Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Tuesday, 24 Feb 2015

Vol. 238 No. 4

Commencement Matters

Water Fluoridation

I welcome the Minister of State, Deputy Kathleen Lynch.

As the Cathaoirleach has read out, this matter pertains to the need for the Minister for Health to provide an update for Members on the Health Research Board’s review of the international evidence on fluoridation of water and to indicate when its findings are likely to be published, given that it was expected to happen last year. A story on the front page of today's edition of The Daily Telegraph raises a fluoride link to weight gain and depression and states:

A study of 98 per cent of GP practices in England found that high rates of underactive thyroid were 30 per cent more likely in areas of the [highest] fluoridation. It could mean that up to 15,000 people are suffering needlessly from thyroid problems which can cause depression, weight gain, fatigue and aching muscles.

I have debated this issue with the Minister of State previously and she knows I do not believe in newspaper articles but scientific evidence. Ireland is the only country in Europe that still puts fluoride in the water. Whether Senators like it, fluoride is a highly poisonous substance. By law, toothpaste in the United States must carry a poison warning. The brushing instructions detail that one is to brush teeth thoroughly after meals with a pea-sized amount of toothpaste and that if one accidentally swallows more than used for brushing one should get medical help or contact a poison control centre immediately. This is the law in the United States. In Ireland fluoride is added to tap water at potentially toxic levels. A glass of Irish tap water contains the same amount of fluoride as a pea-sized amount of toothpaste. Join the dots. In the Netherlands, fluoridation of water is banned by the constitution.

In March 2006 the US National Academy of Sciences completed the most comprehensive, balanced, scientific review ever on the health effects of fluoride in water. Its 500-page report representing three years of work by a panel of 12 scientists acknowledged the following adverse effects of low-levels of fluoride ingestion, which had not been previously identified: thyroid impairment, as confirmed by today's edition of The Daily Telegraph; impaired glucose intolerance, that is, type 2 diabetes; moderate dental fluorosis, bone fractures, moderate skeletal fluorosis, lowering of IQ; and brain damage, especially in the presence of aluminium. I hope the Minister does not have some blurb on dental health. If one drinks a glass of water, it goes past one's teeth. The water does not know to go straight to one's teeth but goes to every cell in one's body. There is more to a person than teeth. We must seriously consider taking fluoride out of the water in Ireland. Given that 80% of it is going down the drain due to leaks, we are wasting even more money.

I thank the Senator for raising this issue. The response I have is virtually the same I had the last time we debated it. The Senator is very passionate about it. As I said the last time I was here, I have no difficulty coming here to answer and be held to account by people who are passionate on particular issues, regardless of whether I agree with them. It is important. During our last debate, I told the Seanad I had been listening to the argument since I was an adult because my late father-in-law was as passionate about the Senator's side of the argument as she is. The difficulty is that the research has found no firm evidence on one side or the other, and this is why the Health Research Board was asked to examine the research in terms of the written evidence and come to a conclusion. I am not certain it will come to a conclusion. The report it was asked to produce will hopefully be completed and published this April. It has been delayed.

I have a great interest in research. Everybody in the country has been listening to the latest research on peanut allergy and whether one should feed peanuts to young children. The research now tells us that one should allow very small children to build up an immunity which may reduce the likelihood they will have allergies. While I am not certain which of us would be prepared to take the risk of doing it with our very small children, nevertheless research and people's opinions change constantly. We asked the Health Research Board to carry out a literature review for us, which it has done. It included the University of York review which was published in 2000 in the United Kingdom and which was quoted during our previous debate on this issue.

It also included the Australian symptomatic review of the efficiency and safety of fluoridation which was published in 2007 and the European Commission's scientific committee on health and environmental risks review published in 2011, to which the Department of Health contributed. None of these reports established any basis for suggesting artificially fluoridated water posed health risks.

I am sure that research will emerge in future that will either confirm or deny the case made by the Senator. I do not have an opinion on the matter personally but, while I am open to persuasion, I must take on board the advice of the Health Research Board. The board began the review in 2014 and completed it in early January. The reason it has not yet published a report is because it has been submitted for international peer review to ensure accuracy and objectivity. It is the intention to publish the report in April and when that happens I am sure that either the Minister for Health, Deputy Leo Varadkar, or I will come to the Chamber to debate this topic again. Once the report has undergone the peer review process, I am sure it will contain the necessary objectivity. I am also sure that our attitudes towards fluoridation will change in the future in one direction or other. I acknowledge that the Senator is passionate about this issue and accept that she believes what she is saying but we cannot make decisions on this unless they are recommended to us by the people we have charged to prepare the report.

I thank the Minister of State for her reply and look forward to the report's publication in April. I am passionate about this issue but I have also been careful to study the evidence and take advice. I am not a scientist but I wonder what the rest of Europe knows. Similarly, the US National Academy of Sciences produced the most comprehensive balanced scientific report on the issue in the history of the world. I take comfort from the Minister of State's assurance that the report will be sent for peer review. If the rest of Europe does not fluoridate water supplies, should we be taking this risk with our own population? I will be asking Senators to debate this issue as soon as the report issues. Does the Minister of State recall when we used to smoke on aircraft? I think we will look back and say "do you remember when we used to put fluoride in the water?"

That is why I believe not only our opinions but also science changes. Scientific reviews and peer reviews change over time. I agree with the Senator that we should examine the evidence and the policies in place elsewhere in the world.

Orthodontic Services Provision

Cuirim míle fáilte roimh an Aire Stáit. Tá mé thar a bheith buíoch di as ucht an t-am a thógáil leis an cheist seo a ghlacadh. Tá cúrsaí ortódóntaice san iarthar ag déanamh imní do chuid mhaith tuismitheoirí ansin, go háirithe i gContae Mhaigh Eo agus i gContae na Gaillimhe.

In October 2013 it was reported that nearly 40,000 children were waiting for orthodontic treatments, with 462 patients waiting longer than four years. Spokespersons on behalf of dentistry groups such as the president of the Orthodontic Society argued that one could only treat so many patients at a time and the numbers then were in line with the recruitment moratorium within the HSE.

Others were stronger in their statements.

We were told that the lifting of the moratorium on the recruitment of dentists and support staff, including nurses and radiographers, would improve services and reduce waiting lists, but the newly elected president of the HSE's dental surgeon group stated the recruitment embargo was having a negative impact. She went on to state:

Waiting lists for treatment under general anaesthesia, orthodontics and oral surgery have soared due to the lack of resources. This is a reprehensible consequence of the circumstances which now prevail in our public dental service.

She also stated morale in the public dental sector had plummeted.

The Minister for Health was called on to reinstate sufficient numbers of staff to ensure patients had access to equitable public dental and orthodontic services, irrespective of location. It was noted at the time that the largest waiting lists were in the HSE West region, where 215 children were waiting between one and six months for orthodontic services, 705 were waiting for between seven and 12 months, 613 were waiting between 13 and 24 months, 740 were waiting between two and three years and 29 were waiting for longer than four years, a total of 2,302 children.

The then Minister of State, Deputy Alex White, noted that an independent review of the services had been commissioned, but I have heard of no great improvement on the ground. I tabled this question to find out the current situation with orthodontic services. When the head of dental services in HSE West spoke at an Oireachtas briefing in the west, he was scathing of the cutbacks in the system and was concerned that not enough checks were being carried out of primary school children. There had been a scaling back in the number of children he was able to see. He believed that this would cause chronic difficulties down the road. The children attending orthodontic services are referred by clinics. Is there a major problem out there that we have not seen yet? Many children who should be receiving orthodontic referrals are not even getting the primary ongoing checks that are necessary. This issue is affected by the 76,606 people who are awaiting hospital treatment, a problem that is also greater in the west, because hospital treatment is necessary in some cases if an orthodontic procedure is to take place.

I hope the Minister of State will have good news of an improvement. Has the independent review been completed? Has the moratorium eased a little and have more dentists, nurses and so forth been put in place? Have the waiting lists decreased since October 2013?

I will read my script, but I can also discuss a different type of service that we hope to introduce and that has significant possibilities.

As we all know, the HSE provides orthodontic treatment for those who have been referred for treatment before their 16th birthday. Patients are assessed by the HSE orthodontic service under the modified index of treatment need. The index has two components, those being, dental health and aesthetic. Under the modified index, the aesthetic component has three categories. The dental health component has five categories ranging from category 1, where there is no need for treatment, to category 5, where there is a great need. Grade 5 and some grade 4 cases are treated within the public health system.

A regional orthodontic service for Galway and Mayo is provided at Merlin Park University Hospital, with outreach clinics provided in both counties. Unfortunately, a breakdown of waiting lists by county and age is not available. Children are generally referred to the assessment waiting list in sixth class when they are 11 or 12 years of age. Currently, all are assessed within 12 months and all those in the categories eligible for treatment are treated within 36 months of assessment. The nature of orthodontic care means that immediate treatment is not always desirable. It is estimated that, in up to 5% of cases, it is preferable to wait for further growth to take place before treatment commences. We all understand this.

The latest data available for treatment waiting lists are from the end of December 2014. They show that 1,212 children were on the grade 5 waiting list in Galway and Mayo.

Of these, 640 or almost 53% were waiting for less than 12 months; 462 or 38% were waiting for 12 to 24 months; and the remaining 110, 9%, were waiting for 25 to 36 months. The grade 4 treatment waiting list has a total of 2,088 children. Of these, 912 or almost 44% were waiting for less than 12 months; 832 or almost 40% were waiting for 13 to 24 months; and the remaining 344, 16%, were waiting for between 25 and 36 months.

The HSE has established a pilot scheme in Dublin north east, which will involve the use of orthodontic therapists in the treatment of a number of eligible children. Consideration will be given to expanding this scheme to other HSE areas in the future. An initiative which will especially focus on those waiting for four years or longer, which I think was the concern of the Senator more than anything else, will be put in place later this year. A panel of independent practitioners under contract to the HSE will be in situ for three years to treat certain categories of misalignment. It is expected that this initiative will have a positive impact on the waiting lists. It is those waiting the longest about whom we all have the most concern.

I appreciate the information and statistics that have been given. There are still 1,500 children waiting up to a year for treatment, 1,294 or so waiting up to two years and 500 children waiting from two to three years, which is not a huge improvement on the figures we had a year and a half ago. Has the review that was talked about by the former Minister of State at the Department of Health and current Minister for Communications, Energy and Natural Resources, Deputy Alex White, been done? If so, has the moratorium made any difference? Will there be new permanent posts provided under the HSE? There can be service plans, independent practitioners and people brought in from agencies, etc., but what we need are more nurses, dentists and staff within the service. Are there plans to do this?

I do not wish to dismiss what orthodontists and their assistants do in their clinics every day of the week. They do great work and are always juggling to get children in on time under the particular age set out and those with greatest severity as well. We all know that from our own personal if not constituency experience.

The review tells us what we need to do and we have now established an individual within the HSE who looks at how to develop a national programme for orthodontics. In the main, that applies to people under 16 years of age. Part of the review and national programme is telling us we should be looking at alternative methods of treatment, for example, the orthodontic practitioners, who are highly trained nurses already nursing within the dental service and who have taken on additional training in how to fit braces. I am not certain yet and it is just a pilot programme, but I must admit I was very impressed by the people who came in to talk to me about it. I am told that in other countries orthodontic practitioners are widely used, under the supervision of the orthodontist, of course. Other countries have managed to bring down waiting lists and deliver services in a far more timely fashion than we have in the past.

Private practitioners not normally working within the HSE will be assigned in order to ensure long waiters will be dealt with as a priority. My worry is that those children who are waiting longer than four years will go over the age barrier of 16 years before they are seen.

These two initiatives should have a visible impact on waiting lists.

Housing for People with Disabilities Provision

The motion I have submitted relates to funding from the Department to the local authority to enable it to adapt local authority houses to accommodate people with physical or intellectual disabilities. I wish to raise one case, in particular. A family with a daughter who has physical and intellectual disabilities applied to Cork City Council to have their house adapted because the child had to be lifted out of bed every morning. They must look after her needs. She has to be washed and tube-fed. That is the extent of care they must provide for their daughter. In July 2008 they received a letter from Cork City Council confirming that the house needed to be adapted and that the work would be done. In November 2008 they were presented with a set of plans, detailing what was required. To this date no work of any description has been carried out. The child is now an adult; she is 19 years of age.

My understanding is that last year Cork City Council received €361,000 to carry out works of this nature. I do not know where this money was used, but I do know that this family did not have alterations made to their house last year. This is outrageous. Here is a family who are looking after someone with major disabilities and they are not looking for a huge amount. They are just looking for a little support and encouragement in order that they can provide the level of care needed. If their daughter was being cared for full time in a State facility, it would be costing the taxpayer €2,000 a week, but the parents do not want this. They want to look after her at home, but we are not giving them the support they require.

I understand there are several other families in a similar position in Cork city and I am sure there are others around the country. It is time we looked at this issue in respect of the funding from central government, how that funding is used at local level and allocating it to deal with priority cases. That is why I am raising the issue today.

I thank the Senator for raising this very important matter. He will understand I cannot speak about specific cases, but I am disappointed to hear about the circumstances of the case he has highlighted because under the social housing investment programme, my Department allocates funding to support local authorities in undertaking adaptations and extensions to their social housing stock to meet the needs of tenants with a disability or address serious overcrowding issues. This is over and above the funding my Department provides for local authorities under the separate schemes of grants for older people and people with a disability, under which private homeowners can avail of grant assistance towards the cost of adaptations. The support from my Department for local authorities in undertaking adaptations for social housing tenants meets 90% of the cost, with local authorities providing the remaining 10%.

These adaptations, or the provision of extensions, are important to meet the needs of local authority tenants with a disability who may require chair lifts or the installation of a downstairs bedroom or bathroom. Extensions or adaptations are only considered where an alternative property is not available through a casual vacancy in the locality. For example, local authorities can meet particular needs by reserving a four-bedroom house for a larger family. However, in many cases, there may be no option but to adapt or extend an existing dwelling.

The implementation of works under these programmes is a matter for the local authorities. It is for them to determine, in the first instance, if the works are needed to make the accommodation more suitable for the tenant, as well as to prioritise the use of available resources for who need them most.

In recent years a concerted effort has been made to protect expenditure on extensions and adaptations to local authority homes. In 2012 funding nationally in this area was €8.7 million; it was €6 million in 2013 but €8 million in 2014. The Department has written to each local authority asking for its proposals under this scheme for 2015. On receipt of this information from all local authorities, funding will be allocated to each one. I am keen that this year we allocate funding earlier in the calendar year to allow local authorities to get work on adaptations and extensions under way, as well as to allow more flexibility in drawing down the funding from the Department. I hope to ensure funding for these supports for local authorities in 2015 is maintained at the same level as last year. If the opportunity arises to allocate more over the year, I will examine the matter.

Increasing funding in one area of social housing spend, however, usually impacts on the spend in other important areas, whether it be new social housing provision, important regeneration programmes or adaptations and improvements for private householders. Notwithstanding these competing pressures, the Government will continue to channel this important funding to local authorities. Making the allocations earlier in the year will mean that local authorities will be able to deliver these supports to their tenants in a timely manner and, I hope, improve their quality of life.

I thank the Minister of State for his comprehensive reply. I accept how funding is allocated. My issue is with who is responsible for delivering. Ten days ago I spent an hour on the telephone, going from one person to another within the city council. I went from the official who had inspected the house to the official in charge of finance to the architects' department and back to finance. No one person is in charge of a file. Local authorities have disability officers for staff with disabilities. Why can we not have one person allocated the job in a local authority of ensuring an application does not fall between different stools, as a result of which somebody has to wait six and a half years? Will this matter be examined?

I understand this is an important matter, particularly when dealing with somebody with a disability who needs access to State supports. The Government has protected the allocations for this grants scheme to ensure those with a disability will have access to grant aid through their local authorities. The implementation and delivery of the scheme are the responsibility of the housing authority, which is the local authority. If what the Senator said is correct - I have no reason to doubt him - there is an element of dysfunction in the housing authority in question. I suggest it is a matter for the local authority to take it up as a matter of policy with its strategic housing policy committee to see how improvements can be made in the delivery of allocations and how they are spent in order to ensure better accountability and efficiency and, more importantly, that we deliver for those disabled persons who badly need access to these funds.

Road Projects

Will the Minister for Transport, Tourism and Sport address the pressing public concerns about the routes proposed for the Galway outer city bypass? Six routes were proposed in the past few weeks. The process of route selection at a meeting of 500 people last Thursday night was deemed to be unsatisfactory. People's homes, their families and communities have been put under incredible pressure. The process of route selection has been deemed hasty, a point with which I agree.

Everybody is in agreement that a solution is needed to Galway's traffic congestion problems. We understand that a solution to these problems will involve some level of disruption and perhaps some level of destruction. We would expect the planner to ensure the disruption would be kept to a minimum and the brief to the consultants Arup would be to ensure the minimum level of destruction of homes and communities.

We are faced with six routes which involve the destruction of between 50 to 120 homes. In one case it could involve the destruction of 20 homes, including three thatched cottages in the famine village of Menlo, a heritage village. At some future time that village could be a UNESCO protected village that would be important to Galway's bid for the European City of Culture. Four of the routes will involve the destruction of Galway racecourse, which dates from 1869. One of the routes involves the destruction of the recently opened Bushy Park national school - I attended the opening - and, in particular, the astroturf. A doctor was very concerned about the health implications of a major road such as this passing by a children's playground. One of the routes involves the destruction of the university playing pitches.

The process of route selection has been most unsatisfactory. People have heard about the proposals only in the past three weeks. They have until 27 February to submit their comments.

I have spoken to Arup and made the point that if there were a sufficient number of submission against all of the routes, would they start the process again. Arup said "No, not unless the lead client, that is Galway County Council and the city council pull us off.". I ask the Minister to take my proposal to the Minister for Transport, Tourism and Sport, Deputy Paschal Donohoe, and to the Taoiseach that this process would be stopped until there is adequate consultation by Arup with the various communities involved. We are asking that the Minister instruct Galway County Council as the lead client to instruct the NRA to request Arup to prepare a new transport solution in consultation with the residents and their communities.

There was cross-party support that all six proposed routes would fall at last Thursday's meeting. There was unanimity that the six routes were completely unacceptable as the decision was arrived at without meaningful consultation and involved a large level of destruction. However, there was no agreement on an exact solution, but I request that Arup be given a different brief, not just to consider roads,

Earlier another proposed route was turned down in the European Court that involved the destruction of eight homes. There is a big difference between the destruction of eight homes and up to 120 homes. In that case those people were frozen out for 15 years and could not sell their lands. We do not want to go back to that situation.

We have been told that the cost of the bypass will be between €500 million and €750 million. Would that money be available if Arup were to get a different brief to come up with sustainable friendly traffic solutions, including light rail, bus transport as well as roads? The current proposals are too destructive. I look forward to the Minister of State's reply.

I thank the Senator for giving me the opportunity to address this issue on behalf of my colleague, the Minister for Transport, Tourism and Sport, Deputy Paschal Donohoe. The matter was debated in the Dáil on 18 February during Topical Issues, but I am happy to explain the current position on the N6 again.

The Minister has responsibility for overall policy and funding in respect of the national roads programme. The construction, improvement and maintenance of individual national roads, however, is a matter for the National Roads Authority under the Roads Acts 1993 to 2007 in conjunction with the local authorities concerned. The assessment and prioritisation of individual national road projects is a matter for the NRA within its capital budget in accordance with section 19 of the Roads Acts.

The Minister is aware that Galway County Council, on its own behalf and on behalf of Galway City Council, is focused on addressing existing transportation issues in Galway city and surrounding areas. As part of this process, Galway County Council has initiated a public consultation to inform the public of the transportation options which have been developed to address the problems identified, the constraints identified to date, the implications of the EU habitats directive and the project programme. The relevant options cover public transport, smarter travel and road elements. As indicated in the public consultation documents, the position of Galway city between Lough Corrib and Galway Bay, together with the presence of designated sites, presents significant constraints for developing new infrastructure. Galway County Council has, therefore, focused on considering all alternatives in order to minimise the impact on designated sites. The stated objective of this phase of the council's work is to identify a suitable study area for the examination of alternative routes and transportation solutions, determine the key constraints within this study area, develop feasible route options and transportation solutions and carry out a systematic assessment of these options leading to the selection of a preferred route corridor or transportation solution. Such solution will form the basis for the detailed design.

Road options to connect the R336 on the west of the city to the existing N6 to the east have been identified in regard to the possible road component of the transport solution. Six such options have been included in the public consultation process. Galway County Council has indicated that these are draft options which are subject to change in light of more detailed assessments, ongoing studies and the results of the public consultation. In this context, the Minister understands that the purpose of the recent second consultation is threefold. First, its purpose is to update the public on work to date on the project which includes the presentation of the options under consideration. Its second objective is to obtain input from the public on any other additional significant constraints and the impact the proposals may have. Third, it offers the public an opportunity to propose further alternative options which had not previously been considered. The design team will examine the feasibility of such options and determine whether they merit inclusion in the final appraisal of options. The Minister has also been informed that the design team is currently engaged in individual meetings with directly affected landowners and the public to provide more detail on the various options under consideration.

A public consultation process is under way which allows for the public and other stakeholders to make submissions until the end of February in respect of route options. The process will afford the Senator the opportunity to make an input if she believes that is appropriate. The Minister urges members of the public in Galway to engage with the public consultation process to ensure that they are fully informed and have their say on the proposed options. The information received will be collated by the design team and used in the assessment of the route options. I understand that the assessment process is due to be completed by the end of March 2015 and an emerging preferred route option will be identified. This emerging route corridor will subsequently be put on public display.

This matter has now been raised in both the Dáil and the Seanad. As such, the Senator is putting down a clear marker of her concerns about this matter and the effect she believes the project could have on the people she represents and the wider city and county. The process is being led by the local authority. I have outlined the Minister's role, which is responsibility for all road policy in the country and working to deliver funding for projects prioritised by the NRA. While the Minister must wait until the process in Galway city and county reaches a conclusion, he acknowledges concerns about the matter and hopes the process can be used to respond to matters of legitimate concern to many within the city and beyond.

I thank the Minister of State for his lengthy reply. I accept that there are constraints posed by the River Corrib and Galway's status as a medieval city but the effect is not minimal as implied in the Minister of State's response. He said something interesting which I would like him to clarify. He said a third aspect of the process was that it offered the public an opportunity to propose further alternative options which had not previously been considered.

Is the Minister of State saying members of the public are free to come up with a new proposal for Arup? Arup has not stated that to me. Rather, it has stated it will press ahead with the process unless it is pulled off by the county council. That is an interesting option, if it is true; I am referring here to the third paragraph on page 2 of the reply.

I am happy to clarify what I have already stated and what the Minister for Transport, Tourism and Sport, Deputy Paschal Donohoe, has relayed to me. The purpose of the recent second consultation is threefold: first, to update the public on works carried out to date; second, to obtain input from the public on any significant constraints that have been identified and impacts they may have on the proposals; and third, to give the public an opportunity to propose further alternative options which had not previously been considered.

Does that mean public transport options, not just the roads?

This is a major infrastructural project and I have just clarified for the Senator that the public consultation process is an opportunity for her and any other stakeholders, including members of the public, to make submissions and their views known. As I said, it offers the public an opportunity to propose further alternative options. That said, I have also stated in my response that there are many significant constraints in the general Galway area, about which the Senator would know more than I would.

I have some experience of this process with the building of a similar bypass in Waterford city a number of years ago. A number of corridor options were considered but many were constrained. One works through the process by fully engaging with stakeholders and while the Senator is right to represent their views, there is a process in place that rightfully and transparently deals with submissions. A report is drawn up at the end of that process and a recommended route ultimately comes out of it. That is as much information as I can give the Senator and I hope it is of help to her.

Sitting suspended at 3.20 p.m. and resumed at 3.35 p.m.