Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 4 May 2017

Vol. 949 No. 2

Topical Issue Debate

Hospital Closures

The people of Dungarvan in west Waterford were shocked by the sudden and unforeseen closure of 16 beds in the Sacred Heart unit at Dungarvan Community Hospital at the weekend. Like everyone else, I was taken aback by the announcement at the weekend that the remaining 16 beds would be closed at the unit as a result of staff shortages. The way it was announced on the eve of a bank holiday weekend was an attempt to bury the story in the hope it might just go away. Families were contacted last Thursday and Friday and told the unit was closing with immediate effect. The 16 beds closed comprised 11 rehab beds, three long-stay beds and two respite beds. This unit provides vital rehab services and physiotherapy for people recovering from stroke and accident, allowing patients to convalesce on a short-term basis. The importance of the two respite beds cannot be underestimated with families availing of these vital services two weeks of the year when their loved ones get excellent care and the carers get a much needed break. These facilities are a key factor in dealing with overcrowding in our acute hospitals. If we see further reduction in capacity in places such as Dungarvan, how can we possibly deal with the overcrowding in UHW and our other acute hospitals? The hospital in Dungarvan is a vital step-down unit. In January 2017, seven beds were closed in the unit and the closure of the 16 remaining beds is a major blow to Dungarvan and west Waterford. Family members of patients contacted me at the weekend because they are deeply concerned about where their loved ones will be moved to. The unit allowed people from the west Waterford area to stay close to their families. One of the issues cited was a shortage of nurses, which is now at critical stage. There are issues with nursing recruitment and retention but not letting those who will be directly affected by a decision to close know in advance has resulted in serious disturbance and upset among patients, families, staff and the wider community.

Ar an gcéad dul síos, I thank the Ceann Comhairle for allowing us to raise this Topical Issue this evening. It is a very important issue. The Minister has been down to Cashel in Tipperary. He saw the wonderful unit in the old Our Lady's which is lying idle; €23 million was spent on it and there is not a bed inside it. There are managers galore but not a bed. The Minister told me he would do something, yet he has done nothing. Deputy Butler lives in Dungarvan and I am 20 miles away in Newcastle. South Tipperary General Hospital in Clonmel is in the middle of the two, about 20 miles from each place. It is unbelievable. There is bedlam every day of the week on the corridors. It is a retrograde step. It is only an excuse for the HSE to say it cannot get nurses. There are plenty of managers there to get nurses. They have had plenty of time to get them. The HSE is telling us this is only temporary in the Sacred Heart in Dungarvan and in Cashel. We lost a ward in Cashel already when it was transferred to the back of Our Lady's. We lost 12 respite beds for women when that transfer occurred. We hoped it would be a modern, new facility, which it is, but we lost 12 respite beds in the system in south Tipperary. Many of the people in west Waterford come to Clonmel and Ardkeen. They get their procedures in Clonmel under awful pressure. They cannot be released because there is no place to which to be discharged. This is total madness. Is the Minister going to allow himself to be captured by the officials? I do not say that lightly. I wished the Minister well in his position but the officials are ruling the roost and doing a damn bad job of it. The Minister can smile all he likes. Closing respite beds is madness; it contributes to the problem. There is a wonderful facility in the Sacred Heart in Dungarvan and a wonderful facility in St Patrick's in Cashel under Mary Prendergast, who is doing her best. Officialdom is ruling the roost. There are dozens of officials in the new hospital where €21 million was spent but not a bed. It is a bed-free zone and a patient-free zone. The Minister said he would do something about it but he has done nothing. It will cause chaos coming into summer. It will cause absolute chaos when it comes to the winter because these beds in Dungarvan have been lost and we will lose 15 to 18 further respite beds on top of the 12 we have lost already in St Patrick's in Cashel. Where have people to go? Will they go on the streets or the roads? This is pathetic. It is ineptitude by the HSE. It is scandalous. Temporary measures will not work because they are not temporary. Nothing is temporary with the HSE. The only thing permanent with the HSE are the managers and lazy bureaucracy.

I thank Deputies Butler and McGrath for raising this important issue. The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This is clearly what older people and everybody in this House wants. We also have patients who are in genuine need of residential care either on a long-stay or short-stay basis. The HSE is responsible for the delivery of health and personal social services, including those at facilities such as Dungarvan Community Hospital and St Patrick's community nursing unit in Cashel. Both hospitals provide long-stay residential, respite, palliative care and rehabilitation services for older people. As with the health service In general, Dungarvan Community Hospital and St. Patrick’s, Cashel are experiencing significant challenges with recruiting and retaining nursing staff. Dungarvan has 16 whole-time equivalent vacancies, eight of which are required for the Sacred Heart ward. St. Patrick's has vacancies for ten whole-time equivalents. While there have been a number of national recruitment campaigns for nurses, unfortunately a serious challenge has arisen in recruiting nurses to fill vacancies in these facilities. These two examples in Dungarvan and Cashel highlight the absolute importance of ensuring we hire the 1,208 more nurses we are fully funded to hire this year. Nurses, through their representative bodies, the INMO and SIPTU, voted overwhelmingly a number of weeks ago to accept the proposals we put in place. I will be talking to the INMO at its annual conference tomorrow about how we turn the plan into absolute action so that facilities like this can be adequately staffed because this is a very acute problem.

As a result of the nurse recruitment shortages, in order to maintain the delivery of safe, high quality services in compliance with standards and the laws of the land to look after people, which is what is most important, the HSE has decided to move residents internally from the Sacred Heart ward to alternative accommodation within Dungarvan Community Hospital and to amalgamate wards within St. Patrick's. This is a temporary measure and staff will be reorganised to optimise patient safety. Long-stay and short-stay care, including palliative and dementia care all continue to be provided. I assure Deputies Butler and McGrath there is no decision in any way, shape or form to close these facilities or beds. It is a short-term measure whilst recruitment is under way. I say that on the record of the House to give assurances to the people of Dungarvan and the people of Cashel and beyond on this. It is a staffing shortage that we are determined to fix so these beds can reopen. I understand the decision has caused a great deal of upset for residents, families and the local community. I hope further clarity has been and will continue to be brought to the situation by the HSE. I fully accept the point made by Deputies Butler and McGrath about the panic, upset and confusion it caused over the bank holiday weekend.

There was no notice.

The HSE has assured me that patient welfare is a priority for staff and management, which none of us doubts, and has expressed its deep appreciation of the support the hospitals receive from families and the wider community. Both of these facilities are held in high esteem. The HSE acknowledges the concerns expressed on this subject in recent days and apologises to residents and their families for any inconvenience and will work to ensure there is minimum disruption to normal services during this interim arrangement. It is important to note there is no negative impact on existing staffing numbers whilst this interim safety arrangement is in place at both hospitals. Representatives of hospital management are available at all times to residents and their families to discuss any matters of concern to them. They assure me they will continue to work closely with staff representatives to bring both units back to full operating capacity.

My Department will monitor the situation carefully and I have asked the HSE to keep me directly updated on progress. Another factor that has contributed to the temporary closure in St. Patrick's is the structural issues associated with the building, which I acknowledge do not meet the standards one would expect to find in a modem nursing home. Deputy McGrath and I have discussed this before. A replacement for St. Patrick's is, like Dungarvan, included in the five-year capital investment programme for public nursing homes announced last year.

I thought - as I am sure the Minister did - that we had turned the corner and that the closure of wards was in the past. The trend of nurses leaving Ireland has become very worrying. Terms and conditions for new graduates must be improved to ensure that they stay here. The Minister mentioned that he will be attending an INMO conference tomorrow. Last week, that organisation published research showing that upwards of 85% of all soon-to-graduate nursing students are contemplating going overseas to work rather than staying in the Irish health system. Coupled with that is the length of time it takes for nurses who return home to work to be registered with An Bord Altranais, an issue I have raised with the Minister previously. Such registration can take up to 90 days and I know of one nurse who actually gave up and went back to England.

I am glad that the Minister has asserted that this is a temporary rather than a permanent measure and I will be holding him to account on that. This is a vital service for the people of Dungarvan and west Waterford.

I thank the Minister for coming into the House to address this matter. He has said that this is temporary but nobody trusts the HSE. This is a case of sheer ineptitude on the part of senior management in the HSE. A blind woman or man could see that this was coming. The services did not have enough staff and were under chronic pressure. I want to pay tribute to the staff in both facilities for the fabulous work they do and for the excellent treatment they give to patients.

Nobody told me, as a public representative, about this. A patient's family phoned me and when I phoned the HSE, they said that they were going to tell me. This is nothing but subterfuge and deceit on the part of senior HSE management who do not care. They do not care about the patients. I know that the Minister means what he says but the HSE managers do not mean it. They go off on their holidays, tours and trips. They saw this coming and now the hospital in Clonmel will be totally swamped, as will University Hospital Waterford. Clonmel will be totally swamped and when winter comes, God help us. The Minister was there, he saw the facilities and rubbed his hands. He is still rubbing his hands but nothing has been done; rather, this is going to make a bad situation worse. I am glad that the Minister has said that money will be invested as part of the five-year programme because we need new beds in St. Patrick's. Will it happen, though? We will hold the Minister to account.

Finally, I ask the Minister to receive Ms Twomey at his office this evening to bring the current stand-off to an end. I asked him to do so earlier today, as did many other Deputies. The Minister should meet her for five minutes. He should have the good grace to inform her of the current situation.

That is a different matter completely. I ask the Deputy not to go there now, please.

I am not saying that he can solve the problem but I would ask him to meet her, as he has already committed to doing.

I thank both Deputies again for raising this matter. I want to begin by letting both Deputies and all Oireachtas Members and public representatives in Waterford and Tipperary know that I am not satisfied with the lack of communication by the HSE on this issue. I think it is disrespectful and I intend to convey that directly to the HSE. It is not good enough. The HSE needs to inform public representatives so that the truth can get out there.

It needs to inform the families too.

Of course. Patients are of paramount importance. It is very important that the truth is put out there in a factual way. I know that there was a concern in both communities that these facilities were shutting but this is only a temporary measure. It makes sense to brief people and keep them factually aware of the situation so that myths and misinformation do not spread.

In terms of nurses, I fully agree with Deputy Butler. Obviously, we will have the public service pay commission report shortly. That is a broader process and one for my colleague, the Minister for Public Expenditure and Reform but that will provide an avenue for discussion. We have just agreed a number of exciting proposals with the INMO and SIPTU to help to recruit and retain nurses, including under the Bring Them Home campaign. Nurses were offered €1,500 to move back from the UK to Ireland and that sum has now been doubled to €3,000 and it does not just apply to the UK anymore. We also have a number of pre-retirement initiatives to enable older nurses who may wish to stay on and work part time rather than full time to do so without negatively impacting their pension entitlements.

Deputy Butler is right about the Nursing and Midwifery Board of Ireland, NMBI, registration process. I recently visited the NMBI's offices. The board is about to go fully digital which should help in making sure that the organisation is not swamped. It is quite busy in terms of receiving applications but digitisation should lead to a more streamlined process.

The beds provided by public nursing homes like Dungarvan Community Hospital and St. Patrick's in Cashel are an essential part of our health care infrastructure. Without them, many older people would not have access to the care that they need. However, as I said already, quality care and patient safety are priorities and all decisions must be made in the interests of patient safety. At present, these two units do not have sufficient nursing staff to safely maintain the full range of services. Therefore, the HSE is obliged to take the appropriate steps for the management of the patient profile and the staffing resources available.

I reiterate that I am assured that these are temporary measures. Any decisions to close beds are taken in the interest-----

What does the word "temporary" mean in the HSE's vocabulary?

----- of safely maintaining services. The HSE will actively seek to recruit nurses as quickly as possible. I will keep in touch with both Deputies on this matter.

Hospital Facilities

The closure of the medical assessment unit at Our Lady of Lourdes Hospital in Drogheda is a regular occurrence. It is common practice. It happened last week and the unit could very well be closed right now, as I speak. Perhaps the Minister can understand this but I cannot. The unit was opened to alleviate pressure on the very busy emergency department in the hospital. The HSE says that the hospital is very busy so it closes the medical assessment unit and sends patients back into the emergency department. One could not make it up.

Last Tuesday there were 217 patients in the emergency department in Our Lady of Lourdes Hospital. This was an unprecedented number but the medical assessment unit was closed. I contacted the HSE by e-mail on the Monday before last. My email was very straightforward - I asked the HSE to confirm that the medical assessment unit had been closed and to give me a reassurance that it would reopen on the following day. I got no response. I emailed the HSE again on Tuesday and Wednesday but got no response. I emailed again on Thursday but, to date, nobody has bother his or her backside to respond. That is a very serious issue and raises a number of questions. First, it raises the question of a lack of accountability within the HSE. It also raises the question of mismanagement in the context of the closure of a medical assessment unit which was opened in the first instance to alleviate pressure on the emergency department. The fact that the HSE did not respond to my emails leads me to believe that it did not want the public to know what is going on in the hospital.

First, there is the issue of the medical assessment unit. Second, there is the fact that the HSE did not respond to an elected representative on four different occasions. HSE senior managers seem to believe that they are answerable to nobody and are a law unto themselves. I ask the Minister to give his opinion on that. Will the Minister be holding them to account? I want to find out who made the decision not to respond to four separate emails on a matter of great concern to patients at Our Lady of Lourdes Hospital. I also want to know why the medical assessment unit was closed given that the reason it was opened in the first place was to alleviate the pressure on the emergency department. Why is it that droves of patients are now being sent back to the emergency department?

I thank Deputy Munster for raising this issue and assure her that I will be taking it up with the HSE directly. I received an email from the Deputy earlier this week regarding the lack of a response to her queries, which is not acceptable for any public representative or citizen of this country. I will get back to the Deputy directly regarding that matter.

I wish to take this opportunity to address the performance of the emergency department and the medical assessment unit in Our Lady of Lourdes Hospital in Drogheda. While recognising the pressures our emergency departments face, it is worth pointing out that recent data from the HSE indicates that, despite an increase of over 3% in attendances for the first quarter of 2017, the situation at the Our Lady of Lourdes Hospital has been improving, with 42% fewer patients waiting on a trolley compared to the same period this year. It is easy to get lost in percentages but that equates to 850 fewer patients on trolleys so far this year in Our Lady of Lourdes Hospital in County Louth. While there are still too many patients on trolleys, I want to acknowledge the Trojan work being undertaken by staff. Despite the fact that additional patients have attended the emergency department, 850 fewer people in that hospital have experienced being on a trolley this year as compared with last year. We need to build on that progress and I am confident that the staff there will do that.

The emergency department has also seen a sustained improvement in patient experience times during this period. I am sure Deputy Munster will join me in acknowledging the great work of front-line staff and managers in driving this improved performance. I want to thank everybody at Our Lady of Lourdes Hospital for that.

Notwithstanding this, under the framework of the HSE's full capacity protocol, Our Lady of Lourdes Hospital has an agreed escalation plan in place in line with national practice. This plan comes into operation during periods of emergency department overcrowding. I think this is the issue the Deputy is getting to. The plan sets out a range of special measures which can be activated through the escalation process as a last resort. These measures aim to improve the flow of admitted patients through unscheduled care pathways. As part of this, a medical assessment unit may temporarily be used to accommodate a locally agreed number of extra patients to address overcrowding. This is often referred to as surge capacity. At these times, patients are seen in the medical assessment unit rather than in the emergency department. While this temporary change of use may not be ideal in terms of the utilisation of medical assessment units, it enables hospitals to alleviate overcrowding in emergency departments and, most importantly, affords patients a greater degree of dignity. When patients are in a very overcrowded emergency department, it is important to afford them a little more dignity and privacy where possible. That is why decisions of this nature are taken. I accept that it might not always be ideal to use such additional space for these purposes. I have been advised that management in Our Lady of Lourdes Hospital has used the medical assessment unit facility in full accordance with the standard operating procedures as set out in the HSE's full capacity framework.

I assure the Deputy that there will continue to be a strong focus on reducing overcrowding. This should result in medical assessment units being used less frequently for surge capacity purposes. My Department and the HSE are already engaged in a process of commencing planning for next year's winter period. We are continuing to build on and improve trajectory in emergency department performance. In parallel with this process, the HSE's special delivery unit continues to work closely with hospitals, including Our Lady of Lourdes Hospital, to identify improvements that can be made to support patient flow, reduce trolley numbers and improve patients' emergency department experience. The programme for Government includes a commitment to build on the capacity for our emergency and acute services. This Government has agreed to review the management, operation and funding of medical assessment units with a view to extending their hours of opening and providing for weekend opening. My Department is in the scoping phase of this review. I hope hospitals like Our Lady of Lourdes Hospital can benefit from it. A number of major capital projects are under way to increase overall capacity in our hospitals. One such project at Our Lady of Lourdes Hospital will see the construction of a ward block to accommodate a clinical decision unit. This ward block is expected to be completed later this year. I expect that this increased capacity will further reduce the need to initiate the full capacity protocol.

The response from the HSE is not acceptable. First, it contradicts itself. As I said, the medical assessment unit was provided to alleviate the pressures on the emergency department. The HSE has pretty much said in its response that the medical assessment unit was closed because the hospital was so busy. What sort of chaos or mismanagement is that? If it was provided to alleviate pressure on the emergency department, but management is deciding to shut it as soon as the hospital is busy, common sense will dictate that this must lead to overcrowding in the accident and emergency department. Last Tuesday week, 217 patients had to wait all day and through the night. The medical assessment unit was closed. I cannot make up my mind about whether this is happening because of chaos, mismanagement, or both. I would be interested to know whether the Minister thinks it is either or both.

We have been discussing the crisis at Our Lady of Lourdes Hospital for many years. This problem has been further compounded by the decision of the previous Government to remove services from the minor injuries unit of Louth County Hospital, which currently has two registrars who cannot see children under the age of 14 to deal with minor ailments they might have. The Minister has previously given us a commitment to restore those services. Can he tell us when that will happen? All of these cutbacks are compounding the crisis at Our Lady of Lourdes Hospital. Will the Minister ask the HSE or the senior management at the hospital to give a commitment not to shut down the medical assessment unit again, as such a closure would result in a repeat of the crisis we have seen in the emergency department this week?

I am disappointed, if not unsurprised, that the Deputy has not acknowledged the significant progress that has been made by the staff of Our Lady of Lourdes Hospital to reduce the number of patients on trolleys in that hospital this year. These are not just figures; they are real people. Compared with last year, 850 fewer of Deputy Munster's constituents have had to experience a period of time on a trolley in the hospital this year. I want to make it clear that the number of people who have had such an experience this year is still too large, but it is worth noting that there has been a reduction of 850 in that number to date this year. The figures, which are there for all to see, show that people have been able to get in and out of the hospital more quickly because of an improvement in patient experience times. There are still many challenges in our health service. If we do not stop to acknowledge instances of significant progress being made by the staff of our hospitals, what are we actually at? We need to acknowledge it when people make progress. We are making progress in Our Lady of Lourdes Hospital, which is the Deputy's local hospital. I am going to acknowledge that even if she chooses not to do so.

Decisions on how best to utilise space in the medical assessment unit are best made by staff. We have a procedure in place to be followed by a clinical nurse manager, a clinical director, a doctor, a nurse or a manager who is running a hospital with a crowded emergency department. Under the procedure in question, which has been agreed with the INMO, if extra surge capacity is available to afford additional dignity and privacy to patients, that space should be used, even if it is not an ideal situation. We want to minimise the need for such arrangements by tackling overcrowding. We are going to do that by opening a new clinical decision unit. This is a tangible example of how capacity can be increased in hospitals. We are going to recruit more nurses. We have agreed with the INMO and SIPTU that an additional 1,208 nurses will be recruited this year. We will ensure there are more staff back in our hospitals. The bed capacity review will enable us to look at exactly how many beds we need. I am the first person to admit we need more beds in the Irish health service. However, beds are only good when personnel are available to staff them. I will ask the HSE to respond directly to the Deputy on the issue she raised with regard to Louth County Hospital, or else I will come back to her directly on the matter. I will follow up directly with the HSE to ensure the Deputy's correspondence is answered.

Road Safety

I would like to share time with my neighbours, Deputies Mary Butler and Mattie McGrath, whose constituencies are served by the road I am highlighting.

I thank the Minister, Deputy Ross, for coming to the House to discuss this matter. In fairness, the Minister responded to Deputy McGuinness and me when we raised this matter as a Topical Issue in this Chamber last year. We invited him to come down and look at the Piltown bypass, which is a section of the N24 route between Waterford city and Carrick-on-Suir, and he said he would do so. As the Minister probably knows at this stage, 15 lives have been lost on this disastrous stretch of road since it was built over a decade ago. As a member of Kilkenny County Council at the time, I told representatives of the National Roads Authority that the road was badly designed. The 2+1 design of the N24 near Piltown means there is one lane for 3 km, then it goes into two lanes and then it goes back into one lane. There is confusion. There is a wire dividing the two sides of the road. When people come to junctions, they do not know where they are. The proof of that is that there have been 15 deaths on this road since it was built. If one goes down to the Piltown bypass, one will see 15 big crosses that have been erected by local people on the side of the road to commemorate the deaths that have taken place and to mark the worst piece of engineering they have ever seen. Local people are now calling this area the "valley of death".

I have raised this issue previously on Topical Issues. I have submitted written questions to the county council, the Minister and Transport Infrastructure Ireland to ask them to expedite this matter as quickly as possible. I was told that those who were carrying out a safety audit on the road would come back with a report in early 2017, but we are now into May. The last time I made a request in this regard, I was told that the report might not be available until the end of the year. This matter is dragging on and on. After a man was killed in an accident at the water tower junction near Piltown last year, 500 people turned up at the local hall for a meeting that was called by the parish priest. Since then, there have been four more non-fatal accidents at the same junction. The people of the area have come together and said that enough is enough. Between 200 and 300 people, many of them in tractors and cars, held up the traffic in the area for two hours as part of a protest that was held a fortnight ago. This shows how seriously the people of Piltown and the local area are taking this issue.

I ask the Minister to expedite this matter by contacting Transport Infrastructure Ireland and the local council to try to get a result in this regard. The answer is to build an overpass that would take out the two most dangerous junctions. That would provide interim relief of the problems that exist in this locality. I hope that interconnectors will be provided in the long term as part of the development of the N24 route between Limerick and Waterford, which we were promised would be done after the motorways were completed. I ask the Minister to expedite the provision of an overpass at this dangerous junction in the interim. I will hand over to my colleagues who want to say a few words on this issue.

I concur with Deputy Aylward. I live two miles from the Piltown bypass but avoid it like the plague, tending to drive the back road to Carrick-on-Suir. I am nervous of it. It is an unusual road using a two-plus-one design which makes it dangerous. When a car is overtaking, before the driver knows it, he or she will be back in a one-way scenario. I would appreciate it if the Minister could expedite the proposed safety works.

I thank Deputy Aylward for allowing me to speak on this matter.

A group of Members from Kilkenny and I have already met the Minister on this and I know he is committed to visiting the road in question. It is a treacherous and exceptionally dangerous stretch of road because of the spacing between the junctions. The road barrier is a steel rope and would be lethal if one hit it.

There have been 15 deaths on this road. The parish priest, members of the local community and people who have used the road to travel to Waterford have been in touch with me about it. I hope the Minister can address this issue.

I thank the Deputies for raising this issue again, which is not unfamiliar to me. I am very struck by the fact there have been 15 deaths on this particular road. Have those 15 deaths been over the past ten or 15 years?

They have been over the past ten years.

It does not matter as one death is too many.

I have already addressed this issue and it has been brought to the attention of Transport Infrastructure Ireland, TII. It is aware of this issue and it is attending to it, but it is probably not fast enough for the Deputies.

As Minister for Transport, Tourism and Sport, I have responsibility for overall policy and funding for the national roads programme. The planning, design and implementation of individual national road projects is a matter for TII under the Roads Acts 1993 to 2015, in conjunction with the local authorities concerned. Ireland has just under 100,000 km of road in its network. The maintenance and improvement of national, regional and local roads places a substantial financial burden on local authorities and on the Exchequer.

Due to the national financial position, there were significant reductions in Exchequer funding available for roads expenditure over the past several years. Within its capital budget, the assessment and prioritisation of individual projects is a matter in the first instance for TII in accordance with section 19 of the Roads Act. The Government’s capital investment plan, Building on Recovery - Infrastructure and Capital Investment, provides the strategic and financial framework for TII’s national roads programme from 2016 to 2022. As Minister, I have to work within the capital budgets included in the plan. In turn, TII has to prioritise works on the basis of the funding available to it. TII allocates funding specifically for safety works based on its analysis of the network. This year it has allocated approximately €17 million for such works.

Under its HD15 programme, safety works are based on an analysis of accident density across the network. Those sections of the network with considerably higher than average accident densities are selected for analysis. Sections of road which are amenable to engineering solutions are prioritised for treatment.

In addition, TII operates a HD17 programme based on road safety inspection reports. These reports indicate which issues, for example signing, lining or safety barriers, need to be addressed on different sections of road and programmes are drawn up to deal with the priority issues. It should be noted that good pavements also contribute to road safety. TII has allocated approximately €50 million for pavements in 2017.

Kilkenny County Council, the road authority for the area, appointed consultants to undertake a review of the Tower Road-Piltown junction on the N24. The latest update from TII is that an allocation was approved to Kilkenny County Council for a signing and lining scheme to address issues identified by the council’s consultant in the performance of Piltown junction. In parallel, Waterford County Council’s road design office, on behalf of Kilkenny County Council, is currently preparing a preliminary appraisal examining options to close the median crossing at Tower Road junction and the possibility of providing an overbridge at this location.

I am aware of the safety issues which the Deputies have raised. I am particularly anxious that safety should be the top priority in my time in this particular portfolio. I cannot emphasise more the fact that I have told TII that this is a priority. It has responded in a positive way, not necessarily to this particular junction, but to this issue in the future.

As Deputy Mattie McGrath said, the invitation to the Minister to meet the people in the area is still open. People in this area will not let go of this issue. Last Saturday week, they stopped the road for two hours. That was not done lightly as we are peaceful people in Kilkenny. We tend not to block roads unless there is a reason for it.

It is welcome that signage and lining will be addressed but that will not save lives. This is a more serious problem with a small stretch of road with nine junctions off it and a two-plus-one layout. It is completely confusing. Any tourists who have passed this road have said they cannot understand how the road was designed. It was a bad design from the word go and the whole system was wrong.

The overbridge with relief roads on each side to take out the two junctions where most of these 15 deaths occurred is the long-term answer. I am delighted some funding has been allocated and the Minister reminded TII that this is a priority.

Life is the most important thing of all. I know there is a priority where road safety is involved. This is one of these cases where life is at risk which has been proved by the statistics to date. Road safety and saving lives is most important, a point which must be emphasised to TII. An overpass is needed for a satisfactory outcome. Paint and lining will not save lives. It may help but it is an overbridge that is needed until the new road from Limerick to Waterford is done in 15 years’ time.

On the surface and with the statistics produced, the arguments are persuasive. This is tragic and so nakedly awful. The figure of 15 deaths is a figure upon which any Government or State agency must act.

TII funding of €17 million must be spread around the network. The relative dangers of various junctions must be taken into account. It still is not acceptable that this area should go unaddressed. If the Deputies believe it would be helpful, I will visit the road. I promised Deputy Mattie McGrath to come down but I apologise for not doing so yet as it is difficult. If it is acceptable, I can meet a cross-party group from the area.

That would be good.

As well as cross-county representatives.

What about the parish priest?

I would be happy to meet the parish priest. I am sure he will be happy to meet me after today.

What about the rector?

I would be delighted to do that.

If the case remains convincing and nothing has been done by TII by that time, I will take what I think is the appropriate action.

I thank the Minister. His presence there alone would show how seriously he is taking this issue.

UN Committees

Saudi Arabia has been elected to the United Nations Commission on the Status of Women by the United Nations Economic and Social Council. The UN describes this commission as the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women. The executive director of Geneva-based UN Watch has stated that electing Saudi Arabia to protect women's rights is like making an arsonist the town fire chief. It called the appointment "absurd".

We know five European countries voted for Saudi Arabia and we specifically know Belgium voted for Saudi Arabia due to a leaked cable. In the Minister's statement today, he indicated that Ireland has a very strong record in promoting the rights of women and girls at the United Nations, commanding trust and respect across the UN membership. It is an interesting statement given that last year the UN Human Rights Committee ruled that Ireland's laws prohibiting and criminalising abortion violated the human rights of Ms Amanda Mellet. The committee ruled that Ms Mellet was subjected to discrimination and cruel, inhuman or degrading treatment due to Ireland's abortion laws. The same committee on the elimination of all forms of discrimination against women has called for an independent investigation into Ireland's mother and baby homes and Magdalen laundries, saying that victims should get appropriate compensation and official apologies.

We are probably not the best to be throwing stones at anyone but Saudi Arabia is in a different league to all of us. One would struggle to find any country in the world where women are treated so poorly. Given the Minister's statement, the majority of people in Ireland would believe that diplomacy and trade interests have won out and human rights have lost. Perhaps that is not true but it would be good if the Minister could clarify the issue so we could know the truth.

I am slightly surprised the Minister for Transport, Tourism and Sport, Deputy Ross, has not stayed as he said on the airwaves that he wants to know how we cast our vote. It is utterly shocking if a Cabinet colleague does not know. In whose name and on whose authority was Ireland's vote made? As Deputy Wallace states, the United Nations Commission on the Status of Women is the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and empowerment of women. A decision has been taken to allow Saudi Arabia to sit on that body. It is a country based on male guardianship that forbids women from obtaining a passport, marrying and travelling without the approval of a male relative; if they try to do so without approval, women can end up in prison and they cannot get out without permission from the same person. In 2002, Saudi morality police blocked a rescue in a girls' school that was on fire because the girls were not wearing headscarves and black robes; 15 young women died. The Saudi Government enforces sex segregation in virtually all workplaces except hospitals and it fines businesses that do not comply. In food outlets men and women stand in separate lines and in many public buildings women are not even allowed to enter. In most places where there is segregation, women must sit down the back. As one Saudi woman has stated:

the decision to allow this oppressive regime to join a commission designed to empower women makes me feel personally violated and invisible. It is demoralising for us and sends a message that for the international community, Saudi wealth and power are more important than women's lives.

The Minister cannot hide behind a spurious precedent. This issue is outrageous and people have a right to know how Ireland voted.

I am very conscious of the debate in Ireland and elsewhere in Europe about the outcome of last month's election to the UN Commission on the Status of Women. I am a strong believer in the equal rights of women and support the role of the commission in addressing questions of gender equality.

As set out in our foreign policy review, The Global Island, Ireland is committed to advancing gender equality. We played a key role in the establishment of UN Women, the UN body which promotes gender equality and which provides administrative support for the Commission on the Status of Women. Ireland took up a seat on the commission at the conclusion of this year's session for a four-year period to 2021 and we will chair the annual sessions in 2018 and 2019. During its term on the commission, Ireland has pledged to work to strengthen the voice and functioning of the commission. Next year, the commission, under our leadership, will attach particular priority to achieving gender equality and the empowerment of rural women and girls in particular. In 2019 our priority will be to advance equality of access to public services. I want to secure agreement on these critical issues under the Irish chairmanship. To do this we will have to work closely with all UN member states and civil society to deliver the strongest possible outcome for women and girls. I also point out that Ireland has strongly supported equal opportunity across the United Nations. In this regard, the Government was very pleased that a member of the Defence Forces, Lieutenant Colonel Mary Carroll, was last year appointed the first Irish woman in command of an Irish contingent in the UN Disengagement Force in the Golan Heights.

With respect to UN elections, Ireland's approach very much reflects those of other countries at the United Nations and it is an important part of how international relations are conducted. Since 1947, at the United Nations, the rules of procedure for general assembly elections provide that they are held by secret ballot. We do not publicly disclose our voting intentions or decisions. That is normal diplomatic practice and it is widely considered a fundamental aspect of the conduct of sensitive international relations. It would be very damaging to Ireland's ability to conduct international relations successfully if we were to move away unilaterally from this established practice. It would be irresponsible to abandon a practice that has been in place for over six decades, observed by all previous Governments and that is grounded on protecting and promoting the values of small countries on the world stage.

This is not a practice that is specific to Ireland or to elections for the UN Commission on the Status of Women. It relates to elections to any UN body and I am not aware of any member state which, as a matter of practice, publicly reveals how it votes. It allows for the good functioning of the United Nations, which is made up of member states of very different views and political backgrounds. There are many countries in the world with which we have important policy differences, including in the area of human rights. The United Nations provides us with an important forum to discuss these differences. Our membership and leadership of the UN Commission on the Status of Women will provide us with such an opportunity. We will take that opportunity to very good effect. Ireland's engagement on human rights at international level enables us to reaffirm our commitment to the universality, indivisibility and interrelatedness of all human rights, to accountability for human rights violations and abuses and to the protection of those, including women and girls, who are most vulnerable and marginalised.

Saudi Arabia is engaged in genocide in Yemen and has caused a humanitarian disaster but we still continue to trade with the country, so the Minister might forgive us for suspecting that Ireland might have voted for its accession to the commission on this occasion. Only two weeks before the Irish trade delegation landed in Saudi Arabia, the Saudi Ambassador to the US, Prince Abdullah bin Faisal al Saud, was asked if Saudi Arabia would continue to use cluster bombs in Yemen. His answer was short but conveyed quite a bit about the Saudi Administration. His response was, "This is like the question, will you stop beating your wife?", before he let out a big belly laugh. Prince Abdullah compared Yemen to the wife of a Saudi man and seemed to find the idea preposterous that either should stop being punished. He was referring to physical abuse in the case of women and cluster bombs in the case of the people of Yemen. The Minister states that Ireland supports equality of opportunity but the people of Ireland would like to know if we supported the opposite on this occasion. Until the Minister tells us and there is openness about the decision making - this is not a normal issue - the people will like to know the truth.

The Minister will not get away with this one and his answer has been wholly unacceptable. Irish people are absolutely outraged at a country that is infamous for the subjugation of women being given a position on this body. The Minister has history in this as he told us last year that he was delighted to go to Saudi Arabia to strengthen our economic, political and cultural ties with this "key" and "priority" market. It would appear from the Minister's response that markets are more important than human rights. There was no precedent in Belgium's case, and it is a small country that was able to acknowledge how it voted. The Minister's remarks today tally with those of the Taoiseach when he spoke of this State applying "moderation" in the Gulf.

It is a matter of public record that Saudi Arabia has committed war crimes in Yemen, where it has dropped cluster bombs. Some 4 million Yemeni women and children are in a state of malnutrition. Saudi Arabia is a country in which there are public beheadings and floggings for crimes such as blasphemy or losing the faith. It funnels billions to ISIS. People have a right to know and the truth will out on this matter, sooner or later. The Minister might as well come clean. What way did Ireland vote?

I visited Saudi Arabia and had the opportunity of meeting my counterpart. I availed of that opportunity to raise human rights issues and, in particular, the status of women, women's rights and the importance of equality in society. The United Nations at all levels, including the Security Council and the Offices of the UN High Commissioner for Human Rights and the UN Under-Secretary General for Peacekeeping Operations, conducts its most sensitive work in confidentiality. This is fundamental to the effective operation of an institution which we uphold and support. I believe in dialogue in the conduct of international relations. That is the reason I visited Saudi Arabia. It is fundamental to the effective operation of an institution such as the United Nations that matters of sensitivity are conducted in confidence. Indeed, it is fundamental to the operation of relations between states. Ireland does not propose to turn on its head a convention that has been in place since 1947.

Again, I acknowledge the strong support in this House for gender equality and the protection of women's rights, two matters which lie at the root of this discussion. In fact, I am a former vice chairman of the Oireachtas women's rights committee, the only man to hold such an office. I have a strong record of promoting women's rights. Ireland has a strong a record of promoting the rights of women and girls at the United Nations. It is widely accepted that ours is a leading voice in this area. As I mentioned earlier, we will chair the UN Commission on the Status of Women over the next two years. The outcomes from that commission carry considerable moral force. Reaching consensus on subjects related to gender equality empowers advocates for the human rights of women and girls globally. It gives them a voice and a tool to hold governments to account nationally on commitments made globally. In this way the commission has an important role in achieving global gender equality. Ireland will take the opportunity to forward the gender equality agenda during our term on the commission.

As she prepares to assume her role as chair of the UN Commission on the Status of Women, I am happy to ask our incoming ambassador to the UN in New York, Geraldine Byrne Nason, to engage with the Oireachtas Joint Committee on Foreign Affairs and Trade, and Defence regarding Ireland's ongoing work at the United Nations on the specific matter of promoting the rights of women and girls.