I welcome the Minister for the Environment, Community and Local Government, Deputy Alan Kelly.
Commencement Matters
Drainage Schemes Status
I thank the Minister for coming to the House to discuss this important issue. On 19 November 2009 an appalling event occurred in Bandon town when the River Bandon burst its banks. The resulting flooding was of a type seen approximately once in 100 years, causing extensive damage to homes and premises. Many property owners in the town are still unable to obtain insurance against flooding.
Residents and business owners are dumbfounded that following a costly obligatory consultation process on the development of a new drainage and sewerage scheme for the town, Irish Water has apparently torn up the consultant's recommendation and instead proposes to pursue a solution based on the existing, obsolete infrastructure. It seems the company is trying to get away with a rather cheap solution in recommending that a one-pipe system will be adequate. In rejecting this proposal, experts, engineers and residents note the irony that while home owners and farmers are obliged to upgrade their septic tanks, Irish Water sees fit to put forward such an anti-environmental solution in the current regulatory climate.
Will the Minister insist on this second-rate solution not being acceptable in Bandon or anywhere else in Ireland? Irish Water should not be allowed to get away with it. If it is a question of funding alone, where is the money that was ring-fenced for this purpose, with cast iron promises from various Ministers in both the current Government and its predecessor? I was in Bandon in the aftermath of that dire flooding and saw premises under 5 ft. and 6 ft. of water. The townspeople have been extremely patient but I am asking the Minister to give a guarantee today that they will get the best scheme possible and construction will begin sooner rather than later. It is past time this issue was addressed. It is almost six years since that appalling flood and nobody can guarantee that a similar event will not take place along the Bandon river basin. If it should do so before the drainage infrastructure is in place, it will be a disaster. The related flood relief scheme, which is being dealt with by the Office of Public Works, must also proceed as quickly as possible. I hope the Minister will give me good news to take back to west Cork.
I hope to do so. I thank the Senator for providing me with the opportunity to outline the current status of wastewater services in Bandon. State investment in water services infrastructure was previously channelled through my Department's water services investment programme and the rural water programme, a function which is now largely devolved to local authorities. The high-level goal of the water services investment programme was to ensure the timing and scale of such investment facilitated economic and other development, compliance with statutory requirements for drinking water and wastewater treatment, and the achievement of environmental sustainability objectives.
Bandon sewerage scheme phase 2 was included in the last investment programme which ran from 2010 to the end of 2013, with work to be carried out under separate contracts for the network and an upgrade of the wastewater treatment plant as well. As the Senator is no doubt aware, since 1 January 2014 Irish Water has had statutory responsibility for all aspects of water planning, delivery and operation at national, regional and local levels. This includes responsibility for the delivery of water services capital infrastructure.
Shortly after the transfer of responsibilities from local authorities to the new utility, Irish Water published its proposed capital investment plan for the period 2014 to 2016, which is available on its website. Under the capital investment plan, investment is prioritised where it can deliver the most urgently needed improvements in drinking water quality, leakage, water availability, wastewater compliance, efficiencies and customer service.
The Bandon sewerage scheme is included in the investment plan and Irish Water has provided me with an update on progress on the scheme. I understand Bandon is served by a combined sewer system which collects storm and foul flows. The network suffers from flooding because it is overloaded and I am aware of the floods to which the Senator referred. The initial design included a two pipe system in the town, with new storm and foul combined sewers. For practical reasons, the storm pipes were only capable of removing about 25% of the storm flows from the foul system and did not resolve the flooding problem.
Irish Water has redesigned a scheme to fully resolve the flooding problem, comply with required environmental standards and to have capacity for future foul flows if they arise. The initial design of the scheme would have cost some €8 million. However, the current re-designed proposals will cost approximately €5.2 million. Irish Water has confirmed that consulting engineers are in place and the detailed design is at an advanced stage. Subject to agreement with Cork County Council regarding the inclusion or otherwise of storm water sewers, Irish Water expects to tender the contract before the end of quarter 3, 2015, which I expect to happen.
I thank the Minister for coming before the House and giving his response. There is a lot of anxiety among the flood group, townspeople, ratepayers, shopkeepers and residents that the scheme which will be delivered is not what was originally proposed and planned. I am putting the Minister on notice in a gentle, rather than adversarial way. If the scheme which will be delivered and is expected to go to tender towards the end of the summer or the start of the autumn is less that adequate for the needs of the people of Bandon and its surrounding areas and if it is in any way second rate, he or I will never hear the end of it. I thank him for his response and hope things can proceed. The people of Bandon have been waiting for generations for this scheme. Not alone will it have to be efficient and up to the best standards, it should also be the best available to ensure the residents, businesspeople and ratepayers in Bandon will get the very best scheme possible, having waited almost six years for it to come to fruition.
I thank the Senator. I am aware of the anxiety of those in Bandon. I am quite conscious of the issues. I know the town quite well, as the Senator knows, and this is a real issue. I assure him that under no circumstances would Irish Water contemplate putting in place a substandard scheme. Many schemes have been re-examined, such as the Ringsend plant in Dublin where greater efficiencies and a better service have been provided as a result of the work Irish Water, as a considered entity with economies, can put into such schemes. I am quite confident that what is proposed in Bandon, even though it involves a smaller, but quite substantial amount of money, will deal with all of the issues the Senator has raised. I will meet Irish Water later today and raise the issue again.
Ambulance Service Provision
I welcome the Minister and thank him for taking this debate.
I am rather concerned about what appears to be a serious lack of paramedics in the west. I remember in 2006 or 2007, when Professor Drumm was in charge of the HSE and there was talk of closing the accident and emergency department in Roscommon County Hospital, he promised that we would almost have an advanced paramedic at every crossroads in the country. That never materialised. I do not blame the staff who operate the ambulance service or the paramedics we have. They provide an excellent service within the limited resources available. I acknowledge that a person can be lucky, and when the system works it works very well. If it happens to be the case that an advanced paramedic is within ten or 15 minutes of a patient, it is a great service.
However, I spoke to one paramedic who told me that there was a need for 100 additional paramedics in the west.
Some years ago, west Roscommon was ear-marked for an ambulance base. To date, this has not been delivered. There is a dispute involving staff who do not wish to move from their present location to this new ambulance base. It is not being staffed, outside of what is already in the system. This is different from the other two ambulance bases promised at the same time, on Achill island and in Tuam, which were staffed.
The week before last, in my home town, a 19 year old lad had a heart attack. The ambulance and paramedics were called. Two local firemen worked on him to keep him alive as long as they could. Unfortunately, he was dead by the time the ambulance arrived 40 minutes later. Later that day, in the same estate, an ambulance was called for an elderly man. The ambulance arrived and the man was put into the back of it, but the ambulance would not start. Elderly people had to push the ambulance down the hill to start it. Later that evening, conditions were not great and there was a car accident. Again, the ambulance took 40 minutes to arrive at the scene. It is nearly a crime in Dublin not to have an ambulance within eight minutes, but it is hit and miss down the country. It really is a matter of luck on occasions. I have no doubt the HSE will tell the Minister that we have a great system which is working well. The evidence on the ground is to the contrary.
I have a solution to the problem for rural Ireland. It is one which can be implemented within 12 weeks. I have run it by the Minister for the Environment, Community and Local Government, Deputy Alan Kelly. I have spoken to firemen about it. There will be no resistance to this suggestion. Four firemen out of every brigade in local towns, in counties such as Roscommon, could be trained to emergency medical technician, EMT, level. They could be first responders. The training course takes just 12 weeks. I ask the Minister to consider piloting this in County Roscommon in order that we can prove there is a better system. This suggestion would enhance the paramedic system in place.
I thank the Senator for raising this matter and giving me the opportunity to update the House on our plans for ambulance service improvements this year. I am happy to confirm that these plans include providing more paramedic cover in the west, although certainly not one at every crossroads. In 2015, a €5.4 million budget increase has been provided to the National Ambulance Service to help address service gaps. In that regard, provision is being made for 50 additional paramedic posts in the west. Some of these posts will be used to staff ambulance stations at Tuam and Mulranny and others will assist in the move from on-call to on-duty rostering. On-call rostering means paramedics remain at home and wait to be called out. This, on average, results in a 20 minute delay in despatching an ambulance. We are, therefore, moving from this to on-duty rostering where crews will be in their stations or vehicles ready to go immediately on despatch.
It is also intended to expand the number of community first-response teams, particularly in more rural and sparsely populated areas. These are volunteer groups in the community who are registered and trained to a certified standard. The National Ambulance Service calls out a local responder to a cardiac emergency in the area. This responder gets to the scene before the arrival of the ambulance crew, applies his or her cardiac training and increases the person's chance of survival. There are currently over 100 teams operating around the country, but we need more and are working on this.
Of particular benefit to western counties is the emergency aeromedical support service. This service was established under the Government and is particularly targeted at the midlands and west. It provides rapid access to appropriate treatment for very seriously ill patients where this may be difficult to achieve by road. I am looking at proposals to examine the service on a permanent basis and I am in discussions with my colleague, the Minister for Defence on this matter.
Discussions around ambulance response times can become emotive. We only seem to ever hear about the delays. We do not hear about the high quality treatment being provided by paramedics and how the service has improved so much in recent years. It is important to point out that response time performance is improving year on year in the face of increasing demands. Response time targets only measure one aspect of ambulance performance. Ideally they would be part of a suite of assessments. Internationally, more and more ambulance services are moving towards patient outcomes as a better indicator of performance. The National Ambulance Service introduced a patient-outcome target for out-of-hospital cardiac arrests last year and more are being developed.
There are three major reviews of the ambulance service under consideration, namely, the recently published HIQA review, the national capacity study and the Dublin ambulance service reviews.
These three reviews, when taken together, will provide us with very good information to help drive further service improvement. I am working with the HSE to prepare an action plan on completion of all three reviews within the timelines to realise a new strategic vision for ambulance services. The National Ambulance Service is focusing on addressing some of the service gaps in the west in 2015. Specifically, that will involve 50 new paramedics and a move from on-call to on-roster service, which is very important.
The Senator suggested we use fire crews in these circumstances. I certainly think there would be a strong case for training them up as community first responders. That makes a lot of sense. I cannot for the life of me see any reason that is not a good idea. It would be a little trickier to train them to emergency medical technician level. I would need to see a worked-up proposal. If a person who is trained to such a level does not use his or her skills regularly, he or she can become deskilled and that can actually be unsafe. That would have to be worked up and considered carefully in consultation with the pre-hospital emergency care council.
I thank the Minister. I agree with him that the issue of poor call-out times for ambulances is an emotive one, particularly when things go wrong. I praised the ambulance staff and the paramedics in my contribution. I acknowledged that if the patient is lucky enough to have them arrive on time, he or she will receive a far better service from them. I would appreciate it if the Minister would discuss with his colleague, the Minister, Deputy Alan Kelly, my suggestion that firemen should be trained. They are all local to towns. Some of them are already trained as first responders while others need to receive such training. If they had the right training, the life of the 19 year old lad I mentioned, who was a neighbour of one of these firemen, could have been saved. Who knows? We do not know. I appreciate the Minister's answer. I would like it if he spoke to the Minister, Deputy Alan Kelly, about my suggestion.
I would certainly be happy to discuss it with the Minister, Deputy Alan Kelly. As I said, if they are willing to be trained as community first responders, that would make a lot of sense. I think the possibility of training them to become paramedics would have to be examined carefully to make sure we would have the quality of service we need. The main improvement we want to make in the west this year involves the recruitment of 50 additional paramedics, as provided and budgeted for in the 2015 service plan. The move from an on-call ambulance service to an on-roster service is also crucial. Many of the delays west of the Shannon can be attributed to the fact that ambulance crews in many parts of the country have to be called out from home. This year, we intend to move to a system whereby they are based in the ambulance station or in the vehicle. That will cut up to 20 minutes off calls. I think that is really significant.
I thank the Minister.
Public Relations Contracts Expenditure
Gabhaim buíochas leis an Aire as ucht teacht isteach anseo chun déileáil leis an gceist atá ardaithe agam. The last time I raised a Commencement matter, I asked the Minister to explain the expenditure by the Saolta hospital group on public relations consultants. The Minister kindly responded by sending me a letter dated 12 February. I think he was attending the European Parliament at the time. I thank the Minister for that response in which he outlined the expenditure made in the 2014 financial year only. I was quite concerned to learn that the Saolta group spent €169,444.80, inclusive of VAT, on hiring a PR consultancy firm, Setanta Communications. Many people find it difficult to understand how it is possible for dedicated personnel within the public service, who are on public sector pay, to work in the communications area while at the same time organisations funded by the taxpayer are getting into business with private sector PR companies.
I note from the Minister's earlier response that the HSE has not provided the Saolta health care group with staff to deal with communications matters. The HSE has its own communications people, and possibly in addition even its own PR companies engaged in addition. As Saolta was not given staff to deal with communications matters, it had to go to the private sector and pay out a six-figure sum for one year only.
The Minister has advised me of an interim arrangement whereby a member of the HSE West communications team was provided to Saolta. When that was not in place, Saolta advertised internally for dedicated communications personnel and, while awaiting the outcome of the recruitment process, went out to tender again for PR and communications services and this tender was awarded. That seems like a massive waste of money. I cannot understand why public sector bodies are spending so much taxpayers' money effectively on looking good to the taxpayer. If it is a matter of responding to people's letters and giving an account of one's stewardship, then surely there are people within the organisation whose task it is to do that. However, people rightly suspect that there is considerably more.
I have previously highlighted that there are only four venues in Ireland for baby-cooling treatment, none of them in the west. I have made the point that the sum paid out on PR by Saolta in 2014 would pay for two neonatologists, based on the salary scales in University College Hospital Cork which were published in January. In a 2013 study, Johns Hopkins University estimated the cost of a baby-cooling mat at €10,000. We have a problem with spending money on spin doctors that could and should be spent on real doctors. I would be grateful for the up-to-date figures for 2015, including all outstanding invoices. I would be interested to ascertain whether the Saolta group is continuing to spend taxpayers' money on PR consultants at the same rate as occurred in 2014. I believe - I suspect the Minister also believes - that the spending on PR consultants should be redirected to patient care.
I have spoken in this House decrying the HSE's ongoing failure to provide therapeutic hypothermia, or baby-cooling facilities, for newborn children in the west. I do not know what the Minister's views are on that. However, it is shameful that money spent on PR consultants could have been used to hire staff and obtain equipment to provide such facilities in hospitals in the west.
I take the opportunity to ask the Minister another question. On a previous occasion, he kindly came to the House and responded to my question on the HSE audit of the award of the Northgate contract and whether issues arose that would have implications for the then CEO of Saolta, Mr. Maher, who I now understand has moved to a job in the east of the country.
The Senator should not name people in the House, as he well knows. The person concerned is not here to defend himself.
That is understood. However, the Minister told me the report would be available by the end of last year, but it still has not happened.
The Senator is way over time.
Can the Minister enlighten me as to what has taken place? Does the Government have a particular view?
I thank the Senator for raising this issue.
I am advised that the Saolta University Health Care Group has not paid any invoices for external communications support since the start of this year. As outlined to the Senator last week, Saolta University Health Care Group awarded a contract for communications support at the beginning of the year following a competitive tendering process. The first invoice will fall due for payment at the end of the first quarter of 2015, but has not fallen due yet.
The Saolta University Health Care Group has not been provided with staff to deal with communication matters by the HSE. It receives a very large number of press queries and needs to be resourced to answer these. The cost to hospitals in any part of the country of unbalanced, incomplete or inaccurate information in the public domain can be considerable and it can also result in avoidable worry and anxiety for patients and their families and unfair reputational damage to front-line staff.
Irrespective of whether health bodies use money for PR in-house or externally, the spending is not so that public bodies can look good to the taxpayer, but often just to manage and respond to the enormous number of media and public queries that are directed at the health service. If they are not responded to, the consequences of misinformation and incomplete information can be enormous reputational damage to front-line staff and hospitals and can cause enormous anxiety for patients and their families. That is why it is done. It is not done in an effort to look good to taxpayers. It is more of a case of getting information and the truth out there.
I am advised that Setanta Communications provides media services to Saolta. Its fees in 2014 came to €137,760 plus VAT.
There was an interim arrangement whereby a member of the HSE West communications team was provided on a part-time basis to support the group. However, this has not been in place since August 2014. The Saolta University Healthcare Group has advertised internally for dedicated communications personnel and is awaiting the outcome of the recruitment process.
I am advised that Saolta University Healthcare Group has made a public commitment to use the most cost-effective way of making its new identity known to the public and health sector. For example, stationary stocks, signage and existing branding will be used until stocks run out and replacement opportunities occur and will then be replaced with the new logo at that time. Saolta University Healthcare Group is also availing of cost free opportunities such as photo opportunities.
Given the current financial constraints to which the health service is subject, I emphasise again the importance the Government places on ensuring the health service provides value for money in all spending.
In respect of the other matter raised by the Senator, I understand the investigation is still ongoing and I do not have a further update on it.
I thank the Minister for his response. While I understand his explanation and justification for spending six figure sums on PR companies, I do not think spending this amount of money simply to deal with press queries is essential to public welfare. It could be inferred from his statement that none of this money was used for training people on how to conduct interviews and so on. For that reason it would be very interesting to see the invoices for the precise services that have been provided by PR companies such as Setanta to organisations such as Saolta University Healthcare Group. I think it should not cost so much money simply to keep patients informed of what is going on in hospitals. Misinformation or reputational damage will not necessarily arise from reduced spending as it does not require six figure sums to be spent on PR to get the message across. It is simply a matter of being organised and explaining what Saolta University Healthcare Group does in a truthful and timely fashion.
There are two issues, first, whether the PR communications function should be done in-house or outsourced. My view is that the choice is based on whatever gives the best value for money. If one can do the communications in-house more cost effectively than by outsourcing, that is what one should do. Sometimes public bodies outsource this function because it is more cost effective, cheaper and better to have external experts do it. In my Department if we do not have the in-house expertise, not necessarily in public relations but in other areas, we would outsource it. For example, if we were looking for scientific advice on something, rather than hiring scientists and professors to do a one-off job, we often go to the Institute of Public Health.
The second issue is whether the health service needs to spend money on public relations.
So much money.
I believe it does, unfortunately. One can argue about the amount, but we would all love to live in a world where the health services did not have to worry about media queries or stories that are put out that can very severely damage the reputation of hospitals, small hospitals in particular, and front-line staff, nurses, midwives, doctors or EMTs. Stories that are put into the public domain by interest groups are often not the full truth but are part truth or may have another agenda behind them. It is important that the health service is equipped to fight back against this.
When stories about hospitals all over the country are put into the public domain, it is important that the clinical directors, the clinical leads and the CEOs, as needs be, are prepared and trained and are able to go out in public and answer people's questions and explain to them what is happening and answer media concerns. If they do that badly, it can be very damaging. One has only to think about the one bad interview by the chief executive of Irish Water a year ago to understand the level of reputational damage that can be done to an organisation by a CEO or clinical person doing a bad interview. We would love to live in a world where these things did not matter.
I am not sure that justifies all the expenditure on the dark black arts of PR.
Sitting suspended at 3.10 p.m. and resumed at 3.30 p.m.