Seanad Éireann díospóireacht -
Tuesday, 15 Oct 2013

Vol. 226 No. 11

Adjournment Matters

Hospital Consultants Recruitment

Senator Thomas Byrne

Gabhaim buíochas leis an gCathaoirleach as cead a thabhairt dom an t-ábhar an-tábhachtach seo a phlé ar an Athló anocht.

The issue I raise is the lack of a paediatric urologist and general lack of paediatric urology services in the Children's University Hospital, Temple Street. There is a vacancy in the hospital for a consultant urologist. Urologists perform a variety of functions but the specific group I have in mind are children with spina bifida. Children and adults with this condition experience serious problems with many of their internal organs and kidney failure is often the cause of death in people with spina bifida. Only this year, a friend of mine with the condition went to his eternal reward and, as such, I am well aware of many of the problems experienced by children and adults with spina bifida.

The case I raise involves a mother in County Meath with a young child who is unable to have routine tests carried out on her child's kidneys as a result of the lack of a paediatric urologist. I understand it is essential that people with spina bifida have regular standard checks done. These include blood tests for kidney function, renal ultrasound, DMSA scans, bladder function assessments and a number of more infrequent tests such as video urodynamic studies and spinal MRI tests. This type of routine monitoring of patients is not available for young children because of the lack of urologists in the Children's University Hospital, Temple Street, which deals with spina bifida. The position is so bad it is not even possible to see a consultant privately because the country lacks the necessary facilities.

I ask the Minister of State to indicate when a paediatric consultant urologist will be appointed to the Children's University Hospital, Temple Street. People need to be given hope that they will not find it necessary to travel abroad for routine medical treatment and monitoring. I look forward to a positive response.

Minister of State at the Department of Education and Skills (Deputy Sean Sherlock)

I am taking this matter on behalf of the Minister for Health, Deputy James Reilly, who has been unavoidably detained.

The availability of dedicated urological input is particularly relevant for children with spina bifida, a highly complex physical disability. On average, 30 children are born each year in Ireland with open spina bifida, the most severe form of the condition. Best practice is that there are multiple professionals involved on a spina bifida team. Early intervention by a specialist and local team is essential to optimise long-term functioning of the children in question and prevent medical complications later in life.

The Children's University Hospital, Temple Street, is the national tertiary care centre for spina bifida. All infants born in Ireland with spina bifida are transferred to Temple Street after birth for ongoing neonatal management. Children with spina bifida are seen by a multidisciplinary team at Temple Street which includes a consultant paediatrician with a special interest in spina bifida, a spina bifida nurse specialist and neurosurgery input.

The model of care being developed by the Health Service Executive is to share care between the specialist team in Temple Street and the local team. The best care should be provided nearest to the patient's home, with guidance and support from the specialist team. However, it is acknowledged that many complex issues are best managed by the specialist team.

The multidisciplinary spina bifida clinic was established in Temple Street in February 2011. However, there has not been any dedicated urological input to date. A recruitment process was under way in 2009-2010, from which the hospital hoped to recruit a consultant urologist. Unfortunately, the recruitment process did not produce a suitable candidate for the post and a further recruitment process in 2012-2013 was not successful either. However, a new recruitment process is in train. The post is with the national recruitment service, to be advertised by the Public Appointments Service. The HSE is hopeful this new recruitment process will succeed in hiring a suitable candidate.

While awaiting the appointment of a consultant urologist, spina bifida patients are being reviewed by a consultant surgeon who has been granted honorary status at the hospital. The hospital has also been in negotiations to establish a regular clinic with a UK paediatric urologist. This is complete and dates have been scheduled for 17 and 18 October and in December for visits from the UK paediatric urologist. An appropriate service level agreement is in place.

Consultants at the Children's University Hospital, Temple Street, have identified patients requiring this support. As an interim arrangement, children requiring urgent urological input are prioritised clinically and seen in the United Kingdom under the treatment abroad scheme. All patients are being kept under regular review and referred to the UK on a case by case basis for treatment, pending the appointment of a permanent urologist.

The Government is acutely aware of the challenges that patients with spina bifida and urological conditions generally and their families face in managing their care. The Department is committed to providing the best possible health service and will continue to work with the HSE to ensure the best possible outcomes for spina bifida patients.

Senator Thomas Byrne

Certainly, if treatment is required, that needs to happen, but in many of these cases it is not treatment that is required but the regular monitoring of these patients to prevent the necessity of treatment or to prevent serious injury or death, which unfortunately often results. The HSE and Department should treat it as urgent to get somebody in to monitor these patients and keep them right as best they can.

Court Sittings

Senator Mark Daly

I welcome the Minister of State. The Courts Service has decided to close the courthouses in Kenmare, Cahersiveen, Killorglin and Dingle and has claimed it is a cost-saving measure. I am afraid the service has not carried out a comprehensive analysis of the cost to the State of this move. It has not considered how much it will cost the State in man hours given that gardaí who normally give evidence in Kenmare, Cahersiveen, Killorglin or Dingle will now need to travel to Killarney and will have to wait there for their case to be heard. Witnesses, including expert witnesses such as medical practitioners and others, will need to make the same journey. The Courts Service has not carried out any effective impact assessment - it has just considered the cost of the court buildings. It has not considered the cost to the State of all these witnesses and gardaí giving evidence in a centralised location, in this case Killarney.

The increased cost on citizens in south Kerry who will now have to travel has not been considered. The 2006 Crowley report showed that 12% of the population in south Kerry do not have a vehicle. In order to get justice those people would need to travel to Killarney. Given the economic downturn since then, one can imagine that figure has not improved. They would need to get a bus to Killarney and bus timetables do not always coincide with court sittings, particularly for return journeys if the court sitting continued until late in the afternoon.

Access to justice is a fundamental right laid down in the Constitution. Up to now the most vulnerable, including those seeking barring orders and the elderly, were able to access justice locally, but they will no longer be able to do so as a result of this bizarre move. I say it is bizarre because one would have thought the Department would have done a comprehensive review to determine the number of garda hours that will be taken up in travelling. Going from Dingle to Killarney or Tralee and back takes two hours alone and the same applies in the case of Cahersiveen. What is the cost for the State to pay for gardaí to travel by squad car over to Killarney for court hearings? What are the costs for the witnesses and citizens? I ask the Minister to reconsider the issue. What is proposed is centralisation, something of which he is aware given what has happened with Garda stations in his constituency. Justice is being removed from the people at a local level and being transferred to the centre, meaning not only will the State be at a financial loss but the citizens will also be at a loss because access to justice is being put beyond their reach.

Deputy Sean Sherlock

I preface my remarks by saying I know my good neighbours in County Kerry to be a neighbourly and affable bunch. One would never be stuck for a lift to any part of the county at any given time of the day or night.

Senator Mark Daly

If I ever need a lift, I will make sure to give the Minister of State a call.

Deputy Sean Sherlock

The Minister for Justice, Equality and Defence, Deputy Alan Shatter, is unable to be here and has asked me to convey his thanks to the Senator for raising the matter. As the Senator may be aware, under the provisions of the Courts Service Act 1998, management of the courts is the responsibility of the Courts Service. The 1998 Act provides that the Courts Service is independent in the performance of its functions, which, of course, include the provision, maintenance and management of court buildings. Decisions about court venues are entirely a matter for the Courts Service board and the Minister has no role in the decision.

In the current financial climate, the service has been obliged to review all aspects of its organisational and operational structures throughout the country with the specific objective of ensuring that it can continue to maintain the delivery of front-line court services and an appropriate level of service to court users. The Minister has been informed that no court venue has been singled out or indeed exempted from the review process.

A comprehensive review of all venues throughout the country has recently been completed, the purpose of which was to establish a general framework within which venues could be considered for closure taking into account a range of criteria such as case load, proximity to an alternative venue, physical condition of the building, availability of holding cell facilities, etc. The likely impact on other justice agencies, such as An Garda Síochána and the Irish Prison Service, was also taken into account. The Minister is informed that the review identified a range of venues nationwide, which, based on the criteria applied, could be considered for closure subject to a detailed assessment and the preparation of a business case in respect of each identified venue.

Since its establishment in 1999, the Courts Service has amalgamated nearly 160 venues, while, at the same time, the service has benefited from a very substantial capital investment to upgrade court accommodation around the country. The policy has been very successful, resulting in a more efficient use of time for the Judiciary, court users and gardaí. Rather than short sittings in the smaller venues, a full day's list can be dealt with which leads to reductions in delays in the District Court.

The Senator has inquired, in particular, about courthouses in County Kerry. The Courts Service has informed me that Kenmare, Cahersiveen, Killorglin and Dingle have been identified as venues to be considered for closure subject to a detailed assessment and the preparation of a business case as mentioned earlier. Standard courthouse requirements include basic facilities such as consultation rooms, victim support facilities and holding cells for prisoners which are essential to ensure public safety and efficient use of Irish Prison Service resources.

The Senator should note that the service has advised that the identification of venues as part of the review process does not necessarily mean that the identified venues will close, as each identified venue will be subject to a rigorous examination. The Courts Service board will take no decision on the future of Kenmare, Cahersiveen, Killorglin and Dingle as District Court venues without full prior consultation with local interested parties and court users. The Minister has been advised that the consultation on the identified venues is under way. Submissions were sought from a range of local interests and the closing date for receipt of submissions was 25 September 2013. The Courts Service has indicated that it has met local interested parties and the service has assured the Minister that the views expressed in the consultation process will be taken into account in the decision-making process. As I mentioned, the final decision on the closure of any venue is a matter for the board of the Courts Service.

I thank the Senator for raising the matter and appreciate his interest in the administration of justice in County Kerry. I know the Senator will understand the need for the Courts Service to take the necessary measures to promote greater efficiency in the courts and hope the constructive engagement involving the Courts Service will result in reasoned and appropriate decisions being made on the venues concerned.

Senator Mark Daly

I am pleased the Minister of State is offering to give lifts to people in County Kerry if ever he happens to be passing through. I note the response in respect of the criteria being laid down by the Courts Service, which amounts to saying that if things such as holding cells, victim support facilities and consultation rooms are not in place, those courts are more likely to close. However, those facilities have not been in place for 90 years in some places. We went through the Emergency and the Civil War and did not have these facilities. Now, as the Minister of State is aware, the criteria are designed by civil servants to justify the closure. They are making the argument that these courts do not have Rolls-Royce facilities. Although they have been functioning perfectly for more than 90 years, the Courts Service is using the lack of facilities as an excuse to close them. I do not blame the Minister of State in this regard, but-----

Acting Chairman (Senator Marie Moloney)

Does the Senator have a question for the Minister of State?

Senator Mark Daly

This is about access to justice for the elderly, sick, infirm and those living alone. According to the report, 3,000 households in County Kerry do not have access to a motor vehicle. I seek a response from the Minister of State on this matter because the people who write these submissions do not realise how difficult it is – although the Minister of State and I are aware - to get from one town to another if one does not have use of a car. When discussing the criteria-----

Acting Chairman (Senator Marie Moloney)

The Senator must conclude. This is supposed to be only a brief statement.

Senator Mark Daly

I will conclude on this point. The overall cost in terms of man hours and time used by the Garda and other professionals has not been taken into account. In fact, there are no savings. It is simply a question of more man hours being tied up sitting in courts far away from the Garda barracks.

Acting Chairman (Senator Marie Moloney)

Does the Minister of State wish to respond?

Deputy Sean Sherlock

I acknowledge the statement of the Senator. If we are to make statements in public fora such as this, we should try to extrapolate a little more from the data. The data go back to 2006 and suggest some 3,000 houses do not have access to a motor vehicle. We can extrapolate from them the number of people who will present before the justice system and it would be fair to say the figure would be minuscule, but if they did have to present at a venue which was a little further away, to reiterate an earlier point I made, I imagine their access to justice would not be prevented in any way. I imagine the neighbourly people of County Kerry would facilitate them in any way they could.

As I have stated, the Courts Service operates independently and makes independent decisions. There is no doubt that the Courts Service has identified venues which should be considered, as the Senator has outlined, but subject to a detailed assessment and the preparation of a business case. The response I am giving from the Minister for Justice and Equality is clear in that sense.

The Seanad adjourned at 7.25 p.m. until 10.30 a.m. on Wednesday, 16 October 2013.