Seanad Éireann díospóireacht -
Wednesday, 14 Nov 2012

Vol. 218 No. 8

Adjournment Matters

Hospital Staff Issues

Senator Kathryn Reilly

I welcome the Minister of State to the House. This issue concerns podiatry services and I am sure the Minister of State is aware there was much concern about the availability of podiatry services and posts in various hospitals across the State, especially promised positions and posts that have not been filled. I raised in particular the case of Cavan general hospital and the HSE issued a response at 5 p.m. yesterday in this regard. It confirmed that a podiatrist had been recruited and commenced employment in the Cavan hospital but the post holder subsequently resigned. The HSE is commencing a process of recruitment to fill the post.

The Cavan-Monaghan hospital group has advised that there is an interim contingency plan to ensure that a podiatrist is providing care to patients who have been prioritised and require urgent attention. As the focus of this matter has shifted, I will highlight the background to the request for the matter, particularly the contingency plan that will be in place until the post is filled in Cavan hospital. There seems to be much uncertainty, particularly with regard to patients with diabetes, who have a concern about the filling of those positions not only in Cavan but across the State.

The HSE promised it would provide 16 whole-time equivalent podiatrists in 2010 across Ireland to screen for foot disease and deal with at-risk feet. The national diabetes programme set a target of 30 April 2012 for the recruitment and appointment of podiatrists. Figures from November indicate that six of the 16 posts are officially deemed to be filled by the HSE, and there is concern that the recruitment embargo was affecting the filling of these positions. Will the Minister of State clarify why the posts have not been filled? There is concern, particularly among patients with diabetes who are trying to avail of this care. There is a high incidence of amputations in the past couple of years, with 2,539 people with diabetes having lower limb amputations between 2005 and 2011. Therefore, the availability of podiatrists is important.

We received the two-line response from the HSE yesterday evening. Will the Minister of State confirm that the position promised is subject to an ongoing recruitment process? A podiatrist had been appointed but resigned. What is the contingency plan to service the Cavan hospital, which must service both Cavan and Monaghan?

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

I thank the Senator for raising the issue and even if the issue was solved, we would have to consider the broader process. Diabetic foot disease is one of the most common, serious, feared and costly complications of diabetes. Patients with diabetes are between 15 to 40 times more at risk of a lower limb amputation than their non-diabetic counterparts. Some 80% of lower limb amputation in diabetes is preceded by the development of a foot ulcer and it is estimated that the annual incidence of lower limb ulceration in patients with diabetes varies from 2.2% to 7%.

Diabetic foot disease is costly, with patients frequently requiring admission to hospital, investigations, surgery and a prolonged hospital stay. International studies show that targeted foot care and proper screening of at-risk cases can result in a reduction in the incidence of foot ulcers in patients with diabetes. With the targets of reducing foot ulcers, lower limb amputations and hospital costs in patients with diabetes, the national diabetes programme submitted a business case for the 2011 HSE service plan and was successful in recruiting 16 extra podiatrists across the country to manage diabetic foot care. As a consequence, the national diabetes programme developed a national model of diabetic foot care using current podiatrists and newly-appointed diabetes podiatrists. It is hoped that over time, the number of diabetes podiatrists will increase and the model will change and adapt to accommodate the increase in podiatry numbers.

The Government has decided that the numbers employed across the public service must be reduced in order to meet the fiscal and budgetary targets. The end 2012 health service employment ceiling has been set at 101,960. Within the overall ceiling, the HSE can make exceptional appointments but the number of posts must be kept to a minimum given the need for the health sector to make financial savings this year in additional to the employment targets.

Given the HSE's current financial situation, it introduced a recruitment pause in July this year. Apart from critical exceptions, this pause applies to all posts except for service plan development posts in primary care, mental health and child protection. The HSE has confirmed that a 0.5 whole-time equivalent podiatrist was recruited and commenced employment on 5 June 2012 in Cavan General Hospital. Unfortunately, the individual resigned from the post on 31 October. However, the HSE has commenced the process of recruitment in an effort to fill this post as soon as possible. Meanwhile, an interim contingency plan is in place to ensure a podiatrist is providing care to patients who have been prioritised as requiring urgent attention. The cumulative impact of staff reductions from this year and previous years presents a significant challenge for the health system in delivering services. However, the HSE is seeking to mitigate the impact of these reductions by using the provisions of the public service agreement to bring about greater flexibilities in work practices and rosters, redeployment and other changes to achieve more efficient delivery of services; delivering greater productivity through the national clinical programmes to reduce the average length of stay, improve day of admission surgery rates, increase the number of patients treated as day cases, etc.; and limited and targeted recruitment in priority areas.

The Senator has rightly outlined the issue relating to diabetes and it is one of the clinical programmes we intend to deliver through primary care. Advances have been made but, I agree entirely, not enough

Senator Kathryn Reilly

If the Minister of State could pass on information on the stage the recruitment process is at, I would appreciate it. Given the person holding the post would have given notice, I do not want this to take too long.

Deputy Kathleen Lynch

I will get further information for the Senator but my experience is that it takes a considerable number of weeks between advertising, recruitment and getting someone in post.

Crime Prevention

Senator Thomas Byrne

I am grateful to the Cathaoirleach for the opportunity to raise this issue, which was listed as "The need for the Minister for Justice and Equality to tackle rural crime". I do not expect him to go out to defuse riots like Churchill did when he was Home Secretary. It would be an interesting proposition but it is not necessary. There is no question rural crime has reached epidemic levels. Driving around the rural parts of my constituency, one would be under the impression they are wealthy because all the properties have electric gates. This phenomenon is particularly concentrated in parishes into which known criminals have moved. When politicians are canvassing or farm salesmen or others going about their normal business, they encounter electric gates which have been put in place out of fear. The fear of crime in rural areas has not been drummed up falsely; it is based on statistics. According to the annualised totals in the Central Statistics Office, CSO, report, burglaries increased by 10% in the year to the end of the second quarter. In the Garda eastern region, they have increased by 24%, which is a frightening statistic, and I am not convinced every burglary is being reported to the Garda because, in some cases, people feel nothing will happen. I encourage people to make sure they report these crimes not only for insurance purposes, but to make sure the statistics are right.

I know of many cases. An elderly woman living alone was rescued by my uncle who heard her screams 300 metres down a rural road. Four months later, a family is still traumatised after people dressed up as gardaí entered their house, burgled it and threatened them. Theft of cars and money is widespread and it is being facilitated by our good road network. People are travelling from Dublin to County Meath in the Garda eastern region to commit burglaries before returning home. The figures bear that out with a 24% increase in the number of burglaries in the past year.

Fear has increased following the decision of the Minister for Justice and Equality to close more Garda stations in rural areas. He closed some last year and there is speculation about others that will be closed. The speculation in newspapers is leading to more fear among the good citizens of this country that not only might they be burgled, but there will not be a Garda presence to protect them. People see Garda stations in their areas as a sign of help and it is no coincidence in my area that some of the worst burglaries have been committed in parishes that are not adjacent to stations. Stamullen is near the motorway but there is no Garda station for miles and the area is looked on as easy pickings. The Garda in conjunction with the Minister for Justice and Equality must come up with a radical strategy to address this.

I pay tribute to the communities throughout Ireland that are taking steps themselves to deal with this problem. In my area, Mr. Ronan Murtagh and the Drumconrath community alert group pioneered text alert schemes which are becoming more widespread in the State. That is an example of a community taking the initiative. When the Stamullen community alert scheme was set up, it had a noticeable impact on the crime figures. Communities need more help from the State and the Garda because when burglaries increase by 24% in the Dublin commuter belt, which comprises the bulk of the Garda eastern region, people have reason to be frightened and have reason to expect a comprehensive response from the Government.

Deputy Kathleen Lynch

I thank the Senator for raising this matter, which I am taking on behalf of the Minister for Justice and Equality, who unfortunately cannot be present due to other business. While the incidence of crime is generally lower in rural than in urban areas, I assure the House that the Minister is conscious of the deep distress burglary and similar crimes can cause to householders in rural areas and the broader impact it can have in terms of fear of crime in our communities. The Minster also shares the widespread outrage at incidents of aggravated burglary in rural areas and is confident that gardaí are doing everything in their power to bring the perpetrators of these heinous crimes to justice. The latest official crime statistics from the CSO show that most types of crime are falling and this reflects well on the work of An Garda Síochána. In particular, crimes against the person, including murder, are down by 8%, as are assault and related offences, which are down by 9.7%. Public order and damage to property offences are also down by 13.1% and 10.8%, respectively.

Both the Minister and the Garda Commissioner remain concerned about the incidence of burglary and, therefore, welcome the progress being made as part of Operation Fiacla, which is running for 12 months initially, with effect from February 2012. The operation is the subject of regular monitoring and review by senior Garda management and is focused on identifying and targeting gangs involved in burglaries around the country to disrupt their activities and bring them before the courts. Operation Fiacla is intelligence driven and specific burglary initiatives have been implemented in each Garda region to target suspect offenders. As of 19 October, 2,493 persons had been arrested and 1,404 persons had been charged as part of the operation, reflecting the substantial efforts being made to tackle this problem by the Garda. These results show that the Garda Commissioner is effectively deploying the substantial resources available to him in a targeted approach to confront those engaged in this form of criminality.

In addition to the concerted law enforcement efforts being pursued by An Garda Síochána, crime prevention is a key strategy in tackling crime in rural as well as all other areas. The Garda national crime prevention unit and crime prevention officers at divisional level provide advice, information and support to organisations, businesses and individuals aimed at reducing burglary and property crime. Furthermore, the Garda national model of community policing plays a key part in responding to crime by taking into account and responding to local conditions and needs.

Under this model there will be a community policing team in each district, headed up by a sergeant. Clear objectives will be set, such as high visibility in the community, ease of contact by members of the public, and enhanced support for crime prevention strategies. In this regard the Garda Síochána continues to work closely with communities to enhance community safety in a wide range of local fora, including through partnership programmes such as community alert and neighbourhood watch, as well as more formal structures such as joint policing committees.

While the Minister fully understands the concern that communities may have about Garda station closures, he is convinced that in providing a modern, effective police force, the emphasis should not be on bricks and mortar. Until the station closures earlier this year, the State had a Garda station network that was mostly unchanged since 1922 and that took no account of modern transport, communication and policing methods. It is the Government's intention to ensure front-line services are maintained at the highest level possible through the most efficient use of resources. The Commissioner has the Minister's full support in this regard and has every confidence that he and everyone in the Garda Síochána will continue to deliver an effective police service in rural as in all other areas.

Senator Thomas Byrne

I thank the Minister of State for her response. I pay tribute to the Garda Síochána, which is working hard in local communities. I put particular emphasis on community alert, neighbourhood watch and the joint policing committees. More needs to be done in the teeth of Operation Fiacla. Statistics show that burglary, in particular, is increasing. I acknowledge that other crimes, such as murders - down by 8% - and assault, have decreased but burglaries affect most families who are victims of crime. Burglaries account for the largest number in the statistics. In the eastern region, in the 12 months to the end of the second quarter this year, there were 5,867 burglaries and only four homicides. When we talk about the reduction in homicide, it is not really relevant to the average person. Every murder is terrible and has a terrible impact on communities and families but burglaries are more likely to affect people in their day-to-day lives. I want to put the pressure on to continue the good work of the Garda Síochána. The Government needs to give more resources to the Garda Síochána and give a stronger focus on rural crime, particularly burglaries.

Deputy Kathleen Lynch

I will convey the sentiments of the Senator to the Minister. We are all agreed that ensuring people feel secure in their community is very important. We do not want everyone migrating to large population bases just because they do not feel secure in their own community.

Community Development Projects

Senator David Cullinane

This concerns funding for the Waterford City Community Forum and the need for the funding not only to be ring-fenced but to return to 2010 levels. The Waterford City Community Forum is one of a number of fora across the State providing a valuable service in bringing together a range of community and voluntary organisations. It is an umbrella organisation with links to Waterford City Council that ensures proper networking and sharing of information between various community and voluntary bodies, State bodies, public representatives and members of the community. At a time when communities are suffering because of cutbacks, the community and voluntary sector is being asked to step into the breach and provide services previously provided by local authorities or State agencies. It is important these organisations and community fora are supported. I can vouch for the Waterford City Community Forum. One of the strengths of the community forum is that the people elected from constituent organisations, of which there are 220 in Waterford, use their representatives to sit on a range of State positions. This includes strategic policy committees, joint policing committees and others. These fora members provide a vocal and necessary community voice for those representing the community and voluntary sector.

The Department of the Environment, Community and Local Government supplied figures in respect of Waterford. The Waterford City Community Forum received €25,925 in 2008, which was reduced to €24,344 in 2009 and to €21,522 in 2010. In 2011, it was halved to €11,696 and in 2012 it will amount to €11,213. Following that pattering for the next five years, the forum will end up giving the State money. It is important funding is returned to a realistic level to enable the forum to have a worker doing the necessary work of providing information sharing, dissemination of information, organising meetings and overseeing an important structure. I hope the Minister of State agrees. I impress upon the Minister of State the importance of funding these fora. I can only vouch for the Waterford City Community Forum, which I am familiar with and which has done fantastic work. In view of the proposed amalgamation of Waterford city and county councils, there is concern about how the forum will continue to be funded. During discussions about the merger, the concerns of the Waterford City Community Forum should not be lost. I have concerns about the merger, which may be outside my control, but I hope the voice of the Waterford City Community Forum is heard and that the issues are dealt with.

Deputy Kathleen Lynch

I am responding to this matter on behalf of my colleague, the Minister for the Environment, Community and Local Government, Deputy Phil Hogan. I agree with the comments of the Senator on community development and community fora and the work they do in the co-ordination of various groups in areas desperately in need of such input. I share the concern that sometimes, when there is a louder argument, the smaller argument gets lost. It is important we do not lose sight of the smaller part of the puzzle.

I will briefly provide the Seanad with some background information on the community and voluntary fora and then discuss the funding provided for the fora by the Department of the Environment, Community and Local Government. Community and voluntary fora were established in each city and county, in association with the establishment of the county and city development boards in 2000. The fora have facilitated the community in making an input into the work of the boards and local government generally, as well as having representation on the local authority strategic policy committees, joint policing committees and many local development companies.

The White Paper on supporting voluntary activity in 2000 provided that funding would be made available through the Department of the Environment, Community and Local Government to support the fora. The funding is used to support the fora in organising meetings, communicating information and providing capacity building and training for forum members, particularly those representing the socially excluded. In deciding the distribution of funding to the fora, criteria were developed by the Department to ensure counties with smaller populations receive a reasonable amount while also catering for the bigger and more populated counties and cities. As set out in the National Recovery Plan 2011-2014, current economic circumstances mean public expenditure has had to be substantially reduced across Departments, agencies and programmes. As a result, there were competing demands for very scarce resources from a range of genuine interests and difficult decisions had to be made. The priority in these circumstances is to limit, to the greatest extent possible, the impact of expenditure reductions on essential services on those most in need. In this context, a review of the funding made available to the fora from the Department's vote was necessary and unavoidable.

Following the review, a commitment was made that the community and voluntary fora would continue to be supported and a provision of €600,000 was provided in the Department's Vote for 2012 to support the fora in each county and city council area. The funding is in addition to the financial support provided by local authorities for the participation by fora representatives on county or city development boards, strategic policy committees and joint policing committees.

Waterford City Community Forum was allocated funding of €11,213 by applying the criteria developed by the Department of the Environment, Community and Local Government which are based on population census results. At this stage the Minister cannot give a commitment to any individual organisation regarding budgets for 2013. He will, however, endeavour to make the best possible use of the resources available.

I am sure the Senator would not have expected any commitment at this point in the budgetary process. The Minister is very much aware of the value of community fora.

Senator David Cullinane

I am sure there are the same difficulties throughout the country. Nevertheless, the 220 community and voluntary organisations that make up the Waterford City Community Forum are struggling to keep their own funding. The Minister's response, read by the Minister of State, refers to scarce resources. We all accept that. All organisations are fighting tooth and nail to hold on to their resources. This, however, strengthens the case for an over-arching umbrella group that is properly funded and can ensure maximum sharing of information in order that each organisation does a smaller proportion of the total work. Even this support structure is being undermined. Given that funding went from €24,000 to €11,000, the only employee the forum has is now working part-time and that, obviously, has an impact.

Will the Minister of State relay to the Minister the importance of providing support for the community and voluntary sector which is struggling? Community and voluntary organisations need a proper support base.

Deputy Kathleen Lynch

There is no disagreement. We are agreed on the value of the work done. The difficulty is that as the pot of money has reduced substantially, the amount that can be distributed must equally be reduced. We are not disputing the value of community fora. I will, however, convey the Senator's views to the Minister.

The Seanad adjourned at 7.05 p.m. until 10.30 a.m. on Thursday, 15 November 2012.