Topical Issue Debate

Hospital Services

Tá áthas orm deis a bheith agam labhairt ar an ceist tábhachtach seo in Ospidéal na hOllscoile Leitir Ceanainn. This is the fourth time I have had an opportunity to raise a Topical Issue on Letterkenny University Hospital but, with no disrespect to the Minister of State, Deputy Finian McGrath, the Minister has yet to present himself in the House to debate these matters. I will deal later with the political aspect of it, in which he is more interested. I am pleased to bring this issue before the Dáil today. I am convinced that by doing so, I have secured the necessary funding for the replacement of the telemetry monitoring unit at the hospital. I know the answer already. It is a sad indictment that it took a Deputy like me to drag the Minister to the House to deal with this.

For the last six weeks, no cardiology rehabilitation services have been provided in Letterkenny. They have not been available for outpatients who had heart attacks or who had undergone a cardiac procedure. As the Minister of State knows, this service should be available four weeks after a heart attack or stent procedure. It is a critical, essential treatment for cardiac patients. The service commenced in Donegal in 1999 and has been excellent. I pay tribute to all involved in it. In addition, it was available in the community in my own town of Dungloe, as well as in Ballyliffin on the Inishowen Peninsula. The approval of funding for the telemetry monitoring unit is only the first step, however. There is no point in having this unit if it is not fully staffed. There is only one nurse available while a second nursing position has remained vacant for six years with the result that the equipment in the unit cannot be used to its full potential.

For the last number of years, we have been failing to provide the minimum number of cardiac rehabilitation sessions. The Irish Association of Cardiac Rehabilitation recommends a minimum of two sessions per patient. Due to staffing shortages, Letterkenny University Hospital is unable to provide that, which is not good enough.

I am here to represent the people of County Donegal and want to ensure that they will get the same services as those that are available throughout the country. Without the second nurse, this will not be fully utilised. The first step we need to take after the announcement I expect the Minister of State to make today is to ensure that the second nurse is made available and that the funding is provided for the employment of that nurse as quickly as possible. It is not acceptable to me that patients in County Donegal are treated in this manner. The second nurse is absolutely essential.

This was decided today by the Minister for Health, Deputy Harris, but the Minister of State, Deputy McGrath, may not be aware that the Minister is more interested in the PR surrounding the statement which the Minister of State will make this evening than the patients in County Donegal. Although not in the same wing, the Minister of State is in government, and that Government spent some time this afternoon, after I had raised the issue, deciding how it could get out a statement before I raised it in the Dáil and secured a favourable response. I am not interested in the politics of this. I put the people of County Donegal and their health ahead of any politics. I await what the Minister of State has to say.

I thank Deputy Pat The Cope Gallagher for his passionate representations on behalf of the people of County Donegal. I know from my visit there a few months ago that he is also very much involved in disability services issues. I thank him for his kindness and for being an excellent host.

I offer the House the Minister's apologies. The Minister for Health would like to thank the Deputy for raising this important issue and wishes to acknowledge the inconvenience and upset that the suspension of the cardiac rehabilitation programme, as part of the overall cardiology rehabilitation services at Letterkenny University Hospital, is causing to patients who are eager to continue on their path to recovery.

Cardiology rehabilitation services are aimed at optimising physical function in patients with cardiac disease or who have had recent cardiac surgeries. As part of the programme, patients attend rehabilitation sessions under the direct care of nursing staff and the supervision of a consultant cardiologist. A critical element of this type of rehabilitative care is the gathering of telemetry data on patients undergoing these sessions. These data are gathered using monitors worn by the patients while undertaking physical activity during their rehabilitation sessions.

Evidence based research shows that cardiac rehabilitation can reduce hospitalisation by 30% in the following year. A recent health technology assessment by the Health Information and Quality Authority rated cardiac rehabilitation as one of the most effective self-management support services and the importance of the continued provision of these services is recognised by the Department of Health and the HSE. However, the HSE advises that there is currently an unmet need for these types of cardiac rehabilitation sessions. The HSE is currently preparing a self-management support framework which will specifically target this issue at a national level.

With regard to Letterkenny University Hospital, the Saolta University Health Care Group has advised that the cardiac rehabilitation programme has been suspended for the past few weeks on the advice of the consultant cardiologist for reasons of patient safety. This is due to the technical malfunction of some of the telemetry monitors required to monitor patients during their rehabilitation sessions. Saolta advises that these malfunctions are due to expected wear and tear on the units. It is important to note Saolta has confirmed that these issues are not affecting the monitoring of telemetry for cardiac patients in need of acute care. Telemetry services are in place in Letterkenny University Hospital for these critical patients.

Since 2012 the HSE capital plan has included a separate allocation for the equipment replacement programme. In 2017 this allocation was increased to €35 million. Saolta has advised the Department of Health that it has applied to the HSE for suitable replacement units through this scheme. In light of the critical need for the cardiology rehabilitation service in County Donegal, Saolta has advised the Department of Health that it has recently given Letterkenny University Hospital authorisation to order suitable replacement telemetry devices. This process is currently ongoing.

I thank the Minister of State for, in particular, the last paragraph in his statement, which was that the funding will now be made available. After six weeks, I have no doubt in my mind, and I am not trying to promote myself in any way, that it would not have happened if not for the raising of this Topical Issue in the House. People were scurrying in various offices, wondering how they could get this statement out before the issue was raised in the Dáil. Had I not had the opportunity to raise it today, I am convinced that there would be procrastination until September. Between now and September, I will be calling on the Minister to return to the House to confirm what he will have done with regard to the second nurse.

I know the Minister of State cares. When he was in County Donegal, he met many people, took a particular interest and followed through. I am now asking the Minister of State to bring to the attention of the Minister for Health and the HSE the importance of providing the necessary funds for a second nurse. Why would the HSE expend between €40,000 and €50,000 on this piece of equipment, which is so important to those who require these services four weeks after a heart attack or stent procedure and two to three months after surgery, and not use it to the full? We need the second nurse. From a health and safety perspective even, a second nurse is absolutely essential. I know the HSE is trying to say that this is not affecting the monitoring of telemetry for cardiac patients in need of acute care. We know that. However, these are for patients who have had their surgery carried out in other parts that are not in the hospital. That is absolutely essential.

Good Government PR seems to be more important than the substantive issue of health care. We must ensure, and I will ensure, that the patients in County Donegal receive the treatment that is available in all other parts of the country. I thank the Minister of State and ask him to pursue this because I will be pursuing it vigorously over the next number of weeks.

I will bring all the suggestions that the Deputy raised back to the Minister for Health, particularly the second nurse issue and his major point that the people of County Donegal should be treated equally to those in the rest of the country. I know the Deputy is a supporter of cross-Border services. This is particularly relevant to County Donegal. The primary percutaneous coronary intervention, pPCI, service provided through Altnagelvin Hospital in Derry - a cross-Border cardiology project - became operational on 4 May 2016. This service provides pPCI services at the area hospital in Derry for patients with a diagnosed heart attack in County Donegal. Patients are also referred to a state-of-the-art new cardiac laboratory at the same hospital. These things are happening in terms of the delivery of health services.

It is also important to remember that, in terms of budget allocations, model 3 hospitals, of which Letterkenny University Hospital is one, were allocated amounts ranging from €57 million to €141 million in 2016 and that Letterkenny University Hospital was resourced towards the top of that range at approximately €120 million. We will invest in services. We need to develop them. I will bring the Deputy's message about the second nurse being made available and the development of services for the people of County Donegal back to the Minister.

If I may, I wish to acknowledge the excellent coronary care unit that was opened in Letterkenny last week.

General Practitioner Services

The next issue will be discussed by Deputies Mattie McGrath and Jackie Cahill.

Ar an gcéad dul síos, I thank the Ceann Comhairle and his good deputy, now sitting on this side of the House, for allowing us to raise this important Topical Issue. However, I wish to record that I am disgusted that the Minister for Health is not here. I met him in the corridor behind the Ceann Comhairle's seat only 15 minutes ago, so he is in the House. This is not the first time that this has happened. He is running around speaking on the phone but he will not come in and answer questions.

In front of our eyes, we can see what is happening. General practitioners in rural areas are disappearing.

A report out today states that 666 GPs are currently over 60 years of age and that 244 of these are over 65 years of age. I have been warning the Minister and, indeed, his predecessor, our current Taoiseach, about the impending crisis in rural general practice for a number of years. We are now even closer to the cliff edge, with the viability of general practitioner services in significant areas of the country at stake. It is obvious. Today's report is stark and deeply worrying. It shows that Cavan, Clare, Dublin, Kerry, Offaly, Tipperary, Cork and Wexford stand to lose at least 25% of their GPs in the next seven years. That is a crisis by any definition. Of course, the HSE would not see a crisis if the combine harvester in front of Agriculture House drove over and hit it with one. It cannot, or does not want to, see a crisis.

One of the frustrating aspects of this saga is that the Government could immediately address some of the burn-out issues confronting a significant number of GPs by reviewing the silly implementation of the children under six free GP scheme, which I and the Tipperary GPs opposed. We were the last people standing. Now, we see the rewards of it. Since the implementation of the scheme attendance by these children at some practices has increased by up to 40%. It is crazy. They would not be there at all if the scheme was not in place. This is clearly impacting on GPs. The Minister must examine this.

He should also examine the financial emergency measures in the public interest, FEMPI, legislation, which crippled GPs. Some 35% or 36% of their income was wiped away. It affected not only their earned income but also the equipment they use to run their premises and so forth. They have provided a valuable service in Ireland over the decades. They are the front line but they have an onerous task. Many of them are fleeing the country. I await the Minister of State's response because this is outrageous.

I thank the Ceann Comhairle for selecting this Topical Issue. It is a significant issue throughout Ireland and has been a particular problem in Tipperary over the past 12 to 18 months. We have failed to attract young doctors into practices, even practices that appear on the surface to be very attractive. We must tackle this problem immediately.

Some 27% of doctors in County Tipperary will retire in the next seven years. This problem must be approached on a number of fronts. One of them is finance for primary care. There is not enough investment in primary care. A study was carried out in a practice in Longford recently where proper primary care was being provided for diabetes patients. This reduced complications by 80%. The saving this generated in avoiding expensive secondary care is enormous. Primary care needs more nurses, physiotherapists and occupational therapists. If resources were put into primary care, the savings down the line would be immense.

The quality of life must be addressed to attract young doctors into general practice. We expect doctors, particularly those in single practices, to work extremely long hours. They have alternative options in Canada and New Zealand that are far more attractive. If we are serious about this, we must change their terms and conditions. New contracts and a new pay structure must be put in place. There must be investment incentives for rural doctors to upgrade their premises. Rural practices are not part of a primary care centre so if tax breaks were put in place to incentivise doctors to invest in their practices it would be a great help. Many local practitioners feel frustrated that they do not have the wherewithal to invest in their practices. The FEMPI legislation implemented huge cuts, including a severe cut to the rural practice allowance. That must be restored and increased to approximately €25,000. The travel allowance, or distance code, had a huge effect on primary care in rural areas.

All these issues must be addressed if young doctors are to be willing to take up the challenge of serving in these practices.

I thank Deputies Mattie McGrath and Cahill for raising this important issue. I assure Deputy Mattie McGrath that the Minister, Deputy Harris, is hard working.

He is out in the corridor. He is afraid to come here.

He is working 24-7 on all sorts of issues across the board. It is an extremely important portfolio.

The Government is committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services, especially in remote rural areas and in disadvantaged urban areas, and that general practice is sustainable in all areas into the future. We wish to ensure that existing GP services are retained and that general practice remains an attractive career option for newly qualified GPs. As of 1 July last, 2,491 GPs held General Medical Services, GMS, contracts with the HSE and this is continuing to increase year on year. A further 438 GPs hold other contracts to provide services such as immunisation, the national Heartwatch programme, methadone and cancer screening.

The HSE, based on the demographic profile of current GMS GPs, expects that approximately 157 GPs may retire on age grounds between 2017 and 2021. Efforts undertaken in recent years to increase the number of practising GPs include changes to the entry provisions to the GMS scheme to accommodate more flexible shared GMS GP contracts and to the retirement provisions for GPs under the GMS scheme, allowing GPs to hold GMS contracts until their 72nd birthday, as well as the introduction of enhanced supports for rural GP practices. These steps should help to address the future demand for GPs by enticing GPs who may have ceased practising for family or other reasons back into the workforce, facilitating GPs to work past the standard retirement age and encouraging more GPs to work in rural areas.

Separately, the State is seeking to train more GPs to provide GP services to the population. A Programme for a Partnership Government commits us to increasing the number of GP training places to 259 annually. In 2009 there were 120 places available and in 2017 there are 186. This is an increase of 55% in seven years. The Minister is anxious to achieve further increases in the number of GP training places in future years and officials from the Department of Health are working closely with the HSE and the Irish College of General Practitioners, ICGP, to ensure that all available places are filled to meet the future manpower needs of general practice.

I accept the point that there are many challenges facing those in general practice. That is why the Minister has repeatedly emphasised the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector. Health service management has already progressed a number of significant measures through engagement with GP representatives in recent years. These include the introduction of a diabetes cycle of care for adult patients with type 2 diabetes, an enhanced support framework for rural GPs, which is expected to double the number of qualifying GPs to approximately 330, and a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting. These measures, combined with the children under six and the over-70s initiatives, will increase the financial support for general practice.

The next phase of engagement on a new GP contract is under way and the sustainability of general practice in rural areas will be considered in this context. The process will also seek to introduce further measures aimed at making general practice a fulfilling and rewarding career option into the future.

It is typical to read out a reply prepared by the mandarins. The Minister for Health is not listening and rural Ireland, as is normal, will be hardest hit by the retirement level among GPs. The figures are available. I do not know where the Minister of State got his figures for the usual spin. There are two GP associations to be dealt with. The Minister, Deputy Harris, and the HSE must address this as a priority, not least because if people do not have access to local GPs they will end up in accident and emergency departments, and the crisis in emergency departments is growing every day. It is appalling. The GPs are not respected. The contract is 40 years old. The GPs give huge time to providing a wonderful service. I compliment all the GPs in Ireland for the work they do on the front line and in dealing with crises each day, ranging from those in a single practice to those in the many big ones, including the three or four in my home town of Clonmel, in Thurles and elsewhere. The Government is seeking to roll out primary care centres, to be paid for through public private partnerships. They are not a success either. They are failing. I was surprised to hear today that one in Mitchelstown, across my county's border, is struggling. They are not the answer.

It is all spin that looks lovely on paper. The Government must act to support the GPs. It must deal with FEMPI and the other issues and give the GPs a half decent rural practice allowance. Let them do what they are trained to do under the Hippocratic oath, namely, serve and save sick people. They should not be treated as if they were little better than skivvies, which is how they are being treated. Again, the Minister should have been here. He is out running around the corridor. I know he is getting married and is busy, and I wish him well in that regard. Nonetheless, he should have been here for this debate.

Is the Deputy going to the wedding?

I have not been invited yet.

While I appreciate the Minister of State's response, he did not address the issues. He referred to additional general practice places and so forth. Doctors are deciding their fate with their feet by choosing to emigrate. A doctor who was in practice in Tipperary for ten years emigrated recently, leaving a major void in the town. For two years, a practice with 800 medical card holders in my home town of Thurles failed to attract a single applicant to take it over, although a locum recently agreed to take it over for six months.

It is obvious that the terms and conditions available to general practitioners are not sufficiently attractive to persuade young doctors to take up the challenge of running general practices in both urban and rural areas. The severe cuts imposed under the financial emergency measures in the public interest legislation must be reversed immediately. A new contract must be introduced to make it financially attractive for young doctors to take up the challenge of general practice. Investment in primary care centres will be part of addressing this challenge because it will generate substantial savings in secondary care. A doctor told me recently that it was no longer practical to stitch cuts sustained by young men playing hurling and all these cases are being referred to accident and emergency departments. This adds significantly to the costs of accident and emergency units and worsens overcrowding.

I appeal to the Minister of State to address this problem, which is getting worse by the day as the age profile of doctors increases. A contract must be introduced with terms and conditions that will convince young doctors to remain in Ireland.

I reject Deputy Mattie McGrath's comments about the Minister for Health, Deputy Harris. The Minister is exceptionally hard-working and deals with the issues that matter on a 24-7 basis.

He should come into the House and face us.

To respond to the Deputy's points on rural Ireland, we listen to the views of people living in rural areas. I do not engage in spin; I pursue sound policies.

Deputy Cahill called on the Government to deal with the issues facing general practitioners. Let us consider the facts regarding general practice. As of 1 July, there were 22 vacancies in the General Medical Services scheme nationally. As there are currently almost 2,500 general practitioners contracted to provide services under the scheme, this constitutes a vacancy rate of less than 1%. All vacancies are currently covered by a locum general practitioner, which means a GP service continues to be provided in all the affected areas.

That is not true.

In 2016, the total amount paid to general practitioners under the General Medical Services scheme was approximately €518 million, including more than €85 million in subsidies for the employment of staff, namely, practice nurses, practice managers and secretaries. Some GPs also receive payments from the Health Service Executive under various other measures such as the Heartwatch scheme and the Health (Amendment) Act 1996. The total amount paid out in such fees increased to approximately €44 million in 2016.

I acknowledge the issues raised by the Deputies and accept that vacancies must be filled and that some young medical graduates are moving abroad. However, we are addressing these issues and doing our best to ensure excellent general practice services are provided throughout the country. Priority must be given not only to recruiting more general practitioners in rural areas but also in disadvantaged areas, including areas in my constituency of Dublin Bay North. We will push very hard to achieve this.

Nursing Home Fees

I congratulate the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, on his appointment. As chairperson of the all-party working group on dementia, I look forward to working with him on the issue of older people. Thankfully, people are now living longer and most of us will live independently for the rest of our lives. Fewer than 5% of elderly people require care late in life and every effort should be made to facilitate this. Under the nursing home support scheme introduced in 2009, often referred to as the fair deal scheme, the State offers financial support to people whose care needs indicate they require long-term residential care. The scheme covers the cost of the standard components of long-term residential care, namely, nursing and personal care appropriate to the level of care needs of the person; bed and board; basic aids and appliances necessary to assist a person with the activities of everyday living; and laundry service.

Age Action Ireland, which does fantastic work to protect elderly people, has uncovered disturbing evidence that some nursing homes are ripping off the elderly. Last week, it published a new briefing paper on nursing home charges which states that older people and their families are being prevented from choosing nursing homes under the fair deal scheme because of additional charges. One of the key principles of the fair deal scheme is that older people have choice and no one is prevented from choosing the nursing home he or she prefers for reasons of income. However, steadily increasing charges imposed by nursing homes are pricing older people and their families out of the market because the extra charges are a step too far for some families. When someone is completely dependent on the State pension, as many people are, he or she is left with only €50 per week after making the contribution levied under the fair deal scheme. Obviously, he or she will not be able to afford an additional charge of up to €200 per month imposed by some nursing homes for social activities.

While nursing homes are permitted to charge additional fees to fair deal residents for certain services, some of these services may be required to be provided by the Health Information and Quality Authority. Age Action Ireland has uncovered abuses in charges to the elderly for services such as social activities, incontinence wear and therapies. Residents, some of whom are of limited means, face charges ranging from €15 to €100 per week. As a result, they have only limited funds to buy clothes or gifts for grandchildren, which can cause them distress.

Openness, transparency and accountability are key for every service provider and we all have a reasonable expectation to be made aware of the cost of any service we buy or employ. It is not too much to expect that fees charged by nursing homes should be publicly available online and easy to understand and that patients should be informed of extra costs they may incur prior to taking up residency. In this regard, I welcome the response from Nursing Homes Ireland, which has made clear that nursing homes must be transparent in pricing and long-term care. The organisation also provides all members with a template contract for care. I look forward to the Minister of State's comments on the issue.

I appreciate the opportunity to speak on the important issue raised by Deputy Butler, which has been reported in the media and is a source of considerable concern for the individuals affected and their families.

The nursing homes support scheme, otherwise known as the fair deal scheme, provides financial support towards the cost of long-term residential care services in nursing homes and ensures that long-term nursing home care is accessible to everyone assessed as needing it. Participants contribute to the cost of their care according to their means, while the State pays the balance of the cost. The scheme covers the cost of the standard components of long-term residential care, namely, nursing and personal care, bed and board, basic aids and appliances and laundry service. A person's eligibility for other schemes, such as the medical card scheme or drugs payment scheme, is unaffected by participation in the nursing homes support scheme or residence in a nursing home.

In determining the services covered by the nursing homes support scheme, it was considered very important that the care recipient and taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the nursing homes support scheme as this would involve effectively paying twice for the same service.

Although the nursing homes support scheme covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the nursing homes support scheme retains at least 20% of his or her income. The minimum amount that is retained is the equivalent of 20% of the non-contributory State pension. An operator should not seek payment from residents for items which are covered by the nursing homes support scheme, the medical card or any other existing scheme.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on his or her admission to the nursing home. This contract must include details of the services to be provided to the resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the Health Service Executive are not parties to such contracts, which are concluded between each resident and the private or voluntary nursing home.

Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. I would encourage anyone with concerns to raise them with the nursing home through this complaints procedure. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has gone through the complaints procedure of the private nursing home concerned.

Age Action's paper, which highlights this issue, is welcome and I assure the Deputy that we are committed to ensuring members of the older population are protected and get the care they need and deserve, particularly at this vulnerable stage in their lives. An interdepartmental agency working group has been established to progress some of the recommendations contained in the review of the nursing homes support scheme, which was published in 2015. I have requested that the working group further examine the matter the Deputy has raised, namely, additional charges, and report to me on same. I have also met Age Action and Nursing Homes Ireland in the past week to discuss the issue of additional charges. It was a productive meeting.

To improve the transparency of these additional charges, I have outlined that a schedule of charges should be provided to potential residents on inquiry as opposed to at the point of admission to a nursing home. Nursing Homes Ireland undertook to advise its members to do so and has reissued its template contract for care to all members. Furthermore, next week I will meet the National Treatment Purchase Fund, NTPF, and HIQA to discuss this issue further and determine their positions on it. The Department of Health will continue to engage with relevant bodies and monitor the issue.

It is important that older people are protected and have all the information they need to make an informed decision, especially as many older people who are entering long-term residential care are at a vulnerable stage in the lives.

I thank the Minister of State for his answer and I welcome his request for a schedule of charges to be provided to potential residents on inquiry rather than at the point of admission. This important element is the crux of the matter.

As spokesperson for older people, I have visited many nursing homes in Waterford city and county and have been impressed by the services offered. However, the core of the issue is the fact the subvention provided by the Government is on average €200 more for public nursing homes than it is for private nursing homes, which may be contributing to the additional costs some residents are incurring.

I was surprised by a recent answer to a parliamentary question that each private nursing home had to negotiate and agree a price for long-term residential care services with the NTPF. It varies from nursing home to nursing home. When the Minister of State meets the NTPF next week, he might suggest that the prices be more standardised.

I was also surprised to learn that a private nursing home had received a subvention of €910 when a public nursing home in the same area had received a subvention of €1,100. Surely one would expect the same level of care in each nursing home and, it would be fair to say, that the costs of subvention would be similar. I appreciate and understand that the subvention would be more in respect of a patient with additional complex needs, but that was not the case in the instance in question. I am delighted to hear that the Minister of State has been working with the steering committee that was established to oversee the review of the pricing system for private long-term residential care facilities. I await that report.

The Minister of State might not have heard me say it, but I am the chair of the Oireachtas all-party group on dementia. We are meeting him in the morning with Senator Kelleher. I look forward to working with the Minister of State.

I appreciate a spotlight being put on any issue affecting older people, who are my area of responsibility. As the Deputy will be aware, I have only been in the job for three weeks and this issue has arisen straight away. There is an onus on us as a Government and a society to protect vulnerable people and ensure older people are not being taken advantage of in nursing homes. From my perspective on what is happening, the jury will be out until I get the full picture. That is why I am looking forward to my meetings, including a further one with Nursing Homes Ireland this week, the NTPF and-----

-----HIQA. We must ensure that we do not compromise any of the activities undertaken in nursing homes. I want there to be more activities undertaken. It is not right that older people should just sit in a chair with their heads to one side for the entire day or lie in bed without being moved. They should get entertainment, stimulation and so on. We must ensure and encourage a comprehensive range of activities for older people. I do not want anything in this debate to take from that. We are adding years to life, but we also want to add a good quality of life to the years people are spending in nursing homes.

As Age Action is stressing, the key to this is consistency and transparency. The Deputy referred to both when discussing the online publication of charges. I would have no difficulty with the charges being covered by the State or anyone else. We can examine any method, but activities should continue and be charged for - if they are charged for at all - in an open, transparent and consistent way. If that is done, I will be satisfied that our elderly people are being looked after.

I welcome the attention that the Deputy is bringing to this very important subject.

Garda Stations

I thank the Ceann Comhairle and his office for selecting for discussion what is an important issue on the ground in Sligo and a significant issue for the men and women of the Garda there who have to work day and night in a dangerous, unsafe and outdated station.

During October 2015, I was delighted to be able to announce to my constituents that, after much negotiation and representation from my office, County Sligo was to be allocated a new regional Garda headquarters under the Garda capital investment programme. That Sligo was earmarked to receive this new top-of-the-range Garda facility lifted the spirits in the Garda force locally and gave a vote of confidence to Sligo in general as a regional town which the Government was keen on investing in and improving. I thank the Minister for his attendance at this debate but, much to my disappointment at the time, the progress made on this project since the original announcement by the former Minister for Justice and Equality, Deputy Fitzgerald, has been unacceptable.

It is clear to me from the OPW's responses that I have received to parliamentary questions that there have been few or no developments in real terms on delivering on this issue since 2015. I have been advised that the site allocation period for acquiring a suitable location in Sligo for a new Garda station has been longer than anticipated and has been under way since January 2017.

Why has this only been the case with the Sligo Garda station? While I understand that the former Minister reaffirmed last February that the delivery of a new regional Garda station to Sligo remained a Government priority, we are still no clearer on questions like where the site will be located, when construction will start and how long it will take before the people we trust to uphold law and order in my constituency of Sligo, Leitrim, south Donegal and west Cavan are given the safe working conditions they deserve to be able conduct their work.

The Minister will be aware that the lack of progress with the new Garda station is holding up the development of two other stations, one in Macroom and the other in Clonmel, because they are lumped in as part of a single public private partnership project. For some reason, those two projects are at a much more advanced stage than the Sligo project.

The urgency on my part regarding this issue comes after reading a damning report conducted by Michael Reilly & Associates, which the Garda Representative Association commissioned this year to evaluate the overall health and safety problems at the station in question. The report's findings are shocking and raise several issues of concern that only a new station would address. For example, the report identified serious health and safety issues, including infestation by rodents, ventilation problems, poor heating and dampness, limited and inadequate toilet and shower facilities, leaking toilets, failures in building compliance, fire safety failures, failures in HSE health and safety procedures and requirements, hazardous safety issues, cramped public spaces, limited and outdated cell accommodation, inadequate canteen facilities, lack of interviewing rooms, no garage facilities, poor office accommodation, little or no IT infrastructure, limited file storage areas, no purpose-built armoury and many other serious items of concern.

From reading the report, it is clear that gardaí in Sligo are not being given the tools, resources and standards required to do their jobs effectively in combating crime in the Sligo-Leitrim division.

Will the Minister explain to me what is happening with regard to the development of the new Garda station in Sligo? Will he explain to me why there has been such a long delay in Sligo as opposed to the other two areas? Will he advise me as to when we can expect a site to be identified and construction to start on the new Garda station in Sligo?

Does the Minister have good news for Sligo?

I acknowledge the contribution of the Deputy in raising this issue of importance. As Deputy McLoughlin will be aware, the Office of Public Works, OPW, has primary responsibility for the provision and maintenance of Garda accommodation and works closely with the Garda authorities in this regard. As Minister, I do not have any direct role in these matters.

The programme for Government recognises that An Garda Síochána must also have the modern technology and other resources, including fit-for-purpose buildings, necessary to do its job. The programme notes that the capital plan for 2016 to 2021 secured resources in this regard.

Deputy McLoughlin will be aware of the significant efforts being made by Government to enhance the working environment generally for members of An Garda Síochána and of the major investment which has been committed under the capital plan for 2016 to 2021 to upgrade Garda premises, the Garda fleet and Garda ICT infrastructure. This is evidenced by the Garda station building and refurbishment programme 2016-2021, which is an ambitious five-year programme which will benefit more than 30 locations around the country and includes more than €60 million of Exchequer funding as part of the capital plan, as well as a major public private partnership project. Under the programme, new Garda stations will be provided in a number of locations, including Sligo, Macroom and Clonmel, by means of public private partnerships.

I know the Garda station in Sligo very well. I know it needs refurbishment. I would go further and say that it needs replacement. In that regard, I am advised by the Garda authorities that in the context of the public private partnership, the Office of Public Works is progressing the acquisition of sites, including a site for the Sligo development. The Deputy will be aware that, earlier this year, the Office of Public Works published advertisements in Sligo with a view to acquiring a suitable and appropriate site.

Pending the development of the new station in Sligo, the acquisition of the site and the building of a modern state-of-the-art facility, I understand that local Garda management and the Office of Public Works have been working closely to develop proposals to improve the accommodation situation in the existing station in Sligo. This includes exploring options for the relocation of certain functions outside the station and reconfiguring the premises to meet the needs of front-line operational personnel and to address space or health and safety concerns. I also understand that other short-term measures have been taken to address and improve the accommodation situation at the station, for example, works to refurbish fully the toilets above the public office were completed in July of last year and a new industrial standard kitchen facility has been installed.

I assure the House that the Government is fully committed to proceeding with its major investment programme which aims to provide new Garda stations and to modernise older stations at key locations around the country, including Sligo, to ensure a safe, modern working environment for gardaí as well as fit-for-purpose facilities for visitors, victims, suspects and anyone making use of the Garda station in Sligo or in any other part of the country.

I thank the Minister for his reply but it does not answer the questions which I raised. The Minister is quite right that the OPW has a major role to play in this. As Minister for Justice and Equality, he will be aware of the needs of An Garda Síochána and the environment in which gardaí work at the moment and he has outlined some of those issues. He will be aware that gardaí must have proper facilities to combat crime, which they are doing. I acknowledge the work which An Garda Síochána is doing under very difficult circumstances. Will the Minister intervene with the OPW to ascertain why there has been such a delay in locating a site? A number of sites have been identified and it is time for the new site to be identified very quickly and then we can get on with the other areas in the country.

It has been brought to my attention that some of the senior Garda personnel are to be transferred to another site in Finisklin. This has not happened. Perhaps the Minister would take note of that in future, along with the need for extension, investment and upgrading of the Garda station in Tubbercurry, County Sligo. This is vitally important. There are a number of issues there which are very concerning for An Garda Síochána. I have been highlighting these issues for a number of years. I have been told about the issues in Tubbercurry, the issues around the site which was to be occupied by senior Garda personnel in Finisklin and the need to vacate a part of the Garda station in order that there would be more room for the gardaí on duty in Sligo Garda station. There are a number of issues. I appeal to the Minister. It is vitally important the Department of Justice and Equality and the OPW get together and make an immediate decision in respect of the site required for Sligo Garda station.

I very much regret if Deputy McLoughlin is disappointed with the answers which I have endeavoured to give him. I assure him of the help and assistance of the Department of Justice and Equality and my office, and of my own interest in this issue. The issue, as I see it, is the acquisition of a local site in Sligo. Perhaps the local Deputy could assist and use his good offices to assist in the provision of a local site for a Garda station. I assure him that the Government will provide the appropriate resources for the construction of the Garda station. Again, I assure the Deputy and the House that the OPW and local Garda management continue to work closely to improve the accommodation in the existing station in Sligo, which I acknowledge is inadequate. In the circumstances, it is not fit for purpose. Actions of a short-term and interim nature are proceeding. These actions have been taken to address the issue and to improve the accommodation in Sligo.

I reassure the House that the Government remains fully committed to proceeding with a major investment programme which aims to provide a number of new state-of-the-art Garda stations in conjunction with a number of new courthouses. I had the pleasure and privilege of opening one such courthouse yesterday. I assure Deputy McLoughlin that it is a priority of this Government to modernise older stations at key locations, including Sligo, to ensure the provision of a safe modern working environment for gardaí as well as fit-for-purpose facilities for all who use them. I have an obligation to ensure the provision of these things. I ask the Deputy to keep in contact with me on this matter.