I welcome the Minister of State, Deputy Finian McGrath. There were three health issues raised. As the Minister of State was coming to the House I decided we would deal with the health issues. I have been considering that if there are a number of health issues or education issues and there is a Minister coming to the House we might as well deal with two or three of the topics. Senator Murnane O'Connor has four minutes and if she can do it in less I would appreciate it.
Commencement Matters
Disability Services Provision
I welcome the Minister of State. The Holy Angels Day Care Centre was opened in Carlow in 1978 in the basement of Carlow's old district hospital by a Presentation nun, Sister Columba. She was given a cheque then for £100 by the South Eastern Health Board and, with the names of five children with special needs from the local area, Holy Angels was set up to provide a day care service for children with special needs of preschool age.
In 1983, the present centre at Strawhall was purchased at a price of £52,000 and prefabs were put on the site to accommodate the children. In 2005, a needs assessment was carried out and the school was told that the current site would not allow for expansion due to the amount of children it looked after. In 2007, Holy Angels received a donation of a site from a private individual. Following that, the HSE assigned a design team to draw up plans.
In 2011, the HSE told Holy Angels the project would go to tender. In 2012, the HSE advised Holy Angels that in order for the work to commence, the HSE had to own the site. In February 2015, a delegation from Holy Angels met with the then Minister for Health, Deputy Leo Varadkar, in Carlow. The Minister said that he could not believe that the HSE needed to own the site.
There are currently 35 children in Holy Angels ranging in age from 18 months up to six years with a waiting list of over 20. Holy Angels is waiting 11 years for the capital funding for its new school. It has been overlooked for years and is at a stage where it cannot expand or take in children who need to attend the school. It has gone from the basement of an old hospital to prefabs and is still in prefabs 39 years on. This is 2017 and we have children with special needs in prefabs. These are the most vulnerable children in our society who have been forgotten. This is unacceptable. Holy Angels has a great manager and staff with a great fundraising committee who have been fundraising in order to help with the building of the new school which will cost approximately €400,000.
I joined the board last year and I see the great work that is being done on the board and the great work that the school does. The current situation is unacceptable. After 11 years there is need for the capital funding that was already committed as the prefabs are no longer suitable. I appeal to the Minister to give us the funding after 39 years. Last year I tabled a Commencement matter for the Minister, Deputy Harris, and he came to Carlow. Urgent work needed to be done. The roof was leaking, the doors needed to be repaired and the floorboards needed to be replaced. He gave us €150,000 about eight months ago. However, that was short term. It is not acceptable now and it is not going to last. The prefabs are not going to hold for much longer. We have a massive waiting list in Holy Angels. We need the capital funding and we need to provide the preschool for these special needs children. I thank the Minister of State.
I thank Senator Murnane O'Connor for raising this very important issue regarding disability services. I also want to welcome the fact that she has raised the issue of funding for Holy Angels Day Care Centre. I would like to outline the current position on this important matter.
Health capital funding was outlined in the recently published public Estimates for 2018 and the HSE is currently developing its capital plan for 2018 to 2021. A project brief for the replacement children's disability services, to include the Holy Angels preschool element, was submitted to the national HSE capital steering group which agreed to recommend the project, in principle, subject to amendments to the brief and the preschool element. The revised brief and schedule of accommodation was subsequently submitted to the national capital steering group in September 2017 for noting at the next capital steering group meeting. I understand that the October 2017 meeting has been rescheduled to the first quarter of 2018 and the date remains to be confirmed. Following the meeting in early 2018 the prioritisation and funding allocation of this project will be considered in relation to other service priorities and projects already approved. Minor capital funding has been made available to undertake the essential maintenance on the existing premises and those minor capital works were completed.
The HSE has recognised that the first class early intervention services and service for school age children with disabilities are paramount. We accept that argument. The HSE is currently engaged in the reconfiguration of the existing therapy resources under the national programme on progressing disability services for children and young people up to 18 years. The aims of the programme are to bring about equity of access to disability services and consistency of service delivery with the clear pathway for children and their families to disability services regardless of where they live, what school the child attends and the nature of the individual child's difficulties. Significant resources have been invested by the health sector in disability services in recent years, including the additional €31 million secured last year. I will bring back Senator Murnane O'Connor's concerns to the Department, the HSE and the Minister. As she said, €150,000 was provided as an interim measure and we do need to act on this matter.
That was a very constructive response. Senator Murnane O'Connor should be very brief.
I am disappointed because I was hoping for clarification today. The school was originally founded in a hospital basement 39 years ago and it progressed to prefabs. It is unacceptable to have babies and young children in prefabs. Those children are the most vulnerable in the community. The Holy Angels centre does a marvellous job. The staff are excellent and the children are getting the best care they can in the circumstances. I urge the Minister of State to provide a commitment on the issue. I am disappointed but I will pursue the issue until we get the funding. A new school is needed for the Holy Angels centre.
I fully accept the Senator's point. I know she has been pursuing this issue for a long time. I commend the staff at the Holy Angels centre who are doing an excellent job. I give Senator Murnane O'Connor a commitment that I will go back to the senior Minister in the Department of Health and try to make this a priority issue.
The Minister of State, Deputy Finian McGrath, will communicate directly with the Senator. In fairness this is her third of fourth time to raise the issue.
Hospital Waiting Lists
I wish to raise surgery treatment for cataracts, which more particularly affects the elderly. Huge difficulties are encountered by people in need of such treatment in Limerick and the mid-west. As we speak, 783 people in the mid-west are waiting approximately 15 months for cataract surgery from the time they had their assessment. That is not acceptable. Many elderly people have come to me to raise the issue. Following surgery people go overnight from a situation of being almost blind to being able to see. One elderly gentleman who came to see me recently told me he was on the waiting list to have surgery on both eyes. He was so distraught that his family came together to ensure he could have an operation on one eye at a cost of €2,000. The operation was carried out in Ireland which meant it did not qualify for the treatment abroad scheme and he was not on the waiting list for sufficiently long to qualify for the National Treatment Purchase Fund.
We must find ways to allow such people to have the operations they need. A proposal is before the HSE at the moment from the University of Limerick hospital group to develop a cataract surgery hub at Nenagh General Hospital.
It would seek to operate five days per week. A full complement of staff would be in the order of 16, including two ophthalmologist consultants, two registrars, two clinical nurses, two general nurses, one advanced nurse, two ophthalmologists and clerical staff. The revenue budget would be approximately €1.75 million per annum in order to have the facility fully up and running. There is a capital cost of €500,000 to buy equipment. If the facility is fully up and running, is will deal with approximately 45 cases per week. The waiting list would be gone in nearly a year.
I am asking that the Department and HSE would give the go-ahead for €500,000 to meet the capital cost. It would take three or four months to commission the equipment. The start date would be in quarter 2 of 2018. It would be possible to get the equipment under existing tender frameworks. The minimum complement of staff required to get the facility up and running is approximately six, involving one consultant ophthalmologist, one registrar, three nurses, and one member of ancillary staff. Approximately €500,000 per year would be required. The Minister could allocate €375,000 for revenue for 2018 and €500,000 up-front to meet the capital cost. This amounts to €875,000. What I propose has to be done.
The reason I refer to Nenagh General Hospital is because it has a state-of-the-art theatre, two brand-new theatres, a day ward and a procedure room in place. It is a model 2 hospital. It is very much in keeping with the thinking on elective care. As matters stand, cataract surgery is being done at the university hospital on the regional site. The number of procedures is in the order of 30 to 35 per week. At times, however, the theatre must be reserved for acute emergency procedures. That work will continue. In addition to the 30 or 35 procedures per week at the regional site, we want an additional ten to 15 procedures to be carried out per week, resulting in up to 45 per week. This would require an allocation €875,000, including €500,000 to meet capital expenses and €375,000 for revenue. Over time, the figure should be increased to €1.75 million in order to carry out 45 procedures per week. This is an urgent matter for Limerick and the mid-west.
I thank the Senator for raising these important issues. He is a strong advocate for disability and health services in the Limerick and mid-west area. I was in Limerick recently at an awards ceremony dealing with young people with disabilities and addressing the matter of training people to work at preschool level. I thank the Senator for his work in this regard. I intend to return to Limerick to visit the services properly as soon as possible.
I welcome the opportunity to address the House on this matter and outline the measures that have been taken to reduce waiting lists for cataract surgical procedures. Given the long wait for outpatient, inpatient and day-case ophthalmology procedures, the HSE is currently undertaking a demand capacity analysis for this speciality. The HSE has established a steering group and, to date, work has been undertaken on identifying current capacity, projecting future demand for cataract procedures and how to enhance public hospitals' capacity to meet patient demand.
As part of this demand capacity analysis, work is ongoing to identify possible capacity measures to address cataract waiting lists. Possible future measures include the development of new units and maximising the use of theatre sessions that are currently unused. There is potential to provide more eye care services within primary care, which would help to divert patients from acute hospital services. Expansion of services at hospitals is, of course, another option. In that context, the hospital at Nenagh has been identified as a possible location where ophthalmology services could be developed. Such a service has the potential to help reduce the waiting time for patients in the mid-west and also to provide services for some patients from outside the University of Limerick hospitals group.
I understand that the cost of service development, both capital and revenue, has been scoped out by the University of Limerick Hospitals group and has been submitted to the HSE acute hospital division to help inform the demand capacity analysis. I understand that work on the demand capacity analysis is not yet complete. I look forward to receiving a report from the HSE in due course.
The House will be aware there has been significant progress throughout 2017 to reduce waiting lists, including for cataract procedures. The HSE and National Treatment Purchase Fund, NTPF, have worked together to continue to drive down long wait times for inpatient and day case procedures. Waiting list numbers published by the NTPF at the end of October show that the number of public patients on the active waiting list for cataract surgery has been reduced by over 16% over the past six months. Between April and the latest available figures, the number on the overall list fell from 13,552 to 11,863. The cataract waiting list fell from 10,304 to 8,667. The waiting list of patients waiting more than 15 months for cataract procedures was reduced from 1,694 to 421. This reduction shows the combined impact of both the HSE's waiting list action plan and the NTPF’s waiting list initiatives to reduce waiting list numbers.
The NTPF continues to authorise treatment for cataract surgery and to work with both public and private hospitals to access treatment for patients. These reductions in waiting lists are promising. I am aware and accept the Senator's point that more needs to be done to tackle waiting lists in the future. To that end, budget 2018 provided an additional €10 million in 2017 for further waiting list initiatives including cataract procedures for the remainder of 2017. Next year, €55 million is being allocated to the NTPF, which more than doubles the 2017 allocation of €20 million. This significant increase in funding reflects the fact that reducing waiting times for patients is one of the Government's key priorities. This funding will enable the provision of treatment for patients across a range of procedures, including cataract procedures.
The Senator has just one minute because we are trying to avoid a Dáil vote.
I thank the Minister of State for his reply. I have a few observations. He spoke about the National Treatment Purchase Fund. In the mid-west, 500 cataract operations took place, covered by the National Treatment Purchase Fund at a cost of €2,000 per operation, which amounts to €1 million. The aforementioned hub for cataract operations in Nenagh would provide value and enable people to have cataracts treated in their home area. I ask the Minister of State to follow up with the HSE acute hospitals division to get a sign-off on the €500,000 to enable the capital procurement to start to take place. We are looking for €375,000 for 2018 to enable the procedure and to get this measure off the ground. I feel passionately about this. It has to happen. We have 783 mostly elderly people waiting for cataracts operations in the mid-west for up to 15 months. That is inhuman and cannot be allowed to happen. I ask that the sign-off now take place for the capital to enable equipment to be purchased to enable operating to begin from the second quarter of 2018 and to ensure we can reduce the waiting list over time in order that instead of people with cataracts being obliged to operate in darkness for 15 months or more, they can at least enjoy their existence and be able to see things.
I will bring the Senator's concerns about Nenagh and the €375,000 back to the Minister and the HSE, and I will bring that message to the acute hospitals division too. I agree that the figure of 783 people waiting in the mid-west is not acceptable and that we have to act promptly. If an extra €55 million is spent next year to deal with waiting lists-----
Capital is also needed for the equipment.
We will have to be creative and see if there is funding within that budget.
General Practitioner Services
I thank the Minister of State for coming before the House. My question relates to patient safety, clinical effectiveness and cost effectiveness and the evaluation of telecommunications, in other words, GPs using telecommunications for giving one-to-one advice over the Internet. What regulation exists on this and how are we going to develop this area, which would be of benefit to GPs, especially in rural areas where patients would be able to access doctors without having to travel long distances to meet them? We talk about developing primary care centres where there would be a far bigger number of GPs working, but they would be a greater distance from many people in rural areas. It is in that context that I raise this matter. It is important that we roll this out and regulate it properly to ensure that it works and patients are safe. As I understand it, there is nothing to prevent someone from starting such a service under the current legislation.
I thank Senator Burke for raising this important matter. I welcome the opportunity to outline the current position. I assume the Senator is referring to the clinical and cost effectiveness and patient safety aspects of the teleconsultation services which are remotely delivered online rather than traditional face-to-face consultation. It is important that the value of these services is given the full consideration in view of the increasing availability and also demand for such services. The importance of ehealth or digital health to support health care reform and its role in the delivery of a modern healthcare system has been recognised for some time. My Department published an ehealth strategy in 2013, which outlined a roadmap to improve the deployment of information technology in the health service to support health care efficiency, patient safety and care. Delivering ehealth in Ireland means the digital transformation of a health care model that exploits the digital infrastructure to enable commonly shared capabilities and access to services and information throughout the health system.
Ehealth has the capacity to provide the building infrastructure and the technology needed to facilitate the wider use of technology to enhance patient safety and patient care in any health care setting. As new technologies emerge, they provide opportunity for different approaches to the treatment of patients, offering alternative health care models of integrated care that can contribute to better outcomes, patient safety and achieve coat efficiencies in the delivery of health services. The Sláintecare report, published in 2017, also emphasised the importance of health information and ehealth as critical enablers to implement the change required to deliver an integrated, high quality health system. The report advocates continued strong support of the ehealth strategy and in particular ensuring the necessary funding for the timely roll-out of an electronic health record, EHR, system.
On the use of teleconsultations in healthcare delivery, there is emerging evidence that telemedicine teleconsultations can be implemented to support an integrated healthcare approach. TeIeconsultations between GPs and patients can provide benefits in certain circumstances, such as the provision of care in remote locations or for chronically ill patients, providing a service in alternative settings that are more convenient for the patient. Such consultations offer alternative channels of service and enhance patient choice.
I thank the Senator for raising this important issue and assure him and the House that as this is an emerging area of service provision, it will be closely monitored by my Department.
What are we going to do to try and progress the matter and what are the Department's plans? Especially in rural areas where we are talking about primary care centres which would lead to the centralisation of GPs creating longer distances for people to travel, is there an overall plan to deal with this issue?
I have not seen any overall plan yet but it is something that I will bring to the Minister, Deputy Simon Harris, and exert some pressure with regard to it. It is an important, new modern aspect of delivering our health services and it is something that should be taken seriously by the Department and the HSE.
I thank the Minister of State.
Garda Stations
I welcome the Minister of State, Deputy Stanton.
The Minister of State is welcome to the Chamber. Last week, Assistant Garda Commissioner Pat Leahy confirmed at a meeting of the Committee of Public Accounts that Rush Garda station was on the list of six stations that were to be recommended to the Government for reopening. I welcome this decision. Rush Garda station's closure in 2012 has had an adverse impact on the local community. Rush is a town with a population of 10,000 people and is growing rapidly.
The Government announced a re-examination of closed Garda stations. When I tabled a Commencement matter in March regarding the need to reopen Rush station, I was told that a report would go to the Minister at the end of May. In July, it was announced to much fanfare that Stepaside Garda station would reopen and that five other stations were listed in an interim report. Various unconfirmed reports at the time placed Rush as one of the five. We in north County Dublin were happy with that, but it has taken until November for the final report to be sent to the Government.
While the reopening is welcome, there is a fear across north County Dublin that this is a false dawn. That is why I am calling on the Minister of State to give a clear timeframe for the station's reopening. Remedial works will have to be completed. Vehicles and ICT equipment must be provided. Most importantly, extra gardaí will have to be allocated to the station. There is a severe shortage of gardaí in Fingal, the fastest growing county council area in Ireland. There are 177 gardaí in its division at any one time, taking into consideration sick leave, maternity leave, UN duty and so on. That is not enough. We must ensure that, instead of these gardaí being reassigned to Rush, more gardaí must be put in place so that Rush Garda station can be reopened without a decrease of service across the division.
Assistant Commissioner Leahy stated last week that he would have preferred to allocate extra gardaí to stations other than Stepaside. Will that be the case with Rush? Will the Minister of State give the people of Rush guarantees regarding the timeframe, whether the reopening will be fast-tracked and prioritised and whether Rush will receive the necessary resources, thereby ensuring that the station will reopen without further delay? When will this station have its doors open and when will it serve the people of Rush again? When will the extra gardaí be assigned as opposed to merely being redistributed from within the division?
The Minister sends his apologies. Unfortunately, he cannot attend because he is taking business in the Dáil. On his behalf, I thank the Senator for raising this important matter.
The Senator will appreciate that the acting Garda Commissioner is primarily responsible for the effective and efficient use of the resources available to him, including in respect of the opening and closing of Garda stations. The programme for Government commits the Government to ensuring a strong and visible police presence throughout the country in order to maintain and strengthen community engagement, provide reassurance to citizens and deter crime. A cornerstone of this commitment is the Government's plan to achieve an overall Garda workforce of 21,000 personnel by 2021, comprising 15,000 Garda members, 2,000 Reserve members and 4,000 civilians.
Revisiting the decision that was taken to close Garda stations at the depths of the recession is also a part of that commitment. In this context, the former Tánaiste, following the approval of the Government in June 2016, requested the then Garda Commissioner, while fully cognisant of the Commissioner's statutory functions, to identify six stations for reopening on a pilot basis to determine the possible positive impacts that such openings would have on criminal activity, with special emphasis on burglaries, theft and public order.
The current acting Garda Commissioner recently submitted his final report on the pilot.
The report contains a recommendation that Rush Garda station be one of the six Garda stations to be included in the pilot scheme, along with the Garda stations at Ballinspittle, County Cork, Bawnboy, County Cavan, Leighlinbridge, County Wicklow, and Stepaside, County Dublin. The Minister intends to bring the final report to Government shortly. In the meantime, the Commissioner has written to the Office of Public Works and instructed it to progress the matter.
The Minister understands that a timetable for the re-opening of the stations concerned is dependent on a number of factors, including the brief of requirements from An Garda Síochána, the extent of the required refurbishment based on current building regulations, the need to comply with fire regulations and to provide disability access. There are also agreed standards and specifications for Garda cell areas and custody suites which would have to be incorporated into the refurbishment. Once the specifications have been agreed, the works will go to tender and will commence when the contract has been placed.
The Minister of State mentioned that the Minister intends to bring the final report to Government shortly. Can he give me a commitment that this will be done before Christmas? On the specifications agreement, what is the timeframe in that regard? For example, will it be one month, two months or six months? What is the timeframe for the tender process and within what timeframe following closure of this process will a decision be made? These are the specific questions to which the people of Rush would like an answer.
I again thank the Senator for raising this important matter. As I said, the Government is committed to a strong, visible police presence throughout the country in order to maintain and strengthen community engagement, to provide reassurance to citizens and to deter crime. In addition to its commitment to achieving an overall Garda workforce of 21,000, the Government initiated a process to re-open, on a pilot basis, six of the Garda stations closed under the Garda Síochána district and station rationalisation programme. As I said, the acting Commissioner recently submitted his final report on the pilot and the report contains the recommendation that Rush Garda station be one of the six stations to be included in the pilot. The timeframe for the re-opening of Rush Garda station, as in the case of the other stations to be re-opened, is dependent on a number of factors, including the brief of requirements from An Garda Síochána, the extent of required refurbishment based on current building regulations, the need to comply with fire regulations and to provide disability access, in addition to standards and specifications regarding cell liaison and custody suites. Once the specifications have been agreed the works will go to tender and will commence when the contract has been placed.
The Senator has asked a number of questions to which I do not have answers today because the initial question asked for a timeframe for the re-opening of Rush Garda station, which as I outlined is dependent on agreement on specifications and other issues. I will ask that the information requested by the Senator be sent to her as soon as it is available.