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Seanad Éireann díospóireacht -
Tuesday, 27 Sep 2011

Vol. 210 No. 6

Adjournment Matters

Hospital Services

I welcome the Minister of State, Deputy Shortall, back to the House and call on Senator Denis O'Donovan to propose the first motion.

I also welcome the Minister of State to the House to speak briefly on the issue concerning one of, if not the most, geographically peripheral hospital, Bantry General Hospital. It is an old hobby-horse of mine. I was involved in the action committee back in the 1980s.

There is grave concern and a public meeting is being called by a member of the Minister of State's party on Friday night to address a couple of issues. First, the reconfiguration of the ambulance service seems to indicate there will be a loss of acute ambulance services in the peninsular and west Cork regions, places such as Mizen Head and Allihies. Many people do not realise when they talk of being close to the hospital that the nearest hospital, Cork University Hospital, is roughly a two and a half hours drive on somewhat unconducive roads.

Bantry General Hospital currently has an accident and emergency unit of sorts. It is not in the full sense of what that means, but there is a 24 hour, seven day a week service there. In the event of a casualty, it has probably one of the finest intensive care units in Ireland. There are four excellent consultants in Bantry General Hospital. There are cutbacks in different departments and there is a grave fear that, whether it is the ambulance reconfiguration or the reduction of the number of consultants from four to three, any diminution of services would create havoc in this area.

The population base for Bantry General Hospital is approximately 65,000 and takes in a little of south Kerry as well. The important point to note is that not that long ago the hospital had a maternity unit, which is now closed and which we accept will never reopen. What the public will not accept is a scenario where current services, including the assessment unit and minor injuries unit, would be closed at weekends or even during the week by operating on an 8 a.m. to 8 p.m. basis. This would create considerable difficulties because we are so far away from the centre of attention. We will never get a cancer unit or full cardiac unit in the hospital but what we have, we should hold.

The public, public representatives across party lines and the HSE agreed to the reconfiguration of services in order that there would be an improvement. We have a relatively new hospital. A couple of Ministers have visited it over the years. It was only built in 1960. The theatres are under-utilised, and in the reconfiguration it was hoped that a consultant for day elective surgery procedures would come, possibly from Tralee or Cork, and at least keep the flag flying there.

The purpose of my motion is to indicate that there are concerns. I am not one for public meetings, major protests or whatever. I seek reassurance from the Minister of State, Deputy Shortall, or the Minister, Deputy Reilly, that the facilities in Bantry General Hospital which are not utopian, as we would like to have them, but for which we have fought for several decades will be retained and that there will be no diminution of services, whether it be ambulance services, a reduction in the number of consultants or the removal of its 24-7 facilities.

I thank the Senator for raising this issue, to which I am responding on behalf of my colleague, the Minister for Health, Deputy Reilly. I am glad to have an opportunity to clarify a number of points.

The Government wants a health service which is safe, of high quality and affordable. Local hospitals can and should be a vibrant element of local health services. They should provide treatment and care at the appropriate level of complexity for patients in their areas. That care must be safe and not put patients at risk. HIQA has set out the type of services that can safely be provided in smaller hospitals in the reports on Ennis and Mallow hospitals. The HSE is developing proposals for future acute hospital services in Bantry General Hospital, in line with the national clinical programmes.

While the emergency department at Bantry General Hospital deals mostly with minor injuries, with an average of three attendances per day between 8 p.m. and 8 a.m. so far in 2011, Bantry's remote rural location is recognised and this needs flexibility in the application of all programmes of care being delivered. HSE South has in recent months again engaged with senior clinicians, GPs and management in Bantry, most recently on 2 September. Proposals are expected to be finalised in the coming weeks, consistent with the outcome of the comprehensive consultation process. The proposals will reaffirm Bantry General Hospital's crucial role in providing acute hospital care in west Cork as part of a wider network of acute hospitals across counties Cork and Kerry. However, no final decisions will be made on models of service delivery in small hospitals until the Minister has had an opportunity to study this in detail.

Pre-hospital emergency care is critical to the successful implementation of the HIQA recommendations on smaller hospitals. Current evidence suggests patient outcomes can be improved by better treatment and stabilisation at the scene, with ongoing treatment and transport to the most appropriate centre, even if that takes longer. On-duty service gives a modern emergency response service, involving paramedics, advanced paramedics, community first responders and GP out-of-hours services, working together to respond to emergencies. This approach is consistent with international best practice and will ensure compliance with HIQA response times and quality standards.

I am happy to confirm that no ambulance stations are closing in west Cork. In fact, the opposite is true; stations will be moving to on-duty status and away from on-call status. This means our highly trained paramedic crews are on site in their stations to respond to calls rather than having to travel to a station on being called out. It also means resources can be deployed dynamically, based on need and predictable demand rather than simply location, thereby giving greater flexibility and responsiveness. The dynamic delivery model means an on-duty emergency ambulance will be available from within the region, as required. This will produce better response times for people in counties Cork and Kerry and a better service. Other developments include improved arrangements for control and dispatch, practitioner deployment and inter-hospital transfers. All of these will allow the national ambulance service to provide a better, safer, more comprehensive and efficient emergency ambulance service for the people of counties Cork and Kerry.

There has been extensive consultation on Bantry General Hospital's future, both on acute services and pre-hospital support, with the staff, the public and public representatives. The need to change in order to ensure safety and the future role of the hospital is understood and supported. The HSE will continue to communicate with staff, the public, public representatives, health professionals and other interested parties on how best to provide services in the region. The Minister and the HSE recognise the importance of Bantry General Hospital and the contribution it has made and will continue to make to the provision of hospital services in the region.

I thank the Minister of State for her response which, by and large, is reassuring. I hope the fears being generated at local level can be set aside and what the Minister of State has set out will produce positive rather than negative results. I hope that in the coming months the commitments given by the Minister through the HSE on reconfiguration, in particular with regard to acute services, elective surgery and so forth, will be met.

Mental Health Services

I welcome the Minister of State, Deputy Shortall. I raise this matter to request the Minister for Health to fund residential treatment in the United Kingdom for a young woman with a severe borderline personality disorder who has been certified as being at imminent risk of suicide and who has already attempted suicide on 14 occasions. This is a severe and pressing case. It is the first time I have raised a matter of this nature in the Seanad and I do not do so easily. It is a case worth listening to carefully.

I have been contacted by the parents of a beautiful 22 year old woman. For the purposes of this debate, I will call her Danielle which is her first name, but that is as far as I will go in identifying her. She has been unwell for over six years and has been diagnosed with a borderline personality disorder. She started to self-harm at the age of 15 or 16 years and has had many admissions to hospital since. She has required surgery on many occasions. Her problem was discovered during her first term in UCD. Prior to that, she was a bright and energetic teenager with a promising future. She was involved in swimming, dancing and various other activities; she did a lot of voluntary work both in Ireland and abroad and was a very good student. She has spent 20 months of the last three years as an inpatient in various psychiatric wards in both Dublin and Galway and has attempted to take her own life on 14 occasions. The last attempt was on Friday, 2 September while she was an inpatient at a psychiatric facility.

Danielle's parents were advised earlier this year by a number of health care professionals to look for treatment in the United Kingdom or elsewhere abroad. They spoke to the consultant psychiatrist at McLean Hospital in Massachusetts in the United States who specialises in this condition. He advised that the cost of treatment there would be prohibitive and that they should investigate possibilities in the United Kingdom. They feel very fortunate that they have identified the best demonstrated and documented treatment for borderline personality disorder, intensive dialectic behavioural therapy, DBT. With a number of health care professionals, they researched several locations in the United Kingdom and found an institution which treats females with borderline personality disorder, which mostly affects females. Some 95% of the referrals to the centre are from the National Health Service in the United Kingdom.

The outcomes from intensive DBT programmes are excellent. Following this degree of intensive treatment, many need fewer admissions to acute psychiatric institutions. However, intensive DBT programmes are not available in this country. That is the key point to be made.

Danielle had a four hour assessment in the centre in the United Kingdom. Her parents were very impressed by that assessment and the professionalism of those who carried it out. It is a residential centre which offers a range of therapies on a daily basis as part of a lengthy programme of between eight months and one year. They were advised one week after her visit that their daughter had secured a place.

The first application for treatment abroad through the E112 process was made to the HSE on 24 July, but it was refused on the grounds that it did not meet the criteria laid down. The parents appealed this decision and asked the HSE to reconsider the application. They submitted all of the documentation required, as well as the letter documenting the excellent assessment that had been made in the United Kingdom, but, once again, they were refused on the grounds that the family did not satisfy the criteria. Instead, the HSE has offered a limited dialectic therapy service for one hour a week to their daughter.

DBT comprises four elements, but the therapist employed by the HSE can offer just one element of the four. The treatment being offered is less than what Danielle has been receiving in the past two years and that treatment has not worked. The process of applying for treatment abroad is not easy; it is slow and arduous. It takes time, even before an application is submitted, and is highly traumatic and distressing for patients and their families. The family in question have told me their daughter found the process so distressing that she became acutely suicidal and had to be admitted for observation. As a consequence, she is again an inpatient in an acute bed. The more she is refused, the worse it is for her because her coping skills are absolutely gone. The family have informed me that since the appeal was refused, their daughter has lost all hope and the will to live and, for the most part, is deeply agitated. They note she is extremely disappointed she has been refused the treatment and therapy she desperately needs to survive. Moreover, they have told me it was heartbreaking for them to watch her deteriorate before their very eyes in the knowledge she was being prevented from availing of the treatment she urgently needed. They find it hard to keep up her spirits each day, as she cannot understand the reason she is being denied treatment that could give her hope to live and have a life.

This is a willing participant who is not fighting against having such treatment. I am sure many families are going through similar traumas as living with mental illness is not easy. There is still a stigma attached to it in Ireland. There is a dearth of essential therapies, counsellors and psychologists to provide therapeutic care for those with a mental illness. The parents in this case have told me they are both professional public servants who have given more than 30 years of service to their country. They always have paid their taxes and tried unsuccessfully to sell their family home. It is important to note they are prepared to do whatever it takes and have tried to sell their home to raise money for their daughter's treatment because they are desperate to give her hope and a chance to live. They claim the only viable prospect for their daughter's recovery and long-term well-being now depends on her securing some HSE funding to help to pay for this treatment abroad. I understand it costs approximately €150,000. The parents insist they are not applying for full funding and are endeavouring to sell the family home. In essence, they are trying to save their daughter's life. As she has attempted suicide 14 times, each day constitutes a struggle to ensure she lives.

I acknowledge this is not a normal application to bring before the House in these straitened times. For that reason, I was careful before so doing. I look forward to the Minister of State's response.

I thank the Senator for raising this matter on the Adjournment. The Government has prioritised the development of the mental health service in line with A Vision for Change. In that context, it is committed to reforming our model of health care delivery in order that more and better quality care is delivered in the community. It is its intention that over time access to modern mental health services in the community will be significantly improved. It is proposed to ring-fence €35 million annually from within the health budget specifically to develop community mental health teams and services to ensure early access to more appropriate services for both adults and children. I am working with officials in the Department of Health and the HSE to deliver immediate and effective progress in this area.

Preventing and reducing the rate of suicide is an urgent public health issue that is at the centre of the Government's efforts and policies to build healthy and productive communities. Our policy strategy on suicide prevention, Reach Out, outlines the actions that must be taken to prevent suicide and deliberate self-harm and to increase awareness of the importance of good mental health. While much progress has been made in implementing these measures, one can never say one has done enough. It is essential that the Government continues to work and even redoubles its efforts. Members will be aware that an additional €1 million was provided this year to ensure the National Office for Suicide Prevention could build on initiatives to date. This special funding has enabled the office to target priority areas, which will make a real difference.

This year the focus will be on the further development of skills-based training and awareness programmes in suicide prevention, improving the response to those who deliberately self-harm, developing the capacity of primary care to help those presenting with suicidal behaviours, improving inter-agency co-ordination and the provision of a 24 hour emotional support helpline. I am sure Members also will be aware of the huge effort and commitment put into this area by my ministerial colleague, Deputy Kathleen Lynch, who, among other things, has special responsibility for mental health and disability services. I know she is working hard to regain the momentum in implementing the excellent strategy on mental health, A Vision for Change, and I am confident she will be successful in bringing about the improvements everyone wishes to see in this critical area for vulnerable groups.

On the case referred to by the Senator, I understand that on 25 July an application was received on behalf of the person in question in the offices of HSE West for treatment under the E112 treatment abroad scheme. A report has been obtained from the HSE on the application for funding and the subsequent appeal of the initial decision. Unfortunately, the decision of the executive which the appeals officer has upheld is that the application does not meet the conditions of the scheme and funding cannot, therefore, be provided. I understand the application was not approved owing to the fact that a treatment plan was available locally in Galway and the view of the treating consultant psychiatrist is this treatment plan should be availed of in the first instance.

I have been informed the person in question was admitted to the psychiatric unit in her area on 26 August following self-presentation and is now under the care of a consultant psychiatrist. It is the latter's view that while the person in question could benefit from admission to the therapeutic service in the United Kingdom, there are treatment services available here from which the patient would benefit and these should be used in the first instance. The consultant psychiatrist will continue to consider the request for treatment abroad while the person in question is under the care of the psychiatrist's team. I hope the person in question will avail of the treatment options being made available and that the treatment will be successful for her.

I again thank the Senator for raising the matter.

I have a supplementary question. I imagine the family's reaction will be one of grave disappointment because my understanding is they are already availing of this treatment. Am I to understand from the Minister of State's response that the conditions attached to the scheme for travelling to the United Kingdom were not met because of the views of the treating consultant psychiatrist? I hope the consultant psychiatrist in question is not taking on too much responsibility that could place a life at risk. The Minister of State should clarify whether the conditions attached to the aforementioned scheme were not met because of the views of the treating consulting psychiatrist.

To clarify, in this case the clinical decision was taken by the clinical psychiatrist. It is the view of that psychiatrist that a treatment plan is available locally in Galway and that it should be availed of in the first instance. This is not something in which a Minister has a role. A clinical decision was taken by the young woman's treating clinical psychiatrist.

We can always come back to it. I thank the Minister of State.

Army Barracks

I welcome the Minister for Defence, Deputy Alan Shatter.

I also welcome the Minister who is one of the few Ministers who personally attends this Chamber to deal with issues relating to his Justice or Defence briefs.

In 1990 the Army moved from the longest occupied barracks in Europe to the new purpose-built Dún Uí Néill Barracks in Cavan town. These are the only barracks to be purpose-built and designed by the Defence Forces since the foundation of the State and are in an important geographic location along the border with Northern Ireland. In recent weeks rumours have been circulating that this strategic base is being considered for closure by the Government. This cannot be allowed to happen. Dún Uí Néill barracks is the most economic in the country, costing less than €200,000 per year to run, which includes maintenance, utilities, electricity, heating and transport fuel.

As well as serving the State as an aid to civil power, the Army based in Cavan has shown great commitment to the community it lives among. Its state-of-the-art gymnasium and other sporting facilities are regularly used by county teams as well as other local football and sports clubs. Senior citizens are facilitated regularly as well as at Christmas time each year. The local Youthreach project participates in a two week training programme during the summer months. The Army also assists groups in fund-raising and facilitates weekly church services. The support it gave to the local emergency services during the bad weather of recent winters was immeasurable.

Some 120 soldiers from A Company 6th Battalion of the western command currently occupy the barracks. This number can increase from time to time as the barracks is regularly used as a training facility. If needed it can accommodate up to 300 personnel at any given time. The Reserve Defence Force plays an important role in supporting the regular Army in this country and there is a full-time company of 120 men and women in the force in Cavan.

To close Dun Uí Néill makes no sense. The impact such a closure would have on the soldiers, their families and the community of Cavan, not to mention the €3 million that would be lost to the economy of Cavan, would be immeasurable. This cannot be allowed to happen and I look forward to a favourable reply in this regard.

I thank the Senator for raising this matter on the Adjournment. As of now, no decision has been made by the Government on the future of Cavan barracks or any other military installation. The issue of the closure of barracks no longer required for operational reasons to effect necessary savings will, however, be considered shortly by the Government.

Various commissions, reports and studies back to the 1990s identified barrack closures as a fundamental requirement towards improving military effectiveness and efficiency. Since then there have been a number of consolidation programmes which have seen the number of barracks occupied by the Permanent Defence Force reduced from 34 to 18 today. Since 1998 a total of ten barracks have been closed under the two barrack consolidation programmes. A total of €84.98 million has been realised from the disposal of seven barracks and while three remain the property of the Department of Defence, agreement in principle has been reached to dispose of two of these. The moneys received from the sales of such properties have returned to the defence Vote as appropriations-in-aid, and these increased levels of appropriations-in-aid have allowed the retention of funding levels for investment in equipment and infrastructure for the Defence Forces in recent years as well as saving substantial sums of taxpayers' money.

Some of the major programmes include the acquisition of light tactical armoured vehicles, MOWAG armoured personnel carriers, two EC135 helicopters, six AW139 helicopters and two new offshore patrol vessels. This approach is in line with the 2000 White Paper on Defence and a Government decision of 29 February 2000 which, inter alia, approved “The allocation of 100% of the revenue arising from the sale of property surplus to military requirements, for investment in equipment and infrastructure for the Defence Forces”.

Notwithstanding the progress made to date, the dispersal of Defence Force personnel over an extended number of locations continues to be a major impediment to essential collective training and to releasing personnel for operational duties. It also imposes unnecessary increased overheads on the Defence Forces in terms of barrack management, administration, maintenance and security. The consolidation of the Defence Forces formations into a smaller number of locations is a key objective of the ongoing defence modernisation programme to maximise the effectiveness and efficiency of the Defence Forces.

As is the case with all Departments, my Department has been actively reviewing all areas of expenditure for which it is responsible to ensure the maximum benefit in the public interest from the use of resources. This is a key element in the context of the comprehensive review of expenditure in which the Government is engaged. My Department has submitted its report as part of that process. This report sets out in clear terms the options available to the Government with regard to defence funding. The outcome of the comprehensive review of expenditure will determine the future resource envelope available for defence.

I wish to ensure that all decisions made and resources utilised are focused on maximising the capability of the Defence Forces and ensuring their continued operational excellence. I am also anxious to ensure, in so far as is possible, that the Government is not compelled by fiscal and budgetary constraints to effect any substantial reduction in the current number of personnel in the Defence Forces which stands at just over 9,500. It is crucial that the Defence Forces retain their existing operational capacity and capabilities and operate within the maximum financial efficiencies both in the interest of taxpayers and to facilitate our meeting our obligations to the EU and the IMF to contain and reduce public expenditure. It is this which will inform decisions yet to be made by the Government.

Cavan is a strategic base and is vital to the security of the State. Its geographical location is very important. Deputy Smith, Councillor Patricia Walsh and I met representatives of PDFORRA last Friday evening. There is great concern among the 120 personnel based in Dún Uí Néill and the 22 personnel currently serving in the Lebanon who are based in Cavan. It is important that the Minister takes into consideration these families as well as the strategic location of the barracks and its importance to the security of the State. To relocate 120 soldiers to Athlone, Dundalk or Dublin will necessitate huge additional expenditure in terms of providing accommodation. If the object of the exercise is to save money, I hope the Minister will examine the issue very carefully. No saving will be realised by closing the barracks, not to mention endangering the security of the State.

In determining what decisions should be made in this area I will pay very careful regard to the views of the military authorities and to what they say to me about security issues. The security issues with regard to the location of barracks are very much something to be assessed based on the expertise of the Defence Forces, and I must listen carefully to what they say to me. I am very conscious that any further consolidation of barracks is a cause for concern and will cause inconvenience and disruption for members of the Defence Forces located in the barracks.

The Senator's party presided over the closure of ten barracks in different parts of the country. The closures undoubtedly were disruptive from the perspective of those members of the Defence Forces affected. Sadly, the legacy we have inherited as a Government, the financial and fiscal constraints imposed on the State by outside forces and the excessive level of our public expenditure can only be addressed by making difficult and uncomfortable decisions that in different financial circumstances would not be necessary.

I must have regard to the prevailing reality with which I am confronted in the very difficult decisions that need to be made, while also appreciating the fact that such decisions are disruptive for people. I also have to do it having regard to what is in the ultimate and final interest of maintaining the Defence Forces. My concern is to ensure that I have available to me the funding, as best I can secure it, to maintain the Defence Forces at the current level of 9,500, which is the level they were at in the 1970s. In the context of the Department of Defence I have to contribute to the financial savings that we are required to secure for the year commencing 2012 when there must be a reduction of between €3.6 billion and €4 billion in public expenditure. The tragic and sad reality is that no Department or area of expenditure is immune in this context and I hope it is something the Senator would understand in the context of any decisions that may be made with regard to barracks, should any such decision affect the barracks in Cavan.

The Seanad adjourned at 5.40 p.m. until 10.30 a.m. on Wednesday, 28 September 2011.
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