Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 7 Apr 2022

Vol. 1020 No. 7

Topical Issue Debate

Fire Safety

This case concerns the Metropolitan apartment complex in Kilmainham. It is one of many but this is where, this week, the residents got confirmation of news that they were expecting since January, which is that they could no longer use the underground car park or any of the storage facilities under the complex. The notice came from the fire chief, who had no alternative but to act, as he or she should act in every case where there is a danger and a blatant defect in the building structure, or where some problem is exposed and lives might be at risk if a fire broke out. That is what we presume is behind this notice.

There are 127 apartments and a crèche onsite. Some of the residents to whom I have spoken have suggested there may be other issues but, thus far, the only one that the fire chief has acted on is in regard to the storage space and car parking. It is basically that fire doors and fire stops are missing. We know what happens in the case of an apartment where fire doors do not exist or are left open. Tragically, we saw what happened in New York earlier this year. At that time, the fire chief in Dublin issued a call for people to make sure doors are not left open and are closed in the event of fire. However, if the doors are not there at all, we can imagine the chaos and the tragedies that can occur.

In this case, the apartment dwellers are expected possibly to foot a bill of up to €500,000. Very few apartment complexes would have that set aside in the management company and there are very few residents I know of who would be able to put their hands in their pockets collectively to come up with €500,000 to address this. As has been the case for many of these issues, the call is for the State to step in. It is reckoned that 100,000 apartments of the 170,000 that were built during the Celtic tiger era have major building flaws. The vast majority of those are where builders cut corners, left out fire doors, left out fire stops and exposed future generations to the dangers of fires.

These are not bottom-of-the-market apartments. They are the same as any other apartment in the Kilmainham area, which were selling for nearly €200,000 and are now selling for over €300,000, and I know of other apartment complexes which have been in the media where apartments were sold for €600,000 or €700,000. Yet, a builder, contractor or developer skimped on this vital piece of equipment to protect people's lives.

Because there are so many and it is so widespread, I know the State has looked at this. My colleague Deputy Eoin Ó Broin has written a book on it, which I have read on a number of occasions, Defects: Living With the Legacy of the Celtic Tiger. It is a question of how we address it and how we ensure that people are not living in fear of fire breaking out in their complex. We must ensure that those issues are addressed as quickly as possible and that the State can help them to ensure the cost is not on top of them as it is beyond their capability to pay.

I call the Minister of State.

I offer the Acting Chairman best wishes with her chairmanship. Well done.

Gabhaim buíochas leis an Teachta as ucht an t-ábhar seo a ardú. I thank Deputy Ó Snodaigh for raising this issue. I acknowledge the difficulties the residents of the Metropolitan apartment complex are facing and the stress that is caused when fire safety issues arise in regard to their buildings.

Local authorities have powers of inspection and enforcement under the Fire Services Acts 1981 and 2003. They work with management companies and other stakeholders to ensure that appropriate levels of fire safety are achieved. Those in control of premises have obligations for fire safety in the premises and to comply with enforcement actions taken by fire authorities. As local authorities are independent in exercising these powers, it is not for the Minister to comment on the issues in this particular complex. However, this is not the only development affected by fire safety issues, as the Deputy stated, and there have been many incidences of failures and non-compliance concerns coming to light in apartment buildings built during the building boom. For this reason, the programme for Government sets out a number of commitments in respect of the important policy area of building defects and provides for an examination of defects in housing. These commitments are further supported by actions contained in Housing For All.

In this context, the Minister, Deputy O'Brien, established a working group to examine defects in housing under the chairmanship of Mr. Seamus Neely, former chief executive of Donegal County Council. The plenary working group has been meeting monthly since March 2021, with the exception of August, in addition to sub-group meetings. The group's terms of reference were adopted in May 2021 and are focused on purpose-built apartment buildings, including duplexes, constructed between 1991 and 2013 in Ireland. This particular complex falls into that category. The Minister considers it worthwhile to summarise the terms of reference for the information of the House. These are as follows: to examine defects in housing, having regard to the recommendations in item No. 4, "Addressing the legacy of bad building and poor regulation", in chapter 4 of the Oireachtas Joint Committee on Housing, Planning and Local Government report, “Safe as Houses? A Report on Building Standards, Building Controls and Consumer Protection”; to establish the nature of significant, widespread fire safety, structural safety and water ingress defects in purpose-built apartment buildings, including duplexes, constructed between 1991 and 2013 in Ireland; to establish the scale of the issue, which will include work to estimate the number of dwellings affected by the defects identified, including those already remediated; to consider a methodology for the categorisation of defects and the prioritisation of remedial action; to suggest mechanisms for resolving defects; to evaluate the potential cost of technical remediation options; and to pursue options on possible financial solutions to effect a resolution, in line with the programme for Government commitment to identify options for those impacted by defects to access low-cost, long-term finance.

As part of its deliberations, the working group is consulting with a wide range of relevant stakeholders. Included in the stakeholder engagement was a series of online surveys between 31 January and 14 March 2022 seeking the experiences of homeowners, landlords, directors of owners' management companies and property management agents. These submissions are currently being analysed.

The insights gained through engagement with stakeholders, as well as the outcome of the online consultation, will inform the ongoing deliberations of the working group and support the delivery on its extensive terms of reference and finalisation of its report to the Minister, Deputy O'Brien. The Minister, Deputy O'Brien, is satisfied that the group is working effectively and efficiently on this complex matter and looks forward to a report later this year. I assure the Deputy that once the Minister receives the report of the working group, full consideration will be given to its contents.

Tá sé tábhachtach go leanann an grúpa seo ag obair agus go mbeidh sé chomh tapa agus is féidir. It is important that this happens as quickly as possible because there is a cost in the event of some of these complexes, as happened in Priory Hall, having to be closed. To vacate a complex such as this or others, where there is a fire defect, is a huge cost on residents or tenants, given the scarcity of accommodation in the city as it is.

In some cases, the management company, residents or owners may be able to pursue the developer, but many of those developers and their companies disappeared with the collapse of the Celtic tiger. It then falls on the residents or owners to foot the funding and most will not be able to.

It then falls on the State which, in some cases, had a duty to ensure these properties were built properly. In some cases, the council knew of issues and never addressed them. In other cases, fire certificates were issued in advance of any inspection or without any inspection at all. The committee will deal with those issues and report on them but there is an urgency.

There is a big difference between this and mica. In terms of mica or pyrite, one sees the damage as one lives it. In these cases, the only time one will find out if there is a defect is when a fire breaks out or when a fire officer comes in and issues a certificate to close or vacate one's premises. That is what we do not want and that is why there is an urgency. I know it is a big undertaking, given the scale of the estimate of 100,000 homes with defects that need remedial action quickly.

I assure the Deputy and the House of this Government's commitment in respect of the important policy area of building defects, which is reflected both in the programme for Government and in Housing for All. This Government is committed to dealing with the issue of defects in housing. In this regard, we will continue to drive regulation in the construction sector and more sustainable methods of construction to ensure the mistakes of the past are not repeated.

I am of the view that the issues in addressing defects in apartments requires detailed consideration and the working group the Minister, Deputy O'Brien, has established is the most appropriate forum for considering the complex range of issues involved, as the Deputy has outlined. I have already mentioned the working group's focus on significant widespread fire safety, structural safety and water ingress defects in purpose-built apartment buildings, including duplexes constructed between 1991 and 2013.

While I appreciate this work may not be proceeding as fast as some stakeholders may wish, it is important we give the working group sufficient time to undertake the work as set out in its broad-ranging terms of reference. The Minister, Deputy O'Brien, looks forward to receiving the report of the working group when it has concluded its deliberations.

The Deputy is correct in the sense that some of these defects are not as visible as we would have found with pyrite or mica. Nonetheless, they are equally distressing to the families and residents who have bought properties in good faith. In that regard, the working group report will be critically important in plotting a way forward to try to resolve the many issues. They could be quite significant throughout many of the properties that were built during the Celtic tiger. The Minister, Deputy O'Brien, is deeply committed to trying to resolve these with all of the stakeholders.

Pigmeat Sector

It is good to see Deputy Verona Murphy in the Chair. It may be a sign of things to come in the future.

I appreciate the Ceann Comhairle's decision to allow this subject to be taken this evening. Following a number of parliamentary questions to the Minister for Agriculture, Food and the Marine during January, I also raised directly with An Taoiseach in this House through questions the urgent need to provide adequate Government support to the crisis-hit pigmeat sector.

I welcomed the introduction in early March of the €7 million support scheme for commercial pig farmers. This sector has been suffering significant losses for some time and we know the very viability of some pig units and farms throughout the country is now threatened. Sadly, in recent times, 7% of pig farmers have exited this sector.

Some 10,135 sows are gone from production, which equates to a loss of €66 million in exports on an annual basis. Teagasc has estimated that for every 1,000 sows de-stocked, there is a total loss of employment of 60 people, a loss of payroll of €2.42 million and €6.5 million in export losses. These are substantial losses in any rural community and already we have witnessed many multiples of those losses in employment and generation of revenue.

A number of factors have contributed to this crisis. During the early days of the Covid pandemic, there were staff shortages, which led to a backlog in processing and substantial market disruption, which lowered returns for pigmeat. Brexit impacted very severely on the value and volume of pigmeat exports to Britain, which is by far our most valued and valuable market. Since the start of 2021, the value and volume of those exports fell my 50%, obviously causing a severe adverse effect on the sector. African swine fever had a negative impact on the pig market. Coupled with reduced farm gate prices, there has been a massive increase in feed prices. The war inflicted on Ukraine by the brutal Putin regime has also impacted very severely on supply of feedstuff, alike to other disruptions in global trade in recent times.

This sector is worth €1 billion to the economy on an annual basis and is the third largest sector within agriculture. It also supports approximately 8,000 people in employment and makes a very substantial contribution to the rural and national economy. Teagasc estimates that approximately 30% of farm pig units are at risk of closure. This is very concerning and measures must be implemented by Government, with immediate effect, to deal effectively with this crisis.

A very detailed and well-researched proposal has been submitted to the Department by the Irish Grain & Feed Association, Meat Industry Ireland and the Irish Farmers' Association. This pig stability fund contains a number of proposals containing substantial financial contributions by pig farmers, plus immediate Government help. France, Belgium, the Netherlands, Poland and Slovenia have introduced direct aid for this sector.

Our sector, which is haemorrhaging significant losses, needs an immediate package of financial measures. There has been a major rationalisation of the sector over the years. We do not want to see a further reduction in producer numbers, which would be damaging to our overall agrifood industry. This sector is very efficient and it is a modern industry. It does not receive any support through the Common Agricultural Policy.

I fear that a major de-stocking could create animal welfare issues. It would also be very damaging to the image of our agrifood sector which has been painstakingly built up over many years with major EU and Government support and major investment directly by farmers and others in the sector. I appeal again to the Government to introduce, without delay, an immediate package of measures to ensure that the sector is supported through these very difficult times and that the crisis hitting it for some time is tackled head on.

On behalf of the Minister, Deputy McConalogue, I thank Deputy Smith for raising this issue. It is agreed that it is a key priority for the Minister and the Department and a vital sector for the Irish economy. Our pig farmers have always been remarkably resilient but the Minister is acutely aware of the unprecedented set of challenges, as outlined by the Deputy, they are facing at present. The Minister has been in regular and close engagement with all stakeholders on this matter over recent weeks. The Department is monitoring the market situation closely and is examining all possible measures to assist in supporting farmers through this significant market disturbance.

The continued development of the pigmeat sector is a priority for the Government, given the pivotal role the industry plays in the national economic context. It is the fourth-largest agrifood sector and has shown remarkable growth in recent years. The sector supports approximately 8,000 jobs spanning production, slaughter, processing, feed manufacture and services.

The pigmeat sector across the EU has faced significant challenges recently, including the impact of African swine fever in several member states and consequential loss of third-country markets. This has had a knock-on effect on supply within the Single Market. We are all aware of the cyclical nature of commodities markets. For the pigmeat sector, this is now compounded by rising input costs. The situation in Ukraine, as the Deputy stated, has also exacerbated these challenges.

The Minister has had ongoing discussions in recent weeks with the main banks to discuss the current challenges in the pigmeat sector and the importance of ongoing support. He has emphasised the importance of the sector and of banks supporting their customers throughout the current downturn in the business cycle. The key message was that farmers experiencing cash flow difficulties should engage with banks as soon as possible to discuss options and that the banks should remain committed to supporting their customers. Separately, the Minister met with the Strategic Banking Corporation of Ireland, SBCI, to discuss the Brexit impact loans scheme and the Covid-19 credit guarantee scheme, which are financed by the Department of Agriculture, Food and the Marine, in partnership with the Department of Enterprise, Trade and Employment. These finance schemes can be used for working capital finance and include features to address the current financial needs of pig farmers.

Last month, the Minister announced the pig exceptional payments scheme, PEPS, with a fund of up to €7 million for commercial pig farmers. This is an urgent short-term response to assist producers who would be viable but for the extreme circumstances being experienced now. It is intended to allow space for a more medium-term adjustment to market signals. Applications for the PEPS closed on 20 March 2022. The first tranche of payments has issued, with the remaining applications due for processing as soon as possible.

This scheme is part of a wider package of measures to support the pigmeat sector, including intensified efforts by Bord Bia to promote quality-assured Irish pigmeat in the domestic and export markets, with dedicated media advertising campaigns underway nationally and EU-funded pigmeat promotion programmes running in key export markets. Teagasc has also intensified its dedicated ongoing advisory supports being provided to pig farmers and it is actively engaging with pig farmers to explore the options potentially available to them.

Furthermore, the Department continues to engage at EU level to ensure there is a joined-up EU approach to the challenges arising from Russia's illegal invasion of Ukraine, including through the European food security crisis preparedness response mechanism. Last week, the European Commission announced the adoption of exceptional support measures across the agricultural sector, along with a communication on food security. Additionally, the European Commission, in view of the particularly difficult situation in the pigmeat sector, has opened a new private storage aid scheme to assist in stabilising the sector. The Department is examining the detailed requirements and conditionality attached to the exceptional aid allocation to Ireland of €15.8 million in EU funding.

The Minister for Agriculture, Food and the Marine, Deputy McConalogue, contacted me directly to let me know he is attending a Council of Ministers meeting in Europe and that he could not be here this evening. I appreciate that. Only last night, I engaged with the Taoiseach and the Minister for Public Expenditure and Reform, Deputy Michael McGrath, to emphasise again that the proposal submitted by the IFA, the meat processors and the Irish Grain and Feed Association, IGFA, must be considered, finalised and implemented by the Department. The sector's proposal has well outlined the difficulties, which have been well researched, and where Government funding could be provided. Equally importantly, the proposal outlines the contribution these stakeholders themselves will make.

This is an immediate crisis. The Department may refer to facilities within the banks, through the different Brexit-related funds etc. but the banks are not entertaining some pig producers. I fear the smaller-scale producers will get less of a hearing from our financial institutions than bigger producers. The sector has seen major rationalisation over the years and we do not want to lose any more producers. This is a sophisticated sector. The Minister of State referred to it as being a resilient sector, and it has been. We are all aware that different sectors in farming face cyclical problems over the years arising from the weather and market distortions or disturbances. The pigmeat sector specifically, however, has always ensured more cyclical problems than any other sector in farming or the agrifood industry.

When I was in government and dealing with the pork dioxin issue in 2008, the public finances faced particular challenges but we put a significant amount of funding into dealing with that issue to ensure we continued to have a pigmeat sector here. It was a good investment by the Government. We did not delay in making that decision. We decided quickly, we put the financial support in place and we saved that sector. In the meantime, there has been a great return on that investment made by the Government in 2008. Equally importantly, we ensured that the good name of the Irish agrifood sector internationally was maintained. We must ensure that continues now and that we do not run into any animal welfare issues.

To address the specific issue of the IFA's proposal for a pig stability fund, this is being considered by the Department in conjunction with key stakeholders. It is being requested that a €100 million fund be made available to pig farmers by the Department, with €50 million to be repaid over a 14-year term through a statutory levy on pigs slaughtered or exported live. This proposal would have significant Exchequer implications as well as State aid implications regarding the Exchequer funding element and at a statutory level. The Minister has engaged with the Ireland Strategic Investment Fund, ISIF, to ask that urgent consideration be given to developing a suitable instrument to manage market volatility for the pig sector. Discussions are ongoing regarding developing a financial instrument as a medium-term solution to help address volatility. As I said, these are cyclical issues, and this cycle might be a protracted one.

Nationally as well, the pig roundtable, chaired by the Minister of State, Deputy Heydon, meets quarterly with a focus on key strategic developments in the sector, with reference to the relevant actions set out in key strategy documents. These include the programme for Government and Food Vision 2030. The next roundtable meeting is in early May. A new pigmeat reflection group has also been established at EU level, comprising representatives from member states and key stakeholders, to examine, through civil dialogue, the structural challenges facing the sector, because these issues are impacting across Europe and worldwide. The group has already met twice and it is scheduled to produce a report in the first quarter of 2023.

I reiterate the support of the Minister for Agriculture, Food and the Marine and the Department in trying to resolve the challenges facing this vital sector of the Irish economy and agrifood businesses. We all want to seek a solution that is equitable and fair to the producers and to ensure the sector not only survives but thrives in future.

Medical Register

This issue concerns doctors and nurses from Ukraine who have arrived here. I understand that more than 165 doctors are here now who are qualified and who have been practising in Ukraine for several years. I do not have the number for nurses, but I understand many are here also. A register of these medical professionals is being compiled by a doctor working voluntarily. Originally from Lithuania, he has been working in Ireland for many years and he is working closely with these Ukrainian nurses and doctors to compile a register. He has given me the list of people and their qualifications, including in areas such as anaesthesia, dentistry, ear, nose and throat, ENT, paediatric surgery, dermatology, infectious diseases, internal medicine, oncology and neurology. Therefore, these doctors and nurses have a whole range of qualifications. I met one person who has been qualified for more than 12 years.

My understanding is that the medical training scheme in Ukraine is different from ours. When people here get a medical degree, they then do two or three years in different areas of medicine and that allows them to get some expertise in a wide range of areas. In Ukraine, though, I understand the system is different, in that when people graduate from university they go straight into the specialty on which they wish to focus. If our Medical Council is setting exams for these doctors, how can it set exams that are adequate to ensure candidates have the required expertise in specific areas and that will allow them to work in Ireland? I fully understand that the Department and the Minister must ensure people who gain approval to practise from the Medical Council have adequate skills and that our patients are adequately protected.

There needs to be an engagement with the Medical Council and An Bord Altranais in respect of nurses. They will have a different method and process in nursing education in Ukraine. We have a great number of people with expertise. We also have a great number of people, my understanding is well over 20,000, here from Ukraine. They will also need medical care and we need to be able to adapt accordingly. What level of engagement has occurred between the Department, the Medical Council and An Bord Altranais on identifying the adjustments that need to put in place for a proper structure for examination that would allow these people to come through the system once it is established that they have the necessary skills to practise in the particular area? It is crucial that we expedite this and get these people working. They want to work. I know one doctor, for instance, who is in an observer capacity in a clinic at the moment looking to see how the Irish system works. That is extremely important. When can we see progress on this? What is the likely timescale? I fully understand people who will be practising here will have to be proficient in English. We need to put in place the mechanisms. When can they be put in place and when can we get answers from both these organisations?

It is a very important issue and probably reflective of the many skills that are coming into Ireland with the Ukrainian families who have arrived here in recent weeks. It is important that we support them in finding employment. It is critically important, particularly when there are deficits in our health services around recruitment. Officials from the Department of Health are working closely with colleagues in the Medical Council and the Nursing and Midwifery Board of Ireland, NMBI, to examine ways to support Ukrainian doctors and nurses arriving in the State. The regulators fully recognise the importance of assisting health practitioners arriving in the State and have been actively examining the measures that might need to be taken. As Deputies may be aware, the Minister, Deputy Stephen Donnelly, met with Ukraine's ambassador to Ireland to discuss ways in which we can support refugees. The president and the CEO of the Medical Council also met with the ambassador. The ambassador has kindly offered the support of the embassy in acting as a liaison with the Ukrainian health authorities to support the registration of Ukrainian doctors and also to assist the Medical Council in disseminating information to Ukrainian doctors here.

The council has established an internal working group to examine ways in which it can support these doctors and is engaging with key stakeholders in the HSE, Department of Health, postgraduate training bodies and the Irish Medical Schools Council. The HSE, through the national doctors training programme, NDTP, in partnership with the council and the postgraduate training bodies, is co-ordinating an information-gathering process that will give us basic information about the Ukrainian doctors arriving in the State. The results of this process will then inform what further steps are to be taken.

I am advised that the Medical Council has not yet received a completed application for registration from any of the doctors arriving in Ireland, however it is directly supporting a number of doctors with queries about the registration process and the requirements. The Department of Health is also consulting with the NMBI to consider the matter with regard to how best to support Ukrainian nurses and midwives who have arrived in Ireland. Among the areas for consideration is the recognition of qualifications of Ukrainian nurses and midwives, who may have received training that does not satisfy the minimum training standards that are harmonised across the EU by the qualifications directive. The NMBI has advised the Department that it is engaged with the Royal College of Surgeons in Ireland, RCSI, to develop an interim orientation course to address gaps identified by the recognition process. The NMBI advises that it has also yet to receive a formal application for registration.

Officials in the Department of Health form part of a co-ordination group established by the European Commission examining the issues around the registration of Ukrainian health and social care professionals arriving in EU states as a result of the conflict. This group shares knowledge and best practice and is examining methods to streamline and expedite registration for these professionals, including the use of electronic databases, the EU information centres for academic recognition and machine translation tools. The Department of Health will continue to prioritise this issue and engage with the regulators and other key stakeholders.

I fully accept what the Minister of State said. It has to be carefully managed. It is important the people we allow to practise have the skills. In respect of An Bord Altranais and the Medical Council, is there any one person assigned to deal with this issue? The medical doctor I have been working with is from Lithuania and is working in Dublin. Is there someone he can speak to in the Medical Council or the Department to see how this consultation process can be assisted? Can some information be given to us and to the people who are dealing with these doctors and nurses? While the Minister of State is aware of it, I am not sure if the people on the ground are aware of the process or information that is available. Could that information be made available? People are reluctant to make an application because they are not sure of the criteria or what documentation they need to provide. Maybe some information could be provided by the Ukrainian ambassador or one of the various groups that are assisting those coming in from Ukraine. Has that process started or when can we expect it to commence?

Our thoughts are with all of those affected by the terrible conflict in Ukraine. The Department of Health, the Medical Council and NMBI will continue to support Ukrainian health professionals forced to flee their homeland as they arrive in Ireland and seek to re-establish their lives and integrate into our community. As Deputies will appreciate, our health regulatory bodies have a duty to protect patients by ensuring that all health professionals seeking registration meet the required training standards and are safe to practice. Depending on where doctors qualified and the type of qualifications they hold, some doctors arriving into Ireland from Ukraine may be required to take a pre-registration exam and an English language exam. This exam looks at a number of areas, including communication skills and clinical skills. It is an important step to ensure patient safety.

However, we will continue to streamline the registration process and expedite Ukrainian applications to the greatest extent possible, working closely with our EU colleagues to share best practice and utilise all database electronic verification tools available to minimise formal document requirements, mindful of the fact that these professionals have been forced to flee their homeland and may not be in possession of formal evidence of their qualifications. Where gaps are identified in the training received by Ukrainian professionals, we will continue to link in with the HSE and training bodies to seek to ensure that training opportunities are available to allow those professionals to bring their skills up to the necessary level and work in the Irish system.

The Deputy's idea about a single point of contact, be it on a HSE portal, would be most useful. It would be worthwhile for the Minister and the HSE to consider it, so that people would have a single person they could go to and discuss the whole process they need to go through to get into the Irish system.

Mental Health Services

The definition of dual diagnosis according to the Royal College of Psychiatrists is the coexistence of mental health and substance misuse problems, including both drugs and alcohol. Each of these disorders is both chronic and relapsing and each has an independent course capable of influencing the other disorder. It is recognised by many notable psychiatrists that it is quite unusual for an individual to present to outpatient addiction services with addiction problems only. Many psychiatrists accept that those presenting in such circumstances would have a co-morbid disorder and that this would be the rule rather than the exception.

There is, however, a complex relationship between these two scenarios in that an individual who presents may have what is termed a primary psychiatric disorder but also a secondary disorder of substance misuse. On the other hand, another presenting individual could have a primary substance misuse disorder with associated psychiatric complications. A third individual might have concurrent substance misuse and a psychiatric disorder. A final example would be an individual with an underlying traumatic or stressful experience causing a disorder such as post-traumatic stress disorder which results in substance misuse as well as mood disorders.

According to figures from the European Monitoring Centre for Drugs and Drug Addiction, up to 80% of patients with drug dependency have a psychiatric disorder. The implications of dual diagnosis for an individual are extensive. For example, it can give rise to an acute increase in the severity of the symptoms or non-compliance by the individual with their treatment or medication plan. The individual could experience an increase in the relapse rate. There could be an increased risk of suicide, self-harm and homelessness. Furthermore, there could be a rejection of the individual by psychiatric and drug services and greater complexity in the diagnosis and assessment of the condition

Over recent years, there has been growing acceptance and recognition of the problem of dual diagnosis. However, this does not seem to be matched in actions taken. Some years ago, there was talk of a clinical lead in dual diagnosis having been appointed, but little was heard of this appointment after that. In 2019, in answer to a parliamentary question, Dr. Siobhán Ní Bhriain, the national clinical programme group lead, confirmed the post of clinical lead for the national clinical programme for dual diagnosis was vacant, not having been filled in a skills-matching process following national advertisements by the HSE and the College of Psychiatrists of Ireland. In October 2020, the HSE advertised the position again and the successful candidate was to take up the post in quarter 1 of 2021. Can the Minister of State advise us as to the position on that competition?

I understand there are currently discussions on the development of a draft model of care. Can the Minister of State outline what provision is being made for those with comorbid mental illness and substance misuse?

Dual diagnosis places an enormous strain on individuals, their families and health services. It should be the goal of the HSE to mainstream dual-diagnosis treatment in mental health services. Families and those suffering owing to a dual diagnosis, in addition to those in mental health services, are anxious that progress be made on this issue because the system has failed them over the past several years. We should not allow this to continue.

I thank the Deputy for raising this. In the time I have, I will try to outline the response on behalf of my colleague Deputy Mary Butler, Minister of State at the Department of Health.

Budget 2022 provided an unprecedented mental health budget of €1.149 billion, including €24 million for new developments. The new-development funding will allow further implementation of Sharing the Vision. Investment of €750,000 — the full year cost being €1 million — will enable the continued expansion of the specialist teams under the dual diagnosis clinical programme. Dual diagnosis is a particularly important area because service users living with both substance misuse and mental health difficulties are often the most vulnerable in society. The needs of people presenting with substance misuse and mental health difficulties are complex and may be coupled with other issues, such as poor physical health or homelessness. The complex nature of these needs makes it difficult to ensure that the treatment being given can capture all aspects of service users' needs. The HSE has recognised that there is a need to improve services for people with comorbid difficulties and that an integrated approach between mental health and addiction services is required. The HSE clinical programme for dual diagnosis was developed to respond to this need.

The aim of the programme is to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental health difficulties and substance misuse. This includes increasing awareness of the frequent coexistence of mental health difficulties and substance misuse; ensuring a clear clinical pathway for management of people with such a dual diagnosis, including when they present to emergency departments; ensuring a standardised service is provided throughout the country; and ensuring adolescents are also included within the scope of this clinical programme. Work has already taken place on this aim. This includes the appointment of a national clinical lead and programme manager and the establishment of a national steering group. An integral part of the dual diagnosis programme is the development of a model of care that will ensure a clear clinical pathway for all adolescents and adults suspected of having a dual diagnosis, and access to a timely mental health service nationally.

The model of care is being developed in collaboration with recovery agencies and advocacy groups that represent the experiences of service users. It will be delivered on a community health organisation, CHO, basis and provided in an integrated manner across the primary care division and the mental health service, with a close relationship with acute hospital groups. One of the key components of the model of care is the establishment of specialist teams to support individuals with a dual diagnosis. The first pilot site for a dual diagnosis team is in CHO 3 and received investment from 2021 new-development funding towards its development. In addition, the HSE and Mental Health Ireland have developed a resource for people affected by dual diagnosis. It is available at www.drugs.ie. The website advises people to look after their mental health during the crisis and includes information about accessing mental health and addiction services. Government policies, including Sharing the Vision and Reducing Harm, Supporting Recovery, set out clear commitments to improving services for people with a dual diagnosis. The high-level justice task force is also examining dual diagnosis among individuals who come into contact with the criminal justice system.

The Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill, introduced in the Dáil in 2021 and sponsored by Deputy Ellis's colleagues Deputies Ward and Gould, seeks to define dual diagnosis and amend the Health Act 2004 to require a HSE service plan to include specific plans for dual diagnosis and care services. As I have outlined, these are now in train. With the appointment of a clinical lead, I believe we will see a considerable focus on this critical area over the coming years.

For many years, the health services, particularly psychiatric services, have been struggling. Even before the pandemic, they were struggling. We were not recruiting staff although there was a commitment to do so. I have lost count over the years of the number of people who have been turned away from accident and emergency departments because of a dual diagnosis. In many cases, this resulted in fatalities.

The Minister of State referred to the specialist teams that have been set up, but this is all too slow. There is a pilot scheme in CHO 3 whereby specialist teams are brought in. I despair when I talk to people about some of the cases that have been raised with me in this regard. In each CHO area, we should have dedicated nurses trained in dual diagnosis. Also, psychiatrists in accident and emergency departments should be trained in dual diagnosis and have the ability to deal with it. We fought hard to get psychiatrists in accident and emergency departments — it took the Government a long time to concede on this — so it is not good enough that people are being turned away from accident and emergency departments.

I despair over recruitment in the mental health services. I have heard of people who interviewed successfully for jobs before Christmas but still have not got them. It is totally unacceptable that they are not being employed now.

I assure the Deputy that the expansion of the programme will occur on a CHO basis and in an integrated manner across mental health services in the primary care division and include a close relationship with the acute hospital groups. The point the Deputy made about people who present at accident and emergency departments and acute hospitals is critical.

In response to the Deputy's colleague Deputy Ward, Ms Niamh Wallis, the head of service of the mid-west mental health service, has stated that the national office, along with a consultant psychiatrist, is leading on the development of a model of care for dual diagnosis that will be used nationally. This is a positive development for the mid-west, the nation as a whole and the people who require the support and intervention of this team.

A clinical lead is in place. The pilot programme is in place in the mid-west, with anticipation and funding in place to roll out this programme nationally. I agree wholeheartedly with the Deputy that it is a critically important area for people who present with complex assessments and needs in dual diagnoses. As we have outlined, the response to date has been co-ordinated and there is significant movement happening on this.