Dáil Éireann díospóireacht -
Thursday, 14 Dec 2023

Vol. 1047 No. 6

Saincheisteanna Tráthúla - Topical Issue Debate

Weather Events

Deputy David Stanton

I thank the office of the Ceann Comhairle for selecting this matter. I also thank the Minister of State, Deputy Ossian Smyth, for being here to debate it with me. It is eight weeks yesterday since the awful devastation occurred in my town, Midleton, where shops and homes were badly damaged. Floods, the like of which were never seen before in the region, caused devastation. This evening in particular I want to focus on the roads and bridges that were destroyed. Some of them are still not open. I am sure the Minister of State will appreciate the difficulty that is causing residents, businesses, farmers and so on.

I have been raising the issue consistently since that time because I do not want it to go on the long finger or for the file to be forgotten. I am sure that will not happen. I was told at one stage that Cork County Council is now turning its focus on assessing the impacts the flood waters have had on rural roads and infrastructure in the hinterland of Midleton and Youghal where local primary and secondary roads have been badly impacted. I was told that would allow for a clear picture to develop of the estimated costs for the appropriate works to make the worst affected areas of the road network safe. Safety is an important issue. I got the response on 24 October. We are now heading for Christmas. I understand that Cork County Council has made a submission to the Department of Transport looking for funding. A number of figures have been bandied about, ranging from €23 million up to €50 million and maybe even more. We do not know. Some roads that were extraordinarily badly damaged are still closed. I have never seen the like of it. They were torn up with the power of the water that fell on that particular day. In fact, it was so bad we were lucky no one was drowned.

Could the Minister of State tell me what is the estimate of the damage? Could he tell me if the Department has received a request from Cork County Council for serious funding to repair the damage? When will the Department be in a position to make a decision? I was told on 30 November that the Minister was committed to working closely with Cork County Council to assist in addressing the issues caused by Storm Babet and to help restore our road network. Road grant allocations for the coming year are expected in early 2024. I was also told in that written response that the Department is aware that most of the council's funds in this financial year are expended or committed and any level of reprioritisation of work is limited. I know that Cork County Council got €350,000 to support emergency repairs and to facilitate the opening of some key roads. I was told by the Minister in November that prompt restoration of the road network is required to maintain a safe environment and to enable social and economic connectivity. A certain amount of funding was made available but the reports I am getting are that a Cabinet decision is required to provide significant funding. While that is going on the roads are still closed and the people in the area are being discommoded. Some of these roads are extraordinarily unsafe.

Could the Minister of State let me know, first, if a request has come in from the council? Is there an estimate of the damage? What is it? How soon will the Department of Transport be able to provide the funding to allow the council to get on with the work? I ask that given the fact that the council's funds in this financial year are expended or committed. The council does not have the money to do it, yet the people need the roads to be repaired.

Minister of State at the Department of Public Expenditure, National Development Plan Delivery and Reform (Deputy Ossian Smyth)

I thank Deputy Stanton for raising this issue. I welcome the opportunity to discuss this important topic with Members on behalf of the Minister for Transport.

I understand that Deputy Stanton's questions relate to State funding provided to Cork County Council for emergency repairs of roads and bridges following Storm Babet, with a particular emphasis on the east Cork region.

As Deputy Stanton is aware, Ireland has already experienced several severe weather events this winter, including Storm Babet. Heavy rainfall associated with this event led to widespread flooding in certain areas. Unfortunately, saturated ground conditions and high river levels compounded flooding events, particularly in the south of the country. Consequently, there is significant damage to parts of the national, regional and local road networks.

It takes time to assess the impact of a storm event on the road network. Clean-up activities take precedence, and it is only when river levels recede that a full assessment of damage to bridge infrastructures can be determined. Indeed, the full extent of the damage following Storm Babet in mid-October is only becoming wholly apparent now. Some roads remain impassable and some bridges are still out of commission.

The Department of Transport, Transport Infrastructure Ireland, TII, and Cork County Council are working closely together to identify and assess the damage, and thereafter to plan appropriate remedial action and determine estimated costs of repair.

Prompt restoration of the road network is essential from a safety perspective as well as maintaining key social and economic connections. As such, Cork County Council has begun some emergency rehabilitation works and the Department of Transport has reprioritised funding to provide the council with €350,000 to facilitate the opening of some key roads for access to schools and communities.

Unfortunately, as all regional and local road grants are fully allocated for 2023 there was little additional scope for extra funding for emergency works from this year's programme.

At this point, it is important to highlight that the improvement and maintenance of regional and local roads is the statutory responsibility of each local authority, in accordance with the Roads Act 1993. Works on these roads are funded from the council's own resources, supplemented by State road grants, while the construction and operation of national roads is a matter for TII, in conjunction with the relevant local authorities. I understand that Cork County Council has been in contact with TII regarding the impact of Storm Babet on the national road network, and that TII is currently reviewing the matter.

The Department of Transport emphasises to local authorities each year the importance of setting aside a contingency fund to manage events such as severe flooding and storms. That being said, due to the severity of Storm Babet, some local authorities, including Cork County Council, have sought additional financial assistance to carry out their duties as road authorities. The Minister for Transport is conscious that significant action is required to restore our critical road infrastructure to active use. He is committed to giving due consideration to repair and rehabilitation funding requirements as part of the 2024 regional and local road grant allocations process. It is expected that these road grants will be issued in early 2024.

In summary, the Minister for Transport recognises the requirement for a prompt restoration of the road network. It is vital for safety as well as providing a high level of service and maintaining social and economic connectivity. In 2024, the Minister for Transport is committed to assisting Cork County Council, where possible from within resources, in managing essential repair works, especially the opening of key roads and bridges, as well as investing in future-proofing our road networks to help reduce the probability of such damage reoccurring.

Deputy David Stanton

I understand that the Minister of State is only standing in for the Minister and that he did not write this reply. He probably has nothing to do with it and he is only reading out the script, as I have done myself on many occasions when I was in that position. It is disappointing that there is not an indication on how much has been requested by the council. Perhaps the Minister of State can go back and ask for that information from the Department of Transport. Has a request been made and for how much? He might let me know what it is.

It is also disappointing and a bit alarming when the Minister tells us it is expected that road grants will be issued in early 2024. What does that mean? Is it January, February or March? Does that mean that many of the roads which are still closed and that are damaged and dangerous, as the Minister has acknowledged in his response, will be left that way until some time in early 2024 and then the council will have to go off and start tendering and getting contractors in to do the work? We could be talking about the summer before some of these roads are brought back into use again. I have been highlighting this for quite a bit and I will keep highlighting it and bringing it up because otherwise the file might end up on a dusty shelf somewhere and be forgotten about. The people in the area are very concerned. There are also some private bridges which were very badly damaged and are now dangerous. They could fall into rivers leading to more flooding. In the background the flood relief scheme needs to be advanced as a matter of urgency. Interim measures to do with the flood relief scheme also need to be put in place. Very often when something like this occurs everyone goes into a flutter and a flap and they say “God this is terrible” and that they will do this, that and the other. Then when it dies away, people just kind of forget about it and then the next crisis comes along. But for the people of east Cork this is still very worrying. People in Midleton are very concerned that we could have another flood leading to more devastation. There is a lot going on here and a lot needs to be done but the road network is really crucial along with bridges, including some private bridges like Moore's Bridge and Water Rock, and needs to be taken into account. The council is doing its best but it really needs the Department and the OPW to step up to the mark and assist.

Deputy Ossian Smyth

I believe the Minister for Transport visited east Cork and perhaps Midleton as well at the time of the event. It was not for a photo op but to discuss directly with people how this was affecting them because as the Deputy knows himself, that is the only way to understand what the problem is and how to address it. As I said, Transport Infrastructure Ireland, the county council and the Department of Transport are working together on this. The €350,000 has already been transferred from the Department for immediate works but it takes some time for the extent of the works needed to come to light. I am not sure, and I do not know from this answer, whether the council has submitted a request for funding or whether there is an amount of funding, or if it is ready to do that yet. What I have to go on is a statement that early in the new year new funds will be allocated to fix bridges and fix roads. I imagine they will be the highest priority. How could they not be? We have to have our bridges and roads in order.

The Deputy said that significant funding would require a Cabinet decision. That may not be the case. The Department of Transport has significant funding, as do the council and TII. It may be possible to proceed with the works without a Cabinet decision. If a Cabinet decision is made, a number of Cabinet members represent Cork. I am sure they will look favourably on what is required there.

Vaccination Programme

Deputy Colm Burke

I am asking the Minister for Health to initiate a health technology assessment for an RSV vaccine following recent National Immunisation Advisory Committee, NIAC, approval, particularly in light of the large increase of hospital admissions of patients with respiratory infections. Respiratory viruses are reportable since 2012 and the figures are frightening. Last year, for the 2022-23 winter months, 7,759 cases were reported; 2,231 of those were people over 60 years and over 636 ended up in emergency departments in our hospitals. Across Europe, over 274,000 hospitalisations for RSV have been identified and there have been 20,000 fatalities over the last 12 months.

The vaccine has been approved by the European Medicines Agency since June. The question now is whether we take a decision to make vaccines available. There are two very vulnerable groups, namely those under two years and those over 65. There is a question about assessing cost and implementation but it is also about saving lives. In real terms, it will save huge money because there would be fewer admissions to hospitals and fewer people needing to go to their GPs and requiring care. I ask that the Minister prioritise this issue, that vaccines would be approved and that we would set out a clear programme on their delivery over a very short timeframe.

Deputy Ossian Smyth

I thank Deputy Burke for raising this matter. Both Minister for Health, Deputy Donnelly, and the Chief Medical Officer share these concerns in relation to the high levels of RSV that are circulating in our community.

To begin with, I can confirm that following receipt of NIAC advice on RSV immunisation options in October, and the Office of the Chief Medical Officer having considered that advice, the Department of Health has requested HIQA to undertake a health technology assessment, HTA, in relation to RSV.

RSV is a common winter respiratory virus that generally leads to mild respiratory symptoms. It can, however, lead to severe illness among infants, young children aged less than five years and in people aged 65 years and older. Symptoms of RSV include a cough, wheezing, runny nose, difficulty feeding or decreased appetite as well as a fever and a sore throat. RSV associated deaths among children in Ireland and other high-income countries are thankfully rare.

Since last month, RSV has been circulating at very high levels. The highest rates are in those aged less than one year old, followed by the one to four year age group. In the last two weeks, we have seen the highest number of recorded cases and hospitalisations due to RSV. The majority of hospital cases are in those aged less than one. This surge in the rate of RSV cases is stretching healthcare capacity by placing a significant burden on the hospital system.

The numbers of notified RSV cases and hospitalisations decreased slightly in the last week but remain at very high levels. The number of RSV cases notified to the Health Protection Surveillance Centre in the week ending 9 December is 829. This compares to 985 cases notified during the previous week. The number of hospitalised cases notified to the Health Protection Surveillance Centre in the week ending 9 December is 335. This is a decrease of 9% over the previous week when 370 cases were notified. However, despite the decrease in RSV case numbers it is anticipated that the healthcare system will continue to come under increased strain in the coming weeks due to an expected rise in the transmission and co-circulation of respiratory viruses including Covid-19, influenza and RSV.

It is worth noting that certain infants at high risk of infection are offered a form of immunisation, licensed in Ireland for the prevention of serious lower respiratory tract infection caused by RSV. The NIAC advice notes that in relation to infants, there are two forms of passive immunisation against RSV. First is a long-acting monoclonal antibody which can be administered to the infant directly and second, a maternal vaccine which can provide infant protection through transplacental antibody transfer. Passive immunisation is when a person is given antibodies to a disease rather than producing them through his or her own immune system. Active vaccination involves administration of a vaccine to stimulate the production of an immune response in the form of the production of antibodies. Based on a small number of clinical trials carried out to date, both products have acceptable safety and efficacy profiles.

The NIAC advice also noted that further analysis of cost effectiveness and programmatic considerations is required to determine the most appropriate RSV immunisation strategy for infants. In relation to the over 65 age group, the advice stated that there are two vaccines which NIAC recommends to protect against RSV. The advice also noted that based on clinical trials carried out to date, these products also have similar safety and efficacy profiles and again, further analysis of cost and product availability is needed to determine which product is more suitable for use in Ireland.

As I mentioned earlier, following consideration of the NIAC advice, the Department of Health asked HIQA to carry out a HTA to determine first whether infant or adult immunisation would provide the greatest benefit in reducing healthcare utilisation due to RSV infection and second, what the most cost-effective RSV immunisation strategy for Ireland would be. The outcome, when available, will inform whether or not RSV immunisation will be added to the national immunisation programme.

Deputy Colm Burke

I thank the Minister of State for a comprehensive reply. As he noted, there were 370 admitted to hospital in the last few days of November and early December and for the week ending 9 December there were 335 admissions. That is a huge demand on our health service.

Therefore, everyone will agree at this stage that we need to identify the best way forward with the use of these vaccines and whether we should have a nationwide programme, in particular for children under the age of two or under the age of five, but also for the older age group. Certain people aged over 65 have certain vulnerabilities and we need to identify those as well and have a vaccine available.

The way forward is to have a vaccine programme available. The medication is there, the drugs are now there and they have been approved. It is now about moving on and using them effectively. In real terms, doing a vaccination programme means there are real cost savings for the State. Fewer people will have to attend their doctor and hospital or to need that care. I have come across a number of cases and recently heard of someone who was only 56 and got a very bad viral infection. That person had no prior medical conditions but actually died. They were very healthy but picked up a virus and despite all of the efforts of the medical team dealing with them, unfortunately they were not able to bring them through the difficulties they had. It is therefore important that we fast-track this and move forward with the introduction of a vaccine at the earliest possible date.

Deputy Ossian Smyth

I will refer briefly to the timeline in this regard. It is hoped the results of the HTA will provide important clarity on this matter and will assist in determining the most appropriate course of action. It is expected that the key components of the HTA will be completed by the second half of next year.

It is important that parents are vigilant of their children's symptoms, that they trust their instincts and contact their GP if they are worried, especially if the symptoms get worse quickly. There are things parents and caregivers can do to help curb the spread and to keep their children safe. Parents with babies should try to cocoon them and avoid having them in large crowds or spending time with those who have colds or respiratory symptoms. While we are sick ourselves or have children who are sick, we must keep away from other children where possible and ensure we all wash our hands regularly and use respiratory etiquette for coughs and sneezes. It is vital we keep children with cold or flu-like illnesses home from crèche or school until they are feeling better to avoid spreading these viruses.

With regard to winter viruses more generally, we know that vaccines, where available, are the best means of protection available for us and for those who are vulnerable in our communities. All who are eligible for the flu vaccine and have not yet received it should make an appointment to receive it without delay. Those who are eligible for a Covid-19 booster should ensure they receive that also.

We are dealing with three winter respiratory infections now, namely, RSV, Covid-19 and flu. It is a significant burden on the health service. We have seen that we have managed to greatly reduce the effects of Covid-19 through a broad vaccination programme. I hope we can achieve the same with RSV. The fact that RSV particularly affects babies and children is all the more reason to prioritise it but as the Deputy noted, RSV can also lead to death in older people. I thank the Deputy for raising the issue and the Minister, Deputy Donnelly, has spoken to me about RSV in the past and is absolutely concerned about it, as is the Chief Medical Officer. It is something they are working on and it is a priority for them.

An Cathaoirleach Gníomhach (Deputy Verona Murphy)

I thank the Minister of State and the Deputy. That is the end of the Dáil session but before we rise I will take the opportunity to wish everybody a very happy holiday and happy Christmas. I thank the staff, the ushers, those on sound or security in general and all of the staff here in the Dáil.

Cuireadh an Dáil ar athló ar 6.34 p.m. go dtí 2 p.m., Dé Céadaoin, an 17 Eanáir 2024.

The Dáil adjourned at 6.34 p.m. until 2 p.m. on Wednesday, 17 January 2024.