Dáil Éireann díospóireacht -
Thursday, 28 Mar 2019

Vol. 981 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Sports Organisations

Deputy Noel Rock

We have all been taken aback by the ongoing corporate governance and financial issues within the Football Association of Ireland, FAI. I strongly believe now is the time to set the course right, set the record straight, and commence a truly independent examination of management and finances which further State funding will be contingent upon. That means investigating everything from top to bottom, including lease deals, associated companies, boardroom expenses, etc. It is clear that corporate governance within the FAI is shambolic.

Six weeks ago, Jonathan Hall Associates was appointed to provide a report on senior management structures and the role of chief executive officer, CEO, as the FAI plans for the launch of a new strategic report. No terms of reference have been published to date and, indeed, the FAI has not even responded to the Oireachtas Joint Committee on Transport, Tourism and Sport's request for that report. Incredibly, within six weeks, that report has been produced in its entirety, with no redrafting required and its contents acted upon, via a unanimous vote of the board, culminating in the announcement of a brand new position for John Delaney. This absolutely stinks.

I met an expert in sporting governance who is currently undertaking such a review within a sporting body in another jurisdiction. That review is coming to a conclusion. It took a year. How could this review take only six weeks? Why did the FAI act on it so quickly? Why can the FAI not supply us with this report, given that is has unanimously acted on an element of it? Does the Minister believe this is good corporate governance? Does he believe that taxpayer's money is being deployed effectively? Does he not believe that now is the time for an independent examination into FAI corporate governance and finances? It is time we examined where taxpayer's money is going, as there are clear omissions in the information being given.

On finance, I have spoken with current and former employees of the FAI and am disturbed by what I hear and the documents I saw. While the committee continues working with these sources and readying itself to ask questions about what has previously happened within the FAI at its meeting on 10 April 2019, we need to act now to safeguard taxpayers' money in the future by taking this course of action. If the FAI will not clean up its house, we should at least work to protect the taxpayer.

In the Minister's recent response to a parliamentary question I put to him, he said:

There is no requirement for the organisation mentioned by the Deputy to submit its financial statements to my Department. In line with the terms and conditions of grant funding provided to it by Sport Ireland, the organisation is required to submit a copy of its financial statements to Sport Ireland.

This is a straight question. Is it time to change that requirement?

We see in the public domain today, once again, that for 2019 the FAI requested an early draw down of State funding from Sport Ireland. This is not the first time it has happened and no explanations have been forthcoming. We also saw the revelation of an undeclared director's loan by Mark Tighe in The Sunday Times. The question has to be asked as to why this was necessary. Is it the only time it happened? Why was it not declared? Has the Minister spoken to Sport Ireland on these important matters? Does he have any concerns with regard to the undeclared director's loan? Does he not agree that further taxpayer funding should be contingent on an independent examiner and an independent examination?

The original issue which thrust this story into the public domain was one of borrowed money, but it is quite clear that the board of the FAI is now only existing on borrowed time. These are important questions, they deserve an answer and they deserve a public answer.

Minister for Transport, Tourism and Sport (Deputy Shane Ross)

I thank the Deputy for raising this very important matter. As he knows, Sport Ireland is the statutory body with responsibility for the development of sport in Ireland. This includes responsibility for the allocation of funding across its various programmes and governance oversight of the national governing bodies, NGBs, of sport. All sporting bodies funded by Sport Ireland are required to comply with standards of good governance, including financial oversight and Sport Ireland periodically reviews governance and oversight in the bodies it supports.

The recent media reports to which the Deputy referred, regarding a loan provided to the FAI by its CEO, have raised serious questions about governance and financial controls in the FAI. Sport Ireland is currently engaged with the association to clarify these matters and when the necessary clarifications have been received from the FAI, Sport Ireland will submit a report to me. In the interests of due process and natural justice, it is important that Sport Ireland's engagement with the FAI would be given the necessary time to ensure that all matters are considered thoroughly. Therefore, I do not wish to make any comment on any possible outcome from this ongoing process.

Sport Ireland provides funding to the FAI primarily through the field sports grant. This funding is directed towards participation and games development programmes and is broadly aimed at encouraging and creating more opportunities for young people to participate in soccer. In 2018, €2.56 million was provided for this purpose. In 2018, the FAI also received funding of €142,500 through the women in sport programme; €195,000 in support of the women's national team; €22,500 to support the running of Cerebral Palsy Ireland football; and €20,000 in dormant accounts funding. In total, Sport Ireland provided over €2.9 million in current funding to the FAI in 2018. The total funding provided in 2017 was over €2.7 million.

Sport Ireland has robust arrangements in place in relation to the funding it provides to sporting bodies, including the FAI. As part of Sport Ireland's normal processes and procedures relating to the annual grant cycle, NGBs in receipt of grant funding are required to submit to Sport Ireland a copy of their financial statements. This must include a statement from their auditor that each grant was expended in accordance with the approved submission for the grant funding. Given the amount of funding involved, the FAI, along with the GAA and the IRFU, are generally audited by Sport Ireland's internal auditors every three years. The most recent audit of the FAI was completed in 2016 and a further audit is due to take place later this year.

On my Department's sports capital programme, SCP, the FAI has benefitted from some limited funding over the years with a total of €190,000 allocated directly to the organisation since 2015. A separate grant of €160,000 was allocated in 2015 to AUL-FAI Ltd for the development of a natural playing surface at the Athletic Union League, AUL, complex in Clonshaugh.

I am satisfied that the existing controls in place for all grant payments under the SCP are robust. As we have seen in the past, failures of governance within sporting bodies unfortunately damage the reputation of Irish sport as a whole. This is why it is so important that we ensure strong governance across all associations. Sport Ireland has made it clear that all sporting bodies must take the necessary steps to comply with the governance code for the community, voluntary and charity sector. I know many sporting bodies are making good progress towards achieving this and I encourage them to continue their efforts.

Deputy Noel Rock

In football terms, the response here was what we call a set piece. There was no deviation from the scripted answer and there were no answers to the questions I posed so I may as well ask them again.

We saw the revelation of an undeclared director's loan. The question has to be asked: why was this necessary? Is it the only time it happened? Why was it not declared? Has the Minister spoken to Sport Ireland on these important matters? Does he have any concerns with regard to the undeclared director's loan? Does he not agree that further taxpayer funding, in his opinion as Minister, should be contingent on an independent examiner going forward? That is not a matter for Sport Ireland. That is not a matter to hide behind. That is a policy decision. The Minister sets that. That is a question for the Minister to answer. How could this review only take six weeks? Why did the FAI act so quickly? Does the Minister believe that this is good corporate governance? That is also an opinion and a point for the Minister to make. Does the Minister believe that taxpayers' money is being deployed effectively, based on what he has seen? Does the Minister not believe that now is the time for an independent examination into FAI corporate governance and finances?

It is time we looked at where taxpayers' money is going as there are clear omissions in the information being given from the FAI to Sport Ireland and to the committee on which I sit.

Deputy Shane Ross

Nobody in this House has a greater commitment to corporate governance than I have but I want to see a fair procedure here. I will not say anything which would in any way prejudice the clarifications which are being sought by Sport Ireland for me and for me to reveal to the Deputy when they are published. It is very important that a body such as Sport Ireland is left to do this work, to do this properly and to do it thoroughly. Everybody must be properly heard and when we get the results, they will be published by me without fear or favour to anybody and they will be open to the Deputy and to the committee to examine, but it would be utterly wrong for me to answer the questions which the Deputy is asking here because they are being asked, on the Deputy's behalf as well, by Sport Ireland at this very moment and it will report at a very early stage. At that stage, I will make those results open to everybody to discuss and I will be quite happy to comment on them myself.

Health Services Staff

Deputy John Brassil

I very much welcome the opportunity to raise as a Topical Issue the provision of cardiology services in University Hospital Kerry as it is something which is absolutely critical to the functioning of the hospital. The Minister of State will be aware that University Hospital Kerry is a level 3 24-7 hospital with an emergency unit. As of early last year, it has been operating without the services of a full-time cardiologist. This situation was brought about by the resignation of the previous cardiologist. At the time, there was great concern and I had a Topical Issue matter on it at the time. I was assured in response to my questions in June 2018, that in conjunction with Cork University Hospital, the South/South West hospital group was to appoint two additional cardiologists, split between the two hospitals, and the ratio was to be 75:25, which would effectively result in one and a half cardiologists for University Hospital Kerry, which would allow it to function as the level 3 hospital that it is. We are now into April 2019 and as of yet, we do not have those two positions.

Concern is growing about funding being diverted to the national children's hospital and spending being withheld until we see the downsides of Brexit. Conspiracy theories are emerging because the action that was promised almost a year ago has still not been delivered. Coupled with that, the coronary care unit in the hospital, which is a nine-bed room, is stretched to the limit. There are no facilities for proper consultation among staff or for carers and family members of patients. That sends out a message that there is no genuine desire to provide the type of cardiology services that are needed for a category 3, 24-7 hospital.

Can the Minister of State confirm that funding for the provision of two cardiologists shared on a 75:25 basis with Cork University Hospital is ring-fenced and that those cardiologists will be in place in a very short time, allowing the hospital to then plan for its future as a category 3 facility? Without such assurances, I will be extremely concerned about the hospital's ability to function as it needs to. I remind the Minister of State that such was the concern among the hospital's consultants last year when this issue arose, among many other issues, that every single one of them took the unprecedented step of writing to the South/South West hospital group requesting immediate action on the shortfalls in key positions, including cardiology, respiratory consultancy and emergency room consultancy. I look forward to the Minister of State's response and hope it gives me the reassurance that I and the hospital need.

Minister of State at the Department of Health (Deputy Catherine Byrne)

On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for raising this issue and giving us the opportunity to provide an update to the House. The cardiology department in University Hospital Kerry, UHK, performs a variety of testing on the heart such as electrocardiogram, echocardiogram, stress testing, Holter and blood pressure monitoring and pacemaker checks. It is important to note that, consistent with the recommendations in the national acute medicine clinical programme for model 3 hospitals such as University Hospital Kerry, patients with acute coronary syndrome are transferred to the primary coronary intervention centre in University Hospital Limerick. Cork University Hospital, CUH, is the tertiary referral centre for more complex cardiology patients.

In respect of the Deputy's specific query regarding the status of additional cardiologist positions for UHK, in June 2018, the South/South West hospital group advised that it was developing a business case for the appointment of two consultant cardiologist positions split between UHK and CUH. I am pleased to advise the Deputy that both posts are now awaiting approval by the HSE's consultant appointment advisory committee and, once approved, the advertisement of these posts can commence immediately.

With regard to the wider issue of consultant appointments in general, the Government remains committed to increasing the consultant workforce to support service delivery and to move to a consultant delivered service. While there are approximately 450 consultant posts that are not filled on a permanent basis and are filled by locums or temporary staff to support the delivery of essential services, the number of consultants has increased by 125 in the 12 months to the end December 2018 and by 540 in the past five years. At the end of December 2018, there were 3,096 whole-time equivalent consultants working in the public health services, the highest number in the history of the State.

The HSE is also committed to supporting consultant recruitment and retention, pursuing a number of initiatives, including improvements to the recruitment process, offering contracts to the hospital group rather than individual sites and focusing on family friendly arrangements. It has established a tripartite working group, including the Medical Council, the forum of postgraduate medical training bodies and the national doctors training and planning unit of the HSE to examine posts where the consultants are not on the specialist register as well as recruitment and retention challenges.

Deputy John Brassil

I thank the Minister of State for her response. I am knocked for six by the line that the advertisement of these posts can commence immediately. That is beyond belief. On 28 June last year, in response to a parliamentary question on the very same issue, I was told the replacement process commenced as soon as the official resignation was received from the previous cardiologist. The response further stated that UHK was working with the South/South West hospital regional cardiology group to appoint two additional consultant cardiologists split between UHK and CUH. Here we are ten months later, and I am told that the posts have not even been advertised yet. It is farcical. I do not know if the HSE gives us these replies and thinks we will forget about them and not refer back to previous answers when it comes up with this drivel. It is unacceptable to have told me almost a year ago that two consultants were to be appointed when here we are today and the posts have not been advertised yet.

I was about to speak about the fact that there is a 25% pay deficit between pre-2012 and current consultant contracts. If the HSE is looking for 450 posts, how in the name of God is it going to fill them when there is a 25% pay gap between two people who are doing the same job? I will not go into that now. The response leaves me beyond words but I will take this issue much further. The lack of respect and action is totally unacceptable. This is a 24-7 hospital operating without a cardiologist. What world are we living in?

Deputy Catherine Byrne

I do not have much to add. I have listened to the Deputy and know he is not happy with the response I have been given. The reply states that once the HSE consultant appointment advisory committee approves the advertisement of the posts, the process can immediately commence. I do not see what is wrong with that. I do not know the reason it has taken as long as it has to come to a point where the consultant advisory committee is still in consultation over the consultant posts. I do not know the history of that but I will certainly pursue it with the Minister and ask him to respond to the Deputy. I know the Deputy is not happy with the response but unfortunately I cannot ease his frustration with the reply he has received.

An Ceann Comhairle

It is considered that replies given to parliamentary questions and Topical Issue matters should reflect the best possible and most accurate information available at the time from any Department. The Minister of State is here in good faith, obviously. There is an appeal system in place for Members who are unhappy. It would appear to me that the Deputy has reason to be very unhappy.

Deputy John Brassil

It is not directed at the Minister of State. It is the content of the response that has me extremely frustrated.

An Ceann Comhairle

I suggest that the Deputy avail of the appeals process. The Minister of State is responding to the next matter as well.

Deputy Catherine Byrne

I am in the firing line again.

Occupational Therapy Waiting Lists

Deputy Mick Wallace

I thank the Ceann Comhairle for selecting the issue. The number of children and adolescents awaiting first-time assessment for occupational therapy nationally as of January 2019 was 16,868, a fairly depressing figure. However, the response to a parliamentary question I tabled last week reveals serious inconsistencies in the number of children and adolescents on waiting lists in different counties and local health areas.

The delivery of occupational therapy across the country is deeply unequal. For example, 1,353 children and adolescents were on the waiting list in Wexford according to the January statistics. A total of 666 of these children and adolescents had waited for more than a year for an initial assessment. By contrast, County Clare had only 41 children and adolescents on the list, 39 of whom had been waiting for less than 12 weeks while the remaining two children had been waiting for between 12 and 26 weeks. The number on the waiting list in Limerick as of January was 95, with only five children in Limerick waiting for more than 26 weeks. While these wait times are not ideal, most people would agree that the occupational therapy departments and staff in these local health areas are performing well based on these figures.

However, the national average number of children and adolescents on waiting lists for paediatric occupational therapy in January was 411. The number of children and adolescents waiting for an assessment in Wexford was more than three times the national average. The number of children and adolescents on the waiting list in Wexford was 33 times higher than the number on the waiting list in Clare. Wexford had the second highest number of children on the waiting list according to the data I received. Only Laois-Offaly had a higher figure. The numbers on the waiting lists in Wexford, north of the Lee in Cork and Laois-Offaly are total outliers and those lists need to be tackled as a matter of urgency.

In its response to me last week, the HSE advised that it could not provide a further breakdown for the number of children and adolescents waiting for more than 52 weeks. However, a letter from the HSE to the parent of a child awaiting assessment in Wexford shows that the Wexford local health office is currently dealing with occupational therapy referrals from June 2016, with a waiting list of two years and nine months. The letter goes on to state that resources are limited in Wexford with a 40% reduction in staffing in the past year and that, according to a children mapping process, Wexford requires 35 posts to deal with the demand for this service. The letter is dated 14 March 2019 and notes that as of that date 1,429 children and young people were on the occupational therapy waiting list in Wexford. This represents an increase of more than 5% on the figure I received for January. Things are getting worse and not better. The tone of the letter is remarkable. It was sent by the occupational therapy manager in Wexford and, based on the letter, she is clearly exasperated and worn out by the lack of resources available to her and her staff.

I am still awaiting an answer from the HSE in response to another parliamentary question on the number and locations of paediatric occupational therapist vacancies nationally. A parent in Wexford has told me that Wexford has three occupational therapy vacancies at the moment. What steps will the Minister take to recruit occupational therapists in Wexford? How many occupational therapists currently work in Wexford? How many occupational therapists is the HSE trying to recruit for Wexford? When does the HSE hope to appoint these occupational therapists? Does the Minister believe that occupational therapy services for children and adolescents are adequately funded?

Deputy Catherine Byrne

On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for raising the issue.

The Government acknowledges that challenges exist in access to and the provision of paediatric occupational therapy services in Wexford. The Government and the HSE are committed to improving access to these important services. The Minister has been advised by the HSE that in recent years the demand for paediatric occupational therapy services in Wexford has significantly increased. Along with the increased number of referrals, management in the HSE is reporting that more complex demands are being made on this service.

With regard to the numbers waiting to access paediatric occupational therapy services in Wexford, the HSE has advised that all applications for these services are prioritised upon receipt on the basis of clinical need. High-priority referrals are managed by the HSE in accordance with standard operating protocols with children of the highest clinical need being seen first.

A number of initiatives have been implemented by south east community healthcare organisation, CHO 5, to improve access times to services in Wexford. These include an expanded occupational therapy service to provide assessment and two treatment sessions for school-age children. This is an expansion of the existing service. Additional clinics are also being provided. Under a new initiative, the Central Remedial Clinic is providing an outreach clinic and increased outpatient clinics are being offered to address the needs of the longest waiting.

CHO 5 is also increasing the number of group programmes on offer in the school-age service. A total of 110 children are currently being assessed and provided with group intervention in the first quarter of this year with the aim of providing intervention prior to entering the school-age service.

In order to address waiting times nationally and improve access to services, the Government has committed to increasing the number of occupational therapists in primary care. The HSE’s national service plan for 2019 contains the commitment to recruit 170 community and nursing therapy posts, including 40 additional occupational therapist posts. These additional occupational therapist posts will focus on addressing patients waiting over 52 weeks. The HSE anticipates that over 350,000 primary care occupational therapy patients will be treated in 2019.

The development of primary care is central to the Government’s objective to deliver a high-quality, integrated and cost-effective healthcare system. A Programme for a Partnership Government and Sláintecare commit to shifting the model of healthcare towards a more comprehensive and accessible primary care service in order to deliver better care close to home in communities across the country.

The HSE has also established service improvement groups to develop new standardised models of service provision to support the delivery of occupational therapy and other therapy services. The national service plan for 2019 commits to the implementation of the recommendations from these reviews on a phased basis within existing resources, which will help to address difficulties and pressure areas in therapy services.

Deputy Mick Wallace

I know it is not the fault of the Minister of State, Deputy Catherine Byrne, but this is crazy. She is telling me that the HSE intends to recruit 40 occupational therapists nationally when 35 occupational therapist posts are needed to meet the demand in Wexford according to the occupational therapy manager in the county. This is off the Richter scale. What kind of impact will 40 make on the problem nationally if 35 are needed in Wexford? It will not scratch the surface of the problem. I do not understand that.

The waiting times are shameful and make a mockery of the idea of early intervention. The disparity between the different CHO areas beggars belief. These children are waiting for an initial assessment only. They would then have to wait again for a further appointment. The number of children awaiting an assessment in Wexford is more than three times the national average. I would like an explanation for that. Somebody - I do not know who - is responsible for that. The Government has a responsibility to hold somebody to account for that. There has to be an explanation. The Minister of State probably does not have it front of her, but the Government should supply it. People in Wexford and the parents of the children who are waiting for their initial appointment deserve an explanation.

We know that Wexford is the third most deprived county in the country and in some areas it is the worst. It is unbelievable. The HSE letter to the parent of a child awaiting assessment in Wexford has shown that occupational therapy in the Wexford local health office is currently dealing with referrals from June 2016. This is March 2019.

Can we get some answers and accountability?

Deputy Catherine Byrne

I acknowledge the Deputy's concerns about this issue. Unfortunately, I do not have the statistics in front of me to which he referred. All I can tell him is that the Government has acknowledged the challenge that exists in providing paediatric occupational therapy services in Wexford. There is a campaign to recruit people throughout the country and it is more difficult to recruit in some areas than in others. I am not here to give the Deputy an answer as to why more children would be waiting longer for an assessment in one area compared with another area. I do not know the reason for that and I cannot understand it, to be honest.

However, the challenges that face us all are to make sure that intervention is provided for children who need it. As I stated in my reply, provision has been made for the inclusion of expanded services for school-age children and for additional clinics delivered by the Central Remedial Clinic to address the needs of those who are waiting the longest. It is significant that there is such intervention in schools and that is becoming more prevalent with speech and language therapy and occupational therapy services.

I am here to read a statement but also to note the concerns raised by the Deputy and to acknowledge that in his role of representing Wexford, there are needs in this area that must be addressed. Unfortunately, I cannot address them at the level that he requires. However, I will, as usual, relay the information to the Minister and ask him to come back to the Deputy personally on some of the statistics, when people will be seen, and when the staff who are required will be recruited into the services in Wexford. Unfortunately, I do not have any other answer for the Deputy. I could read a prepared response in conclusion but it would just outline what I stated in my initial reply.

An Ceann Comhairle

We understand the Minister of State's predicament.

Hospital Services

Deputy Martin Kenny

I wish to raise an issue that has become very serious in Sligo University Hospital and for the entire north west. I will paint a picture of the situation for the Minister of State. If an adult or a child in Sligo, Leitrim, south Donegal or west Cavan is diagnosed with type 1 diabetes, he or she is sent for an appointment and an assessment to a unit located in a two-room portakabin in a yard at the back of Sligo University Hospital. They walk through what is literally a building site as a new mental health services unit is being built in the area. The people who work in that small portakabin have to keep the windows closed because of the dust. The Minister of State can see the picture. A family arrives at that portakabin with a child who has been diagnosed with diabetes, and two other people may be waiting to be seen in that small room half the size of the area of the floor of this House. They get an assessment done on the level of insulin or whatever the child needs, they make further appointments, and each time they come back to that unit. The staff in the second room in the portakabin have their computers and their phones there. They monitor people with type 1 diabetes from across the entire north west in respect of whom they receive reports. It is a cramped and unsuitable unit. The HSE has an application in for funding the building of a new unit for the past four to five years but nothing has happened.

There is also the serious matter of people who are diagnosed with type 1 diabetes who need an insulin pump, which is a marvellous advance in treatment. I spoke to a man a number of months ago who was waiting to be fitted with an insulin pump. He knew it had been ordered. In fact, it had been purchased and was sitting on a shelf in that unit but he could not get it fitted because he needed to be trained on how to use it. The specialist nurse who provides the training had been seconded to another part of the hospital and was not available to give him the training. An 18 year old woman who is in college contacted me in recent weeks who is in the same situation. She wants to be fitted with an insulin pump and has been told there is nobody available to train her on how to use what is a simple enough piece of equipment.

There are two issues involved. One is the facility, the cramped and unsuitable unit, and the staffing of it. Quite apart from the unavailability of a specialist nurse to provide training on the use of an insulin pump, the staff who work in this small portakabin are totally stressed out, are under pressure and cannot deal with the demand for this service that they are trying to provide and are providing, in fairness, under very difficult circumstances.

I want the Minister of State to provide an assurance that any person in the north west who needs to be fitted with an insulin pump and wants to have that done will be able to get it done with all the haste that is required and that the training they need will be available as soon as they apply for it and need it. Will the Minister of State advise also regarding progress on the building of a new diabetes unit at Sligo University Hospital?

Deputy Catherine Byrne

On behalf of the Minister, Deputy Harris, I thank the Deputy for raising this matter. As he will be aware, diabetes is one of the most challenging health problems in the 21st century. Just like the rest of the world, Ireland is experiencing sustained increases in the number of people with diabetes. Currently, there are more than 200,000 people with diabetes in Ireland. People with type 1 diabetes make up 10% of all people with diabetes. If not well managed, diabetes can lead to debilitating complications, including visual impairment and blindness, lower limb amputations, kidney failure and heart disease. As a result, the increasing prevalence of diabetes poses a major challenge to our health service, with increasing costs driven primarily by hospitalisation and treating associated complications. This is also evident in the increase in demand for diabetic care in our acute hospitals and our community healthcare organisations, including in the Deputy's area.

The diabetes service team at Sligo University Hospital is led by consultant endocrinologists and serves the populations of Sligo, Leitrim, south Donegal, north Roscommon and west Cavan. This adult diabetes service also includes an insulin pump service. Referrals are also received from Letterkenny University Hospital in this regard. In addition, there is a pregnancy diabetes service, inpatient ward-based consultation service, and an inpatient and outpatient podiatry service. There is a well-established integrated multidisciplinary team approach between both the hospital and the community, supported by specialist diabetic nurses and an advanced nurse practitioner as well as a full range of support staff. In addition to this, there is a paediatric diabetes specialist service that provides a regional insulin pump service for children across the north west. Both the adult and paediatric pump services have experienced considerable growth in referrals both from new patients commencing treatment as well as repatriation of patients from national tertiary centres. In addition, a full endocrinology service is provided, which includes dynamic endocrine function testing.

The HSE has advised that tender documents for the diabetic day unit at Sligo University Hospital have been finalised and are ready to issue to contractors. It is intended to proceed to construction in 2019, with the unit expected to be operational in 2020. The funding of all projects is subject to the availability of capital funding and the progress of other priorities. The Government is committed to the further development of services for people with diabetes and other chronic conditions.

Earlier this month, the Sláintecare Action Plan 2019 was published which will be a fundamental enabler in the delivery of the Sláintecare vision. As part of this action plan, a series of service design and delivery workshops will be held. These workshops will he focused on chronic disease management, including the management of diabetes.

Deputy Martin Kenny

I thank the Minister of State for her response. I acknowledge the inclusion in it to the effect that "tender documents for the diabetic day unit at Sligo University Hospital have been finalised and are ready to issue to contractors" and that it is due "to proceed to construction in 2019". While that is very welcome news, the next sentence states: "The funding all projects is subject to the availability of capital funding and the progress of other priorities." There is always a little fear in that respect, particularly in the context of what has happened with the national children's hospital, but I will not go down that road. The building of this unit would involve a fairly low cost for the major benefit it can create for people with diabetes. I welcome that it will proceed with all due haste and as quickly as possible.

The other issue I raised is that people are unable to be fitted with an insulin pump because of the absence of specialist nurse to train them on how to use it as that nurse has been seconded to another part of the hospital.

That is a serious problem. One lady I spoke to told me of a situation where she was there along with her child, and another child in the hospital had been diagnosed with diabetes and arrived over in their pyjamas to this unit for an assessment, having walked across what was practically a building site. There are no toilet facilities in the place. At the end of the assessment, another man came in to inquire what was happening as he had been waiting for the insulin pump for several months and had not got it. This is a real issue that needs to be dealt with. While I welcome the proposal that there will be capital funds in place to build this, it needs to happen as quickly as possible.

There is also the issue of ensuring adequate staffing. The Minister of State mentioned that the multidisciplinary team is in place but to my knowledge it is not complete and there are holes in that service that need to be filled. That should be done as quickly as possible.

Deputy Catherine Byrne

I have noted the Deputy's concerns. I recognise the reply states there is an intention to proceed with construction in 2019 and it is expected to be operational in 2020, and the reply also states this will be subject to availability of capital funding. All other projects throughout the country are in the same position. It is down to funding, and let us be honest about it.

I am not sure about the status of the multidisciplinary team, which the Deputy said is not complete. I will have to go back to the Minister on that. With regard to training for the pumps, how difficult can it be to train somebody to use a diabetic pump? I know somebody who uses one daily. I am committed to going back to the Minister to ask that a comprehensive answer be given to the Deputy and that the Minister would contact the hospital to find out why training is not happening when the pumps are already there and waiting to be used. We all know a diabetic pump can mean so much to people's everyday lives. I know someone who uses one daily.

I am sorry I do not have more information for the Deputy. As always, I will refer back to the Minister, Deputy Harris. I will do my best to hammer home the concerns that have been raised.