Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 27 Jan 2022

Vol. 1017 No. 1

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services

I welcome the Minister of State at the Department of Health, Deputy Butler. She may need to take bed and breakfast in this place, given how much time she spends in the Chamber.

I welcome the opportunity to raise this important issue. Day care services at the Abbeyleix community nursing unit, which were attended by more than 100 people, have been closed. The hospital has ceased services to allow for its refurbishment and day care services were being housed in a part of the hospital that was being used for storage, but I am told it is not going to reopen. This has left a huge area of east and south County Laois without services, in areas such as Timahoe, Swan, Ballinakill, Durrow, Rathdowney, Borris-in-Ossory and, of course, Abbeyleix itself, as well as all the areas surrounding that. Abbeyleix hospital offered an excellent service. It also provided services for inpatients in the nursing unit, such as chiropody and physiotherapy, along with social activities, which are very important.

It is puzzling that Portlaoise day care centre is closed for refurbishment at the same time, and I do not see activity around it, or at least there was not up to one week ago. The doors just closed. I am not arguing against refurbishment or any investment in facilities such as this but we need to find out why HSE management takes these decisions. Mountmellick day care centre, too, is closed for refurbishment and extension, meaning the entire county has been left without day care services. Laois has no day care services and that is not acceptable. What kind of decision-making is this? Of course, we need to upgrade and invest in facilities and that is all overdue, but we should not close the whole lot to do that.

The importance of day care centres to the elderly cannot be stressed enough. I acknowledge Deputy Butler, as Minister of State with responsibility for older people issues, has a particular interest in this area and she is focused on the issue. They are vital for people, not least those who live alone in rural areas. We should try to support the elderly. There has been something of a change in thinking about this. Throughout the 2000s and the recession that ensued, people were inclined to say nursing homes were the first option. In fact, the first option should be to try to sustain people in their own homes. That is more cost effective, it is what they want and it will be far more satisfactory if we can do that. Those one or two days a week in the day care centre are vital, as families and elderly people tell both me and the Minister of State all the time.

Elderly people may feel they do not have a voice, so I convey to the Minister of State the feelings that have been expressed to me by many families and elderly people throughout the county. We have been left with no day care services. We are now out of Covid, and the Minister of State can imagine how important that one outing a week was, so we should try to provide for it. It is a part of the service, along with home care in some cases, that is needed to keep people in their own homes. Abbeyleix hospital needs to reopen, as do the centres in Portlaoise and Mountmellick, although I ask the Minister of State to focus on the one in Abbeyleix in her response.

The Deputy is quite right; day care centres are very important. A focus I have had since September last has been on trying to get as many day care centres open as possible, and I have an update for him.

It is a key priority for me to allow more people to engage in services that allow them to remain independent and live in their own homes with dignity. The HSE has operational responsibility for planning, managing and delivering health, personal and social services, including day care centres. These services are fundamental to the health and well-being of our older population. Access to these centres can play a key role in enabling older people to live independently in their communities, as the Deputy noted. They provide invaluable support, advice and social interaction for older people, who may be experiencing isolation and loneliness for any number of reasons.

It remains my priority to ensure day care centres reopen as quickly and safely as possible following the necessary closures in 2020 in response to Covid-19. The process for reopening day care centres commenced in 2021 and the HSE continues to work actively on the reopening for older people as a priority. At the end of December, 237 centres for older people, or 73% of the total, had reopened and it is planned that a further 66 will open in 2022.

As the Deputy pointed out, Abbeyleix day care service has been closed since March 2020 due to Covid-19. Older person services in Laois are working closely with HSE estates to identify alternative suitable accommodation for the service to resume. The Deputy will be aware renovation works are under way to improve the residential services at the hospital. To facilitate work, these services were relocated to the part of the building where day services had previously been provided. These works, which were required from the perspective of infection prevention and control, public health and HIQA in light of the pandemic, are expected to be completed by quarter 1 of 2022. On completion, the residential service will be transferred to its original location on the ground floor. Portlaoise hospital proposes to have 18 intermediate care beds available as part its winter planning once this part of the building has been vacated by older person services. This is the area of the hospital where the day service was based.

As an interim solution, people who attended the day service in Abbeyleix hospital will be offered a place in line with infection prevention and control and public health advice at the day service on the Timahoe Road when it reopens following necessary renovation works. These renovations are also expected to be completed in quarter 1 of 2022. The HSE has confirmed to the Department that it is actively sourcing an alternative suitable building to provide a day service in Abbeyleix and the environs of Mountrath and Timahoe. The suitability of the options put forward will be considered by older person services as an alternative day service location for the people who previously attended Abbeyleix hospital. This is currently at the early stages of planning. The HSE has reassured the Department that the staff of the community nursing unit continue to liaise with people who previously attended the service on an ongoing basis.

I thank the Minister of State for the reply and agree wholeheartedly with much of what she stated. She set out the case in detail. Even so, when the HSE closes the door, it can be difficult to get it reopened, as the Ceann Comhairle will be aware. It closed the door of the day care centre in Monasterevin in 2014 and that has not reopened.

I have raised concerns, and I am sure the Ceann Comhairle and other Deputies from his constituency have too, about the issue of relocation. There is a site at the hospital and, where possible, there should be support to keep the service on site. HSE estates needs to re-examine this and try to keep the service on the same site as the nursing unit, as it is now called, or the "hospital", as it is referred to locally, given there are integrated services on the site. A building is being sourced and the HSE will probably end up leasing or purchasing a site. It may be a more cost-effective option to locate the service on site and that should be explored.

The Minister of State mentioned that in December, 73% of centres for older people were open, but zero per cent are open in County Laois. That is the point I am trying to get across. This is a serious situation. Portlaoise hospital is already oversubscribed, as I understand, without the tranche of patients from Abbeyleix hospital, given it is not being extended but rather only refurbished. Similarly, the Mountmellick service covers a huge area, into the Slieve Bloom Mountains, up to Clonaslee and that area. That, too, needs to be reopened.

I ask the Minister of State to take up the issue of these three locations with the HSE. When HSE estates indicates something is at an early stage, that sets alarm bells ringing for me. It needs to be pushed on. I acknowledge the point about day-to-day operational responsibility for planning and managing, as the Minister of State set out, but sometimes the HSE needs a push from a Minister’s office to get it moving.

It is not acceptable that a whole county is left without day care services.

I assure the Deputy I will keep a very close eye on this. As I said, we have 73%, or 237, of day care centres open. Where the challenges arose was in any day care centre that was part of or adjacent to a community hospital, that is, in the community nursing units, and this has happened all over. I will give an example. Even though most of the restrictions were lifted last Friday, there is still quarantine in nursing homes. There are 575 nursing homes in the country and 213 of them have a current outbreak. As I stand here today, 1,000 staff in nursing homes are out due to Covid-related illness.

I chaired an inter-agency meeting last week on nursing homes and community hospitals with the HSE, the Department of Health, HIQA and public health. The number of cases in community nursing units and hospitals seems to be running about two to three weeks behind the spike of 26,000 cases just after Christmas, so we still have to take a very cautious approach.

The problem is bringing people from the community into a community hospital when there are not multiple exits and entrances or multiple dining spaces and sitting room spaces. That is where the challenges are occurring. Of the nursing homes that are not open throughout the country, the majority are located in residential centres and there are challenges with regard to infection prevention and control. I was not aware there were none open in Laois and I give the Deputy a guarantee I will keep a close eye on that. To get older people back into the communities, it is vital they have day care centres. I will liaise with the Deputy again on it.

It can be taken up with HSE estates and management.

Mental Health Services

I thank the Minister of State for the debate last night. I raised this matter during that debate and I want to tie down the particular issue of why there is not in place in the Irish mental health service a regular peer review of psychiatrists and the manner in which they are managing their patients and the prescribing of medication. When a patient is in a hospital setting, there is a team of nurses and doctors in place and there is a whole system where, if a patient is detained for a period of time, there is a full hearing on both sides of the argument as to whether that patient's care in the psychiatric hospital continues. However, for outpatient care, it appears there is a glitch in the system in that there is no peer review. This is my main concern.

I have been speaking to people involved in clinical psychology and to counsellors. All of the accredited counsellors have supervisors so there is a gatekeeper who assists them to make sure the advice and assistance they are giving is in the best interests of their patients and they can continue to improve and learn from that supervisor and gatekeeper. However, that does not appear to happen within the outpatient facility for those requiring care for psychiatric difficulties, whether in regard to depression or anxiety. I ask that a proper structure is put in place to deal with this issue.

As has been very much highlighted in recent days with the review carried out in Kerry, in the South/South West Hospital Group area of the HSE, more than 200 children were adversely affected because the checks and balances were not in place. I do not believe we can continue with the system as structured at present without having some change and ensuring there is that review. I ask the Minister of State to ensure the necessary changes in that area are made.

I thank the Deputy for raising this issue, which is timely and very important. The Deputy asks about peer review for psychiatrists in the context of prescribing medicines to people using mental health services and, no doubt, like me, he is thinking of the publication yesterday of the report of the independent review of care provided in the child and adolescent mental health services, CAMHS, in Kerry. I could go into the report but we spoke about it last night and the Deputy is acutely aware of the devastating impact it had on the children, young people and families affected. The report clearly identifies a catalogue of failings at multiple levels within the system. This is clearly evidenced by the lack of clinical oversight, to which the Deputy alluded, including the absence of a clinical lead and a CAMHS consultant. There was no system used to check the prescribing of medication or the quality of service by the doctor's supervisors. There were also concerns raised regarding governance and oversight of the team by line management and the effectiveness of the CAMHS oversight group.

These failings are central to the issue raised by the Deputy about peer review. The Medical Council of Ireland maintains the specialist register for psychiatrists, who must comply with requirements, including training, to remain on the register. This includes peer review, which is a training issue and is part of the registration process for psychiatrists.

In the context of the report on care provided in south Kerry CAMHS, all of the recommendations, including those related to clinical oversight, will be implemented as a matter of priority, with many already under way. The recommendations made include an assessment of a reconfiguration of the service and a full nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams. Furthermore, a prescribing audit will be conducted in each of the 72 CAMHS teams nationally to include a random selection of files, proportional to the medical caseload, from a continuous six-month predefined time period in 2021. A further audit of case files in north Kerry will also be carried out.

There are 35 recommendations in total in the report which cover other areas such as staff training, clinical oversight, recruitment, care planning and involvement of children and families in governance structures, among others. We all acknowledge that fundamental reforms are needed in many areas of mental health service delivery, not least in child and adolescent services. This report has brought them into sharp relief. We need to take one step further. At the moment, two drafters have been appointed by the Attorney General to start drafting the mental health Bill to amend the Act that was introduced in 2001. That Bill is currently undergoing pre-legislative scrutiny in the Joint Sub-Committee on Mental Health. I believe this is a real opportunity to make sure those checks and balances are put in place and underpinned by legislation.

One of the recommendations in the report published by Dr. Sean Maskey was that agreements should be developed with GPs to share the treatment of children with attention deficit hyperactivity disorder, ADHD, and pharmacists might help if that were to cause difficulties for GPs with regard to medication. Another point in the report was that clear written guides for the use of antipsychotic medication should be developed. There are very good recommendations in the report. I want to know the timeline for the implementation of these, not just in Kerry but for the entire country. It is an extremely good and well-researched report and it contains very constructive proposals that need to be implemented at an early date.

The Deputy is correct. There are 35 recommendations in the report and six of those recommendations are already complete. If memory serves me, I said last night that 13 of them are being progressed and the rest have yet to commence. I will be keeping in close contact with the HSE to make sure these recommendations are in place.

One part of the review we are doing is in regard to the 72 CAMHS teams dealing with those children who are medicated. As we know, out of 1,000 of the case files in Kerry, 500 children were medicated and 500 were not. We are going to do an audit of those children throughout the country who are medicated to find whether this raises red flags. What we are also doing is looking at the standard operating procedures for all CAMHS teams that were introduced in 2015, with the guidance having been updated in 2019. We are also doing an audit to see that those checks and balances are in place.

The most important thing to do is to make sure that any parent who brings a child to CAMHS anywhere in the country has confidence in the service. I know Paul Reid, the chief executive of the HSE, said earlier today that it is working out the details of how these audits will be carried out. I am in close contact with the Department and the HSE. The audits will be done in a timely manner and it is important that they are independent. It is also important that standard operating procedures regarding all CAMHS teams are enforced.

Covid-19 Pandemic

I thank the Ceann Comhairle for giving me the opportunity to raise this important issue. Long Covid has been called a hidden iceberg of long-term illness, yet the HSE has been slow to acknowledge the condition or provide clear care pathways, which could have serious long-term implications for those with the condition, as well as for our health service more generally and for our economy. Various studies give different incidence rates of long Covid. A research paper produced by the Oireachtas Library and Research Service, at my request, estimates that the number of people in Ireland who have had Covid-19 and are experiencing or will experience long Covid is at a minimum of 114,500, and growing, with the continued rate of infection.

The World Health Organization definition of long Covid is where symptoms persist for more than three months from the onset of the initial Covid-19 infection, lasting for at least two months, when they cannot be explained by an alternative diagnosis. In general, those with the condition are impacted in their everyday functioning, with symptoms such as fatigue, shortness of breath and cognitive dysfunction. These effects appear to occur irrespective of the initial severity of the infection, but occur more frequently in women, the middle-aged, and those with more serious symptoms initially. I estimate that if all 114,500 people claim Covid illness benefit, and subsequently claim illness benefit for the minimum five-month duration as specified by the World Health Organization definition, this would cost the Department of Social Protection €925 million. This figure does not include health costs, nor does it take into account the reduction or loss of productivity and absenteeism, never mind the financial and personal impact it has on those with chronic conditions associated with long Covid.

Sadly, in-depth searches of the HSE website and a variety of HSE documents do not identify any sources quantifying or indicating the nature or scale of the impact of long Covid on our health service. This could be a sleeping crisis that may overwhelm the already horrendous waiting lists in our health service.

The HSE stated last September that it planned to establish specialist long Covid clinics. As of today, only a model of care for long Covid has been agreed, with the HSE now starting to implement it. The HSE has stated that a variety of disciplines will need to be recruited to support these clinics. As a result, they have no idea when long Covid clinics will become fully operational. Here is the sting in the tail. It is only after these become operational that pathways to and from general practitioners and community services will be established, even though the majority of people with long Covid will have to rely on their GP to access the service initially. This slow rate of action is in stark contrast to dealing with primary Covid infection.

I thank Deputy Naughten for raising this important matter. Covid-19 is a new disease, so information on it, its features and its course are still emerging. The natural history, clinical course and consequences of Covid-19 are still not completely understood. It is recognised that most patients with Covid-19 return to baseline after acute infection, but a proportion of people report ongoing health issues. There is a lot of uncertainty in the international literature about how many people experience these prolonged symptoms, so it is extremely difficult to determine the scale of this.

People who have had Covid-19 and are in need of further care are currently being followed up by their GP or in hospital settings as clinically appropriate. Treatment is currently focused on the management of specific symptoms. Those in the community who are concerned about persistent Covid-19 symptoms should contact their GP in the first instance. Building on the services already in place to support people with post-acute and long Covid symptoms, I am pleased to be able to inform the Deputy that the HSE has developed an interim model of care for long Covid. A programme manager for long Covid has been appointed and clinical leads representing respiratory medicine, infectious diseases and neurology have also been appointed. This interim model of care outlines how services and supports for people with long Covid should be designed and delivered. I advise the Deputy that an implementation team has been established to oversee this work and its initial priority will be on the establishment of post-acute and long Covid clinics to treat patients as needed, while also working to better understand the demand for this service.

The HSE has advised the Department of plans for each hospital group to have access to both a post-acute and long Covid clinic. It is planned that long Covid clinics will be located at Cork University Hospital, St. James's Hospital, University Hospital Limerick, Galway University Hospital, Beaumont Hospital and St. Vincent's University Hospital. It is planned that post-acute clinics will be located at Cork University Hospital, St. James's Hospital, University Hospital Limerick, Galway University Hospital, Connolly Hospital, Blanchardstown, Letterkenny University Hospital and the Mater University Hospital. The HSE has indicated that long Covid clinics will manage people from 12 weeks post onset of symptoms. Post-acute clinics will be assessing and managing individuals with ongoing symptoms that are four to 12 weeks after initial onset of infection. This will include those that have been hospitalised, in addition to GP referrals for people with more moderate to severe symptoms.

I understand from the HSE that it will be setting up working groups for these clinics over the coming weeks. The objective of these working groups will be to standardise the pathways of care, including multi-disciplinary team supports and operating aspects of the services. This may need to adapt and change over time in response to lessons from the sites, the evolving situation with Covid and emerging evidence. I assure the Deputy that the Department of Health will continue to develop an understanding of the implications of long Covid to inform policy as appropriate.

I thank the Minister of State for her reply. The difficulty with the reply is that I do not see the sense of urgency about this in the HSE. As the Minister of State says in her reply, the HSE is setting up working groups for clinics over the coming weeks. As I have pointed out, it is only when these clinics are operational that referral pathways will be put in place for GPs. The Minister of State is advising people to go to their GPs but the GPs are not being given the tools or the referral pathways for those particular patients. Today, 114,500 people are affected, and that number is increasing. This has to take on a greater level of urgency.

The emerging consensus in the literature in this area is the importance of those multidisciplinary rehabilitative teams for post-Covid patients, as the Minister of State has outlined. Post-Covid rehabilitation will assume increasing importance as the surge of patients is discharged from hospital, placing additional burdens on our health system. The rehabilitative needs of patients are varied and multifaceted. Clinics should offer these multidisciplinary assessments. The emerging literature emphasises the importance of the assessment of post-acute Covid patients after the discharge and of preparedness for the appropriate clinical rehabilitation pathways. Such initial multidisciplinary assessments for long Covid may play a role in reducing unnecessary chest X-rays and clinic appointments and help to focus the type of follow-up care that is needed.

Surely, with limited hospital appointment capacity, we must try to provide focused, targeted support to these patients.

The number of people affected by longer term effects after acute Covid-19 remains unknown and estimates vary internationally. We are still learning about this condition and the supports that are needed to care for those affected by it in Ireland. The Department of Health, through the Health Research Board, HRB, continues to fund research into the clinical impacts of Covid-19 so that we can learn more.

To aid recognition and management of those affected the WHO, through a global consensus process, has proposed a working clinical case definition of post-Covid-19 syndrome which occurs "usually 3 months from the onset" of Covid-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis. The common symptoms identified include "fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning". Symptoms may be "new onset following initial recovery" from an acute Covid-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time. However, the WHO notes that this definition may change as new evidence emerges and our understanding of the consequences of Covid-19 continues to evolve.

In Ireland those affected by long Covid will continue to be cared for through our health services. The HSE's planned service development will also adapt as we learn more about what is needed over the coming period to ensure that all the necessary supports are in place.

Rail Network

The Minister of State, Deputy Butler, is the Minister for everything tonight.

In July 2019, Irish Rail downgraded Bagenalstown train station to an automatic station. Since then, there has been no stationmaster on site and the maintenance of the station has been subcontracted out. In July 2017, this same station was deemed so beautiful that An Post captured it in a commemorative stamp. It was great to see the building on a commemorative stamp. The beautiful stone station, which was designed by the architect Mr. Sancton Wood who also designed Heuston Station, was the stationmaster's home for many years. It continues to be an important part of the fabric of Bagenalstown. To say that it is not busy enough to keep it manned is a slap in the face for this rural town and the people in it, who matter just as much as people in larger towns and cities.

Just last year, Bagenalstown station was added to the Waterford to Dublin early-morning commuter route because, as the Minister of State knows, Bagenalstown is an important town. The move to self-service for this station was a retrograde step. While an Irish Rail staff member can disembark at all stations to help with machine tickets and accessibility issues, there is nobody at the station before a train comes to help those who need assistance. What is worse, the toilets are rarely opened. Steps like these show that we are slowly but surely eroding the rural way of life. Around 140 commuters use the Bagenalstown station and now that restrictions have been lifted and working from home is being phased out, more and more commuters will be using this service.

Transport poverty and inaccessibility are social and environmental issues. More than one in four people living with a disability do not use public transport because of accessibility issues. Although there is the promise of a customer service operative on board to help commuters with mobility and other issues, this is often not the case and the driver has to get out to assist passengers which causes delays. This kind of reduced service will contribute to further reductions in the use of public transport at a time when we need to find more ways to cut our carbon footprint.

To have a train station without assistance or toilets in 2022 is scandalous. What can the Department do to sort this out? I welcome the fact that there will be a public consultation on the need for extra carriages from Waterford to Carlow and Bagenalstown to Dublin. It is my understanding that this will be advertised shortly and people will be encouraged to have their say. One of the biggest issues with the train that comes from Waterford is that by the time it gets to Bagenalstown and Carlow, it is absolutely full and people have to stand. I know that during Covid things changed and fewer people were travelling by train but we will need extra carriages now. I ask that when the public consultation process is being launched that it is heavily advertised so that people are aware of it. We do not want people to say they were not aware of it. We need to cut our carbon footprint, as the Minister of State knows well. I look forward to the response from the Department.

I thank Deputy Murnane O'Connor for raising this topic which I am dealing with on behalf of the Minister for Transport, Deputy Eamon Ryan.

I would like to clarify that while the Department of Transport has responsibility for policy and overall funding in relation to public transport, it is not involved in the day-to-day operation of public transport services, including matters related to public transport facilities in train stations. I understand that the Deputy's question is specifically in relation to toilet facilities in Muine Bheag train station and I advise the Deputy that issues such as this are an operational matter for Iarnród Éireann. The Minister for Transport has no role in such matters.

Nevertheless, the Deputy may wish to note that as part of the overall ongoing investment in the rail network, the Department of Transport recently secured Government approval for additional funding for the infrastructure manager multi-annual contract, IMMAC. The IMMAC provides the funding framework for the protection and renewal of our railway infrastructure. Deputy Murnane O'Connor spoke about the beautiful building in Bagenalstown and the fact that it featured on a commemorative stamp and I agree that it is a beautiful building. With the increased funding secured over the five years of the contract out to 2024, just over €1.1 billion in Exchequer funding will be made available to support delivery. This funding will increase service reliability and punctuality, improve journey times and ensure continued safety of rail services across the network.

A new national train control centre is under construction, with completion and full commissioning by 2024. This control centre will completely transform the management of the rail network as compared with today and will allow for the future expansion of services in the years ahead. These investments are complemented by the 41 new rail carriages which are under construction, with expected delivery to commence in mid-2022. There is significant investment under way in the rail network and services to continually improve the attractiveness of rail transport to customers.

Regarding the Deputy's specific query on facilities at Muine Bheag or Bagenalstown station, Iarnród Éireann has advised the Department of Transport that the company's position over the past couple of years has been to move to online or ticket machine ticket sales. Almost 90% of tickets are now acquired digitally. In July 2019, Bagenalstown station moved from being partially staffed to a full self-service station. Iarnród Éireann has advised that it does not generally provide toilet facilities at stations which are unmanned as such facilities tend to be subject to a disproportionate amount of vandalism and incidents of anti-social behaviour. Iarnród Éireann is rebalancing its customer service provision with greater on-board services, including toilets and fewer facilities located in stations.

As regular customers on the Waterford to Dublin route will know, Iarnród Éireann now has dedicated customer service officers on board over 80% of services on this route to assist passengers. Furthermore, there are ticket sales available at the station via the ticket vending machine and the customer service officers will be able to assist people with Department of Social Protection tickets, seating, service information and more, on board. This means that there will always be assistance for wheelchair customers at Bagenalstown with the on-board customer service officers available to help with boarding and alighting.

Furthermore, in relation to facilities at Carlow, two new lifts have recently been installed at Carlow station, including a new footbridge in January this year. Iarnród Eireann is in discussions with the National Transport Authority, NTA, and Carlow County Council regarding a car park expansion, including bicycle parking, for Carlow station. Finally, Iarnród Eireann has advised that the fleet that operates the Waterford route is its newest and most modern fleet, the intercity railcar, and all trains serving Carlow and Bagenalstown stations have toilets on board for customer comfort.

I thank the Minister of State for her response. I compliment Iarnród Éireann on the lifts at Carlow railway station. It was important that they were installed. It is now 2022 and they were a long time coming but I welcome that investment. I also appreciate that the car parking facilities at the station are being looked at but I am seeking clarity on Bagenalstown station.

It was wheelchair users who came to me about this. They felt it was unfair that they could not access the toilets in the railway station. We have to be very mindful about this. While everything is going online and that is understandable, we cannot shut down our rural railway stations or having them half-manned so that there is a situation where a person with a disability or a wheelchair user is not able to use it. We do not need to go there. I am mindful, as I am sure the Minister of State is, that we keep rural towns going. The railway station is part of Bagenalstown. It has always been there and has always provided a great service. When it closed it was a great loss to the people of Bagenalstown. While the service was going it was not what it had been. It does effect quite a number of people. I would ask that Irish Rail look at this. We should not set a precedent of concentrating only on large stations such as Heuston Station in the big cities and forget our little rural stations that have been the lifeblood of our communities and were there before time, giving great service. That is my greatest worry.

The Deputy raised a valid point. The decision to move to a self-service station in Muine Bheag in 2019 was part of a wider decision by Iarnród Éireann to rebalance its operations. The Minister suggests that as it is an operational matter for Iarnród Éireann, it would be very well placed for the Deputy to contact it on this issue.

The experience of Iarnród Éireann has been that toilet facilities in unmanned stations attract higher levels of antisocial behaviour as well as more incidence of vandalism. However, we all know, if someone is waiting for a train and they are short taken it is very important that the toilet is in operation and that it is available. I know the service from Waterford to Carlow to Dublin. It is all well and good that the trains are of the very highest quality. They are the newest and the most modern fleet. Deputy Ó Cathasaigh will know this very well. They have excellent facilities on board but I take the Deputy's point about anyone who is waiting at the station. It is a beautiful location. The Deputy would be well placed to raise this with Iarnród Éireann. I have no doubt that the Disability Federation of Ireland would also support her call.

A toilet facility is a pretty rudimentary service. If the toilet is already there, it is even more straightforward that it should be made available. It is all very well to tell Deputy Murnane O'Connor that she should follow up on it. Given the millions, indeed, billions of euro that we are now spending on the rail service it would be no harm if the Minister asked Iarnród Éireann to cop itself on and tell them that customers cannot go to the toilet online.

I totally agree with you, a Cheann Comhairle.