Topical Issue Debate

Private Residential Tenancies Board

I thank the Office of the Ceann Comhairle for allowing me to raise this matter. I also thank the Minister of State, Deputy English, for being in attendance.

The Private Residential Tenancies Board, PRTB, was establish under the Residential Tenancies Act 2004 on foot of the report of the Commission on the Private Rented Residential Sector in 2000, which contained a number of recommendations in respect of tenants and landlords. In the recent past, situations involving individuals I refer to as "tenants from hell" have come to my attention. We all know there are landlords who are no saints but the PRTB seems to be biased towards tenants. I am aware of a number of hard-working people who have bought houses and rented them out to tenants. The latter are very often in receipt of rent supplement but, on occasion, decided not to pay this over to their landlords. I do not know what is happening with the money involved but the landlords are not receiving anything. As a result, they try to remove the tenants from their properties but they find this extremely difficult to do. I have come across cases where the type of thing to which I refer has gone on for almost a year. As a result, some landlords have found themselves out of pocket to the tune of up to €10,000. They cannot pay their mortgages and, in some instances, their mortgages can be damaged. The PRTB appears to be powerless to do anything about this. If a landlord fails to pay the mortgage on his or her property and if the latter enters into arrears, his or her credit rating is damaged. I understand that 70% of landlords have mortgages and cannot meet their mortgage payments without the rent paid by tenants. This is an extremely serious issue. If a landlord changes the locks on his or her house when the tenant is out, he or she can face a fine of up to €20,000.

It has been suggested that tenants should not have access to the PRTB dispute resolution process if they do not continue to pay their rent. I ask that the Minister for the Environment, Community and Local Government give consideration to this proposal.

Will the Minister of State indicate the current status of the Residential Tenancies (Amendment) (No. 2) Bill? Is it proposed to amend the principal Act to make provision in respect of the retention of deposits by landlords and the non-payment of tenants who remain in situ? What are landlords to do with regard to such tenants? I request that the Minister for the Environment, Community and Local Government seek to streamline and speed up the PRTB's dispute resolution process. I understand that landlords in New Zealand can access a hearing within ten days if there are rent arrears involved and that any decisions handed down are immediate and fully enforceable. Funding in this regard is provided from a deposit protection scheme which places no requirement on landlords to register tenants.

Will the Minister of State outline the number of determination orders issued in recent years? How many such orders which have not been complied with has the PRTB had enforced through the courts? If the Minister of State does not have this information to hand, I would appreciate if he could ensure it is forwarded to me. I understand that in 2011 the PRTB obtained 54 judgments against non-compliant parties and that a further 25 cases were settled out of court. The board also issued over 10,000 notices under the 2004 Act in which it warned people about being prosecuted for non-compliance. I would like to be provided with an update on this matter. Will the Minister for the Environment, Community and Local Government consider providing the PRTB with better resources in order that it might enforce its orders? The board has indicated that it received 587 requests for enforcement in 2011 and that, with additional resources, it was able to deal with 150 cases in the first quarter of 2012 alone. There is no doubt that it requires extra resources.

The landlords to whom I refer are obeying the law, they are registered with the PRTB and they pay all the charges - property tax and everything else - they are supposed to pay. Quite often, however, they are being left in limbo as a result of the actions of a small number of tenants from hell who will not comply and who ignore all requests for them to do so. It takes landlords for ever to get anyone to take action in respect of such individuals. This is a serious matter and it relates to law-abiding people, many of whom have families, who have made an investment, perhaps for their retirement. I would appreciate a response to my concerns.

I thank Deputy Stanton for raising this issue, which I have come across in the course of my work as a Deputy and a Minister of State. The Deputy is correct: there are issues which affect those on both sides. It is important that we send out the message at all times that the PRTB is there to achieve the right result and that it is not there to favour tenants or landlords.

I am taking this matter on behalf of my colleague, the Minister of State at the Department of the Environment, Community and Local Government, Deputy Coffey, who cannot be present. The PRTB was established under the Residential Tenancies Act 2004 to operate a tenancy registration system and resolve disputes between landlords and tenants. The PRTB replaces the courts for the vast majority of landlord and tenant disputes. For a fee of €25, parties to a dispute can apply to it for mediation or adjudication services. If either of the parties to a dispute is unhappy with the decision of an adjudicator, they can appeal it to the tenancy tribunal within 21 days of the date of receiving the decision. An adjudication decision that is not appealed to the tribunal within 21 days will become a binding determination order of the PRTB. In instances of non-compliance, parties can request enforcement of such orders through the courts.

Demand for the PRTB's services has increased significantly in recent years, reflecting the sizable growth in the private rented sector. The sector doubled in size in the 2006 to 2011 inter-census period, from 9.5% to 19.5% of the overall residential market. Census 2011 recorded 308,750 households in the private rented sector. This has driven a sustained increase in demand for the PRTB's services. In that context, dispute services have increased by 73% since 2008, when 1,650 requests for dispute resolution were received. In 2013 some 2,861 such requests were received. This is a sizeable increase. Enforcement requests have increased by 305% since 2008. There were some 100 requests in that year compared to 405 in 2013. Tenancy registration has increased from 206,054 in 2008 to 282,918 in 2013, a rise of 37%. The Deputy requested some other figures which I do not have in my possession. However, I will obtain the relevant information, if possible, and forward it to him shortly.

The board has responded to the challenges presented by the increased demand to which I refer by pursuing a programme of outsourcing, shared services and improved ICT systems. An online registration system was launched in November 2010 and online dispute management services were introduced in 2012. The outsourcing of the registration function at the end of 2012 has allowed the PRTB to focus on its quasi-judicial processes - adjudication, mediation and tribunals - and on the enforcement of registration and determination orders. I will also obtain the figures relating to determination orders for the Deputy.

In addition to these efficiency measures, legislative changes are in train in support of the work of the PRTB. Among the main issues addressed by the Residential Tenancies (Amendment) (No. 2) Bill, currently before the Seanad, are the separation of the governance and quasi-judicial functions of the PRTB and the delivery of the programme for Government commitment to establish a deposit protection scheme. The Minister is confident that these legislative changes will allow the board to continue to discharge its statutory obligations in an independent, fair and efficient manner.

The Deputy also raised the issue of the timelines. The PRTB reduced the average adjudication time from some 18 months in 2008 to seven months in 2013, and we understand that the time has been reduced further in 2014. I accept that the timeline is not short enough in some cases but it is certainly improving a lot.

I thank the Minister of State for his response. I understand tenants are obliged to continue to pay rent while awaiting a decision under the dispute resolution process. However, I have come across many cases where they do not, and landlords feel the seriousness of this matter is not being accounted for at the hearings. Determination orders are issued as a result of the dispute resolution process. However, this does not really improve the situation for landlords as tenants often ignore them. The PRTB can, by law, enforce the determination orders in court but it is not obliged to. Where does that leave the landlord? This is a major problem for some landlords who have approached me in recent years. It is open to landlords to take the tenants to the Circuit Court for not complying, but this can be very costly, and can range from €5,000 to €10,000. Therefore, many landlords cannot afford it. The tenant may be in arrears, thereby complicating the issue. As I stated, 70% of landlords have loans.

The figures the Minister of State outlined show just how much we are depending on the private rental sector for housing. I have come across a number of landlords who say they are very annoyed and upset and having sleepless nights over circumstances like these. They are thinking of getting out of the sector altogether as it does not pay and is not worth the hassle, trouble and stress. If the landlord makes one mistake, he can find himself before the courts or subject to a serious fine. The PRTB interprets the regulations for notice extremely strictly. I came across one case where the notice was texted and handed in the door two days later. It was deemed that the written notice was not given in the right timeline so the whole case went into limbo after that.

This is a serious matter. There are devils on both sides of the argument but the fact that landlords who are paying the property tax and other charges are being left in limbo is not being addressed. The process should be speeded up dramatically, as in New Zealand.

I will bring the Deputy's concerns to the Minister and discuss the matter with him. The Deputy raised some very important issues. Some tenants believe they have all the rights but no responsibilities, and the Deputy is correct in that regard. We must ensure responsibilities are met on both sides.

There are rogue landlords but this has been addressed significantly in recent years and the PRTB has helped in this regard. Certainly, it is matter of getting the right balance. The Deputy is correct that we are currently very heavily dependent on private landlords. We will need them in the years ahead, even given the announcements yesterday. There is significant reliance on the private rental sector, which needs to be encouraged, but those concerned need to be protected also. I will certainly raise with the Minister the issues raised by the Deputy and ensure he gets a response.

Drugs Dealing

I thank the Minister for Health, Deputy Leo Varadkar, for coming to the House to respond to this debate. I do not need to tell him that we have very serious problems in Ireland with substance misuse. Obviously, the number one problem is alcohol but all the evidence indicates that the number two problem is the misuse of prescription drugs, particularly benzodiazepines and Z-drugs. Vast quantities of prescription drugs are available on our streets. We have all seen the effect of this in Dublin city centre, in particular, and the serious anti-social activity that goes with it. Street trading and related activity are clearly very intimidating for the public. This behaviour undermines the efforts of health professionals to find a long-term path to recovery for those people who are using drugs. Of course, the practice is damaging to businesses and tourism in the city centre.

There are two principal sources for the prescription drugs. One is the over-prescribing of them in our health service and the second is uncontrolled imports. The current law is very weak in both of these respects. Obviously, benzodiazepines have a very important role to play in the treatment of people with mental health issues but the figures show that, by European standards, we have prescribing rates that are much higher than average. When it comes to imports, in many respects the hands of the Garda and customs officials are tied because of inadequate legislation.

Almost two years ago, when I was in the Department of Health, I initiated a renewed focus on the problem of the overuse of benzodiazepines and Z-drugs. A number of measures were initiated, including a project where the PCRS tracked the prescribing patterns of general practitioners. There was intervention among general practitioners whose prescribing pattern was particularly out of kilter with the pattern among the rest of the general practitioner population. A review of the regulations under the misuse of drugs legislation was initiated and provided several measures to help curtail the availability of the drugs on our streets. These measures included new import and export controls, new possession offences and stricter prescribing and dispensing requirements. The Department conducted consultations with interest groups in the summer of 2012 and took on board any issues raised. The Department amended its plans to reflect this process. Preliminary draft regulations were shown to me before I left office in September of 2012. However, for some reason it took an entire year thereafter for a draft set of regulations to be published on the Department's website.

Over three years ago, the projected date for the completion of the new regulations was the following January. Now, two years later, according to replies to recent parliamentary questions, the date is still next January. It is not clear to me what exactly is holding up the regulations at this stage. The unit dealing with this legislation was among the best in the Department in my experience so I cannot believe the fault lies there. Other senior officials should be well aware of the problem. It is not unknown for these prescription drugs to be traded right outside the front door of the Department on Hawkins Street. The Minister may even have seen this occurring himself.

This is a serious drug problem that can be dealt with effectively. The Government is now two years late with the necessary legislation and it is time this was made a top priority in the Department. I hope the Minister will make it so.

I thank the Deputy for raising this matter. Benzodiazepines are a class of medicine available on prescription which are commonly used to treat anxiety, sleep disturbance and insomnia. They are known to be associated with dependence and withdrawal symptoms and consequently are primarily recommended for short-term treatment only. They are a very valuable treatment option when used correctly. However, there is increasing evidence of the inappropriate use of benzodiazepines in Europe, a problem which is not particular to Ireland.

Under the Medicinal Products (Prescription and Control of Supply) Regulations, it is an offence for a person, except where the person is a pharmacist or working under the personal supervision of a pharmacist, to supply a prescription medicine. These regulations also make it illegal for prescription medicines to be supplied by mail order or over the Internet. Additional levels of control are applied to medicines which have a high potential to be misused by means of regulations made under the Misuse of Drugs Acts. These regulations impose restrictions on the production, supply, importation and exportation of controlled drugs, such as morphine, methadone, amphetamines and benzodiazepines. A person who has in his possession a prescription medicine containing a drug controlled under the misuse of drugs legislation for unauthorised sale or supply is guilty of an offence under that legislation. Different levels of control apply to drugs controlled under the misuse of drugs legislation, dependent on their therapeutic value and potential for abuse.

The Department has been reviewing the misuse of drugs regulations to introduce stricter controls on benzodiazepines. In particular, it is proposed to apply formal import and export controls on benzodiazepines, thereby making it an offence for a person to import or export these drugs without a licence. The introduction of these controls will also provide comprehensive national information on the level of use of benzodiazepines and trade in benzodiazepines. It is also proposed to introduce stricter prescribing and dispensing controls for benzodiazepines, as well as an offence for a person to possess benzodiazepines without entitlement - for example, a prescription - thereby assisting the Garda and customs service in enforcing the law on the illicit importation of and dealing in benzodiazepines.

Following a consultation process, a draft amendment regulation was prepared and made available for further consultation on the Department's website. Submissions were received from a wide range of organisations and individuals, including doctors, pharmacists, the Pharmaceutical Society of Ireland, the Irish Pharmacy Union, private and public hospitals - both from medical practitioners and pharmacists - nursing homes, drug treatment centres and experts in addiction services.

These submissions raised a number of legislative issues which require further consideration before finalising the amendments. The process is taking longer than anticipated because it is a complex and technical body of work. Some further work is required and the objective is to finalise the text of the draft regulations early next year.

Once the draft regulations are ready, they will be subject to a three month EU notification period under the technical standards directive before they can be signed into law. This is because of the implications of the proposed regulatory changes on trade in pharmaceutical products.

No doubt the scale and nature of the drug problem in Ireland is constantly evolving. The emergence of new psychoactive substances, the increased strength of cannabis and the prevalence of poly-drug use represent serious challenges for our services in responding to the needs of vulnerable groups. The response of the HSE has involved the reorientation of its addiction services in order to develop a comprehensive integrated addiction treatment service capable of dealing with all substances. The HSE continues to co-operate with local community representatives, particularly in the Dublin city centre area, and liaise with local gardaí to minimise any negative public order issues that may arise.

The Minister's response is disappointing. There is no sense of urgency at all from him in this regard. This is a major problem across the country but most prevalent in the Dublin city centre area. The Minister will get that feedback from all of the local drugs task forces as well. Prescription drugs, after alcohol, are the biggest problem that communities are dealing with.

One would have to ask why no action is being taken on this. This is at the same stage as it was at two years ago. The draft regulations were almost ready to go in January 2013. Here we are, almost two years later, and the issue does not seem to have moved on at all. Is there a problem with resources in the Department? Is the Minister allocating staff? Is Deputy Varadkar personally saying to his staff that he wants this to be a priority? It is a priority for everybody else working in this area. It is certainly a priority from the point of view of the gardaí. The law is too weak for them to tackle the problem in an effective way.

One must ask if there are vested interests coming into play here. Why is it that the Minister is not tackling the problem? It is in his hands to do something effective about this problem and yet it does not seem to be given any priority. There was a report in 2002 which was left to gather dust and my concern is that the same will happen with these draft regulations.

The solution is largely in the Minister's hands. I am appealing to him to take this issue seriously. It is devastating a lot of lives and is causing a lot of problems. It is in Deputy Varadkar's hands to make a meaningful difference to the problem and I ask him to act on it as soon as possible.

As Deputy Shortall will be aware, staff are allocated by the Secretary General, not by me personally.

Priorities are set by the Minister.

This regulation is not on my desk and I have not seen it yet. I am not holding it up. It is delayed elsewhere and I undertake to ask some questions about that.

The feedback that comes from the different groups in the local drugs task force, many representatives of which I have met in the past few weeks, is mixed. There are quite a number of them who take the view that criminalising possession of all drugs is not the way to go and it is not the case that everyone takes the view that criminalisation is the way to go.

That is not what is proposed. I ask the Minister to read the file.

Services for People with Disabilities

I thank the Leas-Cheann Comhairle and thank the Minister for attending here in person for this issue.

This relates to a special school in my constituency, St. Francis's special school in Beaufort, which mostly serves mid-Kerry, but there are children coming to that school from Kenmare and from as far away as Castleisland. The 52 children who attend there have high dependence needs and require specialised care. The problems arose last year when the services were reconfigured. The various multidisciplinary services that are required there, occupational therapy, speech and language therapy and physiotherapy, were delivered by an on-site team and the changes meant that there would be professionals coming in from outside delivering the services. The reconfiguration process for the school was an unmitigated disaster. I have attended a number of public meetings there and have engaged with parents on a regular basis over the past nine months on this, and have met with HSE officials in the county about it.

While the situation has improved somewhat of late in regard to the allocation of hours and the time being spent in the school by the professionals concerned, at the same time the difference in terms of the overall amount of service available to the children compared to what used to be there is far too great and the children who need help are not getting enough help. To compound matters, in the past number of months The Arches, the adjacent respite centre which was available for parents to bring their children to for respite purposes, is no longer available because of various problems that have been encountered by those delivering the services locally. Ultimately, it means there is no respite service available for those who previously would have used this service.

An alternative facility, the Home from Home facility in Ballydowney in Killarney, which provides an excellent service, has approached the HSE and indicated that it is willing to make its physical facility available should the HSE take up the offer and resource the facility with the required staff to provide the valuable and needed respite service, and I hope that this can be done. Locally, the HSE tells me that there is a problem with The Arches respite centre and the HSE is trying to get that sorted out. Ultimately, the children are suffering. Their parents are also suffering. In one family from Kenmare that I am aware of, a parent of a child with high dependency needs had to be hospitalised leaving the other parent alone to take care of that child. That parent is under enormous pressure and has no respite option at all. I understand the parent was given one night of respite. It is not good enough. We need to grab the bull by the horns here and address this for the sake of everyone involved.

I ask the Minister to look at the reconfiguration process and see where it has fallen down, particularly in this instance for this special school. I ask him to consider the broader element of the reconfiguration process but, more specifically in this case, if he could tackle the problem we have with the need for urgent respite care and extra multidisciplinary services for these children.

I thank Deputy Griffin for raising this matter. I am taking this matter on behalf of the Minister of State, Deputy Kathleen Lynch, who is on departmental business elsewhere. I assure the Deputy that the Government is fully committed to the ongoing delivery of vital services and supports to children with disabilities to the greatest extent possible within available resources.

The HSE has recognised that it needs to improve the way in which its early intervention services and services for school-aged children operate. To this end, it is currently engaged in a major reconfiguration of its existing therapy resources for children with disabilities into multidisciplinary geographically based teams, as part of its national programme on progressing disability services for children and young people, from infancy to 18 years. The key objective of this programme is to bring about equity of access to disability services and consistency of service delivery. There should be a clear pathway for children with disabilities and their families to services, regardless of where they live, where these children go to school or the nature of the individual child's difficulties.

These service improvements are a key priority for the HSE's social care directorate. An additional €4 million was allocated this year to assist with this programme. This equates to approximately 80 additional therapy posts. Further investment in the programme will take place in 2015.

The programme is already at an advanced stage in County Kerry. Since October 2013, children's disability services in Kerry have been reconfigured into four geographically-based teams for children and young people with complex needs. The reconfigured Kerry Intervention & Disability Services, KIDS, is a partnership among the HSE South, the Brothers of Charity, Enable Ireland and St. John of God Children Services.

Each team provides a range of multidisciplinary services, including psychology, speech and language therapy, occupational therapy, physiotherapy, social work, preschool and family support services.

The transition to the new service arrangement was carefully planned over a two year period. It included consultation with the relevant service providers and parent representatives. The four teams in County Kerry were also allocated four additional therapy posts in 2014, which will further strengthen service delivery in the region.

St. Francis special school in Beaufort falls within the remit of the KIDS mid-Kerry team. This new team will deliver services in keeping with the new service model. Interventions will be delivered in way that is fair to all children and families within the geographical area on the basis of prioritised need. I have been assured the team will continue to work closely with staff and parents in planning and delivering a service for the children attending St. Francis special school.

The issue of respite care places at The Arches which is operated by the St. John of God services was also raised. I understand the provision of this service has been somewhat constrained as a result of the challenging behaviour of a resident. I have been assured steps are being taken which should resolve the matter in the coming weeks. Once resolved, The Arches will be able to offer an enhanced service to children.

I thank the Minister and appreciate his response. The HSE has responded to me about The Arches and the difficulty with a particular resident. However, one difficult resident should not prevent everyone else from being able to use the service. Perhaps the Minister might liaise with the HSE to bring about a more speedy resolution of the problem. A few weeks is a very long time to wait for respite care for the parent of a child with moderate or profound special needs. Perhaps the Minister might use his good offices to try to speed up a resolution of the matter.

Will the Minister ask the HSE to liaise with the Home from Home service to see whether there is a possibility of providing extra respite care places through its facilities? The service does fantastic work while operating on a shoestring budget. The option should be explored to see whether more places could be provided in a cost-effective manner.

On the reconfiguration process in general, I received an e-mail from a parent which I will not read because, unfortunately, I do not have the time to do so. The parent who wrote it is very frustrated and calls it as she sees it. She accepts that the reconfiguration might have merit in the overall scheme of things, but it has not worked in the case of St. Francis special school where it has resulted in a serious depletion of services. I acknowledge that there were serious teething problems at the start and that there were difficulties with staffing. I appreciate the provision of extra resources and the four additional posts sanctioned in County Kerry for which I lobbied. I am grateful that they have been provided, but that said, it does not seem to be enough to have the level of service required in the school in question and the matter must be revisited for the sake of the children. Will the Minister revisit the issue and examine the level of service being provided in the facility because clearly it is not enough and the children deserve better?

In theory, these things should not happen, but in reality they do and often one difficult individual can cause problems for an entire service. I do not have detailed personal knowledge of or involvement in the case, as the matter comes under the disability and social care directorate of the HSE, for which political responsibility lies with the Minister of State, Deputy Kathleen Lynch. I will certainly make her aware of the Deputy's concerns and the fact that he has raised the matter in the Chamber which indicates the importance of the issue for him and others in County Kerry.

Hospital Procedures

I thank the Ceann Comhairle for selecting this matter for discussion in the Topical Issue debate. I also thank the Minister for coming into the House to reply to it.

I am raising this issue on behalf of a constituent, Mr. Paddy Mooney, with his consent. He is in his late 70s and on a waiting list for a knee replacement operation at Cappagh Hospital since earlier this year. He contacted my office in September and his case illustrates those of many others who have been awaiting hip and knee joint replacement surgery at Cappagh Hospital for some time.

I wrote to Cappagh Hospital at my constituent's request to find out when he could expect to have the knee replacement procedure carried out. I received the following reply which I will read with the consent of my constituent and the consultant orthopaedic surgeon who wrote it. It is addressed to me and from the department of trauma and orthopaedic surgery, Connolly Hospital, Blanchardstown. It reads:

Dear Mr. Kenny,

Mr. Mooney urgently needs to have a knee replacement at Cappagh Hospital. Unfortunately, due to Government policy the financial situation at Cappagh orthopaedic hospital is dire. I am not allowed to do the amount of work that I would like to do, and in fact Cappagh Hospital is severely restricted in the amount of operations it can do. In Cappagh we have seven operating theatres. Currently, only two of these operating theatres work per day and, usually only for half a day. Cappagh Hospital is functioning to about 15% to 20% of its capacity.

If you can arrange through your contacts in government to alleviate this situation, I would be glad to be able to get Mr. Mooney's operation done much quicker. Currently, there are over 200 patients on my waiting list for joint replacement surgery, meaning that my waiting list is well over a year.

Yours Sincerely,

Mr. Paddy Kenny, consultant orthopaedic surgeon.

I subsequently spoke by telephone to Mr. Kenny who reaffirmed the contents of his letter. He later took part in a radio programme, "Liveline" with Joe Duffy, on 10 October. On air, he described the situation at Cappagh Hospital, where on a day-to-day basis usually only two of the seven operating theatres were in use, although he maintained there were enough consultants available to ensure all seven could be fully utilised. He went on to say 24 orthopaedic surgeons were available in the hospital but asserted that owing to a lack of finance sufficient nursing staff were not available to operate all seven operating theatres on a daily basis. He added that hip and knee implants cost on average between €1,800 and €2,000 per implant. He further stated he personally could carry out four to five implant procedures per day if he had the resources to do so and added that he had 198 patients on his waiting list and that the waiting time was 15 months.

A number of listeners telephoned the programme on the day to describe their situation and the level of pain they were enduring while awaiting a hip or knee operation. I have personal experience, as I had to undergo a knee replacement operation some years ago. Accordingly, I can empathise with others in the same position. I was lucky enough to have health insurance and able to have the procedure carried out within a couple of months. I can only imagine the pain a person must endure if they have to wait for 15 months.

I understand the HSE service plan for 2015 was launched today. I will be pleased to learn from the Minister if the situation at Cappagh Hospital will be addressed in 2015.

Long ago when I was involved in clinical practice, I used to take great pleasure in writing such letters to politicians, including to the former Taoiseach, one Bertie Ahern. I am pleased to see the practice has not been discontinued. I thank the Deputy for raising the issue and for giving me an opportunity to outline to the House the current position on it.

Cappagh National Orthopaedic Hospital is a major elective orthopaedic facility which provides a national secondary and tertiary referral service for orthopaedic care for adults and children, including the national bone tumour surgical service. There has been a significant increase, 40%, in the number of referrals to Cappagh Hospital this year. The level of increase has not been observed at other sites and the factors for the increase in referrals are being investigated.

I had the opportunity to meet representatives of Cappagh Hospital yesterday, including the CEO, the chairman, the medical secretary and the medical director, and hear from them first-hand about the challenges faced by the hospital this year. The cumulative effect of a reduced orthopaedic revenue allocation, the cessation of National Treatment Purchase Fund, NTPF, funding and a reduction in private insurance income in 2014 has limited the surgical capability.

Cappagh Hospital has a total of seven operating theatres. However, while there are sufficient consultant staff available to provide services to meet demand requirements, not all theatres have been in use in 2014. As the Deputy outlined, between two and four theatres have been in use. This is a factor of both the need to manage activity levels within the financial capability and the availability of suitably qualified theatre nursing staff.

In terms of access, urgent patients continue to be prioritised and Cappagh Hospital has advised that owing to strict chronological booking policies, all patients attending the hospital are being offered dates for surgery based on their waiting time for surgery having due regard to clinical categorisation.

The HSE has been in active engagement with Cappagh Hospital this year regarding its finances and to examine and agree options for optimising the available theatre resources and to ensure patients have timely access. The HSE recently facilitated €800,000 in additional funding to enable Cappagh Hospital to treat 102 patients from the waiting list in Cavan General Hospital. This will also facilitate treatment for some additional Cappagh Hospital patients. Funding has also been provided this year for 43 active rehabilitation beds at Cappagh and I understand this initiative has worked very well.

I have also been advised that, while challenges remain in relation to inpatient access targets, day case and outpatient 2014 target levels will be achieved this year. For 2015, I understand the HSE will continue to engage with the hospital regarding its budget and to explore mechanisms to ensure optimal use of resources, including theatre capacity, at the hospital within the overall resources available to the acute sector.

The Deputy will also be aware that Cappagh Hospital is part of the Ireland East hospital group, which includes the Mater; St. Vincent's University Hospital; Midland Regional Hospital, Mullingar; St. Luke's Hospital, Kilkenny; Wexford General Hospital; National Maternity Hospital, Holles Street; Our Lady's Hospital, Navan; St Columcille's Hospital; St Michael's Hospital, Dún Laoghaire; and the Royal Victoria Eye and Ear Hospital.

I am confident there will be a structured integration of Cappagh Hospital into the Ireland East hospital group in 2015 and that this will provide opportunities and support for Cappagh Hospital in managing demand and delivering high quality, safe patient care in a cost-effective manner.

I thank the Minister. I note the Minister used to write letters similar to that written by Mr. Paddy Kenny. I note the Minister's hope that a re-organisation of the hospital system will produce a better result. However, the people on the waiting list tend to be older people who need knee and hip replacement surgery. If they have to be on a waiting list for more than a year they will be suffering from pain and trauma. My constituent tells me that he has difficulty walking to the shops and his condition is getting worse. A person should not have to endure that kind of pain in their older years. Such cases should be prioritised.

Is there a particular problem in Cappagh Hospital not replicated anywhere else? If such a problem can be addressed would it mean that the waiting time of 15 months could be reduced? The Minister referred to other hospitals in his reply. Would it be possible to send patients to another hospital for the same orthopaedic surgery? Is that an option for patients?

There is not a particular problem in Cappagh Hospital. It is a very well run and well managed hospital. Ironically, in some ways the hospital demonstrates the consequences of coming in on budget. The hospital does not have an accident and emergency department and therefore, no emergency admissions and as a result the hospital can plan its activities precisely every year. The hospital has come in on budget every year and it has almost no agency staff. However, the consequence is that the hospital has had to cut back activity very considerably and this is the cause of the problem highlighted by the Deputy.

In the HSE service plan published earlier today provision is made for an increase in the number of day cases and day surgery by 20,000 next year. It is intended within the budget of €4 billion for hospitals to provide an increase in the budget for Cappagh Hospital next year so it can begin to ramp up activity. It is hoped this will show results next year in terms of people like the Deputy's constituent and many of mine experiencing shorter waiting lists. The difficulty we have is that as our population ages, the demand for orthopaedic surgery keeps increasing and the budget is not increasing adequately to meet that demand. The situation will be alleviated next year when there will be more money for Cappagh Hospital to carry out these operations, but not enough unfortunately.

The Dáil adjourned at 5.25 p.m. until 2 p.m. on Tuesday, 2 December 2014.