The first issue, tabled by Deputies Niamh Smyth and Mattie McGrath, is for the Minister for Communications, Climate Action and Environment, who is still with us.
Topical Issue Debate
Post Office Network
Deputy Smyth is picking on me all day.
It is the Minister's lucky day, and again we are talking about services that affect rural areas. I, along with many postmasters and postmistresses across the country, was horrified to see the headline in the Irish Independent some days or weeks ago. It stated 400 post offices are to close. As the Minister well knows, the post offices provide an invaluable piece of the fabric and integrity of rural areas. We cannot stand by any longer and see no changes and movement towards making progress on post offices and bringing them into the 21st century such that they will have the technology and services to make them sustainable and worth having in communities.
As the Minister knows, the post offices have to be sustainable. They are businesses. We need to offer a broader range of services within them. We need to consider the financial pressure that the postmasters and postmistresses find themselves under. It requires some fresh thinking and the implementation of new ways of doing things.
There has to be an emphasis on the Kerr report. It was launched almost a year ago, with some practical solutions as to how we can proceed. We will all be the first to admit the figures do not lie. The post offices have suffered significant losses, of between €12 million and €15 million in 2016, and a much greater loss is anticipated for 2017. Postage currently represents 64% of An Post's revenue, down from 74% in 2016. These are facts we cannot get away from. It is largely attributable to the fall in mailing and also to better use of technology. We have talked about broadband so we realise better use of technology is not always a feature in certain areas. There are rural areas in our constituencies that do not have broadband and probably depend on An Post a lot more than areas that do. One facilitates the other.
I am glad the Minister is here to hear this. We in the Rural Independent Group brought in a Bill here last September. It was agreed by the Government. My secretary spent time negotiating with the Minister's office, for which I thank him, and the Taoiseach's office and the Department of the Minister for Rural and Community Development, Deputy Michael Ring - God help us - to agree on wording for it. We agreed on a Bill that committed to doing something about the post offices. We had the Kerr report, and report upon report. It is blatantly obvious that diminishing the business is diminishing the incomes of the postmistresses. That is what is going to happen. Reviews a year or two after a diminishment show diminished income, and the advice is to close the post office. It is closure by stealth.
We have had the Kerr report. I am depending on the Minister, Deputy Naughten. The Minister for Rural and Community Development, Deputy Michael Ring, did a complete Pontius Pilate exercise; he washed has hands of it. He does not care about post offices. He talked about a hurdy-gurdy or some kind of mobile post office and then ran away from it. It was left to a different Department, that of the Minister before us, Deputy Denis Naughten. It is in the hands of the latter. I acknowledge from the negotiations on the formation of the Government that this is a very high priority for the Minister. We expect him to deliver. We expect that the Minister for Transport, Tourism and Sport, Deputy Ross, and the other independent Ministers will insist that the Government cry halt because all the reports, activities and talk are useless.
What does the unanimous acceptance of our Bill in this House mean? Does it mean anything to the postmistresses, their staff and families? I met many of them on Sunday night in Cork on the way home from the meeting in Athlone. They are depressed because the Government is tying their hands behind their backs, blindfolding them and taking away the business. What will offering to give the post offices bank accounts do? It will take further business from them. They should be given responsibility for dealing with car tax or such business. The Government should consider the banking system in Iceland and bring in the credit unions also, if necessary, but it should not be all talk and do nothing for the post offices. It is in the hands of the Minister. I hope he does not wash his hands of the matter; I know he will not. It is bad enough for the Minister for Rural and Community Development, Deputy Michael Ring, to do that. The people deserve better. The post offices are the hubs of the community. They are the tourist offices and they are the facilitators. If anything goes wrong and it is noted that somebody is missing of a Friday, owing to sudden illness, for example, his or her life may be saved in many cases. The Government should have some respect for the post offices at this stage. They are being kicked around like a political football for the past ten years. It is time for action.
I have a lot of respect for postmasters and postmistresses across the country. I should declare an interest, namely, that my aunt in Galway who is also my godmother is the postmistress in Killimor. It is something in which I have a significant interest. I was one of five Members who bothered to make a submission on the Kerr report because I felt so strongly about the issue. Many services can be channelled through the post office network. The payment of motor tax is one very small example.
It is Government policy that An Post will remain a strong and viable company in a position to provide high quality nationwide postal services and maintain a nationwide customer-focused network of post offices in the community. However, the An Post Group lost €13.7 million in 2016, with the core mail business losing over €30 million.
As we know, the post office network comprises just over 1,100 outlets nationwide and reaches over 1.7 million customers. It is the Government's front-office provider of choice for many citizens and seen as a trusted, local, reliable and friendly service.
The four major strengths of An Post are its strong brand; the fact that the organisation is trusted by the public, in particular by older people; it is a nationwide network and that it guarantees delivery and collections five days a week, 52 weeks of the year. These strengths have been built on over the years by the postmasters and postmistresses, in conjunction with An Post. With its nationwide reach, the company brings vans and postal workers to every premises in Ireland five days a week, 52 weeks of the year. It is a valuable service, particularly in rural areas for rurally based businesses. To protect the network, I repealed the cap on the price of a stamp because, despite advice to the contrary, I believe the five-day a week service is an asset to be developed, not undermined. The Government is fully committed to having a sustainable post office network which it sees as a key piece of financial and social infrastructure for urban and rural areas. Part of the strength of the post office brand and one of its selling points is that it reaches all parts of the country and can be accessed by anyone. I expect this to be a cornerstone of any future strategy for the company and the post office network.
An Post has entered a period of structural change and decline in activity, mainly due to the impact of e-substitutions on mail volumes and post office transactions. The environment in which An Post operates is changing and the network needs to change in order to thrive, in particular given the move to digital transactions. This involves harnessing existing strengths such as the trusted brand and the relationship of postmasters and postmistresses with individual communities to build the network of the future. There will be opportunities to develop new or enhanced product lines for the network and I am keen to ensure this will include the concept of digital assist, whereby the post office would become a default option in the provision of Government services for those who are not comfortable in the digital space. The post office plays an important role in serving the needs of businesses and domestic customers alike and this is the forefront of the mandate of An Post. I am acutely conscious of the value placed by communities in rural and urban areas on services provided by post offices and determined to ensure the needs of those committees will be met. The Government remains fully committed to having a sustainable post office network which it sees as a key piece of economic and social infrastructure for rural and urban areas.
In response to the challenges it faces a strategic review of An Post, including the post office network, which will identify the changes and restructuring required to maintain the company on a sound financial footing was initiated and is nearing completion. All opportunities are being assessed by An Post in the context of the review. Until such time as it is finalised and assessed, it is not possible to comment further. The Government will be briefed once a definitive strategy has been agreed.
I wish to make some simple suggestions. An Post services could be extended to allow post offices to act as a central office for State payments and charges. They could deal with the processing of motor tax, local authority and hospital charges and provide banking services. We could ensure the post office would become a hub for shared community State services, as well as an office providing access to broadband and printing facilities. The Department of Social Protection contract could be extended.
It has been many months since the formation of the Government, yet there has been little movement on outlining a plan to safeguard the future of the An Post network. The Government's responsibility for post offices and future network renewal resides with two Departments and three Ministers. The Government received the Bobby Kerr report which outlined a number of practical solutions to address the problems in An Post, but almost one year on, there has been no action. Post offices are an important strategic State asset and play an invaluable role as the centre point of community and commercial activity in urban and rural Ireland. They comprise the largest retail network in the country, with over 1,100 post offices employing almost 3,000 people. The Minister does not need me to emphasise further the importance of the integrity of the network for rural Ireland.
I must declare that my sister runs a post office. Her staff member, Helen, had a stroke and I wish her well in her recovery. I hope the Minister's aunt is not watching the debate or she will have a stroke. It is a good job that he has made his First Holy Communion and Confirmation because he would receive no envelope. She would instead give him a red card. It is up to the Independent Members in government to deal with this issue because it is clear that Fine Gael will not deal with it. The Minister, Deputy Michael Ring, washed his hands of it and is not interested. I have been a Member of the House since the time of former Deputy Mary O'Rourke when lip service was paid to the post office network.
Deputy Niamh Smyth outlined all of the good things about the post office network. Post offices in Kilmeaden, County Waterford and Terryglass closed recently. They might be given a reprieve. Post offices are being closed every day and disappearing before our eyes like snow off a dish when the sun comes out. It is time for the Minister to act. We have had enough reports and strategic reviews. How many staff are working in the GPO? Postmasters and postmistresses are not causing losses in An Post; rather, it is over-staffing in places such as the main post office. When An Post was struggling, the price of a stamp was increased by 30 cent. If any other person was to do that, he or she would go out of business within a short time. It is the sabotage of a wonderful institution and wonderful people.
To answer Deputy Niamh Smyth's question, I am the Minister in charge. There may be technical issues, but the buck stops with me. An Post is accountable to me as Minister and I am accountable to the House for An Post.
I disagree with Deputy Mattie McGrath. It is not a question of sabotage. In my contribution I outlined why I had to increase the price of a stamp. I will not do what my predecessors did, namely, bury my head in the ground in the hope the problem will go away. Last year I was left with a situation, which I outlined for the House on numerous occasions, where I either had to reduce postal services in rural areas to a three-day week service or increase the price of a stamp. If I had done what the Deputy had wanted me to do and not increased the price of a stamp, he would have been the very first to criticise the impact it had had on rural Ireland and businesses. I categorically refute the suggestion and would not tolerate such a situation.
Deputy Niamh Smyth made some very cogent points. When I was on her side of the House, I made the exact same points. I encourage her to talk to my Cabinet colleagues and make the same points to them because she is correct. Myriad Government services could be delivered through post offices. The websites and technology are available. Every single post office in Ireland, with the exception of 34, will have high speed broadband outside the door. That should not be a threat; rather, it should be an asset to be exploited.
The Deputy is also correct in respect of collecting health charges and so forth. An Post needs to provide financial services. The banks have pulled out of provincial towns and rural Ireland. An Post can not only meet that challenge head on but also provide new and innovative financial services.
My final point is relevant to all of us in the House. The only time any of us go into a post office is to buy stamps at Christmas time or during the summer in order to renew passports to go on holidays or buy foreign currency. We need to change the business model of An Post and to get more people, rather than just older people, to use the post office network. We have to hold on to the social welfare service and expand others.
Medicinal Products Availability
PKU is a rare genetic disorder that affects a person's metabolism. People with PKU are unable to break down an amino acid called phenylalanine, phe, a natural substance found in food. This results in a build up of phe in the blood and in the brain, which can cause serious health problems, including, if untreated, severe brain damage. There is much more to it than the dietary effects. It also involves irritability, lack of concentration, stomach pains and just not being like every other child.
The only medical treatment for PKU is the drug Kuvan, which can vastly improve the quality of life of some people with PKU. The drug enables more "normal" food to be eaten and critically improves cognitive functioning thus reducing the real threat of long-term irreversible brain damage. Kuvan received EU regulatory approval in 2009 and is currently approved for use and reimbursed in Austria, Belgium, Bulgaria, the Czech Republic, Estonia, France, Germany, Hungary, Italy, the Netherlands, Luxembourg, Norway, Portugal, Romania, Russia and the UK and certain areas in Sweden, Lithuania and Denmark so why is this not the case in Ireland?
The PKU community cannot see any justification for the drug not being available in Ireland on such a relatively small scale when it is widely available across EU, the rest of Europe and worldwide. Since 2010, Kuvan has been assessed by the National Centre for Pharmacoeconomics, NCPE, twice and rejected on both occasions in 2009 and 2017. The PKU community is frustrated with this process and feels it is unfair as it is designed to fail orphan drugs, which do not have the necessary data. It is an expensive and lengthy process for small organisations such as the PKU Association of Ireland, PKUAI, while also being costly for the HSE. The drug review with the NCPE is set up to fail orphan drugs. These drugs are put through endless assessments which they can never win due to their poor scoring on quality of adjusted life, QALY. To get a reliable QALY, one needs big clinical trials, which are common for things such as oncology or heart disease. In simple terms, for example, a cancer drug could give an additional year of life for €10,000 so the cost of that QALY is €10,000. Sadly, PKU and other rare diseases cannot show examples for orphan drugs because one simply cannot do the clinical trials to produce good QALY. There is a misconception that these orphan drugs are expensive. While this sometimes is the case, the reality is often the fact that the QALY is unreliable. However, this will always be the case in orphan drugs because one cannot get reliable clinical trials with small amounts of patients and data.
The PKUAI strongly urges the HSE to engage with the manufacturers of Kuvan and approve funding for the only drug treatment available for PKU. It is already available in nine other EU countries. Giving access to this life-changing drug for all those eligible could transform the future health of people with PKU throughout Ireland and would be of huge benefit to everybody in the community
Like all Deputies in this House, we received an email from an impassioned mother whose six year old daughter Maria lives with PKU. I had not heard of PKU until I read the email. Ireland has the highest rate of PKU in the world. As Deputy Deering said, the drug Kuvan has been approved by over 20 countries in Europe. This drug has been proven to be medically beneficial for those living with the condition. Sadly, Kuvan has been rejected twice by the NCPE in the past eight years. This has had a devastating effect on the PKU community. My question is fundamental to many things that happen in this House, to orphan drugs and to people who have rare conditions, not because of their choosing but because of circumstances. The NCPE has said twice that the drug is not to be approved. Obviously, the reason it has not been approved is because the NCPE thinks it is not cost-effective. Will the Minister override its decision and tell the manufacturer of this company to sit down and agree a price? It has been done previously with the cystic fibrosis community regarding the drug Orkambi, so I am asking the Minister to override the NCPE's decision because this drug can greatly benefit those suffering from PKU.
I wish to thank Deputies Dino Kenny and Deering for raising this issue. Medicines play a vital role in improving the overall health of Irish patients. Securing access to new and innovative medicines in a timely manner is a key objective of the Irish health service. However, the challenge is delivering this objective in an affordable and sustainable way. Under the community pharmacy schemes alone, over 70 million prescription items will be dispensed in 2017 at an estimated cost of approximately €1.7 billion - taking account of fees and ingredient cost. In addition, the HSE will spend in excess of €500 million in 2017 on medicines through a range of other schemes in hospitals and in other care settings, for example, in nursing homes.
Expenditure on medicines represents one of the largest areas of expenditure across the health service and will continue to grow in the years ahead as our health service continues to meet the needs of our citizens. This is most welcome and can have a transformative impact on the health of patients. However, as the Minister has stated previously, the cost that some companies are seeking to charge for their medicines may result in a situation where certain treatments may never become available to patients. This is the case not only in Ireland but across Europe. That is why it is essential that Ireland has a scientific, robust and evidence-based assessment process in place. This ensures that decisions relating to the reimbursement of medicine are made on an objective and scientific basis recognising the health needs of the population and other factors.
The Health (Pricing and Supply of Medical Goods) Act 2013 provides the legal framework in Ireland for such a process. This Act gives full statutory powers to the HSE to assess and make decisions on the reimbursement of medicines taking account of expert opinion as appropriate. The HSE follows the process set out in the Act for the assessment of all drugs. In reaching its decision, the HSE examines all the evidence which may be relevant in its view for the decision and will take into account such expert opinions and recommendations which may have been sought by the HSE, including, for example, advice from the NCPE.
Sapropterin, or Kuvan, was previously considered under the national pricing and reimbursement processes in 2009. At that time, insufficient evidence was available to support the pricing and reimbursement application submitted by Merck Serono for Kuvan. In December 2015, Merck Serono advised the HSE that the market authorisation for Kuvan was transferring to Biomarin in 2016. The HSE met with the new market authorisation holder Biomarin in May 2016 and was advised that it would be submitting a health technology assessment dossier relating to Kuvan. The NCPE assessment of the Biomarin dossier was completed on 15 September 2017. The NCPE did not recommend Kuvan for reimbursement as it was not deemed to be cost-effective. The HSE assessment process is ongoing and the HSE will take into account the expert advice of the NCPE when making its decision in line with the Health (Pricing and Supply of Medical Goods) Act 2013.
I thank the Minister of State for his reply. Like Deputy Gino Kenny, a constituent of mine has a child with this disease. Obviously, it is a hugely debilitating disease and the family is very concerned in that regard. Fortunately, it was picked up by the heel prick test, which is carried out after the child is born. I disagree with one point made by Deputy Gino Kenny. I am not looking for the Minister to overrule the decision. I am asking him to change the assessment process because this drug will never succeed in being passed under the assessment process at present. As I mentioned in my initial contribution, the assessment process at present only suits tests relating to oncology or other more prominent diseases. This is a rare disease and the structure and the criteria that are there will never allow this drug to be used, which is the crucial point. The criteria for testing drugs dealing with these very rare diseases need to be changed. The process of assessing the drugs needs to be changed in order for this drug to be approved. I suggest that the Minister goes back and looks at the criteria.
This statement does not really mean anything. It is hollow, to say the least. What this comes down to is putting a price on somebody's life. Somebody has made a decision - I do not know if it is the Minister of State - that the price of somebody's life is not worth the price of medication for that. This goes further than providing Kuvan for people with PKU; it involves other orphan drugs like Translarna for people with muscular dystrophy, as was mentioned by Deputy Adams yesterday.
Will the Minister of State override its decision and review the assessment done by the NCPE on orphan drugs? The assessment is fatally flawed. People who have conditions not of their choosing but because of circumstances are being medically discriminated against because of price. I ask the Minister of State to review and override the NCPE's decision.
I am acutely conscious that there are real lives behind these speeches. Sometimes these speeches can come across as very harsh departmental responses but I am acutely aware that real people and children are involved, including mums, dads, brothers and sisters. We are talking about real life and I am not going to forget that for a second. I will have the assessment process looked at and will ask my officials to review it. There is a difficulty in that very clear guidelines are set out on how to assess the process and that is done in law. The process for it is under Schedule 3 of the 2013 Act. The NCPE has made a recommendation but the HSE has not yet made a decision and I want to clarify that. Some recent media reports have presented it in such a way as to indicate that the decision has been made. The decision has not been made, just the NCPE recommendation. It has looked at it under a variety of criteria to assess it, as it is duty-bound to, under the Act, and it has not recommended it but the HSE has yet to make a decision on it and that assessment process is still ongoing. I appreciate the opportunity that both Deputies have given to give air time to the matter and to add a human side to ongoing deliberations.
We spend €1.7 billion on prescribed drugs in this country and that is a challenge. We cannot have an open chequebook scenario when an international pharmaceutical giant comes to Ireland to offer prescription drugs at sometimes twice the rate they are sold for in other countries. There is a negotiation process and unfortunately a business model underpins it. It is of course about human life at all levels, but I reassure the Deputies that the final decision has not been made and the HSE's deliberations are ongoing. I welcome the Deputies' contributions to that process.
Respite Care Services Provision
Bogfaimid ar aghaidh anois go dtí an chéad cheann eile in ainmnithe na Teachtaí O'Dowd, Adams agus Breathnach. Níl an Teachta O'Dowd anseo. Níl sé ábalta bheith i láthair. Glaoim ar an Teachta, Gerry Adams, who has two minutes.
Go raibh maith agat a Leas-Cheann Comhairle. Gabhaim buíochas leis an Cheann Comhairle as an deis an t-ábhar tábhachtach seo a phlé inniu. I thank the Ceann Comhairle for the opportunity to raise the serious ongoing lack of scheduled respite services for people with disabilities in County Louth. Táim buíoch as an tacaíocht ó na Teachtaí eile atá i láthair ón Dáilcheantar sin. Tá muintir Chontae Lú buartha agus tá imní mór orthu i dtaobh an drochscéil faoin easpa seirbhísí. People with disabilities and their families live in a state of perpetual crisis, especially in Louth and east Meath. I am contacted regularly by families who are in dire need and they all have a similar tale of never-ending fights to access services from the State which should be theirs by right. There is a particular absence of sufficient scheduled respite services for citizens with intellectual disabilities and complex needs. I have raised many examples of this in the Dáil with the Minister and recently with the Taoiseach himself.
I raised the situation faced by Sam and his family. Sam is an 18 year old man with severe autism, challenging behaviour and complex needs. He is now 18 and as a result he cannot avail of previous respite services that he once attended. The family is constantly worried about what may happen if there is a family crisis and they cannot care for him. His mother has met with the Minister, Deputy Simon Harris, and the Minister of State, Deputy Finian McGrath, and she is meeting with the HSE's early years manager. She built a community-led campaign which has submitted proposals to the Government yet it seems that her son's needs are invisible. The Minister is aware of these cases and he cannot abdicate responsibility to the local HSE area because it has not been given sufficient resources to expand services.
I think the Minister of State, Deputy Finian McGrath, has a good heart in these matters, and it should not fall upon parents, families and community activists to be responsible for ensuring funding. That is the Minister of State's job. I ask him to ensure that urgent and immediate emergency funding for existing respite service proposals that are in the possession of the HSE should be provided with all speed.
As the Minister of State is aware, we have highlighted the plight of families in Louth who have been looking for respite for their loved ones since this Dáil began. We have organised meetings with the Minister of State and other Ministers and have had numerous representations on behalf of the families. Deputy Adams referred to a perpetual crisis; I would describe it as breaking point. It is wrong that this is allowed to continue. The families themselves could end up seeking residential care since they are under such stress and that would create an even greater cost for the State. There is a proposal to provide respite care to give these families a much-needed break which represents real value-for-money and cannot be ignored any longer. I am dismayed that no funding is available in the short term to fund this facility or indeed any additional respite facilities and services. Following a meeting with the head of social care in Louth HSE and the regional director of St. John of God Drumcar, we were told that HSE capital funding is being used for the ongoing programme of decongregation. Surely, of the overall funding in the Louth HSE, respite care should be a priority. The identified proposal would cost €300,000 each year, representing real value for money. This would purchase 13 weeks of respite care per annum in a six-bed facility with premises and staff suitably trained for adults with challenging behaviour. Up to six persons could receive respite care at any one time and breaks could be for a few days or even a week.
The situation in Louth and the need for resolution has the support of all five Members of this House and, indeed, the single Member of the Seanad from that area. We have met the Minister of State about it. The situation is deteriorating, these families are at their wits' end and we need action rather than talk.
I thank my colleagues for raising the important issue of respite and for giving me the opportunity to outline the position on the provision of respite services in County Louth. This Government’s ongoing priority is the safeguarding of vulnerable people in the care of the health service. We are committed to providing service and support for people with disabilities which will empower them to live independent lives, provide them with greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. The provision of respite services has come under additional pressure, and I accept that aspect of the debate, particularly in the last years. These services were devastated for seven or eight years. More children and adults are now seeking access to respite and the changing needs of people with a disability are also having an impact, as they, along with the rest of the population, live longer lives, which is an important aspect of the debate. A Programme for Partnership Government recognises the need for respite services to be developed further and I am committed to ensuring that this happens. I have been in talks about these issues with the Minister, Deputy Paschal Donohoe, in the last few days and respite services are at the top of my agenda for the Estimates.
A number of factors impact on respite capacity. One problem is that a significant number of respite beds are regularly used to allow unplanned emergency admissions, leading to the number of available respite nights being down against planned activity. The regulatory and policy context has also changed the manner in which residential and respite services are provided, as agencies comply with regulatory standards. Capacity has generally decreased with requirements for personal and appropriate space. Beds can no longer be used for respite where residents go home at weekends or for holidays. These are the current rules. Implementation of the national policy on congregated settings is also reducing available capacity.
In the HSRs social care operational plan for 2017, 6,320 persons with a disability are expected to avail of centre-based respite services totalling 182,506 overnights. There is work going on, but that does not mean that I do not accept the issues in Louth the Deputies have talked about.
Based on existing levels of service and in addition to the centre-based respite service, it is planned that between 2,000 and 2,500 persons will avail of respite services, such as holiday respite or occasional respite with a host family. It is also planned that based on existing levels of service, a further 41,100 day-only respite sessions will be accessed by persons with a disability.
Furthermore, the HSE has been funded to provide 185 new emergency residential placements and new home support and in-home respite for 210 additional persons who require emergency supports has been allocated. This marks a significant change in the way that respite services are delivered.
The HSE social care division has also committed to further developing home sharing as a person centred and community inclusive type of support for people with disabilities involving the development of an implementation plan in 2017. This will address the priority recommendations of the national expert group report on home sharing published in 2016. It will be led by the national designated disability lead in this area.
In the context of respite services in County Louth, further discussion is ongoing at CHO 8 level regarding the emerging need for additional respite services and the options to be developed to meet these needs. The HSE continues to work with agencies to explore various ways of responding to this need, crucially, in line with the budget available. As I said earlier, that is something I am pushing strongly during the Estimates negotiations.
The HSE has advised me that additional funding would be required for the development of respite services in Louth but that no such funding is available in the 2017 budget allocation. From my point of view, I will continue to seek additional funding for respite and residential places as part of the ongoing discussions on the 2018 Estimates process. That is the key point here in relation to delivering respite services, particularly in this context in the County Louth area.
I know the Minister of State a long time and I stated earlier that he has a good heart on this issue, but I ask him to leave aside his script. The Minister of State has not answered the question. My party has put forward a proposal, which is with the HSE, for a dedicated respite service for citizens in County Louth and east Meath. That is what we asked the Minister of State to make a statement on.
In the previous budget, we were told that funding for badly needed respite services was a budget priority. We have not even been told that on this occasion.
The reality is that when an emergency respite care facility has to be provided for one person all the scheduled respite services for others are cancelled. As I have stated previously, what I found in dealing with these family members is the issue of stress. The stress upon parents and carers, and in some cases grandparents, is awful to behold.
There is an opportunity to sort this out. My party has brought forward practical propositions. There are people prepared to provide this service.
I come back to what my credo is about, and I am sure the Minister of State will agree.
Tá an t-am caite.
Because one has a disability does not mean one does not have rights. Society has a responsibility to provide one with one's needs.
Tá an t-am caite.
Tá a fhios agam. I ask the Minister of State to depart from the script and forget the Civil Service speak. There is a straightforward proposition being put to him. The Minister of State should tell us that he will ensure that this is a budget priority.
I do not often find myself agreeing with Deputy Adams but as the Minister of State spoke, I wrote down, "Not one word other than further discussion exploring options." That is of no benefit to the family of a 26 year old severely disabled daughter who have been looking for proper respite care for three years. Even when she gives a few months' notice, she is told there is none available. I will not go into the story of Sam. We have heard it often here. A 93 year old man looking after a 53 year old son with Down's syndrome needs respite for him to get a break. His daughter helps out but has her own teenage daughter with Down's syndrome to look after. Finally, an 80 year old lady who suffered a stroke in April is the main carer for her with Down's syndrome of 36 years of age. The Mum now has her own care needs and they do not know how they will cope. I could go on ad infinitum on this but time does not allow me.
We need action. I said that at the outset. I understand the constraints. Deputy Adams, Deputy O'Dowd and the other Deputies who cannot be here have made it clear €300,000 will solve this problem covering Meath, Louth and a large part of north Dublin. The Talbot Group is in a position to provide what Deputy Adams has referred to. Indeed, other discussions have taken place with other organisations.
We met the Minister of State in July. I respect the Minister of State's office equally but this cannot be allowed to continue indefinitely. In fact, when I came into the Dáil, I asked the then Ceann Comhairle that we would champion the issue of disabilities in this House. That is certainly not championing it in County Louth or right across the country.
I disagree with some of the tone of my two colleagues in relation to championing. First, let us get a couple of issues off the pitch here. I totally support the rights of all people with disabilities. When I entered into negotiation last year, we got €1.68 billion. That is an increase of €92 million. Second, of course, I accept the Deputies' argument that there are huge problems in Louth. Of course, I accept that it is my responsibility to do something about it. That is the first point - get that off the pitch.
I am open to all practical proposals. Since our last meeting in July, I went back to the HSE and put some of those proposals on the table. Over the past ten days or two weeks, and over the summer period, I have been putting in my own proposals in that regard but I remind Deputies as well that I will need support in there. There is a certain amount in the so-called "pot" and I am pushing for those issues. It is important that I get support from all Deputies in the House.
On respite, I will give the Deputies reassurance here today. The Minister is well aware that respite is top of my agenda when it comes into negotiations and over the past four or five weeks it was on it. I accept that we have problems in Louth. I have problems down in Kerry. I can name the counties where the problems are. Equally, I can name the countries that have the services, and good luck to them. The point is we have to deal with those issues.
From my point of view, I will give a commitment today in the House that I will do my best in pushing that agenda. I will also give the Deputies a commitment that I will come back to them on the debate today. Also, I will need the Deputies' support in relation to these particular issues on the broader political agenda.
It is also important to be aware that within six months of this Government's creation we were the first to restore the respite care grant. There are 121,000 people - some of those families the Deputies are talking about - getting €1,700 to buy their own respite services independently in the meantime until we fix the problems that have been neglected for many years. That is the situation.
As far as I am concerned, every person in the State with a physical or intellectual disability has to be treated the same as the rest of us. Such people and their families should be guaranteed respite services as of right. I will keep pushing that agenda. As for how I get on, I will let people judge that.
Direct Provision System
I thank the Leas-Cheann Comhairle. I am glad to have the opportunity to raise this issue which is causing a lot of stress and concern to those affected who are living in direct provision.
We are aware of the difficulties and the issues in direct provision, some of which are being addressed. There have been improvements, but there are other issues ongoing.
This most recent controversy concerns those letters that have been sent to some asylum seekers. Some of them are on deportation orders. Some are waiting on the outcomes. There are some whose status has been resolved. Basically, they have to leave where they have been living.
Of course, this marks a major shift in Government policy. It also marks what can only be described as a lack of compassion and humanity. Those who received the letters were given a certain date by which they had to leave. The letters inform the mainly single, male asylum seekers that the Reception and Integration Agency, RIA, has no role in the provision of accommodation for persons once a decision has been made on their application. Some of those who received the letters telling them to leave have been subject to deportation orders for several years, orders that have not been effected. Some are from countries to which we really could not deport anyone. Until now, the RIA has housed asylum seekers subject to deportation orders, but the recent letter means that it is now reneging on what is set out in the 2010 value for money and policy review, which reads as follows: "The RIA accommodates persons at every stage of the asylum process and beyond that to a point of resolution of the case. The RIA will accommodate persons who have effectively failed the asylum process ... and that accommodation will only cease where a deportation order or other removal has been effected".
What we are seeing is pushing more and more people into homelessness, emergency accommodation or rough sleeping. The directive will increase the numbers of homeless persons at a time when the homelessness figures are rising. We do not need additional homeless persons. The agencies and local authorities working with the homeless are already overstretched. They do not have enough accommodation to house the people who are on their lists.
I understand the principle behind this move, which is to get people out of the direct provision system, which is what the people themselves want. However, the unintended consequence is that such persons are moving into homelessness. I have met one gentleman living in direct provision accommodation who earnestly wants to move into private rented accommodation. He has told me about the call after call and visit after visit he has made looking for accommodation, all of which have been unsuccessful. Another gentleman has had refugee status for over a year, but he has been unable to find accommodation. He has been looking in places other than Dublin but to no avail.
Asylum seekers, including those subject to deportation orders, have no entitlement to social welfare payments. There also appears to be a problem for those outside the direct provision system in accessing homeless services. Of course, once they leave the direct provision system, they do not receive the weekly allowance of €21.60. The housing assistance payment, HAP, scheme has been beneficial for some, but in reality, if Irish people with families and connections are finding it difficult to find a landlord to accept housing assistance payments, one can only imagine the difficulties involved for someone subject to a deportation order. Surely, there is a duty of care on the part of the Department to those who are claiming asylum, many of whom have fled horrific circumstances in their country of origin. That duty of care should last until a person is granted asylum or leave to remain, leaves voluntarily or is deported.
The question to which I was asked to respond was about developments for people living in direct provision accommodation and the Reception and Integration Agency, RIA. The answer I have, therefore, is general and may not actually address the specific issue raised by the Deputy. However, I will try to address it if I have time to do so.
I thank the Deputy for raising this important matter. Direct provision is the system whereby State services are directly provided for protection applicants through the relevant Department or agency. We are talking about asylum seekers or refugees. We do not know who or how many will arrive on our shores in need of or claiming protection. What we do know is that all applicants are immediately offered shelter, full board accommodation and a range of services such as health and education while their application for international protection is being processed.
Of course, no system is without room for further improvement. The Government commissioned the retired Judge Dr. Bryan McMahon to chair a working group to carry out a report on the protection process and the system of direct provision. That report was published in June 2015 and forms the basis for ongoing improvements across the entirety of the system involving all relevant Departments and agencies. In June 2017 the third and final audit of the implementation of the recommendations contained in the report was completed and is available on the website of the Department of Justice and Equality. The audit shows that the vast majority of recommendations have either been implemented or partially implemented or are in progress.
The International Protection Act 2015 was commenced on 31 December 2016. A key feature of the legislation is the introduction of a new single application procedure which will, in time, accelerate the protection determination process and reduce the length of time applicants spend in State-provided accommodation. A number of recommendations made in the McMahon report are related to accommodation and services are being rolled out, including full independent living at the Mosney accommodation centre, cooking facilities in many other centres, proactive engagement with residents and agencies through the "friends of the centre" model and the engagement of an independent assessor to carry out a nutritional audit in centres that are currently catering fully for residents. In addition, the remit of the Ombudsman and the Ombudsman for Children has been extended to cover those living in State-provided accommodation. The Department has also co-ordinated the preparation of a multi-departmental information booklet for persons who have been granted any type of leave to remain in the State and a number of NGOs have been awarded moneys under the EU Asylum, Migration and Integration Fund, AMIF, specifically to provide assistance for persons who have been granted status to move out of State-provided accommodation. It is clear that significant improvements have either been or are being implemented across all aspects of the system of supports for those in the protection process.
When a final decision is made on a person's application, that person is either granted or refused permission to remain in Ireland. For those who are granted leave to remain, we are working with the NGO community, housing agencies, local authorities and religious groups to provide assistance for them to enable them to move into permanent accommodation in communities throughout Ireland. On the other hand, it is incumbent on those subject to deportation orders to remove themselves from the State. It is an integral part of the immigration regime of all developed states that those who have been given due process and determined to have no right to be in the state should remove themselves. If they fail to do so, they will be forcibly removed. A deportation order arises after an extensive process, including various appeal stages. This is the final step and most people voluntarily comply with a deportation order. In fact, they receive a warning letter beforehand, telling them that one is on the way. In that context, it is unreasonable to expect that persons who are the subject of deportation orders can continue to remain in State-provided accommodation indefinitely. If persons wish to comply with a deportation order, they may contact the Irish Naturalisation and Immigration Service, INIS, which will assist them in that process, in other words, pay their fare out of the country. I ask Deputies to encourage people to make contact with the INIS and tell them that they will be helped to leave the state. Prior to the making of a deportation order, assistance and support are available from the INIS for those asylum seekers who wish to leave the state.
I must correct the Deputy on one point. Asylum seekers are not receiving the letters to which she refers. The recipients are not asylum seekers because a determination has been made on their status.
I thank the Minister of State for his response. One of the people I have met has refugee status and been trying for over a year to find accommodation but without success. Some of the people who are the subject of deportation orders do not, for various reasons, believe it is safe to go back to their country of origin and are going to try, for obvious reasons, to fight the deportation order for as long as it takes.
I welcome what the Minister of State said about people being supported in finding accommodation. However, we know that there is a crisis in the provision of accommodation and I feel for those who have been granted leave to remain but who are still living in direct provision accommodation because they have nowhere else to go. They are under terrible stress because they have been told they will have to move out. I know that they have been offered a meeting, although I am not sure if it is with the Minister or departmental officials. I am concerned about the way in which letters arrive to people who are extremely vulnerable, some of whom have been here for a long time. I accept the Minister of State's point that some of them should have left, but they are still here. In some cases, their children were born here. They are in a really difficult situation. The letters also state the RIA has a limited supply of accommodation to cater for new applicants, but according to RIA data, as of the end of August, there were 464 spare places available in direct provision centres.
As the Minister of State is aware, there was a recent Supreme Court case on the right of asylum seekers to work. A task force has been given six months to look at the implications of the court's ruling. One can only imagine how demoralising it is for those who are unable to work. The day stretches out endlessly in front of them. There are people here who have valuable skills who want to contribute to society and would be able to do so. However, they are unable to work. When does the Minister of State expect to receive the report? I know that the task force was given six months in which to report, but does the Minister of State have any idea whether it will report within six months or whether it will take longer to do so?
As far as I know, we are still awaiting the report of the task force. I cannot comment on the report or pre-empt its findings until I receive it.
I am not aware of any person with children who is subject to a deportation order who has received a letter telling him or her to leave the country or reminding him or her that he or she should leave. My understanding is 23 letters were sent, all of them to single persons who will be helped to leave the country. They have been through every hoop and loop of which one could think and every appeals process possible.
They still have not proven their right to be here. Deputy O'Sullivan also mentioned people in direct provision who have status and leave to remain. I have met many NGOs and other groups and we are doing everything we can to get accommodation for the people in question. We want to help them move on with their lives. As I mentioned earlier, everybody who comes here looking for asylum is given a position straight away. Things are getting tight now, however, and I am getting worried about the coming winter. We currently have only 150 beds or so left, which is why it is imperative that we help people move on into accommodation. The letters they received can be used to show that they need to move on. Nobody is going to be forcibly removed from a direct provision centre. That will not happen unless there is a deportation order, in which case the people in question should be gone anyway. If they present themselves to us we will help them fly out of the country and return to where they want to go.
It is certainly not the case, as far as I know, that children are involved here. I would also be interested in any NGO group that might like to come forward to assist with this. I have met the groups and invited them to let me know and I look forward to working with them. People have said we should get rid of direct provision but I have yet to see anybody come forward with an alternative that will work. Somebody coming into Ireland today will have a bed tonight.
I thank the Minister of State.
Go raibh maith agaibh. Tá an Dáil ar fionraí ar feadh 40 bomaite.
Sitting suspended at 4.21 p.m. and resumed at 5.01 p.m.