Topical Issue Debate

National Drugs Strategy

Deputy Maureen O'Sullivan

I am glad to have the opportunity to discuss the proposed new national drugs strategy. It is disappointing that the Minister of State, Deputy Catherine Byrne, was not available today or tomorrow. There are to be meetings with the community and voluntary sectors in respect of their concerns about the new strategy, which have been brought to her attention. As she is dealing with those concerns, it is opportune that I can highlight the issues today and put them on the Dáil record.

I acknowledge the commitment of the Minister of State, Deputy Catherine Byrne, in this area. There is a need for urgency on the part of the Government in respect of the new strategy. It must show that it is really committed when it comes to addiction. It was in Dublin Central, in the north inner city, that heroin appeared first in the late 1970s and the 1980s. The late Tony Gregory played a central role in the community response to its emergence. The north inner city led the way in taking an inter-agency approach to drugs through the local drugs task forces. Under that approach, statutory representatives from justice, including probation services and the Garda, the HSE, education, social protection including FÁS and community employment schemes and the local authority were all at the same table as community and voluntary sector representatives. The projects which work directly with those in addiction are in the voluntary sector.

When it works, that model is the best approach. It works when there is real commitment on the part of all the participants. The problem is that recent years have seen a slow erosion of State support and interest. For the new strategy, the Government must ensure that all the relevant Departments and agencies are active along with the voluntary and community sectors. Progress is being made at present, for example, in respect of medically supervised injecting rooms, tablet regulation - although that took a long time - the work of the Garda in tracking the proceeds of crime at local gang level and in opening the debate on decriminalisation. However, the new strategy has to prioritise actions targeting the communities most affected. The evidence and statistics identify those communities; they are the communities of poverty, educational disadvantage and unemployment, which suffer serious drug intimidation.

We need to re-examine the use of the terms "prevention" and "education". I think the terms "intervention" and "awareness" are more relevant today, especially if the new strategy supports the programmes the community and youth organisations are carrying out in this area. Those programmes could be expanded into schools and into Youthreach. There is a need for programmes that will develop the critical thinking abilities of young people.

The young people's facilities and services fund was a highly significant tool in the prevention and education arm of the strategy and it is illogical to discontinue it without a viable alternative. Its focus was those young people most affected in areas of economic and social disadvantage. For most of the years, the fund had regular monitoring to ensure the money went where it was supposed to go.

The new strategy also needs a clear implementation structure, timeframes for the various aims and objectives and clear roles for all of the players, statutory, voluntary and community. The necessary resources must be provided to really make a difference. Timely access to treatment for those in addiction is needed. The new strategy must also be clear and unequivocal in addressing alcohol. There are agreed recommendations in the substance misuse strategy. It needs to consider seriously specific communities such as the Traveller community, ethnic and new communities and the LGBT community. The voices of drug users must also be included in improving and supporting services.

Will the new strategy be brought to Cabinet before the summer recess? With the change in Taoiseach and a possible Cabinet reshuffle, where will the strategy stand?

Minister of State at the Department of Health (Deputy Helen McEntee)

I thank Deputy Maureen O’Sullivan for raising this important issue. I agree that we need to treat the matter with absolute urgency and assure the Deputy of the commitment of the Minister of State, Deputy Catherine Byrne, to it. As the Deputy is aware, a steering committee chaired by John Carr, former secretary general of the Irish National Teachers Organisation, was established in December 2015 to provide advice and guidance on the development of a new national drugs strategy, to take effect from 2017. The steering committee has spent almost 18 months developing the new policy. The process involved an extensive and comprehensive public consultation; a rapid review of the 2009 to 2016 strategy; the development of strategic actions through four key focus groups and a systematic review of international evidence on drugs interventions by the Health Research Board. I understand that a meeting to sign off on the final report of the steering committee will take place tomorrow, as the Deputy mentioned.

The Deputy will appreciate that it is a matter for the steering committee to deal with any outstanding issues in the context of finalising the report. However, I can outline in general terms the key issues which the Minister of State, Deputy Catherine Byrne, believes will be addressed at tomorrow’s meeting. Regarding alcohol, my understanding is that the new policy will provide an integrated public health approach to substance misuse, which includes alcohol and illegal drugs. I am advised that the new policy will incorporate key actions from the national substance misuse strategy and provide a range of new actions, which will take account of other Government policies and strategies that address the risk factors for substance misuse. It is also expected that the new strategy will build on work undertaken by drug and alcohol task forces to raise awareness of alcohol-related harm within the community.

I have been informed that the new strategy will contain a specific objective aimed at building the resilience of communities to respond to the drug problem. This objective will also focus on communities affected by gang-related crime and the menace of drug-related intimidation, which the Deputy has raised. I am aware that some people living in these communities may be afraid to report drug-related intimidation due to fears of reprisals. For this reason, encouraging people to report drug-related intimidation by strengthening the existing reporting frameworks will be an important aspect of the new strategy.

Maintaining the focus on services for at-risk young people will also be important in order that they can avail of opportunities to participate constructively in community life. Finally, robust national structures will be needed to provide leadership and direction to ensure the effective implementation of the new strategy. All sectors will need to play their part in making the new structures successful, as no single Department or agency can solve these problems on its own. Measuring the collective input of all concerned and improving the performance of the different partners over the lifetime of the strategy will be supported through a new performance measurement system.

I understand the steering committee is expected to submit its final report on the new strategy to the Minister of State, Deputy Catherine Byrne, shortly. The next stage will be to bring the Minister’s proposals on the new drugs strategy to Government, with a view to launching the policy before the end of the summer.

Deputy Maureen O'Sullivan

I thank the Minister of State. I note the response is very general. While we will need to see the specifics, the most important thing is that the community and voluntary sectors will be able to sign off on it tomorrow. The community drug projects play a vital role with some really innovative programmes. They respond to needs as they are presented and were not getting the role they should have been given in the strategy. The evidence is that they are successful in supporting those continuing in addiction and those who are in recovery. Many of those projects are delivering in very difficult circumstances and are being swamped by paperwork. They are on the edge all the time when it comes to funding. I would be interested to learn what are the specific actions in respect of drug-related intimidation because the new strategy needs substantial actions to address this problem.

I have mentioned the Recovery Academy of Ireland to the Minister of State, Deputy Catherine Byrne, previously. It is innovative and encouraging and is keeping people in recovery. Its latest move is pop-up recovery cafés, which are a great idea. I met One Step Clinic recently. It is looking for a pilot programme into the naltrexone implant, which is non-addictive, cost effective and very useful in coping with addiction.

I think more than 3,000 submissions were made on the new strategy. I submitted one myself on prevention and education. I do not think anybody even got an acknowledgement that his or her submission had been received. I hope the submissions will be included in an annexe of the new strategy. The fact that so many people made submissions shows the level of concern, and they should have been acknowledged.

I am aware that the Minister of State, Deputy David Stanton, is working on the gambling aspect. I stress that we need to look at addiction in a holistic way and in its entirety. Alcohol had been left out of the drugs strategy for so long and the same is true of gambling.

Deputy Helen McEntee

It is my understanding that the submissions have been taken on board. I will check why they were not acknowledged. In respect of the community groups and in particular the drug and alcohol task forces, I know myself how important they are. In Meath and Louth we have a community group that works together and a drug and alcohol task force. I know some of the members personally and am aware of the sheer commitment that is there. They come from various strands of our society and that is why it works well.

I have spoken to the Minister of State with responsibility for this. She is absolutely committed to ensuring that they are happy with the strategy, that they have their say and that there is no sign-off until everyone is satisfied. The only way this strategy will work is if there is co-operation, if people work together and if everyone who has done the work to date is happy with how things move forward.

Deputy Maureen O'Sullivan has made several suggestions. Work is ongoing and there will be a presentation tomorrow. Everything will be taken on board by the Minister of State.

Ambulance Service

An Ceann Comhairle

Is the Minister of State taking this matter?

Deputy Helen McEntee

Yes.

An Ceann Comhairle

She is the Minister for the Topical Issue debate today.

Deputy Carol Nolan

Gabhaim buíochas leis an gCeann Comhairle as ucht an deis chun labhairt ar an topaic fíor-thábhachtach seo. I wish to raise the issue of the cost of private ambulances being used to transport public patients in the midlands area. This is an issue of serious concern. I will outline why I believe it should be investigated.

When we look at our health service, we can see clearly that it is failing miserably. Are we wasting resources in some areas? That is the overarching point I want to make. This issue has been brought to my attention and I am seeking clarity from the Minister of State. Recently, I submitted several parliamentary questions to the Minister. I have them before me. I was shocked by the figures, which are most concerning. They show that €4 million was spent by the Dublin Midlands hospital group for transportation by private ambulance operators in 2016 alone. The cost relating to the Midland Regional Hospital, Tullamore, at €1.91 million, accounts for almost half of the total amount paid in 2016.

According to correspondence from the HSE, the requirement for private ambulance use arises from the transfer of non-urgent public patients for various clinical reasons. The examples given include transfers between hospitals, transfers between residential and acute settings and transfers for diagnostic tests at other hospitals. The figures show that over €25 million has been spent on private ambulances to transport HSE patents since 2012. That is a matter of concern. For some reason, this figure increased dramatically during the period in question. In 2012, the figure was under €4 million, but it jumped to almost €6.5 million in 2015 and 2016. At a time when our health service is bursting at the seams, we need to question whether this is the best use of resources. We need to challenge the options being used and deployed.

Those of us who live in Offaly know only too well the impact of cuts to the health budget. The full capacity protocol was implemented 230 times last year at the Midland Regional Hospital, Tullamore. It is meant to be used only in cases of emergency. This was the third highest figure in the State. We continue to have ongoing problems with patients on trolleys and the cancellation of elective surgery as a result of the crisis in the accident and emergency department. One patient on a trolley is one too many.

Can the Minister of State explain why the figures for private ambulance operators have increased so significantly during the past four years? Can she explain in particular why the hospital in Tullamore accounts for such a high proportion of the spend? The figure is €1.91 million for Tullamore, the highest in the Dublin Midlands hospital group. Can the Minister of State outline any plans there are to reduce this spend and invest in the capacity of the public ambulance service?

Deputy Helen McEntee

I wish to pass on the apologies of the Minister for Health, Deputy Harris, who cannot be here. I thank Deputy Nolan for raising this matter and for giving me the opportunity to inform the House of the position relating to it.

The main role of the National Ambulance Service is to respond to emergency 999 or 112 calls, as the Deputy knows. On average, the National Ambulance Service responds to 21,500 emergency calls per month. There is, of course, a significant requirement for transfers of non-urgent patients for various clinical reasons outlined, including transfers between hospitals, transfers between residential and acute settings and transfers for diagnostic tests at other hospitals. The National Ambulance Service provides such inter-hospital transfers through the intermediate care service. By providing this service for lower acuity hospital transfers, emergency ambulances are freed up for the more urgent calls. On average, the National Ambulance Service undertakes 3,800 inter-hospital transfers per month.

In the context of the continued increase in demand for emergency ambulance services in recent years, there is a need to avail of private ambulance services to secure additional capacity for such patient transfers where required. To this end, the HSE has put in place arrangements under a framework agreement that provides for the utilisation of private ambulance providers. In circumstances where providers included in the agreement are not in a position to provide the service required hospitals are permitted to seek patient transport services from other providers recognised by the Pre-Hospital Emergency Care Council. The reality is that there is ongoing need for hospitals to have the flexibility to be able to access private ambulance services where necessary and appropriate. However, the Deputy may be interested to note that the HSE has commissioned a review of public and private ambulance service provision. The purpose is to assess the costs of both services, ascertain the appropriate use of those services and clearly define the parameters for use of public and private providers.

Intermediate care services for the north Leinster area, which encompasses the former midlands area, operate from the Mullingar, Cavan, Cherry Orchard, Castleblayney and Ardee bases. On average, the service based at Mullingar undertakes 41 routine inter-hospital calls per month. Emergency ambulances in the midlands area undertake a similar number of journeys monthly. Where additional services are required, hospitals may directly request private ambulance services.

The National Ambulance Service has undergone a significant process of modernisation in recent years. This ambulance reform programme is taking place against the backdrop of the HIQA review of ambulance services and the National Ambulance Service capacity review, which was published last year. The review examined overall ambulance resource levels and distribution against demand and activity. Implementation of the recommendations of the capacity review will require a multi-annual programme of phased investment in ambulance manpower, vehicles and technology.

In 2017, an additional sum of €3.6 million has been made available to the National Ambulance Service. This includes €1 million for new fund developments. Development funding will be used to increase the number of paramedics and intermediate care operatives in line with the capacity review recommendations.

There is always a need for the public and private sectors to work together to be able to cater for gaps in the system and improvements we are trying to make. Again, the increased number of people accessing and in need of our services will automatically result in increased demand in the public and private sectors. That is possibly another reason why the numbers are increasing.

Deputy Carol Nolan

I thank the Minister of State for her response. I have a serious concern that the increased use of private ambulances for HSE patients is an outworking of the policy of dynamic deployment. That policy is failing miserably and is putting ambulance staff under pressure and patients at risk. Given the reduced availability of public ambulances, we are now in a position where we need to rely on the services of private ambulance operators. There are serious concerns in respect of the dynamic deployment policy. Ambulance drivers have outlined these clearly to me. They are concerned that patients are being put at risk. This is putting them in an awkward position and placing them under considerable stress.

Is the use of private ambulances an outworking of this policy? I believe it is. The Minister of State referenced a review of the system. When will this review of ambulance operations take place? As someone who is concerned about my constituency, I am calling for the review to take place as soon as possible. Will the Minister of State outline the procedure for tendering and procurement? What measures are in place to ensure value for money when private ambulances are used? That is the crucial point. We could have a situation whereby money is being wasted and whereby it could be put into another sector of the health service where it is badly needed.

Deputy Helen McEntee

I agree. The Deputy has raised some valid points. Patient safety should be first and foremost in everything we are doing. It is important to note the fact that the HSE has commissioned a review. I am afraid I do not have the exact details of when it will begin but I can certainly get them for the Deputy. It will look at the service provision, assess the costs of the services, examine the appropriate use of the services and clearly define the parameters for the use of public and private providers. It will look at all the areas of concern raised by Deputy Nolan. I will ask the Minister to come back to Deputy Nolan with the timeframe, an outline of when this will take place and how people can be part of it.

Land Issues

Deputy Éamon Ó Cuív

I am delighted that the Minister of State at the Department of Agriculture, Food and the Marine has come to the Chamber. Perhaps we can clarify this issue.

As the Minister of State will be aware, considerable lands have been burnt in recent months due to the dry season. A large part of this is on commonage. In the west, commonage comprises shares in the commonage, unlike the collops in the east, and part of this is on private land. Let us accept one thing at the beginning and we need go no further on it. Anyone who purposely burned their land is ineligible - end of story. However, where a farmer is a shareholder in a commonage and someone else started a fire which damaged that farmer's land, does the farmer have to take it out of his payment scheme application, despite him having no hand, act or part in the burning and not acting illegally in any way? If that farmer takes it out and then makes a case that he should have been allowed to leave it in, since it was a force majeure case, will the Department put it back in? On the other hand, if a farmer leaves it in, the Department decides the land should not have been left in because it did not become green enough, fast enough, the Department comes after the farmer on the basis the land was not eligible, and the farmer claims force majeure on the basis that he had no hand, act or part in it and it was beyond his or her control that the land was burned, will the Department not penalise the farmer?

The regulation states to the effect that an exception may arise where a farmer can clearly show that they had nothing to do with the burning of the land in question. It is generally much harder to prove that one did not do a thing than that one did do a thing, so it is very hard for a farmer to prove that he did not burn land or start a fire. I am asking a straight question because I think we need straight answers. In the event of a farmer submitting evidence to the Department that there is no ongoing investigation by An Garda Síochána into any allegation of him burning their land, that he has not been charged with such or convicted of such in the year 2017, is that sufficient evidence for the Department that, as stated in the regulation, the person had nothing to do with the burning of the land in question?

We need clarity because between now and whatever the last date is for amending maps, farmers are being asked to make an incredibly difficult decision in that they do not know how the Department will adjudicate this. Do farmers take the land out of the application and make a case to put it back in again, which is very unlikely because if farmers do that, the Department will tell them they took it out, or do they leave it in and say they will fight the Department on the grounds that they had nothing to do with the burning and an exception to this may arise? Since we are only talking about people who did not light fires, does it arise in these cases and are they cleared when they can show, by producing evidence, that they had nothing to do with starting the fire? This is the clarity that farmers deserve because we cannot play hide-and-go-seek with them and leave them in a position where they do not know the correct decision to take. Do they take the land out of their applications and try to put it back in, which is a nonsense because I know if the land is out, the Department will tell farmers they will not get it in again because they took it out, or do farmers leave the land in and fight the Department on the basis that, according to the Department's own words, it will make an exception if the farmers have nothing to do with setting the fire? This is the burning questions in Connemara at the moment.

Minister of State at the Department of Agriculture, Food and the Marine (Deputy Andrew Doyle)

That is indeed the burning question. After being in the Deputy's constituency in Connemara, Cloosh Valley in particular, the evidence of the extent of the burning is very graphic. I will try to deal with some of the specifics.

Deputy Éamon Ó Cuív

Can we throw away the script for this?

Deputy Andrew Doyle

I have to read this. The Deputy will know that from his experience in government.

Deputy Éamon Ó Cuív

I do not.

Deputy Andrew Doyle

As the House will be aware, there have been incidences recently of illegal burning on agricultural and eligible forestry land in the closed period that has led to the outbreak of serious fires in various counties throughout the country. These fires have resulted in significant damage to substantial areas of agricultural and forestry land, and significant expenditure has been incurred by the various authorities in firefighting and control efforts. I am deeply concerned about the impact of these illegal fires across a wide range of areas, including the damage to agricultural land and valuable forestry assets, the loss of important forestry and wildlife habitats, and the serious risk posed to life, homes and property. We cannot not tolerate such irresponsible acts. Under section 40 of the Wildlife Act 1976 it is an offence to burn, from 1 March to 31 August in any year, any vegetation growing on any land not then cultivated. Individuals who are found to have burned vegetation within that prohibited period are liable to prosecution by An Garda Síochána or by the National Parks and Wildlife Service, NPWS, which deals with one of the specific questions. My Department will provide any support required to these parties to ensure compliance with the requirements of this Act.

As I have stated, the burning of agricultural and forestry land during the closed period is illegal. This is clearly outlined in the terms and conditions for the basic payment scheme which issues to all applicants annually. The Department has commenced a comprehensive investigation of the recent incidences of illegal burning using all available technology, including satellite imagery. This investigation involves complex analysis of imagery from a range of resources worldwide to determine accurately the specific locations of lands subject to such illegal burning and also the extent of the area impacted by the burning. Where necessary and to assist the investigation process, such burnt land may be inspected by officials from my Department. The investigation is ongoing and will take some weeks to complete. It would be premature at this stage to speculate as to the actual area involved or the specific number of applicants under the area-based schemes affected. However, the House can be assured that the necessary resources within my Department will be deployed to complete this investigation as quickly as possible.

On the matter of illegally burnt agricultural and eligible forestry land being eligible under the basic payment scheme and other area-based schemes, the Department’s guide to land eligibility clearly states that land which is burned is not eligible as it is not in a state suitable for grazing or cultivation and therefore not eligible for the basic payment and other area-based schemes. The EU regulations governing these schemes prescribe that land being submitted for payment must be in an eligible state. All applicants under the basic payment scheme and other area-based schemes who have submitted their 2017 applications to my Department should review their applications and identify if their application includes land which has been burned in the closed period and consider removing this land from their application. The withdrawal of such land from their application can be undertaken by using the Department's online facility or by downloading an amendment form from the Department’s website and posting it to the Department’s office in Portlaoise. There are specific issues around GLAS and cross-compliance which I can return to.

Deputy Éamon Ó Cuív

We are going around in circles. Unfortunately, most of the Minister of State's response could have been left out. In my question, I discounted those who illegally burnt land. They are ineligible; there is no question. The Minister of State read from a script, the first page and a half of which was irrelevant. The issue is where a farmer did not burn his land and had no hand, act or part in it, but where he is in a commonage, part of which was burnt. Let us throw away the script for a while and make decisions here. The Minister of State, as a hill farmer, knows that he has to make day-to-day practical decisions, and the kind of vague language here is not helping us.

The first question is if I take land out of the application now, do I take it that a case cannot be made to put it back in again because I have taken it out? From the Minister of State's knowledge of how the Department operates, am I correct in thinking that if a farmer takes the land out, the Department is not going to put it back in again? By going down that route, the farmer definitely loses. Route two is that the farmer leaves it in. If a farmer proves in the way I outlined earlier, through An Garda Síochána, the only people who can confirm his innocence, that the farmer is not in any way being investigated for any illegality and that he or she had no hand, act or part in the burning, will the Minister of State confirm if that is adequate proof, or will he suggest alternative adequate proof?

The second question is, if a farmer makes that case under force majeure, will he be paid? The third question is as follows. The Minister of State knows that when hill land burns, it becomes green very fast. If we give it a month or two in the summer, it could be green for a sufficient period to put stock on it.

An Ceann Comhairle

I thank the Deputy.

Deputy Éamon Ó Cuív

May I make a final brief point?

An Ceann Comhairle

The Deputy should be brief.

Deputy Éamon Ó Cuív

If the land becomes green very fast, will that also make it eligible? There are three parts to my question. We need "Yes" or "No" answers because it is not fair to the farmers. I know the Minister of State's heart is with us but it is time for him to take control of the Department instead of the Civil Service taking control of him.

Deputy Andrew Doyle

I will be very frank. Ongoing eligibility checks are carried out. I had a RAPID field inspection last year. One is just a random herd number and one is subjected to inspections on an ongoing basis. The inspectors will be here and because the issue is so high profile, they will be all over it.

In many ways, the Garda or the NPWS determine guilt or innocence in the first instance. If an individual is subject to a follow-through and determined to not have been culpable, the first box is ticked and it is accepted that he or she was not responsible. There is a lot of investigation involved. In the context of the massive fire that occurred in the Deputy's part of the country, there is the question of where it started. It is obvious that, as it blazed through, people had no control over whether it affected their property, commonage or anything else. There were four houses under significant threat.

On the question of eligibility and fast regrowth, 31 May is the date that has to be considered. One must comfortably establish in one's own mind that one was not culpable in respect of starting the fire. These are taken on a case-by-case basis. Each individual must determine if it is green. I know the uplands. We are trying to put a vegetation management plan in place to manage uplands. It will be controlled and managed and will incorporate controlled burning on a managed basis every year, not just in one year. If a person is comfortable that the land will be eligible on 31 May, it might be subject to an on-site inspection. It probably will be subject to such an inspection in any event. If it is deemed to be grazing or forage land, it is taken on a case-by-case basis.

There was a third question.

Dáil Éireann díospóireacht - Wednesday, 24 May 2017