Dáil Éireann díospóireacht -
Thursday, 26 Jan 2023

Vol. 1032 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

General Practitioner Services

Deputy Marian Harkin

I have serious concerns about the NowDoc service. The NowDoc service is an out-of-hours GP service covering three municipalities, Carrick-on-Shannon and Ballinamore in south Leitrim, and Boyle in north Roscommon. There is a possibility that this will be privatised and moved from HSE control. I am concerned about the impact of that. There is a probability, which I will explain in a moment, that this change would ensure that out-of-hours calls would be diverted to a centre in Carlow and that out-of-hours services in Carrick-on-Shannon would be diverted to Sligo after midnight.

I have here a consultation document examining the GP out-of-hours service in Donegal and south Leitrim, NowDoc. The document considers the objectives and some of the proposed options. One of the options proposed in phase 1 is to examine the options available to locate Carrick-on-Shannon under Sligo Caredoc. There are many issues with the NowDoc service and I do not have time to go into them. I want to focus on the possible closure of the Carrick-on-Shannon office after midnight.

As of now the NowDoc out-of-hours GP service covers just more than 70% of the week, operating from Monday to Friday from 6 p.m. until 8 a.m. and 24 hours on Saturday and Sunday. That comes to 118 hours per week, which is significant. However, under these proposals there may be a cut in the out-of-hours service from 118 hours to 62 hours per week because if the service in Carrick-on-Shannon is to finish at midnight any client who requires the out-of-hours GP service would have to be directed to Caredoc in Sligo - a round trip from Carrick-on-Shannon of 108 km or from Ballinamore of 128 km. It is clear from the options presented in this document that if this goes ahead, in a few years rural areas particularly south Leitrim and north Roscommon will not be well served.

I want to ensure that optimum care is provided in the NowDoc area so that people can access out-of-hours GP services in a timely fashion. I am aware that NowDoc and Caredoc have identified a number of concerns that impact on patient safety and quality of service. They are listed in this document and they need to be dealt with. It is crucial that whatever changes are made must benefit patients. They must provide a safe service but they must also ensure greater access to healthcare rather than any diminution of services. As I said, some of the options presented in this consultation document would result in a withdrawal of certain out-of-hours services from Carrick-on-Shannon. I raised this issue this evening to highlight it and to look for a guarantee from the Minister of State that there will be no diminution of services under any changes proposed to this service.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Deputy for raising this issue. The provision of out-of-hours GP care is a fundamental component of general practice and appropriate access to GP out-of-hours services must be maintained.

Under the general medical services scheme, contracted general practitioners must make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside normal practice hours. Most choose to participate in GP out-of-hours co-operatives or other GP out-of-hours service providers to meet this contractual requirement. These services have developed and expanded over time and are now an essential part of our primary care services. Access to GP care outside of usual practice hours is necessary to ensure, to the greatest extent possible, that urgent care needs are met in the community rather than in an acute care setting.

The NowDoc out-of-hours service provides urgent GP care to patients of County Donegal and south Leitrim. As the Deputy will be aware, while GP out-of-hours services are largely provided by private co-operatives, the NowDoc service is run and managed by the HSE in partnership with Caredoc, which provides GPs for the delivery of care.

The HSE community healthcare organisation, CHO, for the region concerned has advised that it has entered exploratory discussions with relevant stakeholders to examine the most effective arrangements needed to continue to deliver a safe, quality-driven service for County Donegal and south Leitrim. This examination of the service forms part of the HSE response to significant clinical concerns raised by the Caredoc GP board members.

The HSE has given assurance that no decision has been made on the redesign of the operating model for those areas, and no decision will be made without the active involvement of relevant stakeholders. The HSE will continue to communicate and engage with all relevant stakeholders to ensure they are fully consulted regarding any future developments.

The HSE CHO has confirmed that there are currently no plans to move the treatment centre from Carrick-on-Shannon or change the level of services provided there. It should be noted that the GP out-of-hours service for Sligo and Leitrim is managed as a singular model of service through a service level agreement with Caredoc. As this model is operating effectively, it is not included in the current examination under way.

Regarding out-of-hours services in general and across the country, the HSE engages regularly with all service providers and provides significant supports towards service delivery. The out-of-hours support grant that has been in place since 2020 was increased this winter. Additional temporary funding has also been provided to out-of-hours service providers to allow the rostering of more doctors in treatment centres between the hours of 6 p.m. and 10 p.m. This allows for more patients to be seen over this busy winter period and helps reduce the need for emergency department attendance.

Service quality and patient safety in the delivery of out-of-hours GP care remain paramount for the HSE, and direct its decision making on the provision of services by providers including NowDoc.

Deputy Marian Harkin

I thank the Minister of State for that. She said, "The HSE has given assurance that no decision has been made on the redesign of the operating model for those areas, and no decision will be made without the active involvement of relevant stakeholders." It is fine that there are no plans. However, this is the document I am concerned about. This is the consultation document that the HSE has put out there. One of the options is to locate Carrick-on-Shannon under Sligo Caredoc. The options cover three phases and this is right up there in phase 1, which means we can be sure that this is an important part of what the HSE is considering.

I am concerned that we may end up at the point where the service is not designed to suit the people but is designed the other way around and the people have to travel long distances to access healthcare to suit the service. Any service needs to consider settlement patterns, especially where there is dispersed population. That needs to be taken into consideration when designing services. This option is the very opposite. The Minister of State can understand that people are concerned when they see this. It is not a plan or a decision right now.

The purpose of my contribution is to try to impress on the Minister of State and the decision-makers that it must not become a plan or decision. Too often, we read lovely words about streamlining, consolidating, centralising and redesigning. Those are lovely words that at the end of the day often mean a reduction in services. I would not like that and do not want to see it happen.

Deputy Mary Butler

I thank the Deputy. Her point is well made. To reiterate, the HSE continues to work in partnership with NoWDOC and Caredoc to ensure the delivery of a safe and appropriate GP out-of-hours service. No decision has been made with regard to any redesign of the service in the area and any such decision will involve the stakeholders concerned. The HSE CHO has confirmed that there are currently no plans to move the treatment centre from Carrick-on-Shannon or to change the level of the services provided there. The Deputy is trying to ensure that does not happen. I assure her that while the HSE CHO concerned is currently examining the delivery of out-of-hours services for the area, no decision has been made and, in particular, there are no plans currently in place to move the Carrick-on-Shannon treatment centre or to change the services provided there. I take on board the points the Deputy has made about the importance of out-of-hours services provided by Caredoc and NoWDOC, or whatever other services are being provided. Those services are hugely important, especially for those who are living in predominantly rural areas, small villages and towns. I will raise the Deputy's concerns with the relevant CHO.

An Ceann Comhairle

I hope the HSE is not engaging in a form of verbal sleight of hand when it talks about there being no plans in place. I am sure Deputy Harkin will bring the matter back should the need to do so arise. Hopefully, as the Minister of State has indicated, there will be no need-----

Deputy Mary Butler

Please God.

An Ceann Comhairle

-----to revisit that particular matter.

Housing Schemes

Deputy Chris Andrews

I thank the Minister of State, Deputy Noonan, for his attendance. I have been meeting with tenants living in flat complexes across Dublin. I attended a meeting earlier today in Pearse House. The level of neglect by the Government and Dublin City Council is horrendous. There are affected flats in Beech Hill, Rathmines, Cuffe Street, Digges Street and York Street. There are too many flat complexes to name individually but I assure the Minister of State that every block of flats has shocking levels of damp and mould. We know that mould has a serious impact on the health of young and old, in particular. A young child died because of mould in a flat in the UK. The time for concern is long gone. We need action now. The chance of the council sorting out this mess and these issues is long gone. The Government needs to intervene directly. It needs to set up a task force with ring-fenced funding for the battle against mould. It is far too serious an issue not to do so. Tenants at Mercer House, Digges Street and York Street deserve better. The climate change funds can be used for insulation to make the flats warm, modern and, crucially, energy efficient. It seems that emission reductions are only for the wealthy. No such schemes are being made available to those in flat complexes. Why not put solar panels on top of flat complexes to heat the flats below? There is none of that innovation because the flats have been, and continue to be, neglected and forgotten. None of the flats has schemes to make them more energy efficient. Every flat should have new secure doors that reduce the need to keep the heating on. Every flat should be insulated and warm. Let us ensure a task force is set up with the funding needed to get rid of the dangerous mould in so many flats.

Deputy Réada Cronin

As the Minister of State knows, Ireland has one of the highest rates of respiratory illness and disease in Europe. We have the highest rate of hospitalisation in the OECD for chronic obstructive pulmonary disease, COPD. Mould triggers and exacerbates respiratory conditions and also causes death, as in the case in England to which my colleague referred earlier. I am sure the Minister of State has heard about that case. The coroner in England made the defining judgment that the death of Awaab Ishak was due to chronic exposure to mould in the apartment in which he was living. That judgment is also of critical importance to us in Ireland because of the amount of mould in the country. We have similar weather to the UK.

I know of a case in north Kildare where the roof of a home has been deemed the cause of serious mould. The council's response so far has been to paint the ceiling. People should not be living in these kinds of conditions in the 21st century. It is unimaginable. That the public should be subsidising these conditions with public money is disgraceful.

I would like to see plans for a mould audit. We should require all local authorities to undertake an inspection and audit of their housing stock for mould. We should mandate a designated number for the reporting of mould in all local authorities. It is a health issue. We should ensure that public money is withheld from any private landlords whose stock is deemed unsuitable. The public should not be funding properties that are bad for public health.

Minister of State at the Department of Housing, Local Government and Heritage (Deputy Malcolm Noonan)

This is an issue I have dealt with at a local level in respect, in particular, of Traveller accommodation. It is a very serious public health issue. I absolutely agree that it needs to be tackled.

In accordance with section 58 of the Housing Act 1966, local authorities are legally responsible for the management and maintenance of their housing stock. Local authorities also have a legal obligation to ensure that all of their tenanted properties are compliant with the provisions of the Housing (Standards for Rented Houses) Regulations 2019. Minimum standards for rental accommodation are prescribed in those regulations and focus on tenant safety. They specify requirements in relation to a range of matters, such as ventilation, structural repair, fire safety, sanitary facilities, heating and the safety of gas, oil and electrical installations. The regulations apply to all properties let or available for let, including social housing. All landlords, including local authorities, have a legal obligation to ensure that their rented properties comply with the standards set out in the regulations.

Responsibility for enforcement of the regulations in the private rental sector, including approved housing body properties, rests with the relevant local authority. The Government is committed to ensuring that a high quality stock of rental accommodation is available for households who rent, be it in the private market or in accommodation provided directly by local authorities. Notwithstanding the legal obligations on local authorities to manage and maintain their housing stock, our Department does in a focused way provide annual funding to local authorities to support their work in this area. For example, under the voids programme, our Department supports local authorities in refurbishing vacant social homes and returning them to productive use. This funding programme was introduced in 2014 and to the end of 2021, returned significant numbers of properties to use with funding of €261 million from our Department.

Our Department launched the energy efficiency retrofitting programme in 2013 with the aim of funding the retrofit of social homes requiring insulation and energy upgrade works. Since the programme commenced in 2013, over €188 million of Exchequer funding has been provided under this scheme. Poorly adapted insulation can sometimes be the cause of mould in properties. That is worth addressing. My Department also provides for the disabled persons grant, DPG, scheme which provides funding for adaptations and extensions to existing social housing stock to meet specific needs of the local authority tenants with a 10% contribution required from the local authority. From 2011 to 2021, a total of €138 million was spent under the DPG scheme.

The selection of properties for inclusion in these programmes and the nature of works to be completed in line with the criteria of the schemes are matters for each individual local authority. The implementation of these focused programmes is separate to the local authorities' legal responsibilities under the Housing Acts to ensure that they maintain their housing stock to the appropriate legal standards.

My Department will continue to support local authorities in these focused stock improvement works and work is also ongoing with the local authority sector, through the City and County Management Association, CCMA, to drive a planned maintenance approach to the management and maintenance of all local authority housing stock. Local authorities are entrusted with providing high-quality housing stock to social housing tenants. The Department is funding the development of a national asset management system for the sector that should greatly assist the sector in this task.

I will come back with a supplementary reply. Both Deputies have suggested a mould audit and a task force on this issue. Those suggestions are worthy of consideration. The issue can sometimes be caused by poor insulation or ventilation. It can also be caused by overcrowding in local authority stock, which is a real problem. Sometimes good advice to tenants can be of considerable assistance in terms of ventilating properties.

I will come back in on the supplementary again to follow up on the specific question.

Deputy Chris Andrews

The problem of mould in flats is not being taken seriously by the Government. We cannot entrust the local authorities to fix this problem which has been there for decades. The homes are passed with just a bit of paint or bleach, which some tenants are given. The days for that are long gone. Government needs to intervene and ensure that the funding is there. The funding can be there if the Government is committed to it. It is not being taken seriously. We need action. We are not seeing action. We have inadequate funding to tackle this serious problem. I believe the Government is overwhelmed by the extent of the mould and neglect in the flats. Glovers Court is not far from here. It was supposed to be retrofitted years ago. Canon Mooney Gardens in Ringsend was also supposed to be treated. That has not happened. There is no real commitment by the Government. It has never been done. People are still living in shocking flats. I spoke to a resident earlier on and he said, "These flats were built to replace the tenements and now we are living in modern-day tenements". I just came from a meeting in Pearse House where that was said to me. Residents living in the flats deserve better.

Deputy Réada Cronin

I appreciate the Minister of State's reply, particularly when he went off-script from the script the Department gave him. Sometimes people are told it is a ventilation matter. They are told to make sure their vents are not blocked. In many cases they are not blocked. That is not the cause of the mould. Earlier I spoke of a tenant who reported her leaks 16 months ago to Kildare County Council. The contractor came out and told her the roof needed to be replaced. The council went out a year later, which was a couple of months ago, and replaced part of the roof, not all of it. The plaster is coming off the walls in some places. The exposed brickwork is still wet. Windowsills are swollen from water and they are rotten. The windows need replacing as well. I appreciate what the Minister of State said. I hope he will take it on board because I do not believe the Department is taking this very seriously. We have to look after our council stock. As landlords, local authorities are responsible to make sure that they are providing decent accommodation. Will the Minister of State try to get a circular out to the local authorities to tell them they have to make sure that their accommodation is up to scratch?

Deputy Malcolm Noonan

To give assurance to both Deputies, it is important to follow up on this in regard to looking at our Department and perhaps the Department of the Environment, Climate and Communications in particular regarding retrofits and to ensure that we work towards eliminating mould from properties. I say this in regard to flats and social housing stock and all housing stock. That is critically important. I have encountered this in Traveller accommodation. It is a serious public health issue. We saw the case in the UK. We are perhaps not fully aware of the impact it is having on children's and young people's health in particular. We will certainly follow up on the questions that have been put to us. Some good ideas have been brought forward and they are worthy of a response.

If we look at the retrofits, there are many good retrofit programmes that the Government has led on and funded. If the wrong retrofit programme or the wrong type of insulation takes place it involves awareness-raising with residents and tenants in regard to ventilation. The ventilation should be part of the retrofit programme. That is vitally important.

Certainly I will take back the points that have been made by both Deputies. They are valid and very useful from our perspective. As I said, the issue of mould is a very serious public health risk and needs to be eliminated. I thank the Deputies for the question.