Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Wednesday, 2 Apr 2014

Vol. 836 No. 4

Topical Issue Debate

Ambulance Service Provision

I thank the Minister for Health for attending. There has been a long campaign for an ambulance service in north Galway and I was one of several representatives who organised a campaign petitioning to have an ambulance base located in Tuam to serve north Galway-south Mayo. We expected a 24-hour service but what we received is a day service that is not fully operational. There is not even a timetable available for the ambulance base. On the one hand, we are told there is an embargo on recruitment and on the other, we are told that there are staff willing to transfer to Tuam to provide the service and we are still waiting.

There is a new building in place and people are very anxious to have a service there. Great work is being done by the Order of Malta but the Minister probably understands that traffic to and from Galway city where the ambulances come from is a huge issue. We do not have adequate staffing or vehicles, there are over 30,000 people in the catchment area and €2 million has already been spent on the building. I know other centres are looking for funding but I make the point that trade unions have been fighting the cause of the people and there are very well-qualified personnel. Many of the staff trained in St. Brigid's Hospital in Ballinasloe. We are still using Galway city as a base even though we have bases in Loughrea and Carraroe in west Galway. Traffic is a huge issue. We are waiting for work on the new Gort-Tuam motorway to start. There seems to be some delay in getting it started. Given that work has not started, traffic will be a huge issue and there will be delays in Tuam and south Mayo, which we hope will be served by the base. I hope the Minister can give us some indication as to how the base in Tuam will proceed.

When I was a Minister, we recognised that the more isolated rural areas were unlikely to ever get an ambulance service adjacent to them. The Minister would appreciate far more than me the rule about the golden hour. As a result, we decided to grant aid through the Order of Malta and the Red Cross the purchase of voluntary ambulances. Local people did all the necessary training up to the standards laid down to become voluntary ambulance workers. We had a very good ambulance service in places like Carna, Leenane and Clonbur in my own area but also around the country. We had ambulances in place anywhere a local community was willing to commit to this service. They were available on call-out. It meant that times getting to incidents were vastly reduced.

It was with great shock that I found out recently that the ambulance service of the HSE has claimed that these people who are trained to the national standard and have the qualifications laid down by the Pre-Hospital Emergency Care Council are not considered sufficiently trained to continue to provide this service. My understanding is that there are four levels of qualified staff - emergency first responder, emergency medical technician, paramedics and advanced paramedics. I understand that the HSE's argument is that these people are not trained paramedics. It is strange that they are allowed to attend football matches gratis and any other event and that if a person has a heart attack there, there is no problem with putting them in the ambulance. However, they cannot do a call-out in our area and we must wait for an hour, an hour and a half or two hours for a first call. An ambulance could be sitting within ten to 15 minutes of the person affected but according to some bizarre rule, they cannot get that ambulance to provide the service.

I presume the Minister was not aware of this. I would not expect him to know every detail of every decision made by the HSE. However, this issue is worthy of an investigation. Perhaps in his reply, the Minister could commit to coming back having investigated the basis for this decision.

I compliment Una Smith and the "Prime Time" team for exposing the reality of what is happening at the coalface in our ambulance service. We have wonderful staff working in appalling conditions. I want to bring the Minister back to something he said in the House on 30 June 2011 when he stood up and promised the people of Roscommon that they would have additional ambulances. He stated:

The service was to be supplemented by an additional ambulance so there would be four ambulances covering Roscommon during the day and three at night. I can guarantee that. There will be extra paramedics available with a car to provide cover if all the ambulances are out of Roscommon at any given time. These are services that I can control and which I will deliver.

The Minister went on to say that "the abiding message I want to send from this House today is that I want to replace that which is not safe with something that is safe". The "Prime Time" report exposed the fact that there has been a complete depletion of all the ambulances in county Roscommon for extended periods of at least two hours on ten out of 14 days that the report analysed. An expert interviewed on the programme highlighted the fact that too few resources are available to the people of Roscommon to meet their needs.

Instead of addressing this issue, the intention is to spread these limited resources over an even wider area with one of the Roscommon town ambulances now to be relocated to Loughglynn to provide a badly needed service to the people of west Roscommon and east Mayo. We have already seen the loss of one of our ambulances servicing the county in Ballinasloe which has been relocated to Tuam for three days a week. Yes, we have a great air ambulance service, which is to be welcomed, but people get heart attacks and strokes at night and the only way the ambulance can be called in is if the paramedic calls it.

We have three nationally recognised ambulance black spots, all of which happen to be in the west of Ireland - Mulranny in Mayo, Tuam in Galway and west Roscommon-east Mayo. The Government is spending €1.2 million on the Tuam base, €470,000 on the Mulranny base and €70,000 on the Loughglynn base with no ambulances and no additional staffing being made available to service those stations.

I thank the Deputies opposite. We covered this area last week in the Chamber and again yesterday at Question Time. I understand that in different parts of the country, different concerns are raised but I welcome the opportunity to outline again the current position relating to our pre-hospital emergency care services.

The National Ambulance Service, NAS, is working to ensure the provision of high quality and timely emergency pre-hospital care services using all available resources as effectively and as efficiently as possible. As with any pre-hospital service, development and modernisation is an ongoing process as technology and clinical standards change. A significant reform programme is under way and additional funding of €3.6 million and 43 staff have been provided in the 2014 national service plan. I believe it is important that we acknowledge that progress is being made.

New governance arrangements are being put in place to ensure the timely assessment, diagnosis, initial management and transport of acutely ill patients to appropriate care. A joint review of Dublin ambulance services, commissioned by Dublin City Council and the HSE, will determine the best model of ambulance services for the city, although I know this does not concern any of the Deputies here. In addition, an independent review of the NAS capacity nationwide will determine the level and use of resources required in terms of staff, vehicles, skills and distribution, for a safe and effective service now and into the future. I am confident that the reports of these reviews will inform the development of a modem, clinically-driven system, properly resourced, for appropriate and timely services to the benefit of patients.

Deputy Kitt raises the issue of services in north Galway and south Mayo. The national capacity review, as well as the HIQA review, will be of importance in the context of the development of services outside the main urban areas and, in particular, the western area which, because of its rural nature and road network, provides a particular challenge for response time targets. The counties in question benefit from the Emergency Aeromedical Support, EAS, service. This service provides rapid air transport of seriously ill or injured patients to an acute facility, where the land transit time would not be clinically advisable. The EAS has completed 556 missions since its inception in June 2012 to February 2014. The Irish Coast Guard also performed over 300 helicopter missions in support of the NAS in 2013 and will continue to do so in 2014.

I would like to assure the House that the NAS will continue to modernise and reconfigure its services to deliver timely and appropriate emergency pre-hospital care. The ongoing reform programme will provide a clinically driven, nationally co-ordinated system, supported by improved technology.

Deputy Ó Cuív commented on the golden hour but things have moved on in that regard. The critical period now is 90 minutes for somebody with an acute myocardial infarction or a heart attack which requires a bypass, which is now done through stenting. All patients going to the relevant centres can avail of this and the outcomes have been hugely improved for people who suffer heart attacks. There have also been huge improvements in the numbers of stroke patients who receive thrombolysis, the blood clot busting agent, which relieves their symptoms, saving at least a life a week and preventing three people per week from going into long-term care. We have gone from the bottom of the list in Europe for such procedures to the very top in a very short timeframe of 18 months.

As the Minister said with regard to Tuam, the traffic situation on the Galway Road is very serious and presents a huge challenge when ambulances have to be called from outside the town. In reference to HIQA, the health correspondent of the Irish Independent, Ms Eilish O'Regan, wrote recently about HIQA conducting a six-month review of the ambulance service. I would hope that the review could be done very quickly because the situation is urgent. I was hoping a start would be made on the new road from Gort to Tuam but there seems to be some delay in that. The contracts were to be signed last week. We have very good staff who I know get good training and I have no issue with the equipment or the ambulances themselves. That said, there is a worrying rise in the number of incidents of serious delays in terms of response times. This has been highlighted by the National Ambulance Service Representative Association. I hope the situation can be improved. I believe a national control centre is to be put in place and steps are being taken in that regard. Above all, however, where a building is available, it should be staffed, training should be provided and the ambulances should be put in place. I hope that can be done quickly in the case of Tuam.

I am delighted to hear about the extended time to an hour and a half but with most of the places to which I refer, an hour and a half would get one there but would not get one back again. I am talking about places where it would take an ambulance well over two hours and up to three hours to get out and get back. The local ambulance, on the other hand, is run on a voluntary basis by people who work to serve their communities and who have huge dedication. They are fully qualified and have received training from organisations like the Red Cross and the Order of Malta, which adhere to very high standards. No explanation has been given as to why they can transport patients who were injured at sports events and so forth but cannot pick people up who need to be brought to hospital. Perhaps the Minister would inquire into this matter because we are always talking about communities helping themselves in this country but it seems that often, when they do, they are rocked back by some rules that come out of the blue and for which there seems to be very little justification.

We were told on the "Prime Time" programme by Martin Dunne, the head of the ambulance service, that we are providing an excellent service to everybody in the west. Along with the north east of the country, we have the worst response times. We have the biggest number of dropped shifts, which means a loss of ambulances. Bizarrely, we also have the biggest underspend on overtime. The only places where there are overtime underspends are the west, the north east and the east, based on the first nine months of last year. That does not include the scheduled overtime cuts that are taking place, with no cover for annual or long-term leave. It is all well and good that we have fabulous uniforms but we do not have ambulances or ambulance staff. I could not care less if the ambulance crews come to us with the knees out of their uniforms if we actually have ambulances and ambulance staff. That has to be the priority. I urge the Minister to intervene directly in this regard. I know the Minister has taken a huge interest in it and has demanded that HIQA comes forward with its report. We need ambulances and staff now. I ask the Minister to direct the National Ambulance Service to put ambulances and staff into the three bases referred to, the only three nationally recognised ambulance black spots of Mulranny, Tuam and west Roscommon. We need those additional services now.

It is important to make it clear, in the short time I have, that nobody who works in the ambulance service believes it cannot be improved - it can be and it will be. The real issue here, which Deputy Ó Cuív alluded to, is the time to care. That is why the early responder and pre-hospital emergency care advance paramedics are so important. That feeds into the Deputy's other concern regarding the Order of Malta and others, who are not trained to deal with people in the same way as the advanced paramedics are trained, which is why they cannot be used in as open a fashion as the Deputy might like. That is not in any way to denigrate the people concerned and we certainly need to look into the issue raised by the Deputy to determine how we can best use the resources available. There must be cases which would be suitable for the Order of Malta to transport - patients who are not acutely ill but who, nonetheless, need to go to hospital. However, I do not think we would want them to be looking after someone who has had an acute heart attack, without the ability to canulate the patient and so forth, or other situations which require the specialist expertise of the advanced paramedic.

In 2013, the HSE target for carrying vehicles to respond within 19 minutes was 70% for echo calls and 68% for delta calls, both of which are life-threatening. For 2014, the target for both call types has been increased to 80%.

There has been in excess of a 1,000% per month increase in ambulance call-outs and this has placed a strain on the service. None the less, they are only 1% and 2% behind those rates this year. The Government has increased spending on the ambulance service both this year and last year. While there was a reduction in the number of ambulance vehicles per se for carrying patients, there are more of them available to do that job now because we have increased the number of vehicles to transfer patients between hospitals, thus freeing up those as well as the number of cars and motorbikes.

We are making improvements, although I can understand that there is room for more. We plan to make more improvements as time goes by. We want people to be reassured that they are able to obtain acute care when they need it. We fully realise and understand also that there are isolated areas with poor roads that are very difficult to access. We will continue to strive to achieve that, however. Mr. Dunne was alluding to the fact that our vehicles are of the highest specification and that our staff are trained to the highest level. Those matters are important. The crucial thing is that ambulances can get to the patient who needs them on time.

They need to respond at all stages.

Mental Health Services Provision

I must apologise for my voice which has been affected by some dental work, but I will try to struggle through. I wish to raise the important issue of the new referral procedure for children in the north side of Dublin to the Mater child and adolescent mental health service. Mater CAMHS deals with the mental health needs of children aged from birth to 16 in Dublin North-Central. Sixteen and 17 year olds are also continuing to use the service. Dublin postcodes 1, 3 and parts of 7, 9, 11 and 6, Dublin North-West, Glasnevin and part of Cabra are also covered. The services provided are psychiatry, clinical psychology, social work, speech and language therapists, occupational therapists, administration, registrars in child psychiatry, trainees and students in all disciplines.

The referral process is for children from birth to 16 years with persistent mental health problems such as emotional, behavioural, developmental and other psychiatric disorders. It also concerns problems that impact on functioning at home, in school or in relationships that have not been resolved by primary care level intervention, including the National Educational Psychological Service. We are talking about deliberate self-harm, suicidal thinking, depression, mood disorder, complex and severe anxiety, attention deficit disorder, attention deficit hyperactivity disorder, significant emotional and behavioural difficulties, post-traumatic stress disorder, complex behavioural problems, conduct disorder, complex behavioural response, psychosis, eating disorders, obsessive compulsive disorder and complex developmental problems.

Local school principals dealing with these very vulnerable children in an acutely disadvantaged area, which is the team A area in Dublin North-Central, are being told they can only get referrals to use the Mater CAMHS service through their local general practitioner. Children in Dublin 2 or 4 can therefore be referred by their local school principal, but children in Dublin 1 and 3 have to go through their GP. This is completely unfair, unwarranted and unnecessary. We are asking school principals to bring a parent and child to their local GP before they can make an essential and sometimes immediate intervention to save a child's mental health or potentially save a child's life.

People working within the service are saying this is completely unworkable. Why is a child in Dublin 1 being treated differently from a child in Dublin 2 or 4? The referral process should be uniform throughout the system. Will the Minister ensure principals in the team A area for Mater CAMHS will continue to be allowed to refer vulnerable children to this most important service?

I thank the Deputy for raising this issue for discussion today and giving me the opportunity to discuss it.

The Dublin north city and county child and adolescent mental health service, formally known as Mater CAMHS, has become part of the HSE from 1 January this year. Currently, referrals can be made to Dublin north city and county CAMHS from 13 different referral sources, which would not be consistent with national policy as advocated by A Vision for Change. The service is currently reviewing its existing clinical care pathway and referral criteria to bring it into line with A Vision for Change and the other mental health specialties. As part of this review it is developing a plan for the implementation for the standard referral pathway and referral criteria which, when implemented, will reflect A Vision for Change and national policy. This plan will be implemented in 2014. Some of the teams had reduced the number of referral sources in anticipation of the wider plan. However, the service can confirm that in advance of its referral criteria being brought in line with national policy, it will continue to consider all referrals, including those from schools.

Community child and adolescent mental health teams are the first line of specialist mental health services for those under 18 years of age, providing acute secondary mental health care. The assessment and intervention provided is determined by the severity and complexity of presenting cases. Nationally, there are a total of 61 child and adolescent mental health teams, comprising 56 community-based teams, two adolescent day hospital teams, and three hospital paediatric teams. All community CAMHS teams screen referrals received, with those deemed urgent seen as a priority and those regarded as routine placed on a waiting list. In the period 1 October 2012 to 30 September 2013, a total of just over 12,000 referrals were accepted by the HSE, representing a 21% increase when compared with the previous 12 months. This statistic alone highlights the challenges being faced in providing mental health services. Arising from the investment in mental health in 2012 and 2013, 232 new posts and €7.5 million were allocated to enhance CAMHS community team provision. Of these, 171 or approximately 75% had started in their posts by 31 January last.

The HSE will continue to prioritise investment in CAMHS services in line with A Vision for Change. The €20 million allocated to mental health for 2014 will allow between 250 and 280 more posts to be filled. As outlined in the national mental health division operational plan for 2014, a comprehensive workforce analysis will inform the best targeting of the 2014 investment. It is expected that a proportion of the new posts will be allocated to CAMHS to build on the 2012 and 2013 investments.

The detailed annual CAMHS reports will continue to report on the activity, access, timeliness and resources of these services. I wish to reiterate the Government's strong commitment to developing mental health services for children and adolescents nationally. I trust this clarifies the matter for the Deputy.

I thank the Minister for his response. I note he said that "the service can confirm that in advance of its referral criteria being brought in line with national policy, it will continue to consider all referrals, including those from schools". The problem though is that the Mater CAMHS is telling local school principals something different. While people within the service are quietly telling principals that they think this is unworkable and they want the previous criteria to remain, the Minister's message and the message local principals are getting from Mater CAMHS are two very different things. I ask the Minister to ensure local schools dealing with these vulnerable children are aware they can still refer such children to the local Mater CAMHS and that the situation has not changed. Will the Minister also communicate that to the service itself? We do not want mixed messages to be coming from the Minister and the local Mater CAMHS.

According to a presentation for principals by that service, the HSE is recommending that referrals come through the local GP. Two very different messages are coming out here, so we need clarity. We are dealing with very vulnerable children in serious situations who will potentially need life-saving interventions.

We cannot play around with words in the circumstances. Principals and school communities need to know what protections they have and what line of responsibility they have. Mixed messages from CAMHS or the Department do not help. If the Minister could clarify the matter or ensure that it is clarified, it would be deeply appreciated.

I thank the Deputy again for raising the matter. It provides an opportunity to communicate with service users as well as service providers. It is the responsibility of the Minister of State, Deputy Kathleen Lynch, who cannot be here due to a family bereavement. I apologise on her behalf and note that our thoughts and wishes are with her. I will discuss the matter with her. I have no doubt that she will be in a position to communicate a clear message to the services concerned. The question of whether it is more appropriate that referrals be carried out through certain pathways rather than in a broader sense is a matter for further discussion given the hugely increased pressure under which the service has come. That increase in pressure is evidenced by the statistics I have just set out to the Chamber.

The Government is committed to dealing with mental health issues and to ending the situation whereby children with serious mental health issues are admitted to adult facilities. We have reduced the incidence of that considerably. We are committed to ensuring that people are looked after in the community, which is the first line of defence. That is appropriate because it is where most needs can be met and it is far more convenient for parents and their children not to have to spend a great deal of time travelling to specialist clinics. It would be better to have local clinics accessed through local referral pathways.

I will certainly raise the Deputy's concerns with the Minister of State and we will clarify matters. The note from the Department is very clear that the current system of referral has not changed. I note from the document the Deputy read out the suggestion that it might be best done through the general practitioner. I do not have a difficulty with that but I accept equally that school teachers who are dealing with children on a daily basis are often skilled at detecting problems that might require further investigation. Such teachers should be facilitated for the sake of the child, which is what we are all interested in.

Planning Issues

I thank the Office of the Ceann Comhairle for choosing this Topical Issue. I will reference a local example, but the underlying issue is one of national importance.

Last Thursday week, 20 March 2014, planning permission which had been granted by Cork City Council for a development on the quays in the city centre of office accommodation for 2,000 workers was appealed to An Bord Pleanála. Under the current rules, any individual or company has an absolute right to make such an appeal. I have two difficulties with the current situation, the first of which relates to the length of time and uncertainty surrounding the appeal process.

An Bord Pleanála uses the unusual term "statutory objective" regarding its intention to deal with appeals within 18 weeks. However, it is not a statutory requirement. There is a statutory requirement on local authorities to deal with planning applications within four months, including a month for extra information. An Bord Pleanála will make the case that it has increased the pace at which it deals with appeals. While Ireland is doing exceptionally well on international competitiveness charts, one area in which we are not faring well involves the uncertainty in the planning process. It is no consolation for a company seeking certainty to wonder whether it will fall within the 20% of appeals to An Bord Pleanála which can take up to a year to process. The proposed development in Cork has a specific client with 700 jobs to offer. We are competing in Cork not only with other Irish cities, but other countries which would like to attract the specific company. One of the reasons the company is willing to locate in Cork is to have specific offices designed and built as quickly as possible.

My second difficulty relates to the mode of appeal. Anyone who has made an application or an objection to an application at the local authority stage may appeal to An Bord Pleanála. The fees on appeal are up to €50. There is no restriction on anyone who wishes to make an observation on a local authority planning application. A person may be based anywhere in the country and object to an application in Cork regarding which he or she has no skin in the game. That must be looked at. People can object for competitive reasons. I note that in Cork an objector has argued that it has similar office space to offer. I assume the company has looked at that. Some business in Dublin might object to a business's plans in Cork without having any reason or having to provide a reason.

I ask that the time for disposing of appeals be made a statutory requirement for An Bord Pleanála. I also ask that the grounds on which an objection can be made be examined while protecting people with geographical or other valid reasons for objecting to a development. We are seeing cases arising in circumstances in which jobs are being created. I urge the Minister to consider the issues I have raised.

I thank the Deputy for raising this important matter. There are two issues to discuss in addressing the issues raised while bearing in mind that under section 30 of the Planning and Development Acts I am precluded from discussing individual developments which are matters for the appropriate planning authority - in this case Cork City Council.

Legislation sets down a requirement for An Bord Pleanála to ensure that planning appeals are determined within an 18 week period. The board has a strategic objective to determine the bulk of cases within this period. In 2013, more than 72% of appeals were concluded within 18 weeks. Those appeals represented the bulk of the planning workload. As of February 2014, the compliance rate for normal planning appeals with the statutory objective was 80%.

An Bord Pleanála operates a classification system designed to identify and prioritise the processing of certain types of appeals. Generally, the system prioritises cases at the earliest stages which have significant employment potential or involve projects of significant economic potential on a national, regional and-or local scale. The project to which the Deputy refers falls into that category. Also prioritised are major infrastructure developments that would not be classified under the legislation as strategic infrastructure. The Planning and Development (Strategic Infrastructure) Act 2006 established a strategic infrastructure division within An Bord Pleanála to act as a one stop shop in respect of all major infrastructure projects. In addition to motorways and local authority projects, which were already handled by the board, the strategic infrastructure division is the sole planning consent authority for major electricity transmission lines, railway lines, heavy and light rail and metro orders, infrastructure requiring environmental impact assessment, such as significant airport or port developments, waste infrastructure, very large energy projects and strategic upstream and downstream gas pipelines.

Regarding the assessment of planning appeals by An Bord Pleanála, it should be remembered that the 18 week objective is broken down into a number of deadlines which facilitate the making of an informed decision. The board must gather all relevant information from the planning authority, applicants and parties to the appeal and enable the relevant parties to provide feedback. The process is particularly challenging in the case of strategic infrastructure. Accordingly, attempts to cut back the 18 week decision period could have a bearing on the ability of the board to make an informed decision, which is key to the whole process. The point the Deputy makes as to the large number of jobs offered by a key employer indicate that the matter will fall into the priority category.

I welcome the reference to priority.

It is not clear, however, whether the company in question can be informed that it is being given priority as the position in this regard remains a little vague.

While I do not have any issue with a timeframe for processing applications of 18 weeks and I am aware of the 80% target and the other figures cited by the Minister of State, I cannot understand the reason the position cannot be changed to require An Bord Pleanála to meet the same target as local authorities, which must deal with 100% of applications within four months. I fully accept that An Bord Pleanála's performance has improved and that if decisions are made within the timeframe in 80% of cases, 80% of applicants will be happy. However, if An Bord Pleanála were required to process all applications within 18 weeks, large companies would have a definitive timeframe for a decision on their application and could report to their parent boards that a cap of 18 weeks - essentially four months - applies to the processing of planning applications in Ireland. I ask the Minister of State to consider this matter.

The Minister of State did not refer to the second issue I raised, namely, the practice by which companies lodge objections to planning applications for competitive or, worse still, scurrilous reasons. If an objector is not located close to the site to which a planning application pertains or if the objection is clearly motivated by competitive reasons, these factors should be taken into account, either by expediting the decision or disqualifying the objection. I make clear, however, that in the case I raise the companies in question have valid reasons for objecting. I am not suggesting their objections are scurrilous.

I am sure Deputy Murphy will agree that we must ensure there is confidence in the planning process, that the process is transparent and that the right to object is respected.

The Government is working on construction policy and will publish a strategy on the issue in the near future. Many planning issues are under consideration and all issues related to planning are kept under constant review. Planning legislation will also be introduced later in the year. However, I cannot provide any commitments on the issue of objectors living in a local area or having valid reasons to object. At this point, there are no plans to change the position in that regard. As I stated, however, these issues are kept under review.

I reiterate that An Bord Pleanála is making good progress in reaching its objectives. While it is not required to meet a target of processing 100% of applications within 18 weeks, it aims to achieve this target and is making steady progress towards doing so. It has assured the Department that it prioritises planning applications that are strategically important or involve job creation. This should offer encouragement that the application in question will be dealt with as speedily as possible.

Homeless Accommodation Provision

The number of people seeking housing advice as a result of losing their homes increased by 43% in 2013. Each week, between three and five new cases of families in mortgage distress present at my office. This is in addition to families already being processed by my office. For most of the families involved, dealing with this issue is a disaster. They experience the stress of potentially losing their home and the financial challenge of trying to meet mortgage repayments, while trying to feed and clothe their families and cover the costs of school, visits to the doctor and so forth. Facing all of these issues is a perfect storm for many of these families.

Another group of people are in a worse position, however. In addition to mortgage distress, unemployment, negative equity and so forth, an increasing number of people seeking advice at my office are dealing with relationship breakdown. In other words, not only are they experiencing all of the crises faced by other families, but they are also facing family breakdown. In a significant proportion of the cases of mortgage distress my office deals with, the main reason is the breakdown of relationships. In many cases, the person who remains in the family home is unable to meet the mortgage repayment on the home. It is unfortunate that this problem is not discussed in the House or media because the numbers affected are growing.

If this were not bad enough, many families are facing homelessness as a result of their circumstances. Separated mothers or fathers and their children may be able to secure support from their local authority if they have experienced physical abuse from a partner and have been forced out of their homes. However, in many of the cases I deal with, families cannot live in the family home following a separation because the environment in the home has become extremely unhealthy for one of the partners and the children. While physical violence may not occur, such toxic conditions force people to leave their homes. Typically in such scenarios, families who apply for rent supplement or to be placed on the local authority housing list, all of which are extremely long, are informed that they do not have a housing need because they have a house or their name appears on a mortgage. These people are being left in limbo as they face the possibility of homelessness. While it is technically correct that they have a house, the toxic nature of their home environment means they do not have anywhere to live. In such circumstances, the mother and children must present to the local authority seeking emergency accommodation. Many of the people in question are accommodated in bed and breakfast accommodation, flats or must share a house with other people, none of which is suitable for families. The cost of temporary accommodation such as bed and breakfast solutions is shockingly high.

Families in these types of cases have no option but to become homeless because the current legal position and structure does not recognise their family circumstances. Sleeping rough is becoming more common on the streets of Dublin and other towns and cities and the number of people accessing emergency homeless services has increased by 40%. These issues are interrelated and I ask the Minister of State to think hard about a solution for families experiencing the circumstances I have outlined.

I thank Deputy Tóibín for raising this matter. While different personal, financial and social reasons can contribute to a person becoming homeless, for those involved the effects on their personal life are similarly traumatic and disabling. Societally, the ramifications of homelessness are also equally as destructive and costly. For this reason, I am strongly focused on achieving the Government's ambitious goal of ending long-term homelessness.

In February 2013, I published the Government's homelessness policy statement which set out the aim of ending long-term homelessness by the end of 2016. The statement emphasises a housing-led approach, which is about accessing permanent housing as the primary response to all forms of homelessness. The availability and supply of secure, affordable and adequate housing is essential in ensuring sustainable tenancies and ending long-term homelessness.

The homelessness oversight group, which I established in 2013 for the purposes of reviewing the progress of the approach being advocated in the statement, identifying obstacles and proposing solutions, has submitted its first report to me. The report considered the prevention of homelessness, the families presenting as homeless and housing supply. A copy of the report is available on my Department's website.

On 25 February 2014, the Government approved the establishment of a homelessness policy implementation team and an implementation unit. The team is tasked with implementing the oversight group's first report. This will include the preparation and publication of a structured, practical plan to make the transition from a shelter-led to a sustainable housing-led response to homelessness and achieve the 2016 goals for homelessness.

The implementation team is representative of the key State agencies dealing with homelessness, housing and related services because the solutions to homelessness do not solely reside in my Department.

The team is being led by my Department and includes a senior official from the Department of Social Protection and the Health Service Executive, as well as the managers of Dublin City Council and Monaghan County Council, representing local authorities. The team will report on this plan to the Cabinet committee on social policy later this month and quarterly thereafter.

I am acutely aware of the significant number of families now presenting as homeless in the Dublin region owing to economic difficulties, job loss, a decline in house supply and, as mentioned by Deputy Tóibín, relationship breakdown. More than half a billion euro in funding is being made available through my Department in 2014 across a range of housing programmes and I expect that in the region of 5,000 social housing units will be provided this year. I am committed to continuing to develop innovative and sustainable approaches to the provision of social housing. I want to see an increase in the supply of new social homes and to ensure that every available appropriate unit that exists is transformed into a home as quickly as is reasonably possible. Included in this is the transfer of NAMA units, in respect of which 596 were provided to the end of 2013.

On the specific issue raised by the Deputy, the Social Housing Assessment Regulations 2011 provide that a household with alternative accommodation that would meet its housing need is ineligible for social housing support, but the regulations clarify that paragraph (1) does not operate to exclude from eligibility for social housing support an applicant who owns accommodation that is occupied by his or her spouse, from whom he or she is formally separated or divorced. Under the enactment, a deed of separation is sufficient to set aside this ineligibility ground and it is not necessary to await judicial separation or divorce to get a decision on social housing support in these cases. I am aware that there are people who do not have a deed of separation. The legislation operates satisfactorily in most cases. However, I am currently considering in the context of the housing (miscellaneous provisions) Bill currently in preparation, whether legislative change is warranted to deal with exceptional cases that present difficulties under the current arrangements. I am examining whether it is possible to provide for greater flexibility in this regard.

Many people in relationship breakdown do not have the funds to engage in the separation and divorce process. Many of the families involved are at their wits end. While some people may potentially have a legal claim to a property, owing to the difficulties they have left behind all they want to do is start afresh. I will give one example from the many cases with which I have been dealing. A young mother of three children who suffered abuse in her family home applied for social housing but was refused on the grounds of owning a home. Following many applications for rent allowance she was eventually approved, only to have it withdrawn, again for the reason that she owned a home, as a result of which she amassed huge rent arrears and was forced out of the house by her landlord around Christmas time. Following reapplication by her for rent allowance, and with a great deal of pressure from my office, the rent allowance was re-approved. She then engaged in a huge trawl of accommodation in the town but could find none within the rent cap for the area. As a result she had to uproot her family from their home and her children from their schools and move to another town. The house she secured is damp and as her youngest child has asthma he cannot reside with her in the house and has to live with his granny for most of the week. The landlord has stated that he did not want to rent out the house but was forced to do so by the local authority because it is under pressure to house people. The window of the house recently fell out. This woman is in serious difficulty and is trying to find alternative accommodation.

The current rent cap for County Meath is causing major difficulties. There is no separation of areas to reflect higher rents. The people about whom I am speaking are in serious difficulty. I listened to the response by the Minister of State and accept that she recognises the problem. However, much of her response related to objectives, teams, reports, plans and so on. There are families in fiercely distraught circumstances. Not having the confidence of a roof over their heads is one of the problems which this Government needs to address.

I do recognise that it is a real problem. I am examining whether something can be done to address it in the next piece of legislation relevant to this area. The problem is that for a person to get onto a local authority housing list he or she must establish that he or she has a long-term housing need. In many of the cases involved, a person's name may, at the point of registering as having a long-term housing need, be on the deeds of a house. We are examining what can be done in this regard, including whether they can be provided with short-term accommodation, with their application being reviewed at a later time. I accept families are experiencing real problems in this area. We will try to address them as soon as we can.