respective localities. They will have no doubt noted the value of the programme in assisting local clubs in meeting the sporting needs of their areas and targeting clubs in areas of social disadvantage. By doing this, the Government is supporting the provision of facilities where there may be little prospect of such facilities being provided by communities acting alone. These facilities provide an opportunity for participation in sport which leads to healthier lifestyles and a reduced likelihood of younger people drifting into anti-social behaviour.

It is a common misconception that the programme has been discontinued. The programme is very active, with €48 million provided by the Department of Tourism, Culture and Sport in 2010 to cover the payment of grants. This funding will allow more than 1,000 payments to be made to sports clubs and community groups in every county.

Since 1998, Churchtown GAA club has received four allocations under the sports capital programme, totalling €231,579. Of this, only the €50,000 provisional allocation made in 2008 remains to be drawn down. All grant allocations are subject to compliance with the terms and conditions of the programme. These include, for allocations above certain specified thresholds, the execution of a deed of covenant and charge. This places a charge on the grantee's title to the property and is intended to protect the taxpayer's investment by ensuring the facility remains in sporting use for at least 15 years. The Department's legal adviser, the Office of the Chief State Solicitor, deals with the grantee's solicitor in executing this deed.

The Chief State Solicitor's office wrote to the grantee's solicitor on 31 August last seeking confirmation that registration of a deed of covenant and charge in respect of previous allocations had been completed in the Property Registration Authority in accordance with undertakings provided at the time. The office informed the Department this afternoon that no response had been received to the letter of 31 August. Until this confirmation is received, formal approval of the provisional allocation made in 2008 cannot be progressed. The Deputy will appreciate that in the current circumstances, a high priority must continue to be attached to protecting public investment in sports facilities properly. The club's solicitors should confirm registration of the previous deed to the Chief State Solicitor's office as a matter of priority and the Department will continue to liaise with the grantee on an ongoing basis to assist in progressing the allocation.

Water and Sewerage Schemes

I thank the Ceann Comhairle for affording me an opportunity to raise again the urgent need to improve the sewerage scheme at Kilmallock, County Limerick. For the past ten years, the town has been at the top of the list for the development of a sewerage scheme. The current sewerage system in Kilmallock is in urgent need of upgrading as both the plant and network are deficient.

The existing waste water treatment plant in Kilmallock was built in the 1940s to cater for a population of only 1,500. It is heavily overloaded and effluent discharges are a significant source of pollution in the River Loobagh. The proposed new sewerage scheme consists of the construction of a new waste water treatment plant and main lift pumping station at the north-west end of the town. It is proposed to replace or up-size the existing trunk sewer along the river bank, extend existing foul sewers and install a new 300 mm diameter storm sewer along the Kilfinnane Road.

One of the defects of the current scheme is that the storm sewer is part of the main sewer scheme and is being unnecessarily treated by the effluent plant. The proposed treatment plant site is situated north west of the town on the southern bank of the River Loobagh. The treatment works will be sized to cater for a design loading in phase 1, which runs until 2026, of 4,000 PE, with the plant designed to cater for an expansion to 8,000 PE in phase 2. Treated effluent will be discharged into the River Loobagh and effluent standards are based on the assimilative capacity of the river. Serious concerns arise regarding the pollution caused by the current discharges into the river. On 31 July 2003, the Minister for the Environment, Heritage and Local Government, the then Deputy Cullen, promised by way of letter that the scheme would commence in 2004. When will it commence and what is the expected date of completion because sewerage schemes are being developed elsewhere? Infrastructural development has not been abandoned simply because of the recession although I appreciate the level of activity has been reduced.

The Minister of State should provide a few for County Donegal.

I apologise to Deputy Neville but I could not resist.

When will work on this scheme commence? I had expected that this scheme would commence because it was promised sincerely two years ago. There are two vital questions to which the people, traders and organisations in Kilmallock seek answers. First, the environmental section of the council is anxious to ensure that sewage disposal in Kilmallock complies with European Union urban waste water treatment work directives. In December 2003, Environmental Resources Management Limited presented a report commissioned by the Kilmallock town traders, which outlined 37 recommendations for improvement in the town, many of which were dependent on the construction of a sewerage scheme. The population of Kilmallock has declined significantly over the years because of the lack of opportunity to develop housing there, although some development has taken place in recent years by a contractor who privately organised the disposal of sewage. The proposals currently before the Department will provide for a population equivalent of 4,000 with a possibility of future development.

I refer to the marginal pricing policy for the towns. At present, the allocation is 40% to Kilmallock. The council cannot come up with this if the scheme comes to fruition because income from development charges has completely dropped off as a result of the recession and, consequently, the finances are not in place. As the Minister has increased the level of marginal pricing policy to 90% in other areas, I also seek such an allocation. Moreover, the domestic demand to which I ask it to be extended does not add a lot. It is important to have a sewerage scheme to attract new commercial enterprises and to do so, a new plant is required. A plant is needed for industry and for the other reasons I already have outlined.

I must ask the Deputy to conclude.

The contract documents have been with the Department since last year. Amendments were sought earlier this year but were sent to the Department from Limerick County Council approximately six months ago. I ask that this scheme be fully sanctioned and that a move be made towards organising a contract to complete the scheme as was promised in 2004.

I thank Deputy Neville for the opportunity to outline the current position on the Kilmallock sewerage scheme. My Department's water services investment programme, a copy of which is available in the Oireachtas Library, includes a contract for the procurement of a new waste water treatment plant under the Kilmallock sewerage scheme to advance to construction during the period of the programme at an estimated cost of €3.4 million. My Department has completed its assessment of Limerick County Council's revised contract documents to procure the Kilmallock waste water treatment plant under a design build operate, DBO, contract and will convey its decision to the council shortly. Under the contract, the council proposes to construct a new treatment plant and ancillary works, including a new pumping station and trunk sewer to transfer flows from the existing treatment plant to the new facility.

I am aware of the importance of the new treatment plant to Kilmallock and its environs. The existing plant is operating at, and sometimes beyond, its design capacity and in doing so can be a source of pollution in the receiving waters, namely, the River Loobagh. The discharge licence for the existing treatment plant issued by the Environmental Protection Agency requires the council to commission a new plant. The council's proposals currently before my Department will alleviate these concerns and cater adequately for the needs of Kilmallock and environs for many years.

I should point out that the council's proposals do not include the upgrade and extension of the existing collection system in Kilmallock that had been a part of the Kilmallock sewerage scheme under the previous water services investment programme. Last year, local authorities, including Limerick County Council, carried out an assessment of needs to review and prioritise their proposals for new capital works in their areas. These assessments were subsequently appraised in the Department in the context of the funds available and key criteria that complemented those used by the authorities. Inevitably, through this process, certain projects that had been included under previous phases of the water services investment programme had to give way to others that are more strategically important at this time. However, the council can consider the works to the collection system for inclusion under the next phase of the programme after 2012.

I am pleased to inform the Deputy that the Department has reviewed the overall funding for the DBO contract and, as a result, a greater proportion of the costs will now be borne by it. This will reduce the financial burden on Limerick County Council in the delivery of a key water services project in its area.

As I stated earlier, my Department will write to Limerick County Council shortly regarding the DBO contract documents and the enhanced funding arrangements for the Kilmallock scheme. I assure the Deputy that my Department will continue to work with Limerick County Council to ensure that the Kilmallock sewerage scheme and other key water services projects in the county are advanced as far as practicable during the period of the new programme.

Voluntary Housing Associations

I thank the Ceann Comhairle, the Leas-Cheann Comhairle and the Minister of State for affording me the opportunity to raise this Adjournment matter once again in the House. I sympathise with the Minister of State opposite with whom I had this discussion last July. This matter relates to a voluntary housing scheme that was funded in its entirety by the Irish taxpayer through the capital allowance scheme and which was in receipt of the usual site for a nominal fee from the local authority. Although the concept worked well initially, for some unknown reason after the collapse of the Celtic tiger the association suddenly woke up and sent out demands for arrears of rent to several of its tenants. This was not exactly the best time to so do from an economic perspective. In addition, it set about carrying out repairs, some of which were required and some of which were neither warranted nor requested. A dispute now has arisen in which the local authority wishes to take no part in which the heating arrangements in a number of houses have collapsed. The association refuses to carry out repairs, even though it is responsible, because arrears rest on this particular case.

The Minister is familiar with this particular issue and while I do not wish to delay the House, I wish to simplify matters. This particular project was built at the taxpayer's expense with 100% funding in every respect. All that is required from such voluntary housing associations is that they administer the scheme, collect rent, have an annual general meeting, abide by the articles of association and carry out their duties in accordance with the rules and regulations as laid down. It is alleged by the tenants that this is not now taking place and has not taken place for a number of years. Therein unfolds an impasse. As the Minister of State has the power and the will if he so wishes, I ask him to facilitate a meeting between the tenants, the association, the local authority and public representatives to be presided over by himself, if necessary, to bring this dispute to a rapid conclusion. This can be done quietly, amicably and effectively or it can be done the hard way. Threats are being issued to tenants at present to the effect that they will all be in court by Christmas and that the usual conclusion will be that they will be evicted and so on. Neither the Minister of State nor I wish to see something like that happen. Nor should it happen. I merely ask the Minister of State to put in place the arrangements with the local authority, the housing association, representatives of the tenants and public representatives with a view to arranging an immediate resolution of the problems and putting in place the necessary procedures to ensure this does not continue.

I thank Deputy Durkan for raising this item as it affords me an opportunity to once again confirm this Government's commitment to working with the voluntary and co-operative housing sector.

I would like to begin by reflecting on the successful relationship to date between my Department, local authorities and the voluntary and co-operative sector. Since the 1980s, we have together overseen the delivery of some 23,000 homes under the capital funding schemes. This partnership has thus been a very successful one, with homes provided to many of the more vulnerable members of our society.

As the Deputy is aware the voluntary and co-operative housing programme has been delivered through two main funding measures — the capital assistance scheme and the former capital loan and subsidy scheme. Both schemes are administered by housing authorities. The capital assistance scheme provides capital funding of up to 100% of the approved cost of accommodation for people with specific categories of need. The capital loan and subsidy scheme provided 100% funding for the provision of standard housing for low-income families and individuals in need of social housing. In all cases where 100% funding was availed of, all tenants must be drawn from the local authority housing waiting lists. Léim an Bhradáin, the project specifically raised by the Deputy, was funded under this scheme.

My Department is anxious to ensure that all projects funded under the capital funding schemes are operated and managed in accordance with the terms of the schemes. Approved housing bodies are required to enter into a legal agreement with the local authority, creating a mortgage charge on the dwellings provided under the schemes. This is to ensure that the accommodation is used in accordance with the terms of the funding schemes.

My Department is currently engaged with the Irish Council for Social Housing in framing a policy to improve all aspects of governance, including matters relating to the operation of the management and maintenance of housing units provided under the funding schemes. This work is ongoing.

This brings me to the matter raised by Deputy Durkan. I outlined to the House last July the requirements necessary for a body seeking funding under section 6 of the Housing Act 1992. Funding of more than €3 million was provided in 2000, under the former capital loan and subsidy scheme, for the provision of 32 houses at Easton Road, Leixlip by the approved body, Léim an Bhradáin.

My Department's primary role in relation to the provision of accommodation under the capital funding schemes relates primarily to the provision of funds for individual projects. It is responsible for the legislative basis for the schemes, annual budgeting and recoupment of expenditure to the local authority. It is a matter for the housing authority to ensure compliance with the terms and conditions of the schemes and to have in place suitable liaison arrangements to oversee the administration of the schemes in order to preserve the investment made in the dwellings provided.

Housing bodies are the de facto owners of the accommodation and, as such, are responsible for the proper management and maintenance of the dwellings. Approved bodies are eligible for an annual management and maintenance allowance of €543 per occupied dwelling. This allowance has not been paid to this association to date but I understand that an application with accompanying documentation, including a full rent review and audited accounts, is being examined by Kildare County Council. I will ask the council to ensure all accounts are in order and the rent charged complies with the terms and conditions of the scheme before a decision is taken to approve any additional funding.

The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Thursday, 11 November 2010.