Leaders' Questions

Scoliosis is a condition that affects several hundred children and adolescents in Ireland. It is a progressive disease that involves the curvature of the spine. It causes increasing difficulty with breathing and has an impact on the heart and other internal organs. As the Tánaiste can imagine, it has a particular effect on children who are sensitive with respect to their appearance as they travel through their school lives. It is a very sensitive situation. Scoliosis has an impact on the condition and mental health of children and affects how they get about the place.

This issue was forcefully brought to my attention by a young woman called Sophie from Galway. She is 15 years old. She once led a cheerful, confident and outgoing life. She had an excellent attendance record in school. She was once a grade A student. In February 2014, she was diagnosed with scoliosis. By the summer of that year, her condition had deteriorated and urgent surgery was recommended. She went through many tests and scans in preparation for the necessary surgery. Neither Sophie nor Sophie's mother has heard a word from the HSE since those tests and scans were done. She has been left in limbo since that time. That has too often been the experience of many families who carry the burden of scoliosis. It seems the HSE and the Minister do not act until people in the media, such as Ferghal Blaney of the Irish Daily Mail, contact the HSE to ask about scoliosis cases.

The delay of almost two years is now having an impact on Sophie's internal organs. When she presented herself to a GP yesterday, she learned that the curvature of her spine is now at an angle of 80°. The impact of this could puncture her lung. Worse still has been the impact on her mental health. She is no longer able to attend school. Sophie is now on anti-depressants as a consequence of having to wait two years for an intervention.

To add insult to injury, Sophie, who is a child, received a personal letter from the HSE last week telling her that she would be sent to Barringtons Hospital in Limerick. The members of her family members celebrated and were relieved. When they rang the HSE this week, they were advised that the letter had been sent in error. Hundreds of adolescents like Sophie are languishing on waiting lists as they wait for treatment. Is the Tánaiste happy with how such children are being treated by the Government and the HSE?

Anybody who has experienced scoliosis, who has family members or friends who suffer from it or who knows someone who suffers from it will be aware that it is a very difficult condition. The impact of it is obvious when one considers that it affects growing children. I am not familiar with the details of the particular case highlighted by Deputy Keaveney. I will ask the Minister for Health to ask for a report from the HSE on the subject. I apologise for any error that has been made by the HSE. I hope the HSE will have apologised for any such error as well. I hope any error has not had too severe an impact on Sophie and her family.

In a general sense, people who are familiar with scoliosis may know that it has been the subject of a significant expansion of resources in our health system. It is important that we acknowledge that the provision being made for the number of cases to be treated has pretty much doubled in the lifetime of the Government. Treatment is now available in many different locations, some of which have seen increased capacity, including Blackrock Clinic, Cappagh hospital, which is a dedicated orthopaedic hospital, and Temple Street children's hospital. As we speak, the construction of a new theatre at Our Lady's Children's Hospital in Crumlin is under way. This will provide additional resources for dealing with this difficult condition. Two additional orthopaedic consultants have been appointed at University Hospital Galway.

This particular disease, which has a stronger presence in Ireland than in many other countries, has received significant attention. There has been a doubling of resources and an increase in the number of locations where patients are treated. In addition to dealing with cases in Blackrock, Temple Street and Crumlin, we are also now referring a number of cases to the UK Royal National Orthopaedic Hospital in Stanmore near London. This is a mechanism for dealing as quickly as possible with the cases on the list, particularly those presenting great complexity and those involving patients who may have one or more conditions in addition to scoliosis. As medical technology develops, the capacity to deal with more complex cases is improving. I assure the Deputy that the HSE, the Minister for Health and the Department of Health are allocating significant additional resources. Treatment is being provided at a number of locations in the country and, for the first time, in Stanmore near London. I hope the families and individuals who are suffering from this condition will understand that we intend to provide a greatly expanded and enhanced level of treatment. We are doing that by doubling the resources and providing orthopaedic treatment in some of the premier institutions in Ireland.

I acknowledge the Tánaiste's response. The waiting list for children with scoliosis is increasing. The time that children are having to spend on the waiting list is increasing. Teenagers with scoliosis are having to wait up to three years for early interventions. Dr. David Moore, who is a consultant in orthopaedic paediatrics, has said:

Operating on a child who has been subject to unnecessary delays between diagnosis and surgery is like [dealing with a very profound situation]. Research shows that when a child’s surgery is delayed until they hit a 70° curvature ... they are subject to a longer surgery, greater intraoperative blood loss, more fused vertebrae [and] double the blood transfusion risk.

The issue here is early intervention.

The waiting lists in Crumlin's orthopaedic department have increased significantly since March. I ask that the Tánaiste roll up her sleeves to give some level of hope to families who have been languishing on waiting lists and to children who are suffering in pain. I ask her to ensure the Minister rolls up his sleeves too. He is one of the highest paid Ministers for Health in Europe. We are asking for action for children who are languishing in pain on waiting lists.

Early intervention is the key because, after the age of 16, there is little or no point in intervening because the likelihood is that an operation to address curvature will fail. After diagnosis, what is required is investment but we do not see any urgency or political will on the part of Government in this area. Look at the waiting lists in Crumlin - they have increased since March. I acknowledge that, at a very late stage, the Government is attempting to do something but that is only because it is exposed.

Dr. Moore is known to families right around Ireland and to many Members of this House as one of our outstanding surgeons. I assure the Deputy that anything said by David Moore will be taken very seriously by me personally-----

What about the Minister for Health?

-----because I am very aware of his personal reputation and his commitment to children. His family has a very strong history of involvement in medical matters in this country. I said an additional theatre was being built in Crumlin. The Minister for Health has met Professor Moore on several occasions and additional theatre space was one of the proposals from him. The theatre is under construction at the moment and I anticipate it will be finished and available shortly. In order to reduce the waiting list, a specific examination has been done to look at the different issues which face different children. Some are straightforward but others are more complex. In order to help with that, the Stanmore clinic in London, a renowned location, has been commissioned to do some work in conjunction with the hospitals here, namely, Temple Street clinic, the royal hospital and the orthopaedic hospital. Stanmore has accepted 11 patients from Temple Street, five of whom have been waiting for a long time. Two of the families have decided not to progress with surgery-----

For a good reason.

-----on the basis of second opinions while two will be followed up with outpatient appointments in Crumlin. In fairness to the HSE and the hospitals, the staff nurses and medical consultants have a tremendous record of service to children. Anyone who is familiar with scoliosis will know how difficult it is to deal with and one has to get it right. Orthopaedic operations have to have a high level of success although that does not refer to the situation with Sophie which the Deputy said arose from a cancellation. I assure the Deputy that, in resourcing the HSE and individual hospitals and departments dealing with these issues, a concerted effort is under way to deal with children and teenagers who have been waiting a long time. As the Deputy said, this affects their whole lives.

The photographs in many of today's papers are very stark. They show entire communities under water and vast swathes of the country are now flooded. Many of us here today come from communities that have been devastated by the recent bad weather, including my own county of Cork. Homes and businesses have been destroyed. People's livelihoods are literally being washed away, and this is not the first time for many citizens. People in these areas cannot get insurance to cover their homes and businesses against this type of damage and this is a major problem. The Taoiseach was asked yesterday by my colleague, Deputy Pádraig Mac Lochlainn, if he would introduce a State-funded aid package for houses and businesses in areas at high risk of flooding which cannot get insurance cover through no fault of their own. He would not give that commitment. I ask the Tánaiste to argue for this desperately needed package at Cabinet level. Will she tell her Fine Gael partners in Government that we need this package of funding to help the thousands of families whose homes have been destroyed as a result of bad weather this week? This bad weather is set to continue and even get worse so will the Tánaiste please send a message to the people at high risk of flooding that their Government will be there to support them with practical and monetary assistance?

All our commiserations go to all the households, families and businesses affected by the flooding. Hopefully, as the weekend progresses all the work that has been done on the ground by local authorities, the Defence Forces and community welfare staff of my own Department will help to mitigate this very traumatic and upsetting event for any family, particularly in the run-up to Christmas. This is the largest weather event of this type since 2009. The current weather forecast is for a long front and we are not yet sure where it will land. The Department of Social Protection's humanitarian assistance emergency programme was activated approximately three weeks ago, when the first spate of flooding started. Last weekend, together with the county councils of Kerry and Clare, we assisted families to access alternative homes, where appropriate, and other accommodation on a temporary basis. Most people want to stay at or close to their homes so that they can begin the clean-up.

The Department of Social Protection is also activating a €10 million fund to help to meet the immediate costs of the flooding. As the waters recede and the clean-up starts, this fund will help with the provision of furniture and white goods, such as fridges and freezers, which have been destroyed. The third phase will be to help people carry out structural work which may be required on their homes. On the previous occasion this happened in 2009, which Deputy Keaveney will remember, we worked extensively with families in east Galway. In a number of cases, homes had to be knocked and replacement homes built because they were built on flood plains. This work was done in conjunction with the local authority and the OPW. All the measures outlined in emergency provisioning are now in place and under way but it takes some time, particularly with major structural damage, to identify what has happened to a house and what needs to be done.

In Cabinet the other day, we agreed to establish a €5 million fund in conjunction with the Red Cross to assist small businesses who are at a loss and unable to get insurance. Discussions on that are under way as we speak and more will take place over the coming weekend. It is difficult for traders in places like Bandon who have been looking forward to one of the best Christmases since 2007 and 2008.

On the question about insurance, there have been detailed discussions on this issue both in committees and with the Minister for Finance as it relates to his remit. There are a range of views on possible insurance supports and schemes. I do not know if the Deputy has identified the type of scheme she wishes to propose, but it is certainly something that should be examined again. However, we must be careful. Are we saying we will allow the private insurance industry in Ireland to walk away from responsibility for providing general insurance for people's properties, and how will we identify those areas and the insurance risks that will be taken on by the general policyholder in the form of higher insurance payments or through some other scheme? I would be interested to hear the Deputy's proposals on that.

The Government has cut the OPW's flood risk management programme in 2016 by €15.6 million, or 25%.

That is not true.

The €5 million the Government has committed to providing for flood relief will do nothing for home owners as it is allocated to help businesses. The €10 million allocation is means tested and is obviously very restrictive. That is the reason it has not been drawn down.

That is not true.

It has never been fully drawn down. We know this situation will only get worse. The weather forecast is not good. The increased prevalence of flooding in Ireland in recent years has been linked to climate change. There has been an increase in the annual rainfall in northern and western areas, while there have been decreases or small increases in the south and east. The Taoiseach has said we will not meet our emissions targets. This will cost the State €600 million in fines. The risk of flooding is increasing and will continue to increase. Does the Government have a long-term strategy to deal with the risk of flooding and to improve our flood defences? Will the Tánaiste outline that plan? People across the island need to know that our political leaders have a plan to prevent this from happening again.

With regard to the figures the Deputy put forward, in the past 20 years Governments have invested €410 million in flood relief schemes. By comparison, this Government has provided €430 million, in terms of national planning, for flood risk in the coming six years. A number of very successful flood defence and flood alleviation schemes have been put in place in recent times, such as in Clonmel, close to the Deputy's area, where it is working well and, one hopes, will continue to work well. Flood defence schemes have also been installed in a wide range of towns at risk of flooding while work is at a very advanced stage for a number of other schemes.

The Deputy referred to EU rules. EU rules relating to flooding require, for the best of reasons, intensive local consultation on the provision of flood defence schemes. In some cases, this has given rise to serious objections at local level. The Deputy is probably familiar with the discussions in Dublin about some of the flood defence schemes. The public discussion process in the planning process, as required by EU rules, is lengthy. However, the Government has provided for more funding in recent years and over the next six years for flood defences than previous Governments provided over 20 years.

As the previous speaker said, in rural parts of Ireland and in towns such as Athlone, Ballinasloe and Athleague, throughout most of Galway and in County Clare down to the mouth of the Shannon, people are holding their breath because they do not know what will happen in the next few days. Schools have been closed all week in various parts of the west. There are a number of issues we must examine, including what is happening in county councils. In most areas the number of outdoor staff who carry out the water cuttings on roads has been reduced by 60% over the past ten years.

This country appears to be the greatest country in the world for telling people how they cannot do something. Whenever somebody tries to do something positive, they are blocked. The Shannon, Suck and most rivers in this country are blocked with silt. I spoke to a person yesterday who has a canoe on the Suck. Two months ago the person failed to get through part of the river due to the amount of silt in it. When somebody tries to do something on their land or in a river in these parts of the country, five different bodies try to put obstacles before them. They will talk about EU legislation, most of which was signed by this Government in 2011, regarding environmental impact assessments, EIAs, and appropriate assessments. The National Parks and Wildlife Service is the biggest villain of them all. Last year there was a flood on a road in Galway and the road was opened and closed five times. In the end the Garda had to intervene because one arm of the State was blocking another. We saw what happened to people in England two years ago when a number of rivers flooded. However, England, unlike this country, took the bull by the horns. People there decided to take out the dredging machines and to carry out the required work.

Many people do not understand that in rural Ireland we have a managed landscape. It is a landscape where one must manage drains and rivers. However, we are blocked from that because of all the bureaucracy. The Tánaiste spoke about spending €400 million on flood relief. I am aware of a town where €280,000 was allocated for that. In fact, the job itself cost €100,000. People in suits called consultants and engineers spent the rest of the money. We must cut down on this. Is the Tánaiste prepared to put more outdoor workers in place? I travelled around the roads last weekend with a sled containing signs which the council gave me to erect on roads where there were floods in case cars would be destroyed. There were not enough outdoor staff to do it. In addition, the Government should allow ordinary people in communities to get involved and help, because councils are afraid to tell them. Is the Tánaiste willing to put more outdoor staff in place? Will she get the OPW to spend its budgets and not return them to the Exchequer? There was a €15 million underspend this year and a large underspend last year.

Is the Tánaiste prepared to get rid of the bureaucracy in terms of the cost of consultants? I attended a Department of Agriculture, Food and the Marine event in Castlerea, County Roscommon, this week and heard there was nothing we could do. There was a group of consultants present and I asked them what we could do and whether they had a report. They said they had but the funds were not available to solve it. Is the Tánaiste prepared to stand with England? The opportunity is coming. Instead of telling their businesses how to vote, will the Government stand with England and change the EU and its bureaucracy? We have the habitats directive and the water framework directive, but one is colliding with the other. Will the Government introduce emergency legislation to overrule the bureaucracy in this country in order that we can let water flow in rivers?

People will do it in their own areas if they are given the opportunity. Will the Government overrule the EU bureaucracy and the bullshit that is coming from it?

I would appreciate it if the Deputy did not use unparliamentary language.

I am not sure the UK is the perfect model.

They have dredged all the rivers.

I do not know if the Deputy has read about Cumbria and what is happening there.

They dredged there.

Is he proposing the Cumbrian model-----

They have dredged there.

-----where they have spent tens of millions and the result has been no great defence of the poor people?

They have dredged there.

Please, no more interruptions.

What the Deputy is also suggesting is that there would not be consultation in a way that would provide solutions that support local communities and also support wildlife and habitats-----

People are more important.

-----as we are required to do under EU legislation.

And ahead of the people.

A moment ago, Sinn Féin was suggesting that we needed to take drastic action to cut emissions. Sinn Féin knows that is shorthand for cutting our national herd and cutting the livelihoods and activities of farmers throughout the country.

If the land is under water, where will the herd go?

The Tánaiste does not have a clue, God love her.

We have emissions targets to reach.

Instead of a structured, organised approach to the relief of flooding, we are hearing-----

It is emissions from the Tánaiste.

-----a little bit of political grandstanding on the misery of people who are undoubtedly petrified of what may happen over the next four or five days. If the Opposition wants to engage in positive proposals, we need to address the bad planning which located buildings and properties in areas which are no longer appropriate. We need to review that. The climate of the earth is changing and part of that has been, as the Deputy said and as I agree, more difficult conditions in terms of rain, floods and storms in certain parts of Ireland. In terms of the ongoing discussions in Paris, we have a number of challenges. In terms of making progress on this, the €430 million allocated by the Government is a significant amount of money. Deputy Fitzmaurice is suggesting that simple dredging of river beds would address most of the issues. While the Deputy may be right in some cases, I doubt seriously that he is right in all cases. People who are involved in tourism and fishing might not support his view that the rivers of Ireland should simply be gouged out. Deputy Fitzmaurice is making some valuable proposals but he is also making proposals which might have serious unintended consequences for farming and tourism.

He is a man of the land. He knows what he is talking about.

What we need is a conversation that protects both. People all along the Shannon are very interested in promoting the value of tourism, including fishing, along the river.

They do not want to be drowned out of it. They will not be able to promote tourism if they are drowned.

While the Deputy suggests that simply gouging out the rivers is a solution, he needs to think about it. He should, along with communities and other affected people, work out the best solution which is sustainable and which does not damage livelihoods in different areas. I welcome the Deputy's contribution, but he needs to expand it at greater length to say what should be done.

Taking the UK model, he should look at Cumbria and what is happening there at the moment.

Look at what they have done.

I call Deputy Fitzmaurice to ask a supplementary question.

Some of us in the west come from marginal land and have dealt with water and improving our lands our whole lives. That means trying to get water away to grow grass. As such, we may have some idea of how to shift water. I note that Holland is below sea level and is not drowned out of it at the moment. Reference has been made to nature. We grew up with nature in those areas and looked after it. However, the so-called experts came in and told us how to live our lives. The fact is that nature has now been drowned out of it, which is completely wrong and should not have happened, as a result of what has gone on with bureaucracy in this country.

I did not say that dredging the rivers would solve every problem. I understand there are some areas which are low lying. However, in most areas, it would solve the problem. The Tánaiste did not address the point about council workers. I point out to her that putting cuttings on the roads would have gotten rid of a great deal of water. I have seen areas where works carried out in 2009 to install pipes to bring water from A to B have worked. Sadly, there are too many bodies at the moment which are interfering and it is a problem. The people of the land know how to move water. That is the reality. The Tánaiste referred to consultation. The people around Athlone would prefer if there was less water in the area. They are able to farm their land and would be supported in doing so, but the Tánaiste should not patronise them by saying they would much rather be at tourism or whatever. They are well capable of running their lives, but their lives are being taken away because their houses, farms and sheds are flooded.

If we do not decide to address the problem, we will be in trouble as a country. If we do not stand up to what is happening, the west will become a theme park with rules and regulations coming in from Europe. A person should be allowed to live in his or her house without being drowned out of it.

As a Minister I have had to help to resolve situations in parts of the west where, unfortunately, due to changes in the climate and the events arising from the floods of 2009, we had to get some people to move from beautiful homes they had lived in for many years. Deputy Keaveney can confirm that, as would Deputy Grealish if he were here.

All I am saying to the Deputy is that his earlier suggestions of a one-size-fits-all solution and the UK solution, while well meant, are not necessarily the solution.

I never said one size fits all.

We need to work on a scheme of flood protection for the country as a whole. We must change some of our approaches to planning to ensure we do not build permanent structures in areas which are continually subject to flooding on a five to ten-year cycle. That is a nightmare for the people involved. We must revert to local authorities and say they have a responsibility in their approach to planning.

They have no outdoor staff.

What about outdoor staff?

We might as well move to Bandon.

Local authorities have significant income and are, as we speak, devoting significant staff resources to helping people.

They do not have the staff and are 60% down in ten years.

They are helping people in areas affected by flooding. As the Deputy knows, the Defence Forces have also been assisting. We all take our hats off to the people who have been out working night and day with the local communities.

Give them wellies.

Our country is now experiencing 20-year weather events every five years and we must respond to that. Most people in the west value and love their landscape. They have to make a living, but that is done in a variety of ways, not just from farming but also from tourism.