Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Services

The good news can wait.

We are nearly ready.

This Topical Issue matter relates to the dialysis unit in Tallaght Hospital. The HSE and the Dublin Midlands hospital group agreed in 2017 that the building of a new unit would proceed, but inexplicably in January this year that proposal was cancelled. The existing unit is operating above capacity and cannot cope with the numbers attending. Clearly, there are problems in the delivery of the service.

I thank the Deputy for raising this very important issue and giving me the opportunity to address the House on behalf of the Minister for Health.

The Minister wishes to acknowledge the distress overcrowding in the dialysis unit at Tallaght Hospital may cause to patients, their families and the front-line staff working in very challenging conditions. Improvements in healthcare delivery have resulted in the improved survival of all patients, particularly those with diabetes and suffering from hypertension. This, coupled with the increased prevalence of both diseases, has led to a progressive rise in the numbers of patients presenting with end-stage kidney disease who require dialysis. The Minister accepts that the haemodialysis service in the dialysis unit at Tallaght Hospital is under increasing pressure to meet the new level of demand and ensure the provision of timely, safe and effective care for patients.

The dialysis unit at Tallaght Hospital was designed in 1985 and the Minister is aware that there are challenges in complying with current clinical guidelines and concerns about infection control. The dialysis unit is operating at full capacity and there is no scope to increase capacity because of infrastructural issues. In the short term, to address the requirement for additional haemodialysis service capacity, consideration is being given to providing additional funding to enable the hospital to outsource additional haemodialysis sessions to satellite dialysis units. The Deputy will be aware that in the longer term the development of a new facility to replace the existing dialysis unit is planned. The importance of the project is acknowledged as it reflects a long-standing need to upgrade dialysis facilities. Detailed designs have been completed and planning permission has been obtained for the project. The Minister understands that in December 2017 the hospital invited contractors to tender for the works and that the tenders have been evaluated. He further understands from the HSE that its directorate recently approved the award of the contract for the project and that this will be formally communicated to the hospital in the near future. The hospital will continue to work with the HSE to complete the project.

While I welcome the good news that the project will go ahead, I have a difficulty because similar news was relayed previously to the hospital authorities and the patients who use the facility. In that context, I am seeking an assurance from the Minister of State that the project will definitely go ahead. The dialysis unit at Tallaght Hospital is clearly not fit for purpose, given the number of patients being treated and the pressures on staff. There is also a danger of cross-infection because the beds are so close to each other. The HSE is spending over €4 million on private dialysis services and a further €1.2 million on patient transport services. What is happening does not make sense on either health or financial grounds. Clearly, if a commitment is given to go ahead with the project, it must be honoured. As I said, it was agreed to in 2017, but inexplicably the proposal was pulled in January this year. There is no problem with planning permission and the building of the new unit would not have a negative impact on the hospital or patients. It can be built quite readily and is badly needed to increase capacity. The Dublin Midlands hospital group is supportive of the project which forms part of the Government's national service plan. While I welcome the announcement made by the Minister of State that the project is to go ahead, my worry and that of everyone associated with the dialysis unit at Tallaght Hospital is that the development might be cancelled again. I have raised the matter on numerous occasions by way of a Topical Issues debate and parliamentary questions to the Minister. I have also written to the HSE about the matter. It is welcome that things have moved on, but the next step is critical.

I totally accept the points made by the Deputy, particularly about the €4 million being spent on private dialysis services and the €1.2 million being spent on patient transport services. The number of dialysis treatments at Tallaght Hospital has increased to more than 30,000 per year. The dialysis unit had been designed to provide 9,000 treatments per year but had to provide 13,000 per year. The remainder were provided in the aforementioned satellite dialysis units. This level of activity is more than double the national average. However, the Minister accepts that satellite dialysis units cannot manage complex medical disease cases. He is fully aware of the overcrowding in the dialysis unit at Tallaght Hospital and monitoring the position closely. The Department of Health, the HSE and the hospital are working to address the capacity issues in both the short and medium term and taking measures to improve the position. The award of contract has been approved. I will push the issue very strongly and assure the Deputy that work will continue and that developments will be closely monitored.

Maternity Services

It has emerged in the past week from minutes of meetings of the executive of the Saolta group that consideration is being given to merging the maternity services at Ballinasloe and Galway. Mr. Eoghan Murphy of Shannonside Radio obtained the minutes of recent meetings by way of a freedom of information request. The information has caused concern in County Roscommon and north Galway because the maternity service at Portiuncula Hospital in Ballinasloe is a very valuable asset. Is a downgrading of maternity services at the hospital envisaged? What is the status of the services and what does the reference to a merger in the minutes actually mean?

I thank the Deputy for raising this very important issue. I know that he cares passionately about health service provision and the delivery of maternity services, in particular, in counties Galway and Roscommon.

The ongoing, progressive development of maternity services is an important part of the development of the health service and something to which the Government remains committed. As the House is aware, Ireland’s first national maternity strategy, Creating a Better Future Together, 2016 to 2026, was published in 2016 and is being implemented on a phased basis by the national women's and infants' health programme in the HSE. Realising the vision of the strategy requires a fundamental restructuring of maternity service delivery, as well as significant investment over the lifetime of the strategy. A detailed implementation plan for the strategy was published in October 2017. It provides a clear roadmap for the development of maternity services into the future.

This year the Government provided additional development funding of €4.55 million to progress implementation of the strategy and improve waiting times for gynaecological services around the country. In 2014, the chief medical officer’s report on perinatal deaths at the Midland Regional Hospital, Portlaoise, recommended that managed clinical maternity networks be established within each hospital group. That report recognised that smaller maternity units should not operate in isolation as stand-alone entities and should instead be supported through formal links to larger units. The establishment of maternity networks within hospital groups and the sharing of expertise within and across those networks will improve the operational resilience of smaller units and support those units to provide safe, quality services.

The establishment of a maternity network across the Saolta hospital care group was further recommended in the clinical review of the maternity services at Portiuncula hospital, conducted by Professor Walker and published earlier this year. That report also concluded that a maternity network is a requirement to ensure the delivery of high quality, safe and standardised maternity care across the entire hospital group. It is prudent therefore to remind the House that the establishment of maternity networks across our hospital groups represents Government policy and, as such, is a key priority for the Minister for Health. However, to be clear, the development of the Saolta maternity network, and the other maternity networks across our services, does not represent a plan to close any services. Maternity networks are about supporting smaller units to deliver their services in a more standardised and safer manner. The establishment of a maternity network is being progressed within the Saolta hospital group and, as a first step, that network will initially comprise University Hospital Galway and Portiuncula University Hospital. These new governance structures will provide the framework for the delivery of maternity services in the Saolta hospital group to ensure that the needs of women, their babies and their partners are being met, and that a consistently safe and high quality standardised maternity service is delivered across the group.

On the face of it, I welcome what the Minister of State said. He clearly stated there is no intention to close any services but that services will work together. I would like him to state there is no intention, over the coming years, to downgrade any services.

It needs to be understood that Portiuncula hospital, Ballinasloe, is a valuable hospital for maternity services for north Galway and Roscommon. Everyone agrees on the importance of hospitals working together to ensure the best outcomes are achieved for expecting mothers and best practice is always adhered to.

In light of the way it was worded in the minutes of the meeting, there was much uncertainty and uneasiness in the area in case there was something going on behind the scenes without the people in the area knowing it.

I welcome the Minister of State's comments that Galway and Portiuncula hospitals will work together and Portiuncula hospital's maternity services will continue to be available in Ballinasloe and nothing will be downgraded. Will the Minister of State confirm that no service will be downgraded?

I again thank the Deputy for bringing this important issue to the attention of the House. I will bring his concerns to the Minister for Health, Deputy Harris. I also accept his point on uncertainty, which we cannot have with regard to maternity services. The establishment of maternity networks is a central tenet of the national maternity strategy, being key to progressive development of maternity services in the future. Their establishment across the hospital groups is Government policy and is a key priority for the Minister for Health. The full establishment of maternity networks, not just in Saolta but across all hospital groups, will build on the substantial good work already under way in the development of maternity services and will underpin Government arrangements by providing quality assurance and ensuring equity of access to maternity services for women. The key phrases here are "quality assurance" and "equity of access to maternity services for women".

Any other concerns Deputy Fitzmaurice has will be raised with the Minister for Health.

Flood Prevention Measures

I thank the Minister of State, Deputy Kevin Boxer Moran, for being here.

Last Friday morning, Belmullet and Erris were hit particularly hard by Storm Callum, which caused considerable damage in Belmullet town. In particular, the sea wall in the town was breached and the Mullet peninsula was cut off from emergency services for a time, although it was quickly repaired. The staff of Mayo County Council and local people did a fantastic job to ensure far greater damage was averted. If the Minister of State wants to see the extent of the damage, Senator Keith Swanick shared some stunning footage on Twitter which will give an example of how bad it was.

This has shown there is a need for far greater flood defences in Belmullet. We are not talking about high walls, because this is a very scenic area, but greater investment in strengthening the defences that are in place. The defences have, in many cases, been in place for 40 or 50 years and have taken a battering over that time. There is also a need for greater investment in erosion prevention in the Erris area. Mayo County Council does not have the matching funding necessary to invest in erosion prevention. This issue needs to be faced up to. The changes in places like Ceathrú Thaidhg, Gaoth Sáile and Ceann Dhumha Thuama on the Atlantic coast show the impact erosion is having, not just on Erris, but on Achill and right up the Atlantic coast. Greater resources need to be invested in erosion prevention to equip us to better fight storms.

The Minister of State has brought great energy to his brief since taking up the position and has advanced many projects. We need far greater attention paid to erosion defence and defence of our coastal towns which are at the cusp of any storm, particularly as we look into what may a difficult winter ahead.

I thank the Deputy for raising this important topic. My colleague, the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, has overall responsibility for Government policy on coastal strategy and local authorities on identifying works to protect the coast in their respective areas. My office, through the minor flood mitigation works and coastal protection scheme, provides a funding mechanism to support works to protect coastal communities, particularly those at risk from flooding. The management of problems of coastal protection in the area indicated by the Deputy is primarily a localised matter and, as such, it is for Mayo County Council to identify an appropriate, sustainable and viable solution to the problems in Belmullet.

A full report has been requested from Mayo County Council where high spring tides combined with a storm surge and waves associated with Storm Callum resulted in some flooding and the temporary closure of roads in Belmullet over the past week. Mayo County Council provided sandbags which served to provide protection from the extreme event. Following storms early in 2014 the then Department of the Environment, Community and Local Government contacted all affected local authorities regarding the cost of repairs to damaged coastal protection and flood defence infrastructure in the county. The amount made available to Mayo County Council for coastal protection repair works was €4.2 million. I am advised that the council has undertaken repairs of walls at a number of locations in Belmullet, County Mayo, at a cost of €180,000. It is important to note that funding was allocated to immediately assist local authorities for these repair and restoration works to existing coastal protection and flood defence systems and not for new infrastructural projects. It remains open to Mayo County Council to apply for funding in connection with this location and it is a matter for the council to prioritise works in its administrative area.

I acknowledge that good work has been done since 2014, particularly along the Mullet peninsula, in strengthening roads and raising bridges. This is directly related to Belmullet town and I will encourage Mayo County Council to submit an application for a minor works grant and I assume, from the Minister of State's remarks, any such application will be given a good hearing in his Department.

Is ceantar Gaeltachta é freisin. Tá sé tábhachtach go bhfuil toradh an-mhaith i gceist le haghaidh na ndaoine atá ina gcónaí sa Ghaeltacht. Tá deacrachtaí i gceist dóibh siúd a chónaíonn sa Ghaeltacht. Tá sé tábhachtach go dtabharfar gach tacaíocht dóibh siúd atá ina gcónaí in Eachléim agus atá ag coimeád an Ghaeltacht agus an teanga beo.

The Departments of the Minister of State and of the Minister, Deputy Eoghan Murphy, need to look at the issue of erosion. Money is being allocated for erosion but because local authorities do not have the matching funding necessary, it is not being spent. There is constantly an underspend in the erosion budget in local authorities. Meanwhile, our Atlantic coast is changing in front of our eyes. Our natural defences against floods are being weakened and there needs to be a very serious discussion within the Minister of State's Department and the Department of Communications, Climate Action and Environment about how we protect our natural coastal defences in a stronger way.

I could not agree with the Deputy's comments more but I advise that we are coming to budget times in local authorities and, where local authorities have issues with regard to cutbacks, they know that the Minister, Deputy Eoghan Murphy, and I have money at our disposal. If they apply for the schemes, they should have backup funding. They are in areas with coastal erosion. They fully understand that councillors need to step up to the mark to provide that money and we will make the matching funding available. Neither the Minister’s Department nor my Department have been found wanting in supporting all local authorities, particularly in the past year and a half. I have been very vigilant on the ground in meeting people and looking after areas. If Mayo County Council comes to our Department, we will look at trying to do works.

That seems like a very valuable invitation. I thank the Minister of State.

Waste Disposal

I raise the issue of the €75 support, which was announced by the former Minister, Deputy Naughten, on 27 June 2017, when he stated that an annual support of €75 would be introduced for persons with lifelong or long-term medical incontinence and that this support would help people to meet the average annual cost of disposal of incontinence products. That was the Minister's announcement. There was a further significant speech on 5 July 2017 when the Minister stated, when he was announcing some changes to the waste disposal regime, that the final change was to provide a Government-supported €75 per year to assist persons with medical incontinence. This was based on the average cost of disposal of 650 kg of incontinence products and was developed in consultation with industry and patient stakeholder groups.

Fast forward to September 2018, and there are a number of cases, including a specific case of a young person in my constituency who has a long-term need. I seek clarification from the Government as to the status of the €75 support which was announced by the Government in 2017 and further reinforced in 2018. Is this €75 available? Perhaps I have missed something in despatches. I do not think that I have. I need to be able to report back to my constituents whether this is happening. A sum of €75 is a significant amount of money, especially when the annual cost of waste for an average household is quite high. This would give untold support to such families who are in desperate need.

The Department of Communications, Climate Action and Environment is continuing the work of developing, with a number of stakeholders, a mechanism to provide a €75 support for persons with lifelong or long-term medical incontinence to help meet the average annual cost of disposing of medical incontinence products. Unfortunately, this process has taken far longer than originally envisaged. This delay is due to a number of issues. In particular, data protection issues have arisen since the introduction of the general data protection regulation, GDPR. The proposal relates to persons with lifelong or long-term medical incontinence. As the Deputy is aware, any information that relates to the physical health of a person is sensitive personal data and must be treated very carefully. I understand, however, that there is a commitment to introducing a support, as soon as practically possible, in conjunction with relevant agencies and stakeholders.

As outlined by the Deputy and as announced in mid-2017, mandatory per kilogram charging was not introduced for bin collection. Instead, a range of charging options were allowed, which encourage householders to reduce and separate their waste and provide flexibility to waste collectors to develop various service price offerings that suit different household circumstances. As a community, we need to keep our focus on the prevention and segregation of waste to protect our environment and to make the transition to a resource efficient and circular economy. We need to ensure that we are compliant with the targets set under EU waste legislation. This includes the new ambitious target of reducing the level of landfilling of municipal waste to less than 10% by 2035. It is important to be clear that, as a country, we have no spare landfill capacity for the disposal of household waste. The ban on flat-rate fees was necessary to incentivise householders further to recycle and compost more and to send less waste to landfill.

To assist householders, the Department has invested €3 million in education and awareness in what goes into the recycling bin and how to use the brown bin effectively. A household waste collection price monitoring group, PMG, was established in 2017 to monitor pricing developments for household waste collection services during the phasing out of flat-rate fees. The PMG has considered 13 months of data to date. While fluctuations in prices and service offerings have been observed, the overall trend is relative price stability.

The Competition and Consumer Protection Commission, CCPC, recently concluded a study on the operation of the household waste collection market. It made three main recommendations, which are to review the existing national waste policy; in that context, to establish an economic regulator for household waste collection; and to ensure that all the State's resources are co-ordinated to deliver optimal outcomes for this market. The CCPC report, combined with the ongoing work of the PMG and the finalisation of the European circular economy waste and plastics legislation framework, will inform the development of a future national waste management policy, including our environmental goals. Notwithstanding all that progress on the waste management front, there is, unfortunately, further work to be done on delivering that €75 support raised by the Deputy. It is intended, however, to progress this issue as a matter of absolute urgency in conjunction with all the relevant agencies and stakeholders.

I thank the Minister of State for his response and I appreciate that he is taking this on behalf of another Department. It is not his own line Department. This was announced in July 2017. We are far along the road now. The GDPR issues could have been anticipated because that was coming down the line from Europe. Raising the issue of data protection is a bit of a diversion at this stage. I do not think that is an insurmountable issue. Myriad Departments handle personal detail about individuals. One could easily administer a scheme that would give €75 to every family that has an issue relating to long-term medical incontinence. It would have a massive impact on those families with regard to reducing their waste disposal costs.

I implore the Government to come back to me at some stage with a solution and timeline for this. I am not buying the argument that data protection is an issue. It is very easy to design a scheme, given the innovative nature of this country, that would easily meet the needs of the people that we are all trying to represent here. There is not a Member of this House who does not have this issue and who does not have a family in his or her constituency who would benefit from this €75 support which was announced in 2017. I ask the Minister to consult his colleagues with a view to ensuring that we can at least follow through on something that was announced and get over these hurdles, such as the data protection hurdle. I do not believe that is an issue which cannot be dealt with a little bit of energy on the part of the Government.

I am aware that in seeking to put this payment in place, the Department has engaged with Family Carers Ireland, Age Action, Spina Bifida Hydrocephalus Ireland, the Irish Wheelchair Association, the Disability Federation of Ireland, the Alzheimer Society of Ireland, the National Disability Authority, the National Waste Collection Permit Office, the regional waste management offices, the Irish Waste Management Association, the Department of Health, the HSE, and the Data Protection Commission.

All the stakeholders, including the Department, wish to progress this issue as a matter of urgency. I understand the Department is committed to introducing the support as soon as practicably possible. Having said that, I will pass on Deputy Sherlock's concerns to the relevant persons in the hope that the electronic payments system can be put in place as soon as possible.