Dáil Éireann díospóireacht -
Thursday, 21 Mar 2013

Vol. 797 No. 2

Topical Issue Debate

Access to Health Services

Deputy Dara Calleary

I thank the Ceann Comhairle and his office for allowing us to raise this issue and thank Senator Trevor Ó Clochartaigh, who organised a briefing by Mr. Sherif Sultan, the vascular surgeon at University College Hospital Galway and the Galway Clinic, on this topic yesterday. It is not even a funding issue. Someone just needs to take responsibility in the three counties of Galway, Mayo and Roscommon for deciding who pays for this machine.

The arterial assist machine increases arterial blood flow to the leg, and 550 patients in Ireland currently use it. None of these patients is in the three counties I mentioned because of a disagreement between different units of the HSE on who funds this. To rent one of these machines for 90 days costs €1,200 and it can save a leg from amputation. It is for people with severe vascular conditions in their legs who, if their condition deteriorated, might need to have the leg amputated, with all of the associated social, personal and financial costs. There are 127 patients on a waiting list and an ArtAssist machine for those 127 patients would cost less than half the cost of seven amputations.

In University College Hospital Galway, I could be in the room next to the Minister of State but because I am from Mayo I would not get the machine while someone who lives five miles up the road in Sligo would get it. It is ridiculous. I do not know if it is a funding issue but heads must be knocked together to make this service available to the patients in those three counties.

Deputy Denis Naughten

I also thank the Ceann Comhairle for giving us the opportunity to raise this issue. Mary is an example of someone on this waiting list. She is 46 years of age with three young children. She suffers from leukemia and her medication has a detrimental impact on the blood circulation in her legs. She is about to undergo bypass surgery as a last resort to save her left leg. She now urgently requires the ArtAssist pump on her right leg but because it costs €1,100 for 90 days, which she cannot afford because she is a medical card patient, the local authority must rehouse her because she lives in a two storey, three bedroom house. The frustrating thing for Mary is that she lives in north Roscommon, about five miles from the Sligo county boundary, and if she lived on the other side of that boundary, she would not have any problem getting this. Not only would it save her leg, the local authority would not have to construct a purpose built house to cater for her and her young family.

It is frustrating that an anomaly exists within the system in Galway, Roscommon and Mayo that means there is no funding while in other parts of the country that is not the case. As Deputy Calleary pointed out, it is unclear who is responsible and who should pick up the bill.

Minister of State at the Department of Health (Deputy Alex White)

The budget provision for 2013 represents a major challenge to the Health Service Executive and comes at a time of significant reform of the public health system. The gross current voted Estimate for the HSE is €13.4041 billion. Although there is a net increase of €71.5 million on 2012, as the HSE faces unavoidable spending pressures of €748 million, expenditure savings of €721 million will be required to remain within budget in 2013.

Under the Health Act 2004, the Health Service Executive must prepare a service plan and submit it to the Minister for Health for approval following publication of the Estimates. The national service plan which was submitted in December 2012 sets out the quantum and type of health services to be provided in 2013 within the overall level of funding provided. In accordance with the Act, the Minister for Health approved the national service plan and laid a copy of the plan before both Houses of the Oireachtas on 9 January this year. Subsequently, the HSE prepared and published its operational plan and regional service plans which underpin the national service plan at the end of February.

There is provision for expenditure at local level for the purchase and use of goods in local integrated service areas. These are referred to within the HSE as "local schemes" and the device in question would fall within this category.

The HSE has responsibility for the delivery of services set out in these regional plans and to ensure services are delivered within budget. As such it is not a matter for the Minister to issue a direction regarding specific items of expenditure. However, I appreciate the Deputy's concerns and have made inquiries concerning this matter. I have been advised that the provision of ArtAssist pumps in Galway and Roscommon has been discontinued pending the outcome of a review of their efficacy. The national clinical care programmes office has been requested to carry out this review.

Deputy Dara Calleary

After that, my own and Deputy Naughten's remarks still hold. There is a ridiculous anomaly that someone a mile inside a county border can get the machine while someone a mile on the other side is in the wrong county and cannot get it. I will raise this at my HSE meeting in Castlebar, and the Galway Deputies will be raising it tomorrow. It would be good if the Minister of State, Deputy White, could give some commitment because, as the Minister with responsibility for primary care, it would make his job easier. He mentioned budgetary issues. It is clear the availability of this machine will save money in the short, medium and long term, not just in the Department of Health but also in the Department of the Environment, Community and Local Government and in local authorities. That silly anomaly must be addressed for the sake of all concerned.

Deputy Denis Naughten

I thank the Minister of State for his response. The most bizarre aspect of that response was the comment that the Galway-Roscommon NCCP office is looking at the efficacy of this pump. Mr. Sultan, the head of the Western Vascular Institute, has published peer review studies on this equipment and an analysis of the 127 patients on the waiting list showed it is five and a half times cheaper to use the ArtAssist pump than to treat people conventionally. Of those treated with this equipment, 94% will save their legs. Even purely from a social point of view, the efficacy has been proven, along with peer reviewed research. I find it bizarre that the HSE wants to carry out its own review.

Deputy Alex White

I take the points made by both Deputies. On Deputy Calleary's remark on the desirability and necessity for consistency, I would be concerned about this and when I have an opportunity, I would like to find out more about it. It would not make sense if there was an inconsistency across the country for any service.

I would not regard it, however, as bizarre that we should have a system in place for determining the efficacy of devices, procedures or drugs. I am sure the practitioner concerned is eminent and has carried out the studies referred to by Deputy Naughten and serious regard should be had to them. I hold the view, however, that we have a system in place that makes determination on efficacy and appropriateness of devices and medication across the system and we should rely on that.

I cannot say any more than I already have. There is an inquiry being carried out by the national clinic care programme on this but I have taken on board the remarks made by the Deputies.

Hospital Services

Deputy Tom Hayes

I thank the Ceann Comhairle for accepting this important matter.

St. Patrick's Hospital in Cashel is one of the finest facilities in the country. I have no doubt in saying that given the manner in which it is run, its attention to patients and the quality of care delivered. Recently it has been brought to the attention of people in the locality that there were changes in services at the hospital. The reason I raise the issue is to get an assurance from the Minister of State on the future of the hospital and that it will stay in the town. It is part of the infrastructure and has been in place for many years. Many doctors, the late Dr. Willie Ryan and the present Dr. Willie Ryan, among others, were very committed, as are the staff and management, to developing and running the hospital.

The hospital comprises St. Anthony's, St. Clare's and St. Michael's unit, all of which care for the elderly, people who have given long service to the community. Given the proposed changes taking place the staff and the people of Tipperary are concerned that the future of St. Patrick's Hospital was at stake. I seek that confirmation from the Minister of State. I want an assurance on the future of the jobs at the hospital, those who work there, and all the services they have provided over many years and the back-up the hospital has provided to South Tipperary General Hospital and Our Lady's Hospital in Cashel over many years.

There is an historic High Court ruling about south Tipperary hospital services, of which St. Patrick's Hospital is a part. A strong commitment was given at the time by the then Minister for Health, Deputy Michael Noonan, that the future of St. Patrick's Hospital would be assured. I want that commitment reiterated and the people of Tipperary to be given an assurance on the future of St. Patrick's Hospital.

Deputy Alex White

I thank the Deputy for raising this issue. It provides me with an opportunity to update the House on this matter.

As the Deputy is aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to appropriate quality long-term residential care, including the provision of financial assistance under the Nursing Homes Support Scheme. In 2012, with a budget of almost €1 billion, financial support was provided to over 22,000 people in nursing homes.

The Health Service Executive is responsible for the delivery of health and personal social services, including those at facilities such as St. Patrick's Hospital, Cashel, County Tipperary. We are all conscious that these are challenging times for the Health Service Executive in respect of all services. In the case of community nursing units, these include challenges regarding staffing, funding and the age and structure of the units. St. Patrick's Hospital, originally built in the 1800s has a bed complement of 134 beds comprising 95 long stay, 18 respite and 21 rehabilitation beds. The hospital is registered with HIQA for a period of three years with effect from 28 June 2012. HIQA inspection reports have identified the challenges posed by the design and layout of the premises in meeting the individual and collective needs of its residents. Bearing this in mind, and with the aim of maintaining and developing the provision of older person's services in Cashel, the recently published HSE South Regional Service Plan 2013 features the proposed transfer of the respite and rehabilitation beds from St. Patrick's Hospital in Cashel to the adjacent vacant facilities at Our Lady's Hospital campus. As the Deputy will be aware Our Lady's underwent a significant refurbishment to the value of €21 million, completed in 2011. While at present there are no inpatient services at the hospital, a number of day services are provided. Having been refurbished to a very high standard, the hospital is not currently utilising capacity to optimum level but it has the potential to provide high quality facilities for short stay services.

The main reason for undertaking the reorganisation of services is to facilitate the refurbishment of facilities within St. Patrick's Hospital. Following the transfer of respite and rehabilitation services to Our Lady's Hospital campus, a development plan will be prepared around the remaining long-stay facilities at the hospital in order to support its re-registration with HIQA, which will be due in 2015. I assure the Deputy this proposal will be worked through a consultation process with the staff and other relevant stakeholders of St. Patrick's Hospital over the coming period. In this regard a project group has been convened, the inaugural meeting of which took place on 19 March 2013. Membership of the project group comprises of representation from both HSE senior management and relevant staff. I am pleased to confirm that the terms of reference and a schedule of weekly meetings were formally agreed and signed off at this meeting. It is important to note that the proposed transfer of service will improve the facilities and the environment for patients of both facilities. It also ensures the retention of a significant service in Cashel, consistent with the approach taken by the HSE South in relation to services for older people in its regional service plan.

I am pleased to take this opportunity to reaffirm that St. Patrick's Hospital Cashel will continue to play a significant role in the provision of public services for older people.

Deputy Tom Hayes

I thank the Minister of State for placing on the record the fact that the future of St. Patrick's Hospital in Cashel is safe. I hope nobody will undermine that situation again. It has been stated on the public record that its future is safe.

In regard to the consultation process I ask the Minister of State to ensure the HSE and staff undertake all of it. The members of staff are committed people who have given their lives to the support of the elderly in the community. They have worked long hours through thick and thin and in difficult situations. There is no more committed staff than those in St. Patrick's Hospital in Cashel. I want to ensure the proposal is worked through by the HSE in all its dealings with the staff and the management. Under the management of Mary Prendergast, the hospital has gone from strength to strength.

I urge the Minister of State to ensure the consultation process is right. As he said in his reply, a great deal of taxpayers' money has been spent on St. Mary's Hospital and it cannot be left as it has been for some years. I welcome the fact that there will be activity in that hospital for which I foresee huge potential. We have a situation which is unique to many other areas, despite many warnings throughout the county, where there will be two very active hospitals in the town of Cashel for the foreseeable future. That is welcome. I thank the Minister of State.

Deputy Alex White

I do not think I can say anything further other than to agree with the Deputy on the importance of consultation with regard to this matter. A project group has been set up. The terms of reference and a schedule of meetings have already been agreed. I wish all concerned well in that regard. I am sure there will be a productive process of consultation which will be in the interests of the future of the hospital.

School Patronage

Deputy Paschal Donohoe

I thank the Ceann Comhairle for the opportunity to raise the issue and the Minister of State at the Department of Education and Skills, Deputy Ciarán Cannon, for coming in to respond.

I acknowledge the huge work the Department of Education and Skills is already leading in regard to diversity of patronage at second level schools and in having a wide variety of organisations involved in running the secondary schools. The Department has recently made strong progress in this area. As the Minister of State is aware, three Educate Together secondary schools will open in the Dublin area in Hansfield, Lucan and Drogheda. Each of those schools has different patronage arrangements but Educate Together will be involved in each of them. As he is also aware, the Educate Together movement at primary level has been extremely successful. Such schools are popular with parents and teachers and are delivering innovation in curricula and a new school environment which is having a very strong and beneficial effect on young boys and girls across the country.

In Dublin 1, 3, 7, 9 and 11 there is a very large number of very successful Educate Together primary schools. As those students progress to secondary school, there is no Educate Together secondary school available in that part of the city that is capable of taking them in and allowing them to develop their education within that stream. There is significant parental interest and support for this, as the Minister for Education and Skills is already aware. I know he met representatives of the campaign group and signalled that he supports it in principle. This has already been advanced for other schools in Dublin. He asked that work be undertaken to assess the level of demand and what role the City of Dublin VEC could play.

I raise the matter because of the level of parental interest. Even though the campaign is just beginning, it has already obtained 2,500 signatories. Given their numbers we have a duty to parents to offer them a second level option that allows the excellence that has been delivered at primary level to be maintained. It is in the interest of the parents and the students who decide to go to Educate Together schools. I also believe it is in the interest of the overall educational system. All our schools, regardless of their patronage, do a fine job at the moment in moulding young boys and girls and giving them the support they need. Educate Together has brought something to the system that should be welcomed and supported. Given the level of parental demand and interest, I ask that the Government respond to this and put together a plan to meet the need and provide a school in this part of the city. Given the progress made to date elsewhere on this, I ask that the same level of support be given to this part of the city.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I am taking this matter on behalf the Minister for Education and Skills, Deputy Quinn. I thank the Deputy for raising it as it affords me the opportunity to outline to the House the current position regarding the provision of new post-primary schools.

Our school-going population has increased significantly in recent years and is expected to continue to increase over the coming years. It is anticipated that at post-primary level an additional 24,900 pupils will need school places by 2017 with a further 40,800 pupils needing places between 2017 and 2024, based on the Department's statistics.

The figures I have outlined indicate the situation at national level. The challenge for the Department is to establish in which locations the school-going cohort will increase most significantly so that sufficient school accommodation can be put in place to meet demand. The Department is utilising a geographical information system, GIS, for this purpose. The GIS utilises data from the Central Statistics Office, Ordnance Survey Ireland, the General Register Office and the Department of Social Protection in addition to the Department's own databases and data from the local authorities. The Department has carried out a study of the country to identify where there will be a requirement for significant additional school provision at both primary and post primary levels over the coming years.

In June of 2011 the Minister announced that up to 40 new schools are to be established within the next six years to meet our increased demographics. These consist of 20 new primary schools and 20 new post-primary schools. This announcement did not include a proposal to establish a new post-primary school for Dublin 1, 3, 7 or 9. The Minister also announced new arrangements for the recognition and determination of patronage of these new primary and post-primary schools. The new arrangements published by the Department provide a balanced approach to allow applications to be made by prospective patrons for the establishment of schools. The criteria used in deciding patronage of the new schools place a particular emphasis on parental demand for plurality and diversity of patronage.

The Department's forward planning section will continue to monitor enrolments in this area to ensure there is sufficient post-primary school accommodation to meet any projected future demands.

Deputy Paschal Donohoe

I thank the Minister of State for his response. I welcome the progress that has been made in supporting Educate Together at secondary level. Does the Minister of State envisage a review of the number of new schools due to be provided in the next six years to see whether it would be possible for new schools to be included and to ensure the plan remains valid? While I accept demographics plays a key role, it is not just a question of demographics and the Department needs to make choices. There is significant demand in this part of the city for such a school. The total level of demand for second level schools remains unchanged. However, within that demand a big shift is taking place at the moment. I do not say that with any disrespect to or in criticism of the existing second level schools which are doing a great job. However, within the level of demand the Department is tracking by enrolment, a fundamental shift is taking place regarding the kinds of second level schools parents want their children to attend. If the Department recognises that it is right to have within these areas such a large number of Educate Together primary schools, the same logic would dictate there should also be at least one such secondary school available to those parents.

I thank the Minister of State for the answer. I will continue to pursue the point and I would appreciate a response to the two points I have made.

Deputy Ciarán Cannon

The Minister and the officials in the school building unit in preparing to publish the five year capital programme in 2011 carried out considerable and forensic analysis of that likely demographic challenge and where the numbers would create the most pressure in terms of school accommodation. In certain communities that bubble or pressure was occurring at primary level and we have responded to that by putting in place plans to construct primary schools in those areas. In other areas the demographic bubble had moved on to post-primary and again we have responded to that by providing for the construction of schools in those areas between 2011 and 2016. As we come towards the end of that five year period we will carry out a similar analysis to address the next period, one would assume, from 2016 onwards and I understand much of that demographic analysis is under way.

With the very limited resources available to the Department for school construction, the first challenge for Dublin 1, 3, 7 and 9 would be to establish that there is demand for a post-primary school over and above the existing provision. Once that has been established, one would expect the issue of patronage would arise and, as requests for changes in patronage have dictated, there would be a survey of parents in the area to determine the likely patronage of such a school.

My assessment of the response before me would be that we would not decide on the patronage without establishing an actual demographic need for a new post-primary school to service the area driven by population increase. As the Deputy might concede, there are some parts of Dublin city where we are seeing either a levelling off or a reduction of population in some areas. Whether the demographic need would arise for a new post-primary school in the area remains questionable.

The Deputy's other suggestion is that we might divest the patronage of one school in the locality to another patron. He might appreciate the challenges that might arise in such a scenario. At this point, I concede there is a degree of uncertainty over the development of a post-primary school in Dublin 1, 3, 7 or 9. We will certainly continue to engage with community representatives in the area, including the Deputy, and work as best we can to ensure, if and when that demographic challenge arises, we are ready and willing to meet that challenge in terms of school construction. We are also more than willing to engage actively with the community to determine the patronage of such a school.

Tourism Industry

Deputy Kevin Humphreys

I thank the Minister of State, Deputy Cannon, for taking this topical issue which relates to a matter in the constituency of Deputy Eoghan Murphy and myself. I should point out that I have already raised this issue with the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, and have raised my concerns about the proposal with the ESB.

Number Twenty Nine, Georgian House Museum, is located at the corner of Merrion Square and Fitzwilliam Street. It is currently ranked 14th of over 200 attractions in Dublin on the TripAdvisor website. Current opening hours at the museum are excellent, it operates all year and provides, for a small fee of €6, guided tours to tourists and citizens wishing to learn about Georgian household living in the late 19th century. Visitor numbers at the museum rose by 10% in 2012 because of rather than despite the interactive guided tours. The building was first occupied by Mrs Olivia Beatty, the widow of a prominent Dublin wine merchant. A visit to the house gives young and old alike a chance to experience what life was like for the fortunate who lived in such elegant townhouses and the less fortunate who worked in them.

The ESB has used the building since 1928. The Minister of State will be aware that the controversial demolition in the 1960s of the Georgian street scape on Fitzwilliam Street for the ESB headquarters was a major loss to our built heritage in Dublin. The ESB committed to restoration of Number Twenty Nine in the 1980s as a condition of the development of office blocks facing onto Baggott Street and James's Street East in the 1980s. The exhibition is a partnership between the ESB and the National Museum of Ireland and has played an important role since 1991 in making more accessible the history of late Georgian Dublin. Despite savings of €250,000, the ESB wants to downgrade the museum to seasonal opening hours without guides, which would destroy the unique attraction.

In the year of The Gathering, as we seek to improve our visitor offerings, it would be disastrous to cut opening hours from a six day, Tuesday to Sunday, 49 week interactive guided tour offering to an unguided five day, seven month, April to October, offering. Many believe this will lead to eventual closure of the house. For example, while March, owing to St. Patrick's Day, is one of our busiest times, the museum would under the ESB proposal be closed at that time next year when thousands of tourists would be in town. The tour guides, who would lose their jobs under the current proposals, appreciate that the ESB must make savings and agreed in 2012 to a 5% pay cut. While they have put a cost-saving proposal to the ESB, it has not been taken on board.

It would be embarrassing to lose such a tourism gem over such a small saving. I ask that the Minister liaise across Departments and the ESB to ensure the guided tours and opening hours are not lost. Our climate does not encourage tourists. This museum is an all-weather historical tourist attraction, which has been building in terms of attraction year on year. The cost saving proposal put forward by the tour guides would achieve the savings required. In this year of The Gathering, we must treasure these gems and build on them.

Deputy Ciarán Cannon

I am taking this issue on behalf of my colleague, the Minister for Transport, Tourism and Sport, Deputy Varadkar. I wish to advise the House at the outset that the Minister for Transport, Tourism and Sport has no responsibility in this matter.

Number Twenty Nine, Fitzwilliam Street is a restored Georgian house which is run as a museum of Dublin home life in the period 1790 to 1820. It is owned by the Electricity Supply Board and run by it in association with the National Museum of Ireland. Issues relating to the opening hours of the venue or the provision of guided tours, are commercial considerations for the ESB and the Minister has no role in the matter. The ESB, as a commercial entity, must organise its resources in the manner it considers appropriate. It is hoped that it can continue to make this important museum as accessible as possible to visitors and Dubliners alike.

Dublin has a comprehensive range of tourism product, including State assets such as the various branches of the National Museum, the National Gallery, Dublin Castle and Kilmainham Gaol. There are also the long-established visitor attractions, such as the Book of Kells at Trinity College, Christchurch, the Chester Beatty Library and Malahide Castle. In more recent times, Dublin has seen the growth of a range of new visitor attractions, such as the Guinness Storehouse and the Dublinia Viking Centre. These attractions, old and new alike, draw hundreds of thousands of visitors every year. That is not to say we are complacent about the tourism product in Dublin. The Government, through Fáilte Ireland, has continued to invest in the improvement of Dublin's visitor attractions. Last year, a redeveloped Malahide Castle was opened. Approval has also been given for an investment to enhance the presentation of the Book of Kells at Trinity College. To ensure that visitors really can get the maximum value from Dublin's tourism assets, a special walking trail is currently being developed through some of the top cultural and heritage sights of the city centre, running across the city from College Green to Kilmainham. To be called "The Dubline", it will give tourists greater accessibility to Dublin past and present.

Dublin's location is also a natural advantage, which is now being fully utilised as a tourism asset. As a coastal destination on the edge of the countryside, Dublin can be a city where visitors can engage in city-type activities such as museums and shopping or avail of an exciting array of water activities and outdoor pursuits in close proximity to the city. We want to utilise Dublin's natural attractions and will be doing so by marketing the city as "Dublin Plus", a city that is urban and rural and for night and day. The role of technology is now of major importance in bringing a city to life for the modern visitor. Last month, a new app was launched as part of the Discover Ireland campaign to enhance further the experience of those who come to Dublin. The new app uses the latest in GPS and camera technology to allow tourists to become their own guide as they navigate the city's attractions. In a further enhancement to the technology assets available to tourists, free Wifi connections are provided at our main tourism offices.

All of the larger Dublin hotels have hosted a significant amount of North American business, with some hotels observing particularly strong levels of US visitors. Across all hotels, there was a good, strong mix of increased domestic, Northern and UK visitors. Many of the most popular hotels were at 100% occupancy, an increase on their 2012 performance, which was considered excellent at the time. These figures indicate the strength of the Dublin tourism product and reflect the quality of the support being provided by Government to the tourism sector in the capital. We look forward with great anticipation to a strong overall performance for tourism in Dublin for 2013, based on the quality and range of Dublin's visitor attractions and the continuing success of The Gathering Ireland initiative.

Deputy Kevin Humphreys

I am disappointed with the Minister of State's response. The ESB is a semi-State company. The response given is a typical Civil Service one. I do not mean that as a personal criticism as I am sure the Minister of State only had sight of the reply before coming into the Chamber.

The biggest tourist attraction we have in this country is our people. To downgrade Number Twenty Nine to an unguided attraction would be devastating. It is important people have access to a person who can give them the history of the house whether in English, Irish or French. The tour guides involved are skilled and take personal pride in their work. They also acknowledge the great work done by the ESB. These people are not seeking to look after their own needs. They want to ensure development of a quality product that will attract more tourists to this city and country.

As I stated earlier, I am disappointed with the quality of the response. It is a standard response, with little understanding of what tourism is about. As I said earlier, the tour guides are prepared to make further sacrifices to ensure the financial viability of this museum. Dublin is famous for its Georgian buildings. It is important we have people who can inform visitors about how families in those houses lived and about the people who served in them in none too good circumstances.

I ask that the Minister of State report back on this matter to the Minister. I believe a workable solution can be found. The staff are more than willing to engage. This is a unique product which interprets Georgian living conditions at the time. It is a product that must be protected and developed not only for the staff but in terms of the number of tourists it can attract to this city.

Deputy Ciarán Cannon

I appreciate the concerns expressed by the Deputy and they are certainly valid. As I pointed out in the response, No. 29 Fitzwilliam Street is owned by the ESB, which is an independent commercial entity and must organise its resources in the manner it considers appropriate. However, I will certainly share the Deputy's concern with both Ministers, Deputies Varadkar and Rabbitte, in an effort to resolve the situation and will respond to him as soon as we have further news on the matter.