Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 13 May 2015

Vol. 240 No. 2

Commencement Matters

Mental Health Services Provision

I welcome the Minister of State at the Department of Health, Deputy Kathleen Lynch.

I, too, welcome the Minister of State. More than 100,000 Irish people took part in the Darkness into Light walk to raise funds and, much more importantly, to raise awareness of suicide in this country and internationally last Friday night into Saturday morning. This was also the case in County Clare, where six different walks took place. In Ennis, more than 2,000 people took part while in excess of 1,000 people took part in Kilrush in west Clare. More than 600 people took part in the walk in Miltown Malbay, where it was held for the first time this year. There were also walks in Shannon and Killaloe.

Suicide has affected every parish, every region and every county and many people are doing their utmost to deal with it. There are many organisations involved in mental health, all of which bring their own unique perspective, experience, local knowledge base, etc., to the table. All play a pivotal role in raising awareness, preventing suicide and supporting people who have difficulties with mental health. The West Clare Mental Health Association is one of those organisations which has done enormous work in the past few years in supporting people in west Clare with mental health issues. It provides on-the-ground support, intervention support, peer support and financial support and engages in fund-raising - the whole realm of support that, as a society and a state, we have failed to provide. The Minister of State has acknowledged in the past that we have an awful long way to go. Fortunately, we have organisations such as the West Clare Mental Health Association which go some way to providing the necessary supports and filling a very big void in terms of what we should be doing as a state but are not doing. Organisations such as the West Clare Mental Health Association fill that void with honour and do a very good job.

There is a facility in Kilrush which is vacant. As part of its development programme, the organisation is looking to use this vacant facility as a base or a hub to deal with the various services it provides. The facility is vacant and in the ownership of the HSE.

A proposal on the use of this premises by the West Clare Mental Health Association has been submitted to the HSE. This would be a natural step forward that would reflect the spirit of partnership between the HSE, the State and mental health associations nationwide. The West Clare Mental Health Association would maintain the facility which would provide the group with a much-needed base to allow it to continue to develop the vital work it is doing on behalf of the community.

I thank the Senator for raising this issue and giving me the opportunity to outline the position. The Senator will appreciate that the Health Service Executive has statutory and operational responsibility for the planning and delivery of services at local level. The mid-west mental health services provide a range of adult mental health services within the specialties of general adult, psychiatry of old age and rehabilitation psychiatry as well as a forensic service. It encompasses various settings such as service user homes, acute inpatient facilities, day hospitals, day centres and supported community residences. The service, which is community based, has a focus on recovery principles in line with A Vision for Change.

The West Clare Mental Health Association is one of four mental health associations funded by the HSE in the Clare area. HSE Mid-West also funds a number of mental health associations in County Limerick and north Tipperary. The West Clare Mental Health Association provides valuable support and services for people with mental illness, including peer support, social interaction and self-care programmes. The HSE and Department value the role of the association and are extremely supportive of its work. I also acknowledge the excellent work of 103 local mental health associations and numerous other voluntary groups operating nationwide which are engaged in a wide range of activities and services that promote mental health and support those with mental illness.

Until recently, the Avonree Centre was used to accommodate people with a mild to moderate intellectual disability. However, arising from health and safety concerns and other problems with the building, the HSE had to relocate residents to a more appropriate premises. I understand the HSE has carefully reviewed the proposal for the use of Avonree for west Clare peer support services. However, given the unsuitability of the premises arising from health and safety issues, it is not in a position to agree to the proposal. Substantial capital investment would be required to make the building safe and I regret that the funding required is not available to undertake this work. However, if at any stage another more suitable premises becomes available, the HSE will re-examine the request.

I fully accept that the last thing that should be done is compromise people by placing them in a building that is not safe or fit for purpose. I welcome the commitment given by the Minister of State and the Health Service Executive on identifying a suitable centre. I hope it will extend to all State agencies in the west Clare area. As the Minister of State correctly noted, the West Clare Mental Health Association does valuable work. It would be a natural progression for the association to acquire a premises as a hub for the provision of peer supports. I thank the Minister of State for coming to the House to address this issue.

When mental health was at the bottom of the pile, voluntary organisations such as the West Clare Mental Health Association, Cork Mental Health Foundation and Housing Association and similar organisations elsewhere did the type of community-based support work recommended in A Vision of Change. They are very much a part of the solution and it is in the interests of everyone that their future is secured. This will be an ongoing process.

Hospital Services

I welcome the Minister of State. The issue I wish to raise is the need to provide 24/7 cardiology services at University Hospital Waterford. Many people in Waterford city and county and across the south-east region have been involved in a long-standing campaign to secure improved cardiology services at the hospital, including the replacement of the current service which operates office hours with a service providing full-time cover. The previous Minister for Health promised to establish such a service as part of the reconfiguration process which involved Waterford and Cork university hospitals amalgamating in a new hospital group. A shift to 24/7 cover in University Hospital Waterford was regarded as a major plank of this configuration process. Unfortunately, the Higgins report did not specifically spell out the delivery of such a commitment and refers simply to enhanced and improved cardiology services in Waterford. On the other hand, the Minister made a clear commitment on 24/7 cover in his public announcements.

Last week I met representatives of the management of University Hospital Waterford who indicated they did not envisage 24/7 cardiology services being delivered at the hospital in the short, medium or long term. They cited a national review of cardiology services which may result in the centralisation of cardiology services through the provision of full 24/7 cardiology cover in larger population centres such as Dublin, Cork and Galway. However, they stated it was unlikely that other regions, including Waterford, would secure additional cardiologists, support staff or resources to enable them to provide 24/7 cover. I am not being alarmist in this matter as management also defended the current system as safe and indicated that it was acceptable to airlift people to Cork, where necessary, because they can be transported in a timely fashion. This view does not wash with those who living in Waterford who may suffer a cardiac arrest and want assurance that they will be treated as quickly as possible in the nearest hospital. While I accept that specialist services cannot be provided in all locations, University Hospital Waterford is a regional centre providing services to a large population base in counties Kilkenny, Wexford and Tipperary as well as Waterford city and county. A 24/7 cardiology service is needed for the entire region and should be located in Waterford.

Is management at University Hospital Waterford wrong? Is it Government policy to provide 24/7 cardiology cover in Waterford Regional Hospital? If so, when will the service be introduced and the necessary resources provided? What new interventional cardiologist posts, additional resources and capacity will be provided? Will the Minister of State clarify once and for all whether 24/7 cardiology cover will be delivered in University Hospital Waterford ? The answer is either "Yes" or "No". The previous and current Ministers have fudged on this issue by using vague language and giving vague commitments. The Government and the Department should be clear on this issue, one way or another, as the service will or will not be delivered. At least if the Government were honest about the issue, we could consider how to step up the campaign for a full-time cardiology service. I ask the Minister of State to indicate what is the Government's policy on this matter, what resources will be provided and if she is able to tell people in Waterford and the south east whether they will have 24/7 cardiology services in the future.

I thank the Senator for raising this matter. It strikes me that we learn very little from the appalling circumstances in which people find themselves as a result of failures in the health service. The lesson we must learn from recent revelations about maternity services is that services must have continuous throughput and significant volumes if they are to be safe and this is not always the case. Services at the regional cardiac catheterisation laboratory, cath lab, at University Hospital Waterford are led by three consultant interventional cardiologists and their teams. This service is developing in line with best practice and the national clinical programme for acute coronary care.

The cath lab at University Hospital Waterford performs approximately 40 invasive cardiovascular procedures each week and offers a comprehensive range of invasive and non-invasive diagnostic services. These include the insertion of stents, pacemakers and implantable defibrillators. Almost 3,000 procedures were carried out in 2014.

Primary percutaneous coronary intervention, PPCI, is done on patients with ST elevation myocardial infarction, STEMI, heart attacks, which account for some 20% of all heart attacks. It is done in a cath lab by an experienced cardiologist. The cath lab in University Hospital Waterford is open five days a week from 8.30 a.m. to 5.30 p.m. Patients who require PPCI outside these hours are transferred to another hospital in the south-south west hospitals group, namely, Cork University Hospital, or to a Dublin hospital. It is important to note, however, that 24/7 consultant medical cover for cardiac patients and all medical patients is provided at University Hospital Waterford. For 24-hour emergency PPCI cover, there is a requirement, as a minimum, for two cath labs on site. It also requires a minimum of six interventional cardiologists.

As for any complex acute hospital service, a key criterion for deciding whether a 24-hour PPCI service should be provided is whether there is a sufficient volume of appropriate patient activity to ensure the safe provision of the service. Without sufficient volume of patients, staff will not be in a position to maintain their skills and, in those circumstances, it will not be possible to ensure a safe service. That is the most important consideration in all of this. The acute coronary syndrome, ACS, programme was established in order to standardise the treatment of patients with all types of cardiac arrests. The model of care produced by the ACS programme was informed by advice from the principals involved in centres in the United Kingdom and other European countries. The programme was also informed by models of care from the United States and Australia. Experience at national and international level highlights the importance of having sustainable rotas of clinical staff to support the 24/7 requirements of the service.

The designation of PPCI centres outside Dublin is based on the recommendations of the ACS programme report of 2012. These were that Cork University Hospital and University Hospital Galway should provide a 24/7 service, with University Hospital Waterford providing a 9 a.m. to 5 p.m. service. University Hospital Waterford is committed to the progressive extension of the current PPCI service and will be pursuing this in the context of service planning for 2016. An extension to the service would require three additional consultant cardiologists, extra support staff and a second cath lab. This would have a significant capital cost of €1.9 million and an even greater revenue cost of €2.7 million. Another factor to consider is that international best practice indicates a requirement for one PPCI centre per 500,000 to 1 million population.

University Hospital Waterford is a constituent hospital of the south-south west hospitals group. It will, therefore, be necessary for the latter, in the first instance, to consider the issue from a group perspective and plan for the cardiology needs of its group population accordingly.

The Minister of State indicated that the acute coronary syndrome programme report of 2012 recommended that outside Dublin, full 24/7 coverage should be provided at Cork University Hospital and University Hospital Galway, with University Hospital Waterford to continue to provide a 9 a.m. to 5 p.m. service. The report identified additional costs in extending the service at Waterford and the requirement for additional interventional cardiologists, support staff and so on. Reference was also made to importance of having a critical population base. I agree that any service must be safe for citizens, but there is a critical mass of almost 500,000 people living in the south east. One of the concerns expressed by people in the region was that once the new hospital groups were in place, patients in Kilkenny or Wexford who were now grouped with hospitals in Dublin would no longer be seen as being in the catchment area of University Hospital Waterford. I hope what is happening here is not the first step in that direction and we do not end up with the hospital no longer performing the regional service it formerly provided.

Why did the previous Minister for Health give a clear commitment to the provision of full 24/7 cardiology care at University Hospital Waterford but we are now being told it cannot happen because of resources and because we do not have the critical mass? In fact, the numbers seem to be right, as set out in the ACS programme report. Will the Minister of State confirm it is the Government's view that it is unlikely 24/7 cardiology cover will be extended to University Hospital Waterford?

To say it is "unlikely" is not to give a clear answer. It is not a "Yes" or "No". What I am saying is the people running the service in Waterford have indicated that it is a safe service, there is access for patients and they are still pursuing the possibility of extending and enhancing the cardiac service at University Hospital Waterford under the 2016 programme. It is an ongoing process. While I never answer for other people, I would make the point that the only way we should ever deliver health services is on the basis of evidence-based research, not by way of promises at a particular time.

Ambulance Service Provision

I welcome the Minister of State, Deputy Kathleen Lynch. I would have preferred to have seen her here last week when I tabled urgent questions regarding mental health services.

As the Senator knows, I could not be here.

I accept that. However, in this instance, I had really hoped to see the Minister, Deputy Leo Varadkar, because the issue relates directly to his responsibilities. I have been in the Minister of State's position and understand it, but this is a critical issue.

I do not mean to take up the Senator's time, but it might be helpful to him to note that it is possible to defer this matter until such time as the Minister can deal with it.

The issue is very urgent and I am anxious to hear the response from the Department. I take the Minister of State's point, but I will proceed. Perhaps the Leader will examine the issue generally of which Ministers or Ministers of State come to the House to take particular Commencement matters.

My question relates to the need for a rapid response ambulance service in County Roscommon, asks specifically about the total number of ambulances, their location and personnel, that are available in the county each day, and seeks an explanation for the unsatisfactory response times. The current situation is totally inadequate and unacceptable to the people of Roscommon and surrounding areas who have had no accident and emergency service at Roscommon County Hospital since 2011 when it was closed by the Fine Gael-Labour Party Government which falsely promised a rapid response ambulance service. The HSE has failed to deliver that service in the four years since the wrongful closure of the accident and emergency department.

The Sunday Times on 10 May included an exclusive story by Eoin Young-Murphy, an investigative journalist with the Roscommon People. Mr. Young-Murphy unearthed an e-mail from Liam McMullen, consultant surgeon at Roscommon County Hospital, criticising the HSE's failure to deliver an ambulance service to the county following the closure of the accident and emergency department four years ago. In correspondence between Mr. McMullen and the Minister for Health, which was obtained under freedom of information, the surgeon claimed the hospital's patients had been "thrown to the wolves".

Mr. McMullen e-mailed the Minister on 13 January after watching an RTE "Prime Time" report of a leaked study which claimed Ireland is too rural to meet recommended ambulance response times. Mr. McMullen wrote: "You wonder why I, a long-time Fine Gael supporter, will now be voting for local independent candidates." He said there was no longer any way to justify to the public the closure of the accident and emergency unit:

It was hard enough to try to explain why you were closing Roscommon A&E department and to put some kind of honest medical, surgical reasoning behind the decision. That reasoning was based on the promise of an adequate rapid response ambulance service. This is manifestly not in place nor apparently will it ever be.

According to guidelines drawn up by the Health Information and Quality Authority, HIQA, in 80% of cases, an ambulance should arrive at the scene of a life-threatening incident within 90 minutes. According to the national ambulance service figures for last November, this target was met in only 50% of cases in counties Roscommon, Mayo and Galway.

Mr. McMullen was also critical in his e-mail of the HSE decision to commission a UK consultancy firm, Lightfoot Solutions, to undertake a review of the ambulance service. He urged the Minister:

Stop listening to the HSE management. They would not know a patient if they fell over one. Their only goal is to advance up their own management ladder. This means parking their problems with yet another management consultants' firm from England at huge cost.

He went on to criticise the HSE's inability to make decisions: "On no account will they take a decision about anything other than to make sure that no trouble lands on their boss's plate, so that their own future advancement is secure." Mr. McMullen advised the Minister not to cut himself off from what is happening in hospitals. He wrote: "You are quite happy to cocoon yourself in and to be unquestionably reassured by ... management blather and deceitfulness... You have lost all sense of judgment and analysis."

This document was secured under freedom of information, as I said. Mr. McMullen's words are particularly striking, given that he was among those who justified the closure of the accident and emergency unit in Roscommon at the time on the basis of the promise from Government of the provision of a rapid response ambulance service. That did not materialise, of course, and it is due to the diligent work of Mr. Young-Murphy that this correspondence has come to light. It is a fairly dramatic development. The people of Roscommon are very aggrieved that the Taoiseach and previous Minister for Health, Deputy James Reilly, as Opposition Deputies, gave written commitments before the 2011 general election that the accident and emergency department would be open on a 24-7 basis, 365 days per year. There has been an absolute betrayal of that undertaking to the people of Roscommon. The e-mail from Mr. McMullen to the Minister, Deputy Leo Varadkar, is quite explosive.

I apologise to the Senator for not being here last week. My absence was due to unforeseen circumstances. I hope he will agree that I generally make myself very available to Senators.

I accept that. However, it is a very sensitive issue.

I am pleased to have an opportunity to inform the House of current developments in pre-hospital services, both nationally and in the Roscommon area. The National Ambulance Service is working to ensure the provision of high-quality and timely emergency pre-hospital care services, using all available resources as effectively and efficiently as possible. As with any pre-hospital service, development and modernisation is an ongoing process, as technology and clinical standards change. A significant reform programme has been under way in recent years. As part of this, additional funding of €5.4 million was provided this year to improve technology and clinical audit and address gaps in service, especially in the west.

It is important to acknowledge that progress is being made. The single national control system, which is now almost fully operational, is improving our control and dispatch performance. We continue to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. We are also moving to more efficient on-duty rostering and developing a national rostering system. Fifty additional paramedics are being allocated in the west this year as part of that process.

Services in the Roscommon area have been enhanced significantly since 2011. Emergency cover in Roscommon town is provided by three ambulances during the day and two at night. In addition, a rapid response vehicle, crewed by an advanced paramedic, provides cover on a 24-7 basis. It is important to note that we are changing the model of service delivery from one where services are provided to a local area from a fixed ambulance base located in that area to a model of strategic deployment. The general area of Roscommon can be supported from the north by services from Boyle and Carrick-on-Shannon, to the east by crews in Longford and Mullingar, and to the south from Athlone. In addition, services are now coming on stream at Tuam and Mulranny stations which will enhance the coverage across the region of north Galway, west Roscommon and east Mayo. Refurbishment of the former Garda station at Loughglynn which is intended to provide dispatch services is now complete and discussions are under way on staffing the facility.

We have also seen the establishment of the emergency aeromedical service, EAS, which is operated from Athlone by the Air Corps and staffed by NAS advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals and almost 1,000 missions have been completed since June 2012. Roscommon and Mayo are the two counties which have benefited most from the availability of the EAS.

These are all significant achievements, but we intend to drive further improvements to the service. This year, for example, we expect to receive the report of an independent capacity review to determine current and future service needs. Among the areas being examined are staff numbers and skills mix, as well as resource deployment locations. I am confident these reforms and reviews will lead to improvements in our pre-hospital emergency care services to the benefit of the people of Roscommon and the rest of the country. I hope my reply has addressed some of the issues raised in the e-mail to which the Senator referred.

I understand the Minister of State's situation regarding commitments and the difficulty in getting to the Chamber. She has been most responsible to this House and made herself available on almost every occasion she was requested. I hope she is aware of the deep concerns in Roscommon regarding psychiatric services, as I outlined last week. I urge her to take a hands-on approach, come to Roscommon and see what is happening in Castlerea and elsewhere. Her direct involvement would be of help. I have begun to avoid attending any HSE briefings. To be frank, I have no faith or confidence in the management of the psychiatric service in Roscommon. I do not trust the people involved and what they are doing. There is a total contradiction between what we are being told in the Dáil and the Seanad and what is happening on the ground.

Does the Senator have a question on the matter we are discussing?

Regarding the ambulance service, I will convey the Minister of State's response to Mr. McMullen.

The Senator raised a matter that was discussed in the House last week. There are several issues to address concerning mental health services in County Roscommon. I am in the process of compiling a list of the more than 50 new posts we have put in place there. I am gathering both names and locations because I am constantly being told these appointments were not made. When that information is available to me, which will be in the very near future, I will supply it to the Senator and everyone else. Senator John Kelly also raised the issue with me.

I will be bringing in the people who are saying this is not happening and, if needs be, I also will bring in the more than 50 additional staff we have put in post. The only further comment I will make is that sometimes a service is used to achieve other aims. Senator Terry Leyden should know that more than most because he has seen it happening for long enough. Sometimes, too, we politicians allow ourselves to be used. I have been there myself and am not placing that blame on anyone's door. It is necessary to put this matter to bed once and for all. Equally, it is necessary to reassure people who are in need of the service that both management and the staff who deliver the service are competent and capable people working for the good of patients, not for the good of other agendas.

Road Safety

I welcome the Minister of State, Deputy Michael Ring. I have repeatedly raised this particular issue in the past three years, but perhaps now is an opportune time to have a proper debate. It is the question of whether the wearing of high visibility jackets should be compulsory for cyclists and pedestrians, especially in rural areas and where there is no footpath or street lighting. The percentage of road fatalities that are made up of cyclists and pedestrians presents a frightening figure.

We can get all the statistics and facts, but I want to open up a debate on this. I have said to people that I was going to raise this issue and they said I would be accused of creating a nanny state but so be it if we create a nanny state if it is going to save lives. If the Minister of States checks the record, he will see that within three days of my raising this issue on the last occasion, two pedestrians were killed at night in my own county. I will keep raising this issue until something is done.

There are no footpaths or lit-up areas in rural areas, in particular. The term used is "vulnerable road users", and these are said to be pedestrians and cyclists. I do not agree with this. The most vulnerable person on the road is the motorist. The motorist must deal with the rules of the road and needs to have everything right with the car, have it taxed and insured and have seat-belts, airbags and everything else. Drivers are going about their business and yet people will not adhere to the simple requirement that they would wear a high-visibility jacket, in particular on dark evenings in winter. This is why something more strenuous has to be put in place.

To give a piece of anecdotal evidence, two years ago I met a neighbour of mine who had a grá for the drink and who has sadly passed away. It was before Christmas and I said to him: "Don't let me see you back in the village without a high visibility jacket on you." He said he would not, but when I met him four or five nights later, he had no high visibility jacket on him. When I said I would drop one over to his house in the morning, he replied: "Don't bother. I have three of them at home."

In fairness, the Road Safety Authority, FBD Insurance and the IFA and other farming bodies are constantly giving out high visibility jackets and there is a great programme whereby the high visibility jackets are made available to schoolchildren. That is all well and good. However, we have to insist on this. There is no point having people act like the man I have just mentioned, who had three of these jackets at home but was walking back from the village in the pitch dark. There is no good having high visibility jackets at home if pedestrians and cyclists are not wearing them.

I will await the Minister of State's reply. I intend to keep raising this issue because I believe it will save lives.

I thank the Senator for raising this very important matter. The Minister, Deputy Paschal Donohoe, the Department, the Road Safety Authority, any right-minded person and I should be gravely concerned at the number of pedestrians and cyclists who are being killed and injured on the roads. To date in 2015, ten pedestrians and one pedal cyclist have been killed in collisions with motor vehicles. While I am not aware of the individual circumstances behind each and every one of these awful tragedies, I would expect that anything that could attract a driver's earlier attention to the presence of a pedestrian, pedal cyclist or other vulnerable road user may have resulted in a different outcome in these cases.

As of yesterday, Tuesday, 12 May, there were 16 fewer deaths as a result of road collisions than in the same period last year. While it is too early to say whether this trend in 2015 will be sustained, I am confident that the implementation of the actions set out in the Road Safety Strategy 2013 to 2020 will, over time, lead to a reduction in road traffic collisions, fatalities and injuries.

Vulnerable road users, in particular cyclists and pedestrians, are a focus of concern and action for the RSA in the authority's current promotional campaigns. The RSA is continuously engaged in publicity drives involving radio and television advertisements on national and local media. The RSA puts huge effort into educating all road users to the dangers on any road and to instill a sense of personal responsibility into all of us. Specifically, it has devoted significant resources to get the message across to all road users about the dangers for walkers and cyclists on or near roadways. Its high visibility vests and other road safety apparel are in evidence everywhere we look. If we step outside these four walls, we will see the RSA-supplied high visibility vests with its logo and slogan, "Be Safe, Be Seen", on hundreds of cyclists, runners, delivery persons and walkers, among others. I understand that up to 5 million various items bearing reflective material have been distributed to members of the public in recent years. These include the high visibility vests mentioned by the Senator, as well as Sam Browne belts, ruck-sack covers, bicycle clips, torches and other novelty items, all with a road safety theme to them.

The aim of the RSA is to ensure all road users develop safe behaviours and appropriate attitudes to be used on the roads. To do this, it looks to impart knowledge and the appropriate skills to road users as they move through life. The RSA's current policy is to deliver road user education and awareness in a combined approach up to third level education. Educational resources have been developed from preschool all the way up to third level and right into the heart of local communities. These resources are delivered in schools and communities throughout the country on a continuous basis.

While the wearing of high visibility equipment is a part of keeping safe on the roads, there are other safe behaviours to be practised when using roads and these are of equal value. In circumstances where people are negotiating unlit or poorly lit roadways, it is the responsibility of all us - cyclists, pedestrians and drivers - to take extreme care. However, no matter how much effort the RSA puts into its campaigns, there has to be an element of personal responsibility in all of this. Road safety awareness campaigns by the RSA that promote personal protection equipment for pedestrian and cyclists and which support a shift to healthier forms of mobility such as walking and cycling are included in the Government's Road Safety Strategy 2013 to 2020. The supply of high visibility equipment was also provided for under the previous Road Safety Strategy 2007 to 2012. Even now, these items are available free of charge and can be ordered by telephone, e-mail or online directly from the RSA ordering system. The RSA also has a number of sponsorships each year that include a partnership with the ESB on its Back to School campaign and with the Irish Farmers Journal for the ploughing championships.

I am not aware of any country that makes the wearing of high visibility material by walkers and cyclists compulsory. A difficulty with such an approach would be in what circumstances walkers and cyclists would be required to wear such high visibility material, in what weather conditions and at what times of the year, and so on. While I understand the Senator's concern, and we are all convinced of the usefulness of high visibility vests, I understand the Minister believes the current promotional approach to high-visibility material is the correct one and the Minister has no plans to make their use a compulsory legal requirement.

I must compliment the Minister of State on a very comprehensive reply. He is stating more or less what I am stating myself. As I said, it is not that there is a lack of supply. I forgot to mention the ploughing championships, which are very good in this regard, but I referred to the schools initiative and so on. Nonetheless, the gent I spoke to had three high visibility vests at home. The Minister of State spoke about personal responsibility but this is where it lies. The point is how we highlight this issue.

Again, the term "vulnerable user" is used to refer to a cyclist or pedestrian. However, I believe the motorist is the most vulnerable person on the road now because, God forbid it should happen, but if a driver is unlucky enough, in the dark of night, to hit a pedestrian who does not have a high visibility vest, one can be sure it will be fatal if the car's speed is over 25 mph. The point I want to stress about the vulnerable road user is that the person driving the car will have to live with that for the rest of his or her life.

I understand that by making it compulsory, we would be accused of making this a nanny state. However, anything that saves lives should be done. The resources, in particular the high visibility jackets, are available and there is no question mark in that regard. However, is there anything we can do to make people wear them? I have been told by gardaí that they often hand them out to pedestrians when they are on the beat.

The Senator is over time.

I will conclude. I thank the Minister of State for his very comprehensive response.

I continue to believe that anything that saves lives is worthwhile. We have to develop a stronger strategy. Education has worked, to a point, but as the Minister of State said, it comes down to personal responsibility.

I thank the Senator for raising this very important issue. There are thousands more people cycling and walking now than in the past. People are more health-conscious, as one sees every day in the city. The Senator is quite correct to raise this issue and refer to personal responsibility. In terms of the law on road users, it is the same for those on bicycles as those driving cars. Everybody has to obey the rules of the road. Every day one sees people on bicycles driving through lights.

The time has come to examine the issue. The Road Safety Authority has made a major effort in terms of schools and educating people. As the Senator said, he raised the issue with his neighbour. What more can one do? Once cannot put it on for people in the evening and again in the morning. At the same time, there needs to be personal responsibility. While driving around the country, one sees people walking late at night wearing black jackets. Such people have to take responsibility for themselves.

The Senator is quite correct; if there is an accident, the people involved are affected. If a person is killed, that has an effect on families. The Road Safety Authority and the Department are examining the issue. At the current time, they do not consider it is something that should be compulsory because it would be very difficult to implement such a law.

Sitting suspended at 11.25 a.m. and resumed at 11.30 a.m.