Dáil Éireann díospóireacht -
Wednesday, 4 Dec 2019

Vol. 990 No. 5

Saincheisteanna Tráthúla - Topical Issue Debate

Rural Development Policy

Deputy Michael Harty

I thank the Leas-Cheann Comhairle for choosing this Topical Issue matter and thank the Minister for Rural and Community Development, Deputy Ring, for attending to take the question.

The issue I highlight arose from a public meeting held in Newmarket-on-Fergus on the evening of Monday, 2 December. It was attended by all the local Members of the Oireachtas - Deputies and Senators - and the local county councillors, as well as the Garda inspector at Shannon. It was well attended, with more than 700 people, and was a call to us as Members to highlight the issues facing villages such as Newmarket-on-Fergus, which is a case study of what is happening to many villages and towns throughout Ireland. Newmarket-on-Fergus is a town close to Shannon and Ennis that has been bypassed by the M18 and it should do better than it does, which is the point people wished to highlight to the local Oireachtas Members. The problem is mirrored throughout rural Ireland.

The issues raised included the lack of basic services, amenities and facilities in the village; the fact that all the shops and many pubs have closed; the poor streetscape; and the lack of proper lighting, footpaths and public transport. Anxieties were also raised about policing services not being visible or being at a remove from Newmarket-on-Fergus. The town has a small station, which is manned infrequently for a few hours per week, and the policing service comes from Shannon. The issues in that regard were the lack of visibility of gardaí on the ground, a slow response time when the Garda is contacted, and a great deal of anti-social behaviour and illegal drug-taking. There is great concern that such activity is happening in a small village. There has also been a loss of GP services. A long-standing GP in Newmarket-on-Fergus retired last May but a replacement has not been found, which is a source of great anxiety for the community because people have to travel to Shannon or Ennis for a service. There is a lack of support for the public health nurse, the community intervention schemes, and home helps and voluntary groups in general. The loss of a GP is a substantial issue.

The story is familiar throughout Ireland and demonstrates how easily the fabric of a rural society can unravel. Newmarket-on-Fergus has benefited from supports from the Government and from the town and village renewal scheme, through which it received €200,000 in 2017. It received €500,000 from LEADER and €200,000 from a local philanthropic fund - the Tomar Trust - and it produced €300,000 of its own money to build community services in the area. Obair, the local community service, provides services from the cradle to the grave, including elderly services, unemployment services, a community crèche and meals on wheels, the last of which extend throughout south Clare, to Quin, Doora, Newmarket-on-Fergus, Bunratty, Kilkishen, Kilmurry and Sixmilebridge. It is an extensive service that radiates from the town centre and the funding for it was welcome. It has a community café and educational courses.

Newmarket-on-Fergus has received substantial funding. Nevertheless, the issues raised on Monday night were cross-departmental. They spanned health, transport, housing, justice and education, and how the town interacted with the county council. The residents highlighted that while they have been given support, there is much more they could do if they were given additional supports. Not least in respect of policing, medical services and the upkeep and structure of the village, they believe that a great deal more could be done for them.

Minister for Rural and Community Development (Deputy Michael Ring)

We appreciate the voluntary work that is done and the services provided in rural Ireland by voluntary groups. Without them, there would not be many of the services. The Deputy's question was general but he also focused on Newmarket-on-Fergus, which is fine.

There is no doubting the challenges faced by rural towns and villages, especially in the face of a changing retail environment and as people move away from town centre living. The Government is acutely aware of the need to support and revitalise towns and villages. This is a central objective of our investment in Project Ireland 2040 that is being backed up by an investment of €1 billion under the rural regeneration and development fund. It is worth highlighting the significant investment taking place in towns and villages and the many positive stories emerging throughout the country.

Since 2016, I have announced €68 million for more than 830 projects under the town and village renewal scheme, the sole purpose of which is the revitalisation of towns and villages. This year alone, I have announced funding of €15 million for 156 projects under the scheme, six of which are based in County Clare and will receive funding of more than €720,000. I have also approved funding of €86 million under the first call for proposals under the rural regeneration and development fund. Last month, I announced the successful projects from the second call, with 26 projects approved for funding of €62 million. In total, I have announced funding of €9.2 million from the rural regeneration and development fund for ten projects located in County Clare. This is a considerable investment in our towns and villages that will have benefits for decades. We are also focused on identifying policy solutions to the challenges facing our towns and villages. For example, my Department has supported a pilot scheme to encourage six rural towns and villages. Funding has been made available to each of the towns to assist in developing innovative proposals to encourage town centre living. It is envisaged that the lessons learned through the pilot scheme can help to inform the approach to supporting and investing in rural towns and villages in the future.

As for Newmarket-on-Fergus in particular, additional funds have been sought from my Department for a specific project that has significant potential for the community there. I have directly engaged with the group involved to explore the options available to it. The group is already in receipt of significant support through my Department, including grants of €500,000 from LEADER and €200,000 from the town and village renewal scheme. The group is also in receipt of €300,000 each year under the community services programme managed by my Department.

These are just some of the steps being taken by my Department and the Government. I assure the Deputy that I will continue to pursue all options available to me to support towns and villages throughout the country, including Newmarket-on-Fergus.

Deputy Michael Harty

There is a recognition within the community of the support it has been given. The issues raised on Monday night were broader, relating to housing, justice, education and transport. The Minister was right to acknowledge the volunteerism in the town and in many communities. The voluntary organisation in Newmarket-on-Fergus, Obair, was set up 20 years ago and is a fantastic organisation. It has developed services out of the Tradaree centre, which is where most of the services I outlined are delivered from.

There is an issue with housing. There are up to 60 derelict buildings in the small town, yet a planning application has been submitted for a new housing estate. It would make much more sense if the derelict and vacant buildings within the village structure were supported to bring them to a level whereby they could be used as accommodation for families or single people, which would restore vitality to the village, rather than building a new housing estate, which would have to go through the planning process and jump through various regulatory hoops. A great deal of the vacant accommodation could be used to accommodate people rather than building a new estate.

Another issue raised was cross-departmental, given that it is under the remit of the Office of Public Works, Iarnród Éireann and Clare County Council. There was flooding on the rail line at Ballycar between Limerick and Ennis, which passes through Newmarket-on-Fergus. Flooding can interrupt services on the rail line for up to three or four months in a wet winter but it is an important component of the western rail corridor. The issue needs to be addressed, although there are turf wars among the State bodies I mentioned over which of them is responsible. Perhaps the Minister will consider that and bring it to the attention of other relevant Ministers.

Deputy Michael Ring

I thank Deputy Harty for the spirit in which he raised this matter. I work across Government with all Ministers and have to make sure that all legislation and everything that happens at Cabinet is rural-proofed. The Deputy raised a valid point. I have to speak to the Department of Finance, the Minister for Finance, Deputy Paschal Donohoe, and the Government. We set up a pilot scheme for six towns to deal with vacant properties in towns and villages, which is a major issue.

A real difficulty for the retail sector in this country is online shopping. It affects retail, jobs and people. We are coming into the Christmas season and the busiest people all over the country will be couriers, which is having a major effect on our shopkeepers, jobs and rural services. My Department is examining this issue. I gave each of the six towns in the pilot scheme €100,000 and asked them to come back to me with suggestions and ideas. Even before that happened, I looked at a preliminary report. One issue was vacant houses, to which Deputy Harty referred.

Some people will not like what I am about to say. Many on the left think nobody should make a profit. If somebody has a property, there is nothing wrong with the State giving that person support to renovate it and make it available for rent. Some people do not support the ideology I support, but I believe that people are entitled to make a profit if they have properties. If we can encourage people in towns and villages, in particular, to make their properties available for rent, that would help the rental sector and revitalise towns. There is no point in pretending otherwise.

Retail will not return to towns and villages any day soon as long as people are shopping online. Millions of euro are spent online every year. It is a significant challenge for rural Ireland. The town and village scheme, outdoor recreation scheme, CLÁR programme and the urban regeneration scheme have revitalised many towns and villages and created many jobs. There are quality people in every corner of this country. I came into office in 2017 and since then my Department has invested €29 million in Clare alone.

Special Educational Needs

Deputy James Browne

I thank the Minister of State for taking this debate on school places in Wexford for children with special needs. Parents of children with special needs come to me in a state of distress every week. Very often they are worn out, not because their children have special needs but because they are exhausted from having to fight for school places and the basic services they need so that their children can have a quality of life. My heart goes out to them because I know the battle they are facing every single day to ensure that the education and special supports their children are entitled to are provided. Waiting times in Wexford for special needs assessments are unacceptable. Many children are waiting years for the approval of services such as occupational therapy, physiotherapy and speech and language therapy. This is simply wrong.

Today, I want to focus on the lack of school places for children with special needs. Last year, over 850 children with special needs across Ireland received home tuition because spaces could not be found for them in schools. Many of these children are in my home county of Wexford. Many schools in Wexford do not have adequate facilities or spaces for children with special needs. Mainstream schools and special schools have long waiting lists. In Enniscorthy, there are long waiting lists for support classes in St. Aidan's and St. Senan's primary schools. St. Senan's primary school has been waiting at stage 2 for a new build, which includes badly needed special needs classes, for the fourth longest period of time in the country. St. Aidan's primary school has been approved for an additional classroom, but has not received approval to go to tender. This needs to happen immediately to provide the additional classroom which is badly needed this September.

I welcome that a new building for St. Patrick's special school is being built in Enniscorthy, but it started two years after it was promised. Meanwhile, the principal, teachers, special needs assistants and students have to endure Dickensian conditions in the existing building.

Our Lady of Fatima special school in Wexford town is a remarkable school with a wonderful principal in Rita Waters, outstanding staff and special children. The conditions in which teachers at the school have to teach and children have to learn are simply not acceptable. The car park doubles as a schoolyard and a bus collection point, which is dangerous and unacceptable.

Many special schools across the country are waiting up to 13 years for new builds that are badly needed. There are severe problems throughout County Wexford, including in New Ross, Gorey, Wexford and Enniscorthy. Schools that cannot take children are very often not provided with the resources and training that teachers and special needs assistants need to uphold every child's right to an education. Very often, the provision of special needs assistants in schools who can provide the necessary support for students and teachers is inefficient. Appeals are often turned down, but it is impossible for principals to know why that happened.

For those children who cannot get a place in a mainstream or special school, parents often apply to every school in the county and beyond. This is not a solution and it is impossible where both parents are working. More importantly, all children want to go to school where their friends and neighbours attend school. It is distressing for any young child, but especially a child with special needs, to have to travel long distances every day for basic schooling needs and to go to an area where he or she does not know anybody. The only alternative to this is home schooling, which is not a substitute for an appropriate school place unless it is clinically advised. Children are missing out on developing social skills and the opportunity to mix with other children, and all of the benefits that come from that for any child. It can be very destructive to a home environment and where both parents are working, it can be almost impossible to manage. Ultimately, it is not right for the child.

I ask the Minister of State to deal with these issues, commit to an appropriate number of special classes in County Wexford, ensure every child has a right to access education and publish an implementation plan as soon as possible for County Wexford to ensure that children have adequate school places and supports.

Minister of State at the Department of Health (Deputy Jim Daly)

I thank the Deputy for raising this important issue. I am taking this matter on behalf of my colleague, the Minister for Education and Skills, Deputy Joe McHugh.

The provision of education for children with special needs is an ongoing priority for the Government. Currently, almost 20% of the total education Vote, or €1.9 billion, is invested in supporting children with special needs. The numbers of special classes, special education teachers and special needs assistants are at unprecedented levels. Nationally, 167 new special classes opened for the 2019-20 school year, which means there are 1,618 special classes in place compared with 548 in 2011. Of these 1,353 special classes cater for students diagnosed with autism spectrum disorder, ASD. The majority of children with autism attend mainstream classes, where they may access additional supports if required.

Some students may find it difficult to manage full-time placements in mainstream classes and, therefore, placement in a special class or special school setting may be deemed appropriate where placement in mainstream class is not in the best interests of the child. The National Council for Special Education, NCSE, has a statutory function to plan and co-ordinate the provision of education and support services for children with special educational needs, in consultation with the relevant education partners and the HSE. The council has well-established structures in place to plan and co-ordinate special education provision throughout the country. This includes identifying the need for and establishing special class placements in various geographical areas where they are required. It ensures that schools in an area can, between them, cater for all children who have been identified as needing special class placements.

Normally, special classes are established with the full co-operation of the schools in areas where they are required. However there are some parts of the country where the council has faced challenges in getting schools and their patrons to voluntarily agree to provide special classes or school places. I know that this can cause much anguish for the parents and families involved. In County Wexford, there are currently two special schools and 60 special classes in mainstream schools, including four ASD early intervention classes, 33 primary ASD classes and 15 ASD post-primary ASD classes. Seven of the ASD classes are new for the 2019-20 school year. All newly assigned teachers to special classes and schools with newly established special classes undergo a suite of professional development provided by the NCSE through its network of advisers.

The Minister for Education and Skills has the power under section 37A of the Education Act 1998 to direct a school to provide additional provision where all reasonable efforts have failed. The legislation contains a procedure through which the capacity of schools in an area can be tested and, ultimately, a ministerial direction made requiring a school to make additional special education provision available. The Minister for Education and Skills is prepared to use the legislation when necessary to ensure that children can access a suitable education. However, the preference is for schools to engage with this challenge on a voluntary basis because it is the right thing for the children in their community.

To this end, the NCSE is continuing its engagement with schools, patron bodies, parents and others throughout the country to bring the required additional special class and special school placements on stream. The Department of Education and Skills is not aware of any significant unmet need for additional places in County Wexford. If the Deputy has information in this regard, I will arrange for it to be passed on to the NCSE. Special education needs officers are available at a local level to support parents and schools on the placement of students. I again thank the Deputy for raising this matter.

Deputy James Browne

There is a constitutional right to primary education and education in general. This right was placed in our Constitution in 1937, which was very far-sighted at the time because such a right was not common then. It is crucial that this right be upheld and vindicated for every child, no matter what his or her personal situation. Some 850 children could not get places last year, including some in my county. For example, one parent's child was placed on a list at two years of age. The child is now four and a half years old and is 17th on the waiting list for a place at one of the schools in my home town. All the places on offer have been taken. The other school in the town is also full. There is a problem. Perhaps there may be spaces available at the other end of the county which could be used to accommodate children. However, this approach would not be suitable where a child wants to remain in his or her local community or in situations where both parents work. It is not appropriate for a child with special needs to be travelling the length of the county. It is neither practical nor right.

That situation is replicated across Wexford, so I cannot understand the NCSE stating that there is no issue in the county. I regularly meet parents who are in a very distressed state. That is before we even get into the financial distress experienced by parents who have to spend a great deal of money to get occupational therapy, speech and language therapy and physiotherapy that they cannot access from the State. Parents are struggling every day and have a constant fight to get the supports they need. There is a real sense of anguish for these people, because they want the best for their children. Those parents know that every year their children are held back means it is going to be harder for them to catch up and live full and fulfilling lives as they get older. I do not get the sense that the Department and the State are taking this issue as seriously as they should. I know the benefits that can accrue to children with special needs because my goddaughter has Down's syndrome. She is in St. Patrick's special school where she is getting wonderful support. When children cannot get places in such schools or access the supports they need, they fall behind and that adds to their distress.

Deputy Jim Daly

The State, the Government and the Department take this issue very seriously. I also understand the issue well in light of my background as a former school principal and as a parent. I understand the importance of this issue and the anguish that can be caused. As a practising politician, I understand the stress that parents trying to access places for their children can experience.

Specifically in the context of County Wexford, the NCSE has informed me that three places are available for early intervention in Wexford town, nine places for ASD primary school classes, four in north Wexford, four in south Wexford and one in Bunclody. There are also four places in ASD post-primary special classes, with two in north Wexford and two in Bunclody. There are seven places for those with emotional and behavioural difficulties etc. If Deputy Browne would like to make the information to which he refers available to me or to pass it to the office of the Minister for Education and Skills, we will pass it on to the NCSE.

In the wider context of the Government's point of view, since 2011, the amount of money we have spent on special needs education - an area I have a particular interest in and knowledge of - has risen from €1.2 billion to more than €1.9 billion. That is an increase of more than 50%. When I entered the Dáil in 2011, the number of special education classes stood at approximately 500. There are more than 1,600 classes today. The number of these classes has therefore trebled. The Government, the Department and the State are taking this matter seriously. If individual situations need to be brought to the attention of the NCSE, then we are more than happy to facilitate the transfer the information for the Deputy.

Hospital Overcrowding

Deputy Timmy Dooley

I welcome the opportunity to raise the important issue of overcrowding at University Hospital Limerick, UHL. I am disappointed that the Minister for Health, Deputy Harris, has not got the time, inclination or interest to be here to discuss such an important issue. He has no problem, however, travelling to Limerick next week to participate in the opening of what is referred to as the health science academy at University Hospital Limerick. I will read what was stated about that facility, namely, "In collaboration with the University of Limerick, UL, and the mid-west community healthcare organisation, CHO, UL hospital group have developed a health science academy with an emphasis on research, education and training programmes, which will have clear outcomes for patients and impact patient care". The opening has been postponed by two weeks because the last time the Minister for Health was supposed to be present to perform the opening and showboat for the cameras, some 85 patients in the hospital were on trolleys. That event was cancelled hastily, and the Minister was able to duck his responsibility of dealing with the crisis at the hospital.

The Minister of State knows full well, and this is no fault of his, that over the past four years the annual number of patients on trolleys has almost quadrupled. In 2012, there were 3,626 patients on trolleys according to the yearly count. This year, the figure is 12,810 and that is only up to 28 November. That is an appalling situation.

I can go through case after case of constituents of mine who are affected because the Mid-Western Regional Hospital in Limerick deals with patients in three counties, as well as Limerick city. People contact my office daily to tell me about outrageous situations endured by elderly and sick people. An example is that of a farmer in his 70s who was rushed to the hospital when he collapsed on his farm. He remained on a trolley in the accident and emergency unit for almost three days, while still in his dirty farming clothes. He was located beside a patient with an ulcerated leg. It was not possible for his clothes to be changed or for him to have a shower. That man remained on the trolley for almost three days until he was transferred to a ward. That is an appalling situation and is just one of many such cases I hear about daily. People in their 90s are spending 48 hours in what is an accident and emergency department, where the lights are on and there is no capacity to get some sleep. It is a terrible situation in which to treat someone. The nurses and doctors I talk to, who are not alarmist, are saying it is impossible for them to do their job. They cannot get medical equipment through to check blood pressure because of the way the trolleys are stuffed into the space. What we do not want is the Minister coming down to have his photograph taken again outside and inside some new development that is going to benefit people in the future, or at least that is how it is being presented. I want to see the Minister appoint someone, before the end of this week, with a budget and the capacity to look at all of the resources available in the mid-west region and then to try to use them to the greatest extent.

There are closed beds, wards and areas that can be reopened. We need to end this rubbish talk of there not being an embargo on the employment of nurses and doctors, because there is one. That topic has been raised in this House in recent days. There are nurses prepared to come back to this country if they are given full-time contracts. This is a serious situation. I am not crying wolf. I do not play that game. I understand how these things work, but a life will be lost unnecessarily - if lives have not already been lost unnecessarily - because of the overcrowded conditions in which nurses and doctors are expected to deliver services. We need a response from the Minister as soon as possible.

Deputy Jim Daly

I welcome the opportunity to address the House on the issues raised by Deputy Dooley. The Minister for Health wishes to acknowledge the distress that overcrowded accident and emergency departments cause to patients, their families and the front-line staff working in challenging conditions in hospitals all across the country. The number of patients attending accident and emergency departments continues to increase year-on-year. For the first ten months of 2019, the number of patients attending hospital accident and emergency departments increased by 2.7% and the number of admissions to accident and emergency departments has increased by 0.9% compared to the same period last year. The emergency department at UHL, is one of the busiest in the country. As such, the hospital and the CHO were identified as one of the nine focus sites requiring additional investment, focus and support last winter.

According to HSE TrolleyGAR data, there was a 16% increase in patients waiting on trolleys year-to-date in UHL emergency department in October 2019 compared with the same period last year. In October, however, 883 patients were counted on trolleys in UHL, which was a 1.6% decrease compared with the previous month. It is acknowledged that this figure is unacceptably high and the HSE is actively working with the UL hospital group to ease congestion in UHL, with a focus on facilitating transfers to Level 2 hospitals, assistance from rehabilitation units and CHO services, and prioritisation of diagnostics to aid inpatient discharges. The HSE winter plan was launched on Thursday, 14 November in preparation for the anticipated increase in demand over the winter period.

The Government has allocated an additional €26 million to fund the implementation of the winter plan. Each winter action team has set out a range of initiatives it will undertake within its area to implement the plan. The integrated winter plan for University Hospital Limerick will be delivered by winter action team 3. The initiatives for winter action team 3 include additional home support hours to facilitate early hospital-to-community transfers, additional aids and appliances to facilitate early hospital discharge and emergency department avoidance, mobile doctor service units to manage increased demand for home visits and to facilitate emergency department avoidance, a low-level domiciliary rehab team in Limerick city to facilitate early discharge and emergency department avoidance, additional triage nursing support in Shannondoc to support emergency department avoidance, an additional registrar in UHL to help in addressing workflow and improving patient experience times and additional health care assistant supports in University Hospital Limerick to provide staffing at ward level to support additional surge patients.

A capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at University Hospital Limerick, with funding of an additional €10 million allocated in 2019. The HSE has advised that the enabling works are complete and the main contractor has commenced work. It is anticipated that the construction will be completed in 2020. This important project will go some way towards addressing the acknowledged lack of bed capacity in the region. It is recognised that there is a deficit in diagnostic capacity at University Hospital Limerick. A capital development proposal for an extension of the radiology department at University Hospital Limerick to include a second MRI unit has been prioritised by the HSE to progress to design stage in 2020. In the interim, the University of Limerick Hospitals Group has tendered for a modular MRI managed service. The National Treatment Purchase Fund will work with the HSE to fund the activity associated with the MRI scanner as part of the agreed extension in the fund's support for hospital emergency departments for diagnostics at the end of the year.

Deputy Timmy Dooley

All of that sounds fantastic, but the reality is that it is not having an impact on the ground. Trolley numbers at University Hospital Limerick are still unacceptably high and are entirely out of sync with every other hospital in the country. The only solution is for the Minister to appoint a senior official within the HSE or the Department of Health, or an external independent consultant, to decamp to Limerick to take up control. Such a person should report to the Minister on a daily basis with identified outcomes, actions that will address the seriousness of the situation and workflows that will ensure the numbers on trolleys return to the normal average that exists. Of course we understand that there are peak times when numbers are expected to escalate for various reasons. It cannot be acceptable that on two occasions in recent times, University Hospital Limerick has broken all records for the number of patients on trolleys. This is within the control of the Minister. A little forward thinking is required. It is certainly not about establishing an academy. If one were developing an academy around best practice, one would not start at the ground operations in Limerick.

We need intervention and management control. There should be a direct line to the Minister that enables him and the HSE to respond. The appropriate moneys should be put in place to resolve the problem. It is not rocket science. It is about nurses and doctors. It is about money. It is about utilising every available bed in the region. There are private nursing homes that are not at full capacity. It should not be beyond our capabilities to have people decanted into these facilities, where adequate and appropriate nursing care is available to them. Bed capacity in the tertiary hospital should be left to those who need it. We need action. We do not need another photo opportunity with the Minister standing in front of some new development that will be of benefit some time in the future. We need action now. We need to address the people who are on trolleys. We need to have in place a service for the people who will find themselves in hospital over the coming days and weeks, as the winter conditions have a significant effect on older people.

Deputy Jim Daly

I apologise to the Deputy for having to disappoint him on the double. I disappointed him when I appeared here on behalf of the Minister, Deputy Harris. I am going to disappoint him again when I inform him that I will be representing the Minister in Limerick next week. It may be a consolation for the Deputy to know that I will be there for the photo opportunity he mentioned instead of the Minister.

Deputy Timmy Dooley

Good. I will call off the protest so.

Deputy Jim Daly

It must be acknowledged that attendances at our emergency departments are increasing each year. According to the health service capacity review, Ireland has one of the highest acute bed occupancy rates in the developed world. It is widely agreed that additional beds must be a key part of the solution at University Hospital Limerick. Over the past two winter periods, an additional 25 beds have opened in Limerick, including eight as part of the 2018-19 winter plan. The new emergency department, which opened in May 2017, provides modern and safe facilities that are fit for purpose and meet the expectations of patients and families. The high-quality accommodation provided at this new facility better protects privacy and dignity. In response to the Department of Health's health service capacity review, a new 60-bed ward block has been established as a rapid-build interim solution to the bed capacity issue at University Hospital Limerick. The University of Limerick Hospitals Group has welcomed the commitment in Project Ireland 2040 to construct a new 96-bed ward block over the current emergency department. A design team has been appointed for this project.

Improving timely access for patients is at the heart of Sláintecare. The 2019 Sláintecare action plan, which has been published by the Department of Health, builds on the progress made in this area in recent years and includes a work stream on access and waiting lists. Many of the other service reforms and enhancements included in the action plan will support timely access to care for patients in the coming years. Progress has been already made this year in implementing the actions under the Sláintecare action plan. We all acknowledge that there is little doubt that the challenges we face are significant. I firmly believe that every Member of this House wants to find patient-centred, evidence-based, results-focused and sustainable solutions to the challenges facing our health services. Investment alone will not deliver the health service to which we aspire. Equally, this will not be delivered by reforms or productivity improvements on their own. Investment, reform and productivity improvements and additional capacity must be delivered in tandem if we are to have a realistic chance of meeting healthcare needs over the coming decades.

Hospital Services

Deputy Sean Fleming

On behalf of the people of Laois, I have to express severe disappointment that the Minister, Deputy Harris, is not here today. The Minister should be here because the problems at the Midlands Regional Hospital in Portlaoise are firmly within his resolution. He is the only person who can solve them. In light of his failure to attend this debate, I formally invite him to visit the hospital in Portlaoise in the coming weeks between now and the Christmas period. He made a visit there during the Christmas period over two years ago, but he has not been seen or heard from at the hospital since then. The inaction of the Minister for Health with regard to a report that is on his desk is the key source of the problem at the hospital in Portlaoise. The proposal that has been on the Minister's desk since September 2017 involves the full closure of the emergency, maternity and paediatric care departments at the hospital, as well as the cessation of all inpatient surgery there. A small amount of such surgery is taking place there at the moment. The report in question, which was prepared on foot of detailed consultation by the HSE and senior management in the Department of Health, has been left sitting on the Minister's desk for more than two years. Therefore, the position set out in the report remains the current position of the HSE and the senior management personnel. The Minister's inaction is causing serious problems. It is undermining current services in the hospital. Why would people seek to take up employment in the hospital as consultants, surgeons, doctors, non-consultant doctors, nurses or care staff when they know this cloud is hanging over it as a consequence of the Minister's failure to take action?

The previous Topical Issue debate showed us what happens when an accident and emergency department is closed in a region without the promised additional facilities being provided in the locations where patients are expected to go. That is the state we are at. According to this report, the closure of the services at Midlands Regional Hospital in Portlaoise that I have mentioned would necessitate the provision of a minimum of €140 million to upgrade services at Tullamore and Naas hospitals and to facilitate the transfer of all births in Portlaoise hospital to the Coombe Hospital. That money is simply not available. It cannot and should not happen. We are formally asking the Minister to visit Portlaoise and to make a positive statement on the future of the hospital there. The current level of services should be supported and all necessary funds should be provided for consultant posts to facilitate the development of services into the future. Parts of County Laois are only an hour from Dublin. People in County Laois are used to travelling to St. James's Hospital for critical hospital surgeries. We are all familiar with that. Midlands Regional Hospital in Portlaoise, St. James's Hospital and the Coombe Hospital are part of the Dublin Midlands hospital group. It is good that complicated births are transferred from Portlaoise to the Coombe. More than 400 children were delivered in Portlaoise hospital last year. I would say the hospital got close attention in the form of HIQA reports, etc., as a result of the controversy of some years ago. As I have said previously, the circumstances of the death of a child in the hospital were covered up by senior HSE management.

It took a great deal of legal work to establish that. People knew that a child had died at the hospital and HSE senior management covered it up. While there were with no repercussions for the HSE, the reputation of the hospital was damaged. Following on from the HIQA inspections, most people will accept that maternity services at Portlaoise hospital over the past two or three year have been among the safest in the country. I am not aware of any maternal or infant death on delivery in recent times. As a result of a light having been shone on the facility it has improved.

It would be a shame if the Minister were to proceed with the closure of the maternity services and emergency department. If the emergency department is closed, the maternity ward would have to be closed because it would not be safe. We need confirmation that the emergency department will continue to operate 24-7, 365 days of the year, as it currently does. If the Minister would confirm that, we could get on with the future development of the hospital.

Deputy Jim Daly

I do not have a formal reply to read. I acknowledge the Deputy's concerns. I am happy to pass on his invitation to the Minister to visit the facility and to update all of the Members representing the area on the plans regarding the hospital.

Deputy Sean Fleming

I addressed my opening statement to the Minister, Deputy Harris. People will be shocked that the Minister is not here to respond to this Topical Issue matter, which was selected yesterday for discussion today. I expected the Minister to be here. Not only is he not here, he has not afforded the Minister of State, Deputy Daly, the courtesy of giving him a script to read on his behalf. Shame on the Minister, Deputy Harris, for treating the Oireachtas Members of County Laois in such a manner. I do not have an ego, but I represent 85,000 people who live in County Laois and the surrounding counties. I have never encountered this treatment before.

Approximately 40,000 people visit the accident and emergency department each year. On 17 April 2018, in a written reply to a parliamentary question, the Minister said that he would engage in a consultation process with local GPs. In September 2018, well over a year ago, he told me that the process for that consultation had been agreed and an external facilitator was to be appointed. That has not happened. Nothing the Minister has said to date has happened. I note the Minister of State is being provided with a script. If it is related to this matter, it is welcome, belatedly.

My opening statement on this Topical Issue matter is verbatim my opening statement on a Topical Issue Matter on this issue on 19 April 2018, which means I have been raising this issue for 20 months and the Minister has done nothing but add to the uncertainty by not resolving the issue. This uncertainty is damaging the hospital and public confidence in it. It is also preventing staff taking up positions in the hospital. I reiterate my invitation to the Minister to visit Portlaoise hospital and to confirm that the accident and emergency department there will continue in operation. If the Minister was even to contemplate scaling down services, he would be adding to the already overcrowded accident and emergency departments in neighbouring counties in terms of trolley numbers and queues. The other hospitals could not possibly cater for additional people. The Minister needs to confirm that the services currently provided in Portlaoise hospital will continue to be provided, following which we can focus on the development of services into the future.

Deputy Jim Daly

I would like to clarify that there was no intention to insult the Deputy or degrade the issue. It was human error that I was given a response to a different Topical Issue matter. I now have the correct script, which, with the indulgence of the Leas-Cheann Comhairle, I will read.

I thank Deputy Fleming for raising this matter. I would like to reassure him that, as stated previously by the Minister, Deputy Harris, the most important issue in regard to the consideration of services at the Midlands Regional Hospital Portlaoise is that patient safety and outcomes come first. The Minister has committed to securing and further developing the role of the Midlands Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands hospital group. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies and incorporating the hospital into the governance structures within the Dublin Midlands hospital group.

Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services that are not sustainable are discontinued and that sustainable services are safely assured and adequately resourced. Funding has increased by 42% relative to the 2012 budget and staffing levels have risen by 31% from the 2014 base. Governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved. The Dublin Midlands hospital group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise hospital that takes account of the need to develop services at Portlaoise in the context of developing a model of service provision for the entire hospital group. The draft plan has been submitted to the Department of Health. I would like to emphasise again that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan.

The HSE group involved in the development of the draft action plan for Portlaoise hospital included eight national clinical programmes, the National Ambulance Service and the HSE national acute hospitals division. This group focused on the risk issues and the interdependencies of the various clinical services across the emergency department, general surgery, general medicine, general paediatrics, obstetrics, gynaecology and neonatology. The HSE consultations took place with the clinical staff and management in Portlaoise general practitioners, the Irish Prison Service, Tallaght Hospital, paediatric surgery and emergency department services, and the master of the Coombe Women and Infants University Hospital. As the Minister outlined previously, no decision has been made on the draft action plan for Portlaoise hospital. He has committed to ensuring that local clinicians and the community will be consulted before a decision is made, and he has decided that a comprehensive consultation exercise should be undertaken by the HSE with an external facilitator and involving the key stakeholder groups in Portlaoise hospital. The consultation will involve key stakeholders and local community representatives and provide an opportunity to listen to and address the issues and concerns that stakeholders have highlighted. The consultation will also provide an opportunity to set out the immediate priorities for service development and improvement in the hospital.