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Dáil Éireann díospóireacht -
Wednesday, 6 Apr 2022

Vol. 1020 No. 6

Saincheisteanna Tráthúla - Topical Issue Debate

Water Quality

I have raised this matter previously in this House and others have raised it as well. There is a strong emphasis around Dublin Bay on improving water quality in the bay. It is a long-standing issue but it has been particularly highlighted by the number of people using the sea facilities since Covid as they have become much more engaged with all-year round sea swimming. I work with a group called SOS Dublin Bay, which has done extraordinary work and great research on this. I have done my own research on it and found that constituents in my area in Dún Laoghaire have experienced illnesses from swimming. This is replicated around Dublin Bay with the presence of E. coli and other harmful bacteria. We recognise that a major upgrade of water services is needed in the area but there are things we can do to help in the meantime. People want to know if the water quality is good or bad. They acknowledge that a water upgrade is needed but random things can affect water quality, such as a heavy downpour for a day or two, movement of birds and excrement from birds, creating localised problems.

What people really want to know, in advance of the upgrade of the water system, is what the water quality is. We need to get to a point where people can check it on an app on their phone. I can check the weather and tide but I should also be able to check the water quality. The reason I could do that is all-year round testing of the water. We are looking for two things. First, we want all-year round testing of the water and the provision of that information, transparently, to people who live in the Dublin area. That way, if they want to go swimming, they can make a decision based on the water quality on a given day, recognising that there can be random days here or there where it is not good, pending the upgrade. Second, the ultraviolet technology in Ringsend should be made available for longer than it is currently, which is three months. I believe that has been extended partially and I would love to know for exactly how long. I have not got that information from the Department yet.

We have been engaged in a process with the Department for some time. The representatives of SOS Dublin Bay and I have been in correspondence since the beginning of 2021. They met with the Minister of State, Deputy Noonan, in May 2021, and received a letter from him, which was supportive, in August 2021. It set out the various work his Department would engage in. Crucially, it stated the Department would be commencing work to amend the existing bathing water regulations, SI 79/2008, to allow local authorities to determine the bathing season for individual bathing waters and to support Irish Water in additional monitoring of the impact of UV disinfection. If we can extend the bathing season to the realistic bathing season, which is now all-year round, and not just the three months of the summer, we could then have all-year round testing and would be able to provide that information in a transparent way to people who want to use the water.

I have been disappointed with the correspondence and the pace of engagement from the Department and the Minister of State, Deputy Noonan, whose responsibility this is, since then. SOS Dublin Bay followed up with another letter on 25 January pointing out that the purpose of the bathing water directive is to preserve, protect and improve the quality of the environment and protect human health. That must be acknowledged. We need to take further steps to implement that directive.

I thank the Deputy for her ongoing interest in pursuing the very important issue of water quality in Dublin Bay. In order to protect water quality in the bay, work is under way to upgrade and enhance Irish Water's management of the city's wastewater networks and treatment plants. In addition, the Dublin local authorities are collaborating on projects to improve the management of surface water catchments around the bay.

The Minister for Housing, Local Government and Heritage has also requested the national bathing water expert group to report to him on how best to protect the health of people who regularly swim in Dublin Bay outside the regulated bathing water season. The bathing water expert group has been meeting monthly since late 2021. The expert group is currently gathering information on when and where out-of-season bathing occurs. The expert group has developed two questionnaires, one for the public and one for local authorities. This information, to be gathered within the coming two months, will inform the conclusions of the group and the development of advice to the Minister. This may include any additional necessary measures, including regulatory changes and-or monitoring changes.

In parallel, a bathing water task force, chaired by Dublin City Council, is seeking to improve bathing water quality all-year round in Dublin Bay. The task force has undertaken an assessment of inputs to the Elm Park stream catchment as this stream is considered a significant source of pollution for bathing waters in the southern part of Dublin Bay. Other pressures include dog and bird fouling and wastewater discharges. As part of this work, the following actions are being progressed. Irish Water and Dún Laoghaire-Rathdown County Council have closed a sewer outflow at Larkfield and are delivering upgrades to the combined drainage infrastructure at that location, eliminating one source of pollution to that stream. The project included the construction of a new sewer from Larkfield Road to Our Lady's Grove Primary School in May 2021. Installation of a flow and water quality monitor near the outlet of the Elm Park stream will provide information on pollutant loads in the stream just before it discharges into bathing waters. This will assist in predicting water quality problems in order to protect public health.

Additionally, in the Ringsend wastewater treatment plant, Irish Water is operating an ultraviolet filter over the winter months of 2021 and 2022 and is now monitoring to see if water quality improvements were evident during the times the filter was operational. Irish Water is currently collating and analysing the monitoring data and this analysis is scheduled to be completed shortly.

The work I have outlined has been undertaken in addition to the ongoing project upgrade at Ringsend wastewater treatment plant. Furthermore, the programme for Government and the national development plan made significant commitments for Irish Water capital investment in the period 2021-25. I will raise the additional points the Deputy made around advising members of the public who want to use the bathing facilities all-year round in a transparent manner, which I understand is the course of things as people take the opportunity to embrace the outdoors. Any technology we can take advantage of to make that a reality and get information to the source and to citizens' hands is important. I will raise that matter, and the Deputy's other points, with the Minister of State, Deputy Noonan, with whom she has had correspondence.

I thank the Minister of State for his response and acknowledge his attendance here tonight. I know this is not his area but the responsibility of the Minister of State, Deputy Noonan, so I thank him for being here. I appreciate that the expert group is gathering survey data. I am a Deputy for the constituency from north Bray to Booterstown and I have been telling the authorities exactly what the issue is for two years. I have provided my own survey data, as has SOS Dublin Bay. It would be nice if the group engaged with us in this way. A motion was passed by Dún Laoghaire-Rathdown County Council to introduce all-year round weekly testing. I thank the Minister of State for the information about Ringsend.

I wish to highlight a letter from Deputy Noonan to the SOS Dublin Bay group. With the Leas-Cheann Comhairle's permission, I will read it into the record, because I struggle to follow the logic of it. It states:

Department officials, together with the National Bathing Water Expert Group, are currently examining the most suitable options to provide for safe bathing water during the winter months, [the winter months are when the issues are particularly pronounced] and improve the dissemination of information around bathing water quality, both in the Dublin Bay area as well as in other locations throughout the country.

The science underpinning the monitoring and management plans during the current bathing season relates to summer conditions so the National Bathing Water Expert Group are considering this in their discussions and exploring the best options for winter conditions. For example, during summer, sunlight helps to kill harmful bacteria in water. In winter, sunlight is not as effective at killing bacteria and therefore natural background levels of bacteria in bathing waters are likely to be higher. There is also more rainfall during winter months resulting in more bacteria in bathing waters. Bathing waters are currently designated using bacterial bathing water test results over four consecutive summer bathing seasons. For example, if the bathing season is extended to the full year, the 12-month average concentration of bacteria used to determine the designation is likely to be higher than the average concentration over the current summer season. This may result in the current designation of Excellent, Good, and Sufficient bathing waters being downgraded.

The implication is that, because the winter sampling is being taken, it might identify that the water quality is not as good, resulting in our downgrading of the beach. If the water quality is not good, I would like my constituents to know that so they can choose not to swim in it on the day that it is so.

I thank the Deputy for her intervention. As a public representative in the area she should be front and centre in providing information and in any ongoing public consultation or advice that residents are looking for. I will raise what the Deputy has mentioned about his letter with the Minister of State, Deputy Noonan. It is hard to get my head around it when I am reading it at pace but I will bring it to his attention. I have outlined the three areas around the broader context of Dublin Bay, the bathing water expert group and the local authority-led task force that is assessing target areas. We should be liaising with communities and advising them of any deterioration in water conditions so they can make decisions that best suit them. In the modern era we should be taking advantage of technology to do that and to do so in a transparent manner.

The Government continues to invest in our water infrastructure at a high level. The national development plan commitment of almost €6 billion in capital investment to be undertaken by Irish Water from 2021 to 2025 includes a major upgrade of the Ringsend wastewater treatment plant. The Deputy referenced her area, which is a key and important one. I note that the bathing water directive is undergoing a review and officials from the Department are engaging with the European Commission and attending workshops to discuss the revisions required to the directive. Protecting bathers' health out of season is being considered as part of these discussions but as the Deputy rightly points out, out of season is in season now and that is the reality going forward. It is key for citizens to have that information at their fingertips. We will raise the valid points the Deputy has made. I thank her for bringing this up on behalf of her constituents and she has been raising it consistently over a long number of months. We need action in this regard and I will bring that back to the Department.

Emergency Departments

I want to put it on the record that I always thought that when a Minister could not come to a Topical Issue debate it was because he or she was not available. The Minister for Health just walked through the Dáil Chamber less than one minute ago so that is disrespectful. We always gave Ministers a bye if they were carrying out other important business but the Minister for Health walked past us there. It is not good enough and that is no disrespect to the Minister of State, Deputy Feighan, who is here in his place. That shows a disregard for Members and for the House.

I will return to the matter I want to raise. If this report was available at the time I could have raised it prior to the general election in 2020. I am speaking of the report of the independent review of unscheduled care performance. It is quite a damning report and I hope the Minister for Health can address why it was not published before. It took a freedom of information request for this report to be made available. The report reviews emergency care in nine of our hospitals. The report refers to unsafe treatment caused by overcrowding and staff shortages and it was completed prior to the Covid-19 pandemic when staff shortages dramatically increased due to the spread of the virus. Its findings highlight a level of dysfunction at the heart of the HSE, with some hospital staff members stating that they did not know who was in charge. Many of the issues that were highlighted remain. The accident and emergency department wait times in 2022 look like they will reach pre-Covid levels with more than 51,000 patients already waiting longer than 12 hours in accident and emergency departments this year. Some 13,000 people have already waited more than 24 hours for admission. These are incredible figures when one considers the research report by the Royal College of Emergency Medicine in the UK that there is, on average, one excess death for every 67 patients who stay in an accident and emergency department for eight to 12 hours.

I have a particular concern about the plight of patients and staff at University Hospital Limerick, a hospital that continues to have huge numbers of people treated on trolleys and in corridors. Almost 1,600 people have been treated on trolleys there every month of 2020 to date. Despite the best efforts of the wonderful but overworked staff there, the issues of long wait times and treatment on hospital trolleys continue unabated. I spoke to a senior staff member at the hospital today who gave me a shocking first-hand account of how tragically challenging the jobs of staff there have become. The member of staff contacted me in desperation about how difficult the work environment they are facing is. I have no doubt that people are dying unnecessarily due to these failures. Yesterday evening there was only one electrocardiogram, ECG, available across the three wards in the accident and emergency department. Apparently all the other machines were broken. That is one ECG to cover three wards, the triage area and the resuscitation sections. That is a scandal. These are important but basic pieces of equipment that should be readily available to staff. It is a major hospital and the fact that just one ECG is in operation for the accident and emergency department is simply not good enough for me or for the people of Limerick. This is a critical issue but on a more basic level, staff members told me today that there is often a challenge to get blankets and pillows for patients who are waiting. The healthcare staff do their best. Staying in hospital is a worrying experience and even the provision of this as an iota of comfort seems to be a cause of difficulty.

I am from Limerick and these patients could be my friends or family members; they are not simply statistics. The hospital zones are so full that in zones A, B and C of University Hospital Limerick yesterday, trolleys were two-deep in hallways, meaning that patients being moved had to either walk or be transferred through back doors so as not to interfere with those people lingering in the hallways. It is worth remembering that zone C is a Covid area so infection is widespread because people are next to each other.

We would all agree that the Minister for Health has an abundance of challenges facing him but he seems to be getting nowhere fast. I have appealed to him, and I do so again, to expedite the construction of the 96-bed unit at University Hospital Limerick. While it will not solve the problems of the hospital it would be an important signal to the people of Limerick that they are not being ignored and that the Government is committed to rectifying the problems at University Hospital Limerick. Reducing accident and emergency department waiting times is just one part of the puzzle. It needs to be done but it needs to be done as part of wider health reforms. We can invest in GP capacity to reduce hospital admissions and we can increase capacity in staffing numbers in our hospitals. These things take investment and we need to see this Government commit to this major investment.

I welcome this opportunity to address the House on the issue raised by Deputy Quinlivan. The health sector is facing significant challenges in providing emergency care while also managing Covid-19. I acknowledge that this is causing distress to patients, their families and front-line staff. I welcome the release of the report of the independent review of unscheduled care performance under the Freedom of Information Act 2014 following an application to the Department from the Irish Patients' Association. The terms of reference of the report were finalised by the HSE following discussion with the Department, and it was published in June 2019. The review across nine hospital sites was conducted during 2019 by an independent review team, including external management expertise from the National Health Service Scotland, the Scottish Government and National Health Service England.

The report notes that the nine hospitals accepted the inspection visits with good grace, openness and a desire to learn, and that this is a great testament to their acceptance of the huge need for learning and change. During the course of the review the team witnessed many incidents of outstanding practice and excellent patient care and was reassured by the many good things it saw happening. The team also observed many areas that it felt needed to be improved. The report contains significant findings in areas such as: patient experience times; executive leadership; and appropriate care settings. It also gives clarity on: care provision; patient flow; and the normalisation of full capacity protocol. The report makes numerous site-specific recommendations and 30 consolidated recommendations across four themes, covering: leadership and governance; emergency departments and assessment; patient flow; and operational grip. It highlighted the following: the need for better access to routine diagnostics at weekends; the need for more senior decision-makers on-site on evenings and at weekends; and the need for more health and social care professionals working at weekends. The HSE has advised that the arrival of the Covid-19 pandemic in March 2020 required it to respond to the extraordinary challenges posed and in doing so resulted in the implementation of structures and initiatives to address many of the issues and recommendations that were identified in the draft report.

The report has remained in draft format since January 2020 and close-out of the review process to include factual accuracy checks and response from the nine sites reviewed was never completed. The Government has increased health service current funding from €15.3 billion in 2018 to €19.4 billion in 2021, and €20.4 billion this year.

We permanently funded 1,146 acute hospital beds in budget 2021 and more than 800 have opened. Significant funding was provided for additional staff, home help hours, alternative care pathways and community services. It is critical that the funding is used in a manner that has a demonstrable impact on the challenges facing the healthcare system, particularly in relation to overcrowding in healthcare settings. Key to this outcome is an emphasis on alternative options to emergency department attendance and a focus on improving the patient experience in the emergency department.

I thank the Minister of State for the response but it is not good enough for the people of Limerick or most of the hospital staff. I am a Deputy for Limerick. The report referred to nine hospitals. I am sure the Minister of State was just handed his response and read it out. It did not even mention University Hospital Limerick. One would imagine, since I am the Deputy for that constituency, that the response would refer to that hospital. That is deeply disappointing. The workers at the hospital did Trojan work through the Covid pandemic. They need to hear support from central Government and that their concerns are being heard. Calls have been made for a HIQA inquiry into the level of overcrowding in University Hospital Limerick. I have yet to hear whether one will be commissioned.

In a recent reply to a question, the Minister stated that the current congestion in our emergency departments is due to constrained bed capacity, the high number of patients with Covid-19, and increased numbers of delayed transfer of cases. I accept these are important elements, but the report of the independent review of unscheduled care performance shows that the issue in emergency departments preceded the Covid-19 pandemic. It is important to restate and put on the Dáil's record the report by the Royal College of Emergency Medicine that there is an average of one excess death per 67 patients who stay in emergency departments for eight to 12 hours. People are clearly dying unnecessarily in our emergency departments, including in University Hospital Limerick, due to waiting and overcrowding.

Covid is a factor but it has grown old as an excuse for the Minister to hide behind. The problems existed well before Covid. Covid added to them and the Minister's inaction has compounded them. Unfortunately, people in Limerick believe nothing will change while the Minister, Deputy Donnelly, is in charge. The fact he walked through the Chamber literally one minute before I spoke speaks volumes about his interest in our hospital. His speech, which I am sure was crafted for the Minister of State, did not mention Limerick either.

I agree with the Deputy that emergency department overcrowding is a serious issue that needs to be addressed. The Deputy referred to increased attendance in recent weeks. The Covid pandemic put enormous pressure on the system which has resulted in unacceptable delays. It appears the recommendations in this report can be part of the solution to delays in emergency departments. As I outlined in my opening comments, significant additional funding has been provided to the health service in recent years. However, funding alone is not the solution. I agree with the findings of the report that management, leadership and operational grip are important drivers of performance and should get the same level of attention as part of a solution as capacity, staff and enhanced community services.

The Minister, Deputy Donnelly, is due to meet with the chair of the HSE board and members of the executive management team to discuss emergency department performance and the actions required to bring about a sustained improvement across all emergency departments. Deputy Quinlivan has raised the issue of the hospital in Limerick. I will bring it to the Minister's attention. He will discuss this with the chair of the HSE board and members of the executive management team. I will specifically ask for Limerick to be included.

Insurance Coverage

Before commencing, I note that a number of additional beds are to be provided in hospitals across the country. Limerick has consistently had the most overcrowded hospital and is not included. It is not acceptable.

We are on the third Topical Issue matter.

I thank the Leas-Cheann Comhairle and will move on to the Topical Issue debate. I wish to raise the fair at Spancil Hill. I am sure everyone in the House knows it is on 23 June. It is an important cultural institution in Ireland. It is obviously an important horse fair both nationally and internationally. It goes beyond that and is now a cultural icon. It was recently included in Ireland's national inventory of intangible cultural heritage. Like much of our intangible cultural heritage, it is not only intangible but is endangered and will not be around for much longer unless the Government takes action to protect it because it cannot now get insurance. Insurance is a significant obstacle for any event. Occupier's liability is an issue for every organisation in the country, whether they are sporting bodies such as GAA clubs, farmers or any other entity, premises or event in the country that needs insurance.

The fair at Spancil Hill was founded by royal charter, by King Charles, in 1621. It was 400 years old last year, but the fair did not take place in 2020 or 2021 because of Covid. It faces an even bigger threat from the state of the insurance industry in Ireland right now. The inability to get insurance is threatening it. There is a voluntary committee, none of whom could be called royalists, which revived the fair at Spancil Hill in 1989. It was made famous by the song. The committee simply cannot run the fair without getting insurance, which it cannot get since the British company that used to provide it exited the market. Another famous horse fair in Ireland, at Ballinasloe, is in a position to proceed because it is held in the fair green, which is owned by Galway County Council and is covered by its insurance policy. The Spancil Hill fair is held on a farm, which is private property, and has been since the royal charter was granted in 1621. It cannot be held because of insurance.

I ask the Minister of State to look into this matter, and not just for Spancil Hill. There is a little time to save Spancil Hill, but it is a broader issue. I wrote to the Minister of State's predecessor, Michael D'Arcy, when I was not a Deputy, suggesting some legislative change may be appropriate. He spoke about the cost of insurance working group, which was established in 2016 and reported. Almost all the key recommendations have been addressed, including the personal injuries guidelines, which were controversial but were approved by the Judiciary on 6 March 2021, which is a full year ago now. Most of the measures recommended have been enacted, yet Spancil Hill cannot get insurance. It is not unique. It is a substantial obstacle to various events throughout the country. We need to make sure these events take place. The fair at Spancil Hill is iconic, but there are other community groups organising various festivals and events. It will be the first summer back for many of them, like Spancil Hill, which has been in abeyance for two years, and they may not be able to get insurance. I hope the Minister of State has some succour to offer.

I thank the Deputy for Clare, Michael McNamara, for raising this issue. It only came to my attention today after receipt of the information about the Topical Issue debate. I thank the Deputy for highlighting it.

To address a few general points, I understand what the Deputy says about the historic nature of the Spancil Hill fair in Clare. The community is involved and a voluntary committee runs it. It was established by charter 400 years ago. There is a long history attached to this. I know it did not take place in the last two years because of Covid and once before that because of foot and mouth disease. It is part of our national inventory of intangible cultural heritage and plays a key role in the local community, not only from an economic perspective but also, more importantly, because it enriches the social dimension of life in the area and wider region.

Accordingly, I do not take the challenges regarding the accessibility affordability of insurance for such community-based events lightly.

In this case, it seems to me that it is not the price that is at issue but that the fair cannot get insurance. I want to be clear in my understanding of where the Deputy is coming from. He mentioned a number of the legislative initiatives and policy changes taken by the Government in the last year and a half to deal with the insurance industry and the availability of insurance. The Deputy will understand that the Government and Department cannot directly interfere in the provision of pricing of insurance products, nor do we have the power to direct a particular insurance company to provide cover to specific businesses or community groups. Notwithstanding this, as the Deputy mentioned, the Government has an action plan for insurance reform. A number of its actions have already been implemented, including personal injury assessments by the Judiciary. The Personal Injuries Assessment Board, PIAB, is now dealing with this matter and there are test cases in the courts at the moment. This is taking some time. As a result, the number of settlements the insurance industry would normally make in the normal course of events has fallen off dramatically while some of these cases are being dealt with.

The Deputy highlights what I would describe as some of the pinch points in respect of insurance throughout the country. These were exacerbated by Brexit because many of the insurance policies issued here had been done through London. We had a hard Brexit on the insurance industry the day that Brexit occurred. This has led to difficulties and to insurance not being available in many cases now.

Overhauling the legislation will deal with the cost of insurance and the claims the Deputy correctly outlined. However, while that does not provide insurance, it might deal with the cost of insurance. There are only a few of these fairs and similar types of event. In the past year, I have found that if those groups come together and go to a broker, they can, collectively, get a good premium from an insurance company. Rather than each individual fair or street event going individually to an insurance company, if they pool together through some association of fairs, they can increase their purchasing power and the willingness of the insurance industry to take them on will increase.

In my next contribution, I will talk more about the pinch points and show that there may be an option to follow. This is not a commitment from the Department because we are not involved in the insurance industry. If we can provide any advice or direction, we will be happy to do so.

The Minister of State is a master of suspense. I am looking forward to hearing what his proposal is. I would very much welcome any proposal he would have to make, as would the committee in Spancel Hill and the broader community.

This event is organised by a committee and enjoys broad, popular support. It is a big event run with the co-operation of the surrounding community, as well as the Garda. It has not given rise to any trouble so it comes as a big surprise to me, as it will to many others, that it is danger because of insurance. This may be the result Brexit.

We also spoke earlier in the week about childcare. One of the major costs childcare providers face continues to be an increase in the cost of insurance. There is an issue around occupiers' liability insurance in Ireland. If the reforms called for by the cost of insurance working group are carried out and they are not having the desired impact - the Minister of State and I agree they are being carried out – the Government will have to look at the matter again. Governments have a tendency to say there is nothing they can do, it is a matter for the markets, etc., but there was a time in this State when the Dáil could legislate. It was by legislation that the VHI was introduced because the Government of the day - that was a Fine Gael Government whereas we now have a Fianna Fáil-Fine Gael Government - decided that we needed State intervention in the health insurance market in Ireland. We may be close to the time when we need State intervention in occupiers’ liability insurance. This is one example. It is an important example. It very much illustrates what is being lost in Ireland by the cost of insurance. This is an important part of our culture and patrimony that is being lost. Equally, there are childcare facilities that are being lost and many facilities across various sectors are under threat because of the inability to obtain insurance.

My understanding - and I stress the word “understanding” - is that although Clare County Council oversees the fair and supports it with financial assistance, the fair itself falls out outside the scope of the Casual Trading Act 1995 due to its historical charter status. As a result, it cannot avail of group insurance schemes operated by the market, active support teams and the Irish Organisation of Market and Street Traders, IOMST, and, therefore, its organisers must seek insurance on a stand-alone event. In that context, it is similar to other such events as the Smithfield Horse Fair and Ballinasloe Fair.

As regards dealing with pinch points, we had issues in a couple of industries. The Deputy mentioned childcare. Two years ago, after Brexit, there was a serious issue with availably of insurance for that sector. One company is providing such insurance on the basis that the childcare industry came together collectively to have group purchasing power with a large premium. It has secured insurance. I spoke directly to the only company that provides insurance for childcare and reductions in its premiums are coming because of the improved standards and uniform approach taken by the sector.

On a related industry, point-to-point pony clubs and hunts could not get insurance last Christmas. We got that matter sorted, again by a large group of hunts, pony clubs and point-to-point races coming together. Collectively, through two different brokers, they increased competition and got insurance. There is scope to do that here, although I am not making any commitment whatever. It is not my role to get involve in that. However, I ask the Deputy to contact my office and we will talk to Insurance Ireland and Brokers Ireland to see if they can help. I stress again that this a market issue. We will not have a role but if we can point people in a helpful direction, we will be happy to do so.

Before moving on to the next Topical Issue matter, we will deal with messages from select committees.