Commencement Matters

Infectious Disease Screening Service

I thank the Minister of State for coming to the House to take this debate. I would like the Minister for Health to oversee the introduction of the loop medicated isothermal amplification, LAMP, test in hospitals. The test can provide results detecting the presence of meningitis within an hour, dramatically reducing the time taken to produce a result under the current system. This would allow for life-saving treatment to begin much sooner than currently possible. There are 200 cases of meningitis in Ireland annually. Of these, 10% of patients die, 10% suffer major disabilities such as brain damage or amputations and 33% suffer some form of after-effect. Ireland has one of the highest rates of meningitis in Europe. A child suspected of having the disease is subject to a blood test, the result of which is returned within 48 hours. Consequently, some children at serious risk can be sent home with a disease that could kill within a matter of hours. The LAMP test was developed in Queen's University Belfast. It is a test for meningitis, the result of which is returned within an hour, and it has the potential to save numerous lives every year. It is diagnostically as accurate as the current method but it is much quicker and more straightforward for any hospital with a laboratory. A significant cost would not be incurred and it has been trialled over the past few years by the NHS. It is a no-brainer and I would love to think it will be introduced in Ireland because we have one of the highest rates of meningitis.

I thank the Senator for raising this important matter and for the opportunity to outline the thinking of the Department and the HSE in this regard. Meningitis is defined as inflammation of the meninges, which is the lining around the brain tissue, and this can be caused by bacteria, viruses or, rarely, fungi. When testing for meningitis, a sample of cerebrospinal fluid must be taken, which is then examined for white cells that fight infection and subjected to certain culture and molecular tests. The aim of these tests is to identify the specific organism causing the inflammation. There are two reference laboratories in Dublin where testing is carried out - the Irish Meningitis and Sepsis Reference Laboratory at Temple Street carries out bacterial testing and the National Virus Reference Laboratory provides the viral testing service.

There is a move currently in laboratories to test for a greater number of organisms at the same time. These broader tests provide a number of benefits. They have quick turnaround times that can provide results in approximately two hours and they can be performed in the local hospital laboratory without the need to send samples to the reference laboratories in Dublin. The Irish Meningitis and Sepsis Reference Laboratory supports the introduction of tests for meningitis in each hospital that provides an acute emergency service. There has also been significant progress in research into the use of biomarkers for diagnosing sepsis at the time of presentation. An advantage of these biomarkers is that they are not specific to a particular organism and, therefore, have the potential to detect sepsis due to any invasive bacterial infection.

The Senator referred to one particular commercial testing system, namely, the LAMP HiberGene system. This system can be used to test for two particular organisms in cerebrospinal fluid, namely, meningococcus, and group B streptococcus.

As the Senator said, this system has a quicker turnaround that the broader systems I have mentioned. However, it only tests for a very restricted range of bacteria that can cause meningitis and will not identify other causes of meningitis such as pneumococcus and E. coli. The system also does not detect viral causes of meningitis or other viruses that may cause encephalitis, that is, inflammation of the brain. Consequently the other tests must still be carried out to ensure that the correct diagnosis is made. Otherwise, there is a danger that the wrong treatment would be applied with potentially catastrophic consequences.

Finally, I would like to talk about the introduction of immunisation against meningitis into the childhood immunisation programmes in recent years. Every child receives the meningococcal B vaccine at two, four and 12 months of age; the meningococcal C vaccine at six and 13 months; and a booster dose in the first year of secondary school. These vaccines have had a real impact, leading to significant decreases in these forms of meningitis.

This is a very important topic. Does Senator Noone wish to ask a brief supplementary question?

Yes. I was brief enough in my initial remarks in any event. I welcome the move towards testing for a greater number of organisms at the same time and towards a quicker turnaround, which obviously is of double benefit. I have to take as read what the Minister of State tells me about the test to which I am referring being more restricted in what it tests for. I hear where he is coming from in that regard.

In his final comments, the Minister of State referred to vaccinations. This is a matter of very serious concern generally, particularly as there is a great deal of unnecessary scaremongering about certain vaccinations in this country. It has been shown that there has been a reduction in the number of children being vaccinated for meningitis and for HPV, which causes cervical cancer. That is a much larger issue. This is obviously a system to detect meningitis when it occurs, but there is a way to prevent it occurring. We are so lucky to have these vaccines. It is a very serious issue that people are being misinformed and that there is a lot of misinformation about vaccinations. In many respects it is probably more important than detecting it. Obviously, we want a good system of detection. If, however, we have a way of preventing it, surely that is the only show in town. I encourage members of the public to inform themselves before considering not having any of these vaccinations because we are so lucky to have them and children need to get them. I thank the Minister of State.

The Senator is making up lost ground now. She is stealing a bit of time. I call the Minister of State to conclude.

I think we are okay. There is no question regarding the final point. I agree with the Senator on that.

Long Stay Residential Units

I have asked the Minister of State here today to discuss the planned closure of the Rosalie unit in my home town of Castlerea, County Roscommon. A public meeting about the threatened closure of this health facility took place on 8 February. To say that family members of the residents are upset would be an understatement. The unit was previously threatened with closure in 2015 but, following public protests, this plan was reversed. The protests were organised by angry family members who then numbered more than they do now. The cynic in me would suggest that the embargo placed on new admissions since September 2016 was introduced in an effort to minimise the voice of protests which would come once the closure was announced. In an interview last week, Tony Canavan said that the reason this is arising as an issue is that the numbers in the unit have drifted down to a low level and that is because there has not been any new admissions to the Rosalie unit since September 2016. There could not be any new admissions because there was an embargo on admissions. When pressed on the fact that this was because an embargo had been placed on new residents, Mr. Canavan disagreed with the use of the word "embargo". That is, however, what we must call it. It is an absolute disgrace.

The unit at Áras Naomh Chaolain is currently home to 14 elderly high-dependency residents with mental health conditions including advanced Alzheimer’s. It was developed as a specialised psycho-geriatric unit with capacity for 25 people. It is not the same as a general nursing home. I am very familiar with it. I grew up 300 yd. or 400 yd. down the road from it. I am very familiar with the area and my cousin works in the unit.

Fears that the centre would be closed were allayed in July 2015 when then Minister of State at the Department of Health, Kathleen Lynch, told a deputation from Roscommon there were “no plans to close it and there will be no such plans.” For the families of the residents, this offered some relief. That has now been shattered. These patients and their families have been told by the HSE that there is adequate accommodation available in Ballinasloe, County Galway, and Castlebar, County Mayo. I am not sure if the Minister of State is familiar with the hinterland around there but it is an hour's journey from Castlerea to Castlebar or an hour and a half on the train. There is no main direct route to Ballinasloe from Castlerea. There is a road but it is terrible. There is no direct rail link or bus route. It would take at least an hour and a half for families to visit their loved ones in such units. These sorts of excuses are totally unacceptable. Uprooting these people, changing their routines and putting them in new settings different from those they are used to is an absolute disgrace. This unit is their home. I totally disagree with this move. I fell very passionately about it. We in Ireland pride ourselves on having an innate sense of nature. This is not nature. It is terrible. It would not happen in the Minister of State's own home town. This is a political decision and it can be reversed. I urge the Minister of State to deal with it as a priority.

I thank the Senator for the opportunity to clarify some of the facts surrounding this story. I heard the interview to which the Senator refers on local radio, I have read lot of the commentary and I have heard the views of many of the Senator's colleagues and public representatives on this issue. The HSE has confirmed that no decision has been taken to close the Rosalie unit. The focus of the executive over recent times has been, and remains, on meeting the needs and best interests of the current residents of the unit. The 2006 document, A Vision for Change, sets out a comprehensive policy framework for the development of mental health services. It broadly recommends a move away from the traditional institution-based model of care to a more patient-centred, flexible and community-based service, where the need for hospital admission is greatly reduced while still providing inpatient care as appropriate. This Government has prioritised the reform and resourcing of our mental health services in line with A Vision for Change.

On the recommendations in the report, staff and service users are represented on the review group that authored it. The HSE has advised that a consultant psychiatrist and the chair of the review group have also been appointed to oversee the implementation of the report's recommendations. The executive has advised me that capacity exists within the Creagh suite in Ballinasloe to accommodate psychiatry of later life patients who have complex continuing care needs. This is an approved centre under the Mental Health Act 2001, which has recently been extensively renovated and modernised to the highest standards. However, the executive has advised that there is no current proposal to move the residents to this facility. I convened a meeting with local public representatives and the HSE on 24 January last in Leinster House. A key outcome of this meeting was a commitment by the HSE to fully engage with residents and their families regarding the Rosalie unit. The chief officer of community health care organisation area 2 met residents and their families on 8 February. In addition, I had discussions yesterday evening in Galway with the HSE about the Rosalie unit and I will be visiting it on 27 February. In conjunction with the executive, I will continue to closely monitor the development of all community-based mental health services in the Galway-Roscommon area, including those provided at the Rosalie unit. The unit, part of Áras Naomh Chaolain, is located in Castlerea, County Roscommon. As the Senator is well aware, it is a continuing care facility for psychiatry of later life patients.

The Minister of State mentioned the 2006 policy document, A Vision for Change. He also mentioned that a move away from the traditional institution-based model of care is in train. This is not an institution. This is the residents' home. I have worked in St. Ita's Hospital and I have worked in psychiatry. I have worked in different units all over the country. This is the patients' home. Their families are used to visiting them there.

To call this unit an institution is a misnomer and misleads the public. The Minister of State refers to A Vision for Change. At a public meeting held in Castlerea last week, Dr. Charles Byrne, a retired psychiatrist, said that the plan to close the unit violates A Vision for Change guidelines which stipulate that there should be 30 beds per 300,000 population. The population in Roscommon is aging and there are more than 2,000 patients in the Roscommon region with dementia. This is a callous act that violates people at their most vulnerable, because of their dementia and their cognitive impairment. These people have no voice and they probably have no vote, but I guarantee that their family and their supporters do and they will not be silenced on this issue. Nor will I. It is something about which I feel very passionate and I urge the Minister to ensure that this unit remains open.

The Minister of State has said that he will visit it and that there are no plans to close it.

I thank the Cathaoirleach; there are no plans to close it and I do plan to visit it.

Despite everything else.

I will clarify some things for the Senator in the interest of being helpful. The decision not to admit any further patients to this unit was a clinical decision taken by those practising in the area. It was not taken by HSE management or by a politician, whether it was myself or my predecessor. The admissions stopped.

It was taken to silence the advocates for the patients. That is why it was taken.

The Senator has had his chance. It may be the case that never the twain will meet. Perhaps when the Minister of State visits it, Senator Swanick might meet him there.

I would be delighted to meet the Minister of State that day.

I want to clarify a point that is important for the record of the House. The admissions were stopped on the basis of clinical best practice and by practising clinicians.

That was convenient at the time.

I have no problem coming in here to answer questions but the Senator will have to listen to my replies.

Allow the Minister of State to answer the question.

The Senator will have to listen, this is a two-way process. The commitment I want to give to the House, to the Senator and others who are concerned about this, is that my top priority is the residents of the Rosalie unit. It will not be a politician that will dictate the future of that unit or these people, or any HSE management, it will be dictated by clinical best guidance and what is in the best interests of these patients and the residents of the Rosalie unit. That is what I will be guided by, not politics or HSE management. I will take the best clinical advice and ensure their rights are protected and upheld.

Senator Swanick feels very passionately about this matter in his home town or village. It might be helpful if he meets the Minister of State when he visits on 27 February.

I know there is a lot of passion involved but the Minister of State has to respond.

Mobility Allowance

I thank the Minister of State, Deputy Jim Daly, for coming before the House on this matter. This scheme was abandoned or abolished by a decision of the Government in February 2013. I am concerned it has taken so long to address it. I will focus on three areas. In recent weeks, there was a letter from the Minister of State, Deputy Finian McGrath's, private secretary following a presentation that he made to the Joint Committee on Public Petitions last October.

The point was made there that it is not possible to provide an estimate of how many persons would currently be eligible for the payment of the mobility allowance if the scheme had not closed. I find that amazing because I asked the Oireachtas Library and Research Service which contacted the HSE and I have come up with my own estimate. An estimate can be challenged but when one looks at the drop in the number of people in the scheme since it was closed and looks back at the pattern prior to that, I estimate probably up to 900 people have lost out over the past five years since the scheme was closed to new entrants. The Minister of State has been very strong about telling us that none of the people on the scheme has lost out and that they still have it but the people who would ordinarily have been coming onto the scheme, where others died or moved onto other things, have not been catered for. It is not acceptable by any means and the Department has not put enough effort into it.

At that committee meeting I asked when the Department had been first contacted by the Ombudsman. Deputy McGrath told that meeting in October that it had been in 2011 but a report undertaken by the Ombudsman includes several appendices. One, appendix 3 on page 31, is a letter from the chief investigator in the Office of the Ombudsman on 3 February 2009. There was a response to it three months later from the director of the disability and mental health division in the Department. Later that year, both the director general of the Office of the Ombudsman and, finally in November of that year, the Secretary General of Health became involved. Something is going wrong if a Minister of State at a committee does not know the basics of when the Department was communicated with in writing. On that occasion, I also asked why, in 2013, the Department did not put that scheme on a statutory footing. The response I received on 24 January 2018 was that it was not possible to place the then mobility allowance scheme on a statutory basis given the finding that the schemes were in breach of the Equal Status Act. If one reads the Equal Status Act 2000, on page 20, section 14 outlines certain measures and activities that are not prohibited. It simply states: "Nothing in this Act shall be construed as prohibiting (a) the taking of any action that is required by or under" and goes on to outline these, of which the first subsection is "(i) any enactment or order of a court."

In 12 days, it will be five years to the day since the Government abolished this scheme on equality grounds. A simple procedure could and should have been put in place to copper-fasten it as a statutory scheme pending the advice of the Ombudsman, which was to make sure that people over 65 were included - thankfully, people are living a lot longer now. That was not done. At the committee in October, Deputy Brendan Ryan asked the Minister whether there was any funding in this year's budget and he said there was not. We still do not have the legislation and I have no sense or hope that this legislation will actually go through this year. We will then be into the seventh year without dealing with something that was regarded as urgent while ordinary people around the country are losing out.

I am happy to provide an update to the House on progress on the health (transport support) Bill since the closure of the mobility allowance and motorised transport grant schemes in 2013. In February 2013 the Government decided to close both the mobility allowance and the motorised transport grant schemes following reports of the Ombudsman in 2011 and 2012 regarding their legal status in the context of the Equal Status Acts. Since the closure of the mobility allowance scheme, the Government has directed that the Health Service Executive should continue to pay an equivalent monthly payment to the now 4,133 individuals, then 4,700, pending the establishment of a new transport support scheme.

A review group on transport supports for people with disabilities, which was chaired independently, was established in 2013. Membership of the review group comprised representatives of Government Departments, the National Disability Authority and stakeholder organisations, including the Irish Wheelchair Association, the Disability Federation of Ireland and the Centre for Independent Living, among others. Informed by the work of that group, the Government decided in May 2013 that new statutory provisions would be established to provide individual payments to people with severe disabilities who require additional income to address the cost of their mobility needs.

The Government also decided at that time that the details of the new statutory provisions should be worked out by an interdepartmental group to be chaired by the Department of the Taoiseach. The interdepartmental group comprised representatives of Departments and the National Disability Authority. On foot of the work of the interdepartmental group, the Government decided in November 2013 that the detailed preparatory work required for the scheme and associated legislation would be progressed by the Minister for Health in consultation with other relevant Ministers on a priority basis.

In line with the Government decision, the Department of Health has been working to develop legislative proposals for a new transport support scheme. The Senator will be aware that A Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new transport support scheme to assist those with a disability to meet their mobility costs. A general scheme and heads of Bill was completed in draft form and has been subject to detailed legal examination, given the complex legal issues which arose in the operation of previous arrangements. In December 2016, this draft general scheme and heads of Bill was circulated to other Departments and was the subject of consultation between officials in the Department of Health and the Department of Public Expenditure and Reform.

The House will appreciate that it has been necessary to estimate both the numbers likely to qualify for payment and the likely overall cost of the proposals. I can confirm that work on the policy proposals for a new scheme is at an advanced stage. The legislative proposals for the scheme seek to ensure the following: there is a firm statutory basis to the scheme’s operation; there is transparency and equity in the eligibility criteria attaching to the scheme; resources are targeted at those with the greatest needs; and the scheme is capable of being costed and is affordable on its introduction and on an ongoing basis. It is hoped to bring a revised general scheme and heads of Bill to Government shortly in seeking Government approval for the drafting of a Bill for the new transport support payment. The health (transport support) Bill is on the list of priority legislation for publication in the spring-summer session of 2018.

In the meantime, the Department of Health has maintained contact with the Ombudsman in regard to this matter and Department officials have recently met with officials from the Office of the Ombudsman. The Department has also had ongoing contact with the National Disability Authority on the issue.

Go raibh maith agat. We have heard about the work that went on throughout 2013, culminating in the interdepartmental group that was chaired by the Department of the Taoiseach coming to its conclusion in November of that year and the recommendations to the Department of Health. We move down a few lines in the Minister of State's statement and, next thing, we are in December 2016. He then goes on to state, "The House will appreciate that it has been necessary to estimate both the numbers likely to qualify for payment...". That is interesting, given it is part of the engagement between the Department of Health and the Department of Public Expenditure and Reform, and I am sure there would be tensions there. However, the reply from the Minister of State states they could not estimate how many people have lost out on the current scheme, when there are 35 to 40 years of trends available and they know the number is going down each year. I find it puzzling that the Department could not or would not tell us that real people have been losing out year by year on the current scheme. We are being told the Department of Health will provide comfort to the Department of Public Expenditure and Reform about the number of people who are likely to benefit from a scheme we have never seen and that has never been piloted.

This scheme was brought in back in 1979. At the time, we had never heard the language of "personalised budget", "money follows the person" and all of those things, but that is precisely what it was - a simply administered scheme that people had to apply for and which was means tested. Someone got money into their pocket and they could use a variety of different methodologies to make it work for them. It is absolutely crazy and ironic that a Government - this was done by the previous Administration and we have had another one for almost the last two years - would abolish a scheme that was about what we are now told is the new policy. That is exactly what this was doing for over three decades. There was a very simple device at the time, namely, to put a clause or section into some other piece of health legislation and copper-fasten that until the changes were made.

I fully acknowledge there has been a protracted period since the problems with the mobility scheme were first highlighted. However, there has been an unusual degree of complexity attaching to the issues. When the draft general scheme is submitted to Government, it will be a matter for Government to determine the precise policy which should underpin the general scheme. The Members of the House will appreciate that we cannot pre-empt the outcome of the Government's considerations. Again, I appreciate the opportunity to update the House and to reaffirm the commitment of the Minister of State with responsibility for disabilities to the introduction of a new Bill as a priority. I want to again confirm that it is on the list of priority legislation for the spring-summer of 2018.

Sports Capital Programme

I welcome the Minister of State, Deputy Brendan Griffin, and thank him sincerely for his attendance. As he is aware, many towns in the Border region suffered due to the Troubles in Northern Ireland and while, thankfully, that day is now very much in the past, it has left a devastation in many towns. For example, it is fair to say that, in County Monaghan, no town has suffered as much as Clones. Given its close proximity to the Border, Clones had many roads closed during the Troubles and, indeed, those that were open to those wishing to visit Clones were subject to military checkpoints and the delays that come with that. As a result, many businesses have suffered down through the years.

Thankfully, however, the people of Clones have kept the light on and they are fighting back, and they are a very resilient people. One of the shining lights, if I can use that expression, during all of the darks days has been St. Tiernach's Park in Clones, where the Ulster football final is held every year. The first final dates back to 1906.

On that day, Monaghan overcame the Gaels of Antrim to win the Ulster final in Clones. Since then, thousands of people have visited the facility every July for what is one of the great sporting occasions of the year. It is fair to say that it has been recognised by commentators the length and breadth of the country that no venue can match what Clones has to offer on Ulster final day. The Minister of State is a good Kerryman so might argue with that. Most neutral observers would say that because of the narrow streets and warm welcome the people of Clones offer to all visitors from Ulster and further afield on that day, it is a unique occasion and one to be experienced. I know Kerry is quite busy at that time of year, but I would like to invite the Minister of State to this year's Ulster final so that he might experience this unique occasion for himself.

The Government has allocated €50 million to upgrade football stadiums throughout the country. I am making a case for St. Tiernach's Park in Clones. It is a fabulous facility capable of holding over 30,000 people, which is a sizeable amount. I understand it is the eighth largest stadium in the country. It needs refurbishment and the facilities it has to offer need a lift. I would like to make a strong case for the Minister of State to seriously consider St. Tiernach's Park for funding for an upgrade. It has the potential to become a regional centre.

Clones recently opened a new peace park which is a fantastic sporting facility that adds to the many things it has to offer. We now need some money from the Minister of State so that we can upgrade the facilities. It is not just that Clones will look after the people of Monaghan and Ulster, it can also cater for events that would attract individuals from across the entire country.

I thank Senator Gallagher. I very much appreciate him raising this important matter.

The venue in question is synonymous with everything that constitutes Ulster football. As the Senator said, the Ulster final is one of the great occasions on the football calendar. What is special about a facility such as St. Tiernach's Park is the fact it is a town-centre facility and it helps create a fantastic feeling and experience for people on the day of the final. I am very familiar with Fitzgerald Stadium in Killarney, which offers quite a similar experience. I was in Mullingar yesterday and visited Cusack Park. The point was made that it is also located near the town centre. These types of stadium give events an exceptional feel because they are located in the middle of towns, which benefits local economies and creates a festive atmosphere.

I visited Clones in September at the request of the Minister for Business, Enterprise and Innovation, Deputy Heather Humphreys, and was accompanied on the day by the Minister for Transport, Tourism and Sport, Deputy Shane Ross, and members of the Monaghan county board, the Ulster council and the árd stiúrthóir, Páraic Duffy. I saw first hand the situation there and agreed that there needs to be investment, in particular on the health and safety front. A number of other areas also require investment. This is something I would like to see go ahead.

We were brought to the Peace Link to see the fantastic facility that has been developed in very close proximity to St. Tiernach's Park. It is a very impressive and is an excellent facility. When one stands on the track and looks to the left, one can see that the Football Association of Ireland, FAI, is developing facilities for the area. Clones has a great opportunity to become a fantastic sports hub. Everything is within walking distance. We put funding into the area and want to do so in the future.

The most recent sports capital programme delivered €60 million throughout the country for over 1,800 successful applications. We know the funding requirement for St. Tiernach's Park is higher than the threshold for the regional or local sports capital programme. Projects like this and other projects which are seeking large investment from the State to be met, in most cases, with investment from sporting, voluntary or community bodies point to the need for a larger scale project scheme. That is why the Minister, Deputy Ross, and I campaigned for the introduction of a new large scale project scheme in the most recent budget.

We were able to secure €50 million which can be drawn down from 2019 to 2021. We are in the process of drawing up the scheme. We are considering all of the terms and conditions, how the scheme could be administered and what the best use of public money would be in respect of the scheme. It may be one which is suitable for St. Tiernach's Park at some stage. I hope to open the scheme in the coming months. It is something I am very anxious to see proceed because there are many facilities around the country which require large investment from the State. They are now waiting to progress their applications and I am keen to see those projects going ahead.

This is something I know is critically important in the overall scheme of things in terms of economics. What the State might invest in St. Tiernach's Park would be matched by the economy of this jurisdiction with one, two or three Ulster finals. The economics of the project make sense. As the Senator pointed out, we have to acknowledge that this area along the Border was devastated for over three decades during the Troubles and needs additional help even now, 20 years on from the Good Friday agreement. Catching up needs to be done in certain areas.

As Minister of State with special responsibility for sport, I want to be able to assist in whatever way I can. This matter is very much on our radar. As I said, when I visited the area in September with the Ministers, Deputies Heather Humphreys and Ross, I saw, at first hand, what needs to be done and how there is a compelling argument for the investment to be made. I know the project has the backing of the county board, the Ulster council and the árd stiúrthóir in terms of it being a priority for the GAA. We intend to pursue the project and find the correct avenue as soon as possible.

I thank the Minister of State for his contribution, to which I was very heartened to listen. He made the argument for Clones very well. It has the potential to become a sporting hub, not just for County Monaghan but for the entire northern part of our country. One cannot underestimate the economic benefits that the Ulster final brings to a town like Clones. Local people have embraced with open arms the visitors who come to Clones on Ulster final day. It is a significant benefit to the business community and Clones needs a helping hand from the Government. I hope that the Minister will see fit to make an allocation so that the facility can be upgraded and we can promote Clones as a sporting hub throughout the northern part of our country.

Sitting suspended at 11.20 a.m. and resumed at 11.30 a.m.