Adjournment Matters

Health Services

Senator Terry Leyden

I welcome and the Minister of State and thank the Cathaoirleach for allowing this matter to be raised on the Adjournment. Senators have been contacted by members of the public and particularly the group Diabetes Action. I requested that the Minister for Health, Deputy James Reilly, outline the access to treatment for children and adolescents with diabetes and the plans to reorganise diabetic paediatric services in the HSE west area and throughout the country.

Diabetes Action launched an advocacy campaign entitled, Half the Services, Half the Care, in September 2010. Other Members, namely, Senators Marc MacSharry and Brian Ó Domhnaill, asked to be associated with this request, as they have also been contacted by the organisation. The central message of the campaign is that people with diabetes have not been helped sufficiently by general health policy. Rather, various issues need to be addressed in a national diabetes strategy. If the Government implements strategic policies, we may improve dramatically the health of people with diabetes, while saving millions of euro through preventing health complications for such persons in the next decade.

In 2008 the report of the diabetes expert advisory group identified that service provision in this area was inadequate and proposed a comprehensive regional plan to improve the service provided. In the interests of balancing the available resources, it recommended that the majority of patients with type 1 diabetes requiring care, including all paediatric and adolescent diabetes cases, should be treated in hospital diabetes centres. Approximately 70 children and adolescents with type 1 diabetes are living in Roscommon-Leitrim South. While many are cared for locally, many others must travel to Dublin to access intensive treatment because the local paediatric diabetes team is under-resourced. Paediatric diabetes services in Dublin have been inundated with referrals, while local services remain underdeveloped and underutilised. Children with diabetes should be seen four or five times a year in hospital to help to limit the damage high blood sugar levels can cause to the eyes, kidneys, nerves and smaller blood vessels in adulthood, but they are not seen as often as they should be.

Diabetes Action proposes a reorganisation of diabetes paediatric services with eight networks, one of which would serve 350 to 400 children with diabetes in counties Galway, Mayo and Roscommon in order that intensive therapies could be accessed locally. It also proposes a network to serve 200 children with diabetes in counties Sligo, Donegal and Leitrim. The campaign is well organised and the Minister of State is aware of it. I note the response sent to me by Mr. J. J. O'Rourke, PRO for the Leitrim branch of the Diabetes Federation of Ireland. He requested that I raise the matter in Seanad Éireann to highlight an important aspect, the incidence of which is increasing. We can take action to provide a service in the region in the most economic way possible.

I again thank the Minister of State for attending and the Cathaoirleach for allowing me to raise this matter.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I congratulate the re-elected and newly-elected Senators. I also congratulate the Cathaoirleach on his election to his new position.

I thank Senator Terry Leyden for raising this matter on the Adjournment. In 2006 the then Department of Health and Children published a policy report on diabetes, Diabetes: Prevention and a Model for Patient Care. It set out a model of care based on shared care between primary care and acute services which would deliver quality diabetes care at the appropriate level. Many patients with a chronic condition such as diabetes do not require hospital admission but can be managed in primary and community care settings if the appropriate support is available and agreed protocols and pathways are followed. This also applies to self-management and support. It is important, in the current challenging economic climate, that patients receive the best treatment possible in the most cost-effective manner.

The HSE established an expert advisory group to take forward and implement the Department's policy recommendations on diabetes. Its report was launched in November 2008. The report made a series of recommendations relating to the changes required to raise the standards of diabetes care in Ireland to a level comparable to those currently attained in similar developed health care systems worldwide. These include specific recommendations on the provision of paediatric and adolescent diabetes care. A key element was the publication of integrated care guidelines which represented a new way of primary care and acute specialist services working together to reduce the burden of this condition.

The expert advisory group emphasised that real savings could be achieved in health care costs by preventing the complications of diabetes. These would be achieved through patient education and empowerment, primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that would develop. In this shared care model, roles and responsibilities are clearly understood and the model is supported by agreed protocols. This type of care has been shown to be particularly effective for the management of type 2 diabetes.

The HSE established a national clinical programme for diabetes within the clinical strategy and programmes directorate. A clinician was appointed to take the lead on the diabetes clinical programme and he has engaged with all stakeholders, including the Diabetes Federation of Ireland, clinicians and podiatrists to establish a multidisciplinary package for diabetic patients. A multidisciplinary working group, representing a number of nursing and allied health professionals, podiatrists and general practitioners as well as the Diabetes Federation of Ireland, are working through a number of key projects. The key deliverables for the 2011 programme are the implementation of projects such as diabetes retinopathy screening and a multidisciplinary foot care package for patients with diabetes.

It is planned that the diabetic retinopathy screening programme will be offered to all diabetics over the age of 12. The HSE has also established a national clinical programme for paediatrics, which will examine in detail the area of improved services for children and adolescents, and it will develop solutions to address the issues identified. Diabetes service implementation groups have been established throughout the country to progress the recommendations of the diabetes expert advisory group, including those which relate to paediatrics.

A diabetes service implementation group has been established for HSE west, and the group's regional work plan includes a focus on primary care, hospitals, children and adolescent support services, and linkages to the local diabetes implementation groups. The group is supported by three local diabetes services implementation groups, one covering the counties of the north west, another for those in the west and the third for the mid-west. With regard to access to treatments for children and adolescents with diabetes in HSE west, diabetes care is provided to this group at Letterkenny General Hospital, Sligo General Hospital, Mayo General Hospital, Roscommon hospital, Portiuncula Hospital, University Hospital Galway and mid-western regional hospitals. This care is provided by paediatricians with an interest in diabetes, as well as clinical nurse specialists.

In addition, the first paediatric endocrinologist in HSE west was appointed recently at the mid-western regional hospital in Limerick. There are transitional clinics in place across HSE west for children and adolescents who are transferring from paediatrics to adult services. Paediatric care is recognised as an important element of the diabetes programme required to maintain the health of the diabetic population. Regional diabetes services implementation groups are working to improve provision and access to services for paediatric patients with diabetes. I thank the Senator for raising the issue.

Senator Terry Leyden

I thank the Minister of State for her very comprehensive reply. Although I was at one stage Deputy Terry Leyden I am now a Senator. It is a while since I was there. I will convey the Minister of State's reply to the organisation and we will follow up any queries. I thank the Minister of State and her officials for putting so much work into the reply.

An Cathaoirleach

The Senator is glad to be here.

Senator Terry Leyden

I certainly am, and the Cathaoirleach is glad to be where he is. I am thankful for the opportunity to address the issue on the Adjournment, which is a very useful vehicle for getting responses from Departments.

Senator Imelda Henry

I thank the Cathaoirleach for providing the opportunity to speak to this issue on the Adjournment and the Minister of State for coming to the House. The removal of breast cancer surgery services from Sligo General Hospital almost two years ago was very disappointing for the women of the north west. It was an excellent service that worked very well and it is greatly missed. I know the Minister for Health is in discussions with the National Cancer Control Programme manager on the issue and I await the decision on the matter. I hope the Minister will be in a position to return the service for the women of the north west.

Mammography services ceased in Sligo General Hospital in October 2009 and with the transfer of the breast cancer treatment services, the plan was to ensure a surveillance mammography service would be in place in Sligo General Hospital for patients with a previous diagnosis of breast cancer. Given the above, it would be necessary to ensure a service would be provided from University Hospital Galway as the cancer centre, and radiographers would travel from the hospital in Galway on an agreed basis.

To complete investigations for patients falling within the Sligo catchment area, the National Cancer Control Programme funded two radiographer positions. The successful candidates for the positions were subsequently promoted internally and these posts were then subject to the national moratorium, and as such they have remained unfilled to date. Patients have therefore been forced to continue to travel to Galway for post-cancer mammography until resolution of the issue. I ask the Minister to ensure radiographers are put in place as soon as possible.

In September 2008, the Friends of Sligo General Hospital received a national lottery grant of €170,000 in recognition of the need to purchase a bus and formalise a daily service between Sligo General Hospital and University Hospital Galway. At the time of the initial allocation when the Friends of Sligo General Hospital committee sought to purchase a bus service, the quotations received were in the region of €300,000, and it was impossible therefore to proceed with the purchase at that time.

To this end and in the context of the current economic climate, where the cost of the bus has decreased, the Friends of Sligo General Hospital committee purchased a bus in early 2011, with additional funding from Cancer Care West and the Sligo General Hospital oncology unit trust. This bus has been commissioned to the highest possible specification in consultation with patients and local groups and it is expected that the bus will be on the road within weeks. The facility will provide transport for patients from Sligo for breast clinic services, radiotherapy and oncology appointments where necessary, and it is a positive development for patients in the region. The revenue cost of this new bus service is estimated at between €90,000 and €100,000 per year. The HSE is reviewing its policy on eligibility for non-ambulance based transport services. I urge the Minister to expedite this review and make provision to fund the revenue costs for this very valuable and much needed service.

Deputy Kathleen Lynch

I am taking this matter on behalf of the Minister for Health, Deputy James Reilly, and I thank the Senator for bringing it to our attention. I welcome this opportunity to address the House on the issue of cancer services at Sligo and across the system. The burden of cancer continues to increase. This year, approximately 24,000 people will be diagnosed with invasive cancer and over the coming years, the numbers diagnosed will continue to rise owing to the ageing profile of our population. This provides a major challenge for cancer control.

The national cancer control strategy addresses this challenge. It envisions a cancer control system that will reduce Ireland's cancer incidence, morbidity and mortality relative to other EU countries. Prevention, early detection and treatment are all core elements of such a system, and continued progress in these areas remains a high priority for the Minister. With regard to prevention and early detection, the programme for Government includes a commitment to extend BreastCheck to include women who are aged 65 to 69 years of age. At present BreastCheck is available nationwide to women aged 50 to 64. The HSE's National Cancer Control Programme is examining how it can extend the programme to those aged 65 to 69.

With regard to treatment, considerable work was done by the National Cancer Forum, which developed the cancer strategy, on how treatment services should be organised, especially in acute hospitals. The strategy set out the rationale for the restructuring of cancer services in our hospitals and recommended that cancer centres which each serve a minimum population of 500,000 should be designated by the HSE and that Ireland required approximately eight such centres. Accordingly, in 2007 the HSE designated eight hospitals as cancer centres and established the National Cancer Control Programme to implement changes in how treatment services were organised and delivered.

A key element of this is the centralisation of diagnosis and treatment for cancer in the eight centres.

This is in line with international evidence which shows that the best outcomes for patients are achieved by specialist teams in specialist settings with access to ongoing education, training, research and peer review. Sligo General Hospital is one of a number of hospitals from which breast cancer diagnosis and surgery was transferred in line with the HSE's cancer strategy. The transfer took place in August 2009 and women in the Sligo area are now provided with breast cancer diagnosis and surgery at Galway. It is important to note that 96% of women who attend the Galway unit do not have cancer and only one visit is normally necessary. For the small number diagnosed with breast cancer, 85% will require radiotherapy as well as surgery, which would involve treatment in Galway.

Chemotherapy services continue to be provided in Sligo and are linked with the necessary multidisciplinary team in Galway. The Minister is pleased to confirm that recruitment of a second medical oncologist for Sligo is in train. There is also a specialist breast nurse in Sligo and detailed clinical pathways have been worked out for Sligo patients presenting with post-operative infection or other conditions so as to minimise the need to travel to Galway. Sligo also provides a significant range of other cancer services, including surgery for non-melanoma skin cancer and colorectal cancer. It has also been selected as one of the 15 candidate colonoscopy centres for the colorectal cancer screening programme to be launched next year.

The Minister intends to keep the current arrangements for cancer treatment at Sligo under review, particularly in relation to follow-up mammography services for women. These services are currently provided from Galway. The Minister shares the Senator's concerns and will keep the matter under review.

Third Level Fees

Senator Kathryn Reilly

I thank the Minister of State for taking my Adjournment matter on third level fees. Today 58,795 students across the State sat down to their leaving certificate and leaving certificate applied examinations. Six years ago I was one of those students. With my CAO form completed and submitted, I could prepare for college because the absence of third level fees opened up endless possibilities for me, just as it did for hundreds of thousands of students. I call on the Minister for Education and Skills, who last week refused to rule out the re-introduction of college fees, to honour the commitment he made to the thousands of students who are starting their exams today so that they can have confidence in their future. Prior to the election, he told students that he would oppose extra charges. On 17 February of this year he stated:

A knowledge economy begins with a knowledge society, not the other way around. Labour is committed to putting universal education, from the cradle to the grave, at the heart of the next Government.

On 8 April 2008, the Tánaiste asked the following important question: "We should ask ourselves whether the third level sector is under-funded because fees were abolished, or because the abolition of fees was successful, in part, in encouraging greater numbers into third level — numbers were not matched by appropriate levels of Government funding."

The reintroduction of fees will coincide with huge financial problems for families and prospective students. These are the families who are facing the universal social charge, the new levy on private pensions and reduced social welfare benefits. Some of them will be graduates who have already borne the brunt of cuts to their student grants. I hope the Government can at least provide young people with the possibility that comes from an education, having deprived them of so much else.

We need a well educated and skilled workforce if we are to deliver economic growth. The Government recognised this when it committed in the programme for Government to increase the number of places in further education and to provide a range of initiatives to increase access to further and higher education for the unemployed. However, we now hear that the Government is considering the re-introduction of fees. The introduction of fees will be a disincentive for people to enter or return to higher and further education. For most young people it will offer only a choice between hardship in education and an uncertain future of the dole or emigration. That is not a choice to put before our young people. For many the choice will be simple and we will ultimately bear the cost.

We should not forget those who want to return to education to gain new skills. The recent report by the expert group on future skills needs found that jobseekers with third level qualifications coupled with work experience and foreign language skills were the most successful in finding employment, even during the recession.

What is needed now is an appropriate use of the resources we can afford to devote to third level, appropriate levels of pay, less duplication across institutions and a concentration on undergraduate provision in the subject areas that offer the prospect of delivering economic development. The Hunt report recognises that greater investment in higher education is required but suggests that it should come in the form of higher fees. Nowhere does it reveal an understanding of the impact that investment in higher education has on Government finance. The OECD document, Education at a Glance, highlighted not just the individual benefit from investment in third level education but also the benefit to the Exchequer. On average across OECD countries, a man with third level education will generate $119,000 more in income taxes and social contributions over his working life than someone with an upper secondary level of education. The returns to governments arise from higher income taxes and social contributions, as well as a lower likelihood of unemployment and associated costs to the public purse. Graduates clearly benefit personally from a third level education. Over their lifetime they will be paid over 60% more than someone whose education ceased at second level but a progressive tax system should recognise that by taxing higher earners.

Earlier today I pointed out that increasing our competitiveness was crucial to promoting economic growth. The World Economic Forum identified under investment in education and research as key factors that undermined our competitiveness. We cannot gain competitiveness by lengthening dole queues or forcing our young people to emigrate. Now is the time to invest in our education system and in our people. It is not the time to take a policy step backwards nor is it the time to introduce third level fees.

Deputy Kathleen Lynch

I am taking this Adjournment matter on behalf of the Minister for Education and Skills, Deputy Ruairí Quinn. I thank the Senator for raising the matter and will begin by outlining the background to the reform programme that is being undertaken in the higher education sector. The national strategy for higher education to 2030, which was published earlier in the year, provides a working blueprint for enhancing and developing the system to ensure it can meet the challenges of the future. An implementation group is already in place to oversee and co-ordinate the strong partnership effort that is now required across the academic community, higher education leadership and the various agencies and interests that interact with various parts of the system.

It is estimated in the national strategy that an additional €500 million will be needed by 2020 and a further €450 million by 2030 just to maintain current levels of resource per student given the projected level of increased demand for higher education. It is estimated that demand will grow by over 70% in the next two decades. Given our current fiscal difficulties, it is clear there will be resourcing issues if we are to meet projected demand. If we are to maintain and enhance standards of quality in higher education we must now examine closely the sustainability of funding arrangements for the system. We have to reconcile future demand for participation growth with limitations on public resources and a need to protect and enhance core quality. Although the nature of these difficult trade-offs are described in the national strategy, more detail is required with regard to a detailed comparative analysis of international benchmarks for sustainable funding levels in this context. We need to know more about how the three parameters of numbers, funding and quality interrelate in order that we can manage the tensions and trade-offs involved. This will allow us to support realistic and sustainable levels of growth in numbers and inform better choices on policy options for future funding.

The programme for Government provides a commitment to undertake a full review of third level funding with a view to introducing a funding system that will provide third level institutions with reliable funding but does not impact on access for students. We also need to ensure that we are extracting the full value and potential of all of the existing resources available to the sector to do better with less. In this regard, the Minister has asked the Higher Education Authority to undertake further work on the sustainability of the existing funding framework over the course of this year.

As the Senator will be aware, the previous Government introduced a new student contribution charge of €2,000 with effect from the 2011-12 academic year to replace the existing student services charge of €1,500. This increased charge will come into effect in the autumn. The Minister will be considering all the issues involved as part of the wider consideration of the implementation plan for the higher education sector. I thank the Senator for raising this matter.

Senator Kathryn Reilly

Students will be charged €2,000 again this year but there is uncertainty about what will happen in 2012 and 2013. The Minister of State said the HEA is working on a report which the Minister commissioned. Will the Minister outline the terms of reference for the new report to both Houses of the Oireachtas, given the Hunt report has already been published? It would be beneficial to all involved if we could see the terms of reference. Furthermore——

Seanad Éireann díospóireacht - Wednesday, 8 Jun 2011