Nithe i dtosach suíonna - Commencement Matters

Garda Stations

I welcome the Minister of State, Deputy Jim Daly, to the House. His west Cork colleague, Senator Lombard, has four minutes to outline his case.

It is like the three wise men.

As the Minister of State is doing all the responses today, he must be very wise or the patron of hopeless cases.

I am looking for an update regarding the re-opening of Ballinspittle Garda station. It was to be opened under the Garda station reopening pilot scheme announced in February 2017. It is an important and unique location. The 2016 census showed it has one of the largest catchment areas for a rural Garda station. This must be taken into consideration with the significant influx of tourists there over the next several weeks, making it a thriving and busy village.

When I met the local community last weekend, it was concerned at the progress of the reopening of the Garda station. Originally, it was announced it would be open by March 2019 and that date was moved to the second quarter of 2019. I met the Minister for Justice and Equality, Deputy Flanagan, and the Minister of State at Bandon Garda station last February when June or July was mentioned as the opening date. There is local concern about where the project is at currently, given the lack of work on the ground. I am seeking an update on the timeline. Will the station open in the next few weeks or months?

Due to the busy summer period in Ballinspittle and its coastal hinterland, it is a key location that needs its Garda station re-opened. It is important we get an update on when work will begin on the site and when the opening will be. Staffing the station is another issue that needs to be dealt with down the line.

I thank the Senator for raising this matter. I am pleased to provide an update on behalf of my colleague, the Minister of State at the Department of Public Expenditure and Reform, Deputy Kevin Boxer Moran.

The Office of Public Works, OPW, received a request from An Garda Síochána in November 2017, listing six Garda stations to be reopened on a pilot basis as contained in the programme for Government and for the OPW to assist in progressing matters. In January 2018, briefs of requirements were received for five stations, including Ballinspittle. The OPW undertook a technical assessment of all the buildings to ascertain the scope of works needed to reopen each of the stations. It compiled indicative costings based on information supplied and the relevant scope of works. It wrote to the then acting Garda Commissioner in April 2018, providing details and indicative costs for each of the six Garda stations, highlighting key issues and decisions to be made.

An Garda Síochána wrote to the Department of Justice and Equality in July 2018 outlining its requirements, suggesting possible solutions and seeking a capital provision of €2.56 million for the programme and approval to proceed.

In July 2018, the OPW received confirmation from the Department of Justice and Equality that funding was available and that the OPW was to proceed with the implementation of the reopening of the six pilot Garda stations. The OPW fully engaged with Garda estate management to agree the definitive project brief for each station.

The OPW commenced by undertaking technical surveys on the Ballinspittle Garda station building. Garda estate management forwarded a revised brief of requirements in August 2018. A revised crime prevention report and telecommunications report were received in September 2018. Taking these into account, the OPW prepared a layout, which was signed off at a meeting held on site in October 2018, subject to some minor amendments. These amendments were incorporated into the scheme and a final sign-off was received later that month.

In May 2019, the OPW issued a revised drawing showing the boundary area required to provide secure car parking and turning facilities at the Garda station. Approval was received from Garda estate management soon afterwards.

The OPW is now progressing with the procurement process and is currently compiling the tender documents for the required works at Ballinspittle Garda station for issue this month with an expected return in August, with tender evaluation and contract award thereafter. It is anticipated that works will be completed and handed over to An Garda Síochána by the end of this year. It will be an operational matter for An Garda Síochána as to when the completed station will be fully open to the public.

Reassuring the community that this Garda station will reopen is very important. The main bones of the question have been dealt with. It is expected that the tender documents will be back by August, with the works to be completed by the end of the year. That is very important, but, unfortunately, the rumour brigade has been in full swing in that part of the world. This information will help to clarify the issue. I welcome the report. I think we can move forward and have the Garda station reopened by the end of the year.

Hospital Services

I thank the Minister of State for coming into the House. I express my sincere thanks to him for making the long trek from west Cork to Belmullet in north Mayo last Monday to engage with staff and patients in Belmullet District Hospital. They found it a fruitful experience. I genuinely thank the Minister of State for making the effort and recommending the preservation of the 20 acute beds in the hospital. It was an excellent decision, for which I express my thanks.

I was contacted by Councillor Michael Sheehan from Wexford about the reduction in services at New Houghton Hospital in New Ross and other community hospitals. What are the Government's plans for the future of the district hospital network in the light of unprecedented overcrowding in the acute hospital sector? We spoke about this issue the other day and Councillor Sheehan contacted me about New Houghton Hospital, formerly a fever hospital that has been lauded for its quality staff and delivery of care in the community. In the past few years, like many other district hospitals, it has become a care centre for patients with dementia and Alzheimer's disease and those suffering from chronic illnesses. At its peak, it accommodated approximately 80 patients, but with new HSE regulations and guidelines, it has been downsized to 50. However, in the past few months, I understand the HSE has not permitted the admission of any new patient. There are around 30 in the hospital. My understanding is a significant number of beds are available in the hospital that could be used to alleviate pressure in Wexford and Waterford, including in other acute HSE hospitals. The staff have been recognised as doing an excellent job, but, of course, I would expect them to be worried about the future of the facility, given the inability to admit new patients.

HIQA has noted the poor quality of the approach road and the green areas immediately around the hospital as limiting capacity for the residents, but it has also stated the care provided in the hospital is excellent. Given the cuts made by the HSE to local facilities, I am concerned that the hospital will be downgraded. The public in the locality is concerned about an even worse outcome, that it might eventually be closed. That would be a devastating blow to many families in the locality, employees and patients, particularly after the local community raised much-needed funds through Friends of the New Houghton Hospital to provide extra services, equipment and amenities such as a sensory garden.

The HSE claims that there is no demand for the 20 unoccupied beds and that any demand for services has been met by private organisations locally. The question is, as the Minister of State is aware, as we have spoken about the issue, why pay private facilities when HSE beds in the locality are available? It sounds suspiciously like the possibility that elderly healthcare services in the area will be privatised.

I have spoken about the district hospital network since I was elected to the Seanad. The Minister of State knows how passionate I am about it. The hospitals play a vital role in the delivery of a modern healthcare service. Any reduction in the services provided at New Houghton Hospital would be counter-intuitive and counter-productive and fly in the face of Government policy. As the Minister of State is aware, the district hospital network prevents admissions to the acute sector and facilitate discharges. Without a lot of investment but with appropriate investment, the district hospital network could provide extra services and prevent people, particularly the elderly, from having to travel long distances to avail of services. In doing so they often have to depend on a public transport system that is inadequate in certain parts of the country or the road network. Lateral thinking is needed. As I said to the Minister of State on Monday, outreach clinics to provide, for example, cardiac or respiratory rehabilitation services, could be held in these facilities.

I seek an update on the posittion at New Houghton Hospital. How does the Minister of State feel about the expansion of the district hospital network nationally?

I thank the Senator for his welcome and comments about my trip to Belmullet. It is always nice to see a familiar and friendly face when one goes on such a trip and to meet a medical officer with whom I am familiar. I thank the Senator for the courtesy he showed me during my visit.

Residential care is provided through a mix of public, voluntary and private provision. It is worth highlighting that the net budget for long-term residential care in 2019 is €985 million and that over 23,000 clients, on average, at any one time will be in receipt of financial support. Public residential care units such as New Houghton Hospital in New Ross, County Wexford are an essential part of the healthcare infrastructure. In total, they provide about 5,000 long-stay beds, amounting to approximately 20% of the total stock of nursing home beds nationally. There are also about 2,000 short-stay community public beds. The standard of care delivered to residents in these units is generally very high, but we recognise that many public units are housed in buildings that are less than ideal in the modem context. Without them, however, many older people would not have access to the care they need. It is important, therefore, that we upgrade the public bed stock. That is the aim of the five-year capital investment programme for community nursing units which was announced in 2016. It provides the framework to allow for an enhanced programme to replace, upgrade and refurbish these care facilities, as appropriate.

The HSE is responsible for the delivery of health and personal social services, including the facility at New Houghton Hospital. HSE community healthcare organisation area 5 which includes County Wexford is committed to delivering services for older persons through a community-based approach that supports older people to live in their own homes and communities and, when needed, residential care centres such as New Houghton Hospital. The hospital which dates from the 1970s is registered with HIQA as a residential long-stay unit, with a maximum of 42 beds. Services provided include long-term care, dementia care, rehabilitation, convalescence and respite, palliative and end-of-life care services. The HSE has informed the Department that the hospital has an excellent reputation locally as a care facility, that the welfare of residents is a priority for staff and management and that they are deeply appreciative of the support the hospital receives from families and the wider community. However, the HSE has also informed my Department that demand for beds at the hospital has decreased, in part because of the availability of residential beds in new facilities in the New Ross area. I have requested more detailed information from the HSE in that regard in order that my officials can properly evaluate the situation. I will be happy to update the House again in due course.

In addition, the HSE has experienced challenges in recruiting and retaining required staffing. As a result and to continue to provide quality care, while at the same time providing additional personal and communal space for residents in line with regulatory requirements, in recent months the number of operational beds in the hospital has decreased to 31. In line with usual processes, the HSE will continue to review all of its services to ensure the continued provision of high quality, value for money residential care, with the older person at the centre of all decisions made.

I thank the Minister of State for his comprehensive reply. I am somewhat heartened that he might come back to us with further updates because for the HSE to pay a private facility to look after patients, usually at very high cost, at a time when there are 11 unfilled beds in New Houghton Hospital is nonsensical. Families, patients, employees and local representatives are very concerned. I look forward to liaising with the Minister of State on this matter in the coming weeks.

Audiology Services Provision

I raise a matter I have raised on a number of previous occasions, namely, the number of children affected by failings in the audiology service across counties Roscommon and Mayo. As I am sure the Minister of State is aware, 49 families received an apology from the HSE on 7 June 2018, while a further 57 received an apology earlier this year for failings in audiology services. The failings have had a significant impact on the children affected and their families.

Since June of last year, I have been working with many of these families and it has been a difficult year because we have not seen adequate evidence of the HSE providing an apology and putting in place adequate supports for these children. We faced issues about access, particularly to educational supports because many of the challenges that these children face have manifested themselves within the education system, especially in special educational hours, assistive technology, access to domiciliary care allowance and medical cards, and a long-term pathway for these children to transition along. We must ensure that these children, like others, achieve their full potential.

Over the past year, one would think that these families were asking for something to which they are not entitled. They have been wronged by this State and we need to ensure that proper supports are put in place for these children. I have been working with the chief health officer in area 2, Mr. Tony Canavan. At that time, I asked questions of the HSE, as part of the Department of Health, and the Departments of Education and Skills and Employment Affairs and Social Protection. We have had many meetings but the most recent was in March and we have not had any follow-up since on the many concerns we still have.

These children and their families do not want to have to access these supports or battle for every support they need. Many of them have been assessed by relevant professionals who have recommended specific forms of support, particularly within the context of the education system. I want to know what the Government and HSE are going to do to support these children properly. We are, at this stage, beyond platitudes. We want action. What supports will be put in place? We know that each child has different needs but we want to ensure that their needs will be supported for the good of their education and health.

I thank the Senator for the opportunity to provide an update on the supports in place for children affected by the failings in audiology service in Roscommon and Mayo. In April 2011, the HSE published the report of its national audiology review group, NARG. The group developed recommendations to address inconsistencies and inadequacies in audiology services. Arising from the recommendations of the review group, the HSE appointed a national clinical lead for audiology and four assistant regional clinical leads to deliver a modernisation programme and to implement new care pathways and improved clinical governance. The newly appointed HSE assistant national lead raised concerns about the standard of audiology assessments and hearing aid management provided in Mayo-Roscommon.

Following on from these concerns, the HSE commissioned a look-back review of paediatric audiology services in Mayo-Roscommon during the period 2011 to 2015. In June 2018, the look-back report was finalised and shared with the families of 49 children who were identified in the report as needing follow-up care.

Since then the HSE has provided a comprehensive programme of services, where required, to all 49 children identified in the report. In addition, the HSE has assisted parents in accessing necessary educational and social protection services. The implementation of the programme of supports and services has been led by the chief officer in HSE west and has been facilitated by a dedicated named point of contact based in the HSE west primary care office. These services include occupational therapy, speech and language therapy, physiotherapy, psychology, counselling for parents, ophthalmology, funding for lT, audiology equipment, and aids and appliances. A HSE liaison contact person has assisted families in many areas, including completing applications for services and communicating with other Departments and agencies. Families have been reimbursed where they have had to source services privately and for expenses associated with attending audiology related appointments. These services include play therapy, art therapy, educational psychology, and private ear, nose and throat consultant appointments.

Nine families have contacted the Department of Education and Skills. A review of the educational supports available to these children has been completed. The Department has contacted schools and parents or guardians, as appropriate, on the outcome of its review. The educational needs of these children have been assessed and appropriate supports and assistive technologies have been provided. Domiciliary care allowance applications have been allowed in respect of five hearing loss related applications, one has not been allowed after appeal, and one is going through the appeal process. The chief officer of HSE west has chaired a number of meetings with families. These meetings have been attended by senior officials in other Departments and agencies.

The HSE has apologised to all of the families for the inadequate services provided to all of the children concerned during the period in question and is ensuring that appropriate follow-up facilities are put in place. It is important to remember that the failures in question came to light through various initiatives to improve the quality of service, first by the commissioning of the NARG report to set standards of care, second, by the appointment of the new assistant regional audiology lead to assess the level of services provided in Mayo-Roscommon against the standards and recommendations contained in the NARG report, and subsequently by the commissioning of the look-back review to investigate the concerns raised by the new audiology lead. As a result of all of these actions, all of the children affected have either received or are receiving the appropriate care they need.

I will reflect on the last sentence of the Minister of State: "As a result of all of these actions, all of the children affected have either received or are receiving the appropriate care they need." I find that response very disingenuous. I have just come from another meeting with education officials. I can and will provide the Minister of State with a file of all the different challenges in the education system that have not been solved. That file applies to assistive technology and special educational hours. Every support that has been secured over the past year has been secured because parents, not the HSE, have been proactive. I have worked with many such parents and I find that reply exceptionally disingenuous to the families who have been affected by audiology failings. I have no more to say on the issue.

I am sure we will hear more from Senator Hopkins on that issue.

National Children's Hospital

The Minister of State is welcome to the Chamber this morning and I thank him for taking time out of his busy schedule to come here.

There has rightly been much outrage at the savage and massive overruns with the children's hospital, the detrimental effect that is going to have on the health services in the future, and how taxpayers' money has been squandered by those who failed to do their jobs properly. Indeed the HSE has warned that it would be almost impossible to deliver the planned, multi-billion euro investments in new healthcare facilities in the coming years because of the cost overruns at the national children's hospital. A recent report showed that the overrun means healthcare will need an additional €107 million in 2020, €120 million in 2021 and €150 million in 2022. The HSE has been concerned for some time, apparently, that the €11 billion funding arrangements for new hospitals, nursing homes, ambulances and equipment under the Ireland 2040 capital development plan are not balanced and that most of these large-scale projects are pushed out to the last ten years of the plan.

The HSE stated that the issue, along with having to deal with cost overruns from the new children's hospital in the years 2020 to 2022, "has made what was a very difficult situation now almost impossible". I understand the Cabinet was told last December that a number of health projects might have to be curtailed and others might have to be suspended completely due to the soaring costs of the children's hospital.

A letter to the Secretary General of the Department of Health, dated 3 May, from then acting director general of the HSE, Ms Anne O'Connor, outlined growing concerns about the capital funding position of the organisation and the emerging impact of the children's hospital on its overall capital programme. Crucially, Ms O'Connor highlighted the impact on the quality of care that the HSE can offer, which has been in many instances directly affected and even compromised by the quality of infrastructure.

The news comes as it has emerged that the financial position of the HSE for 2019 is now more serious than had been understood to date. In the first three months of the year, it recorded a total overrun of almost €103 million. This followed a €600 million deficit last year. The Government needs to come clean on what projects will proceed and what projects will not.

On healthcare projects in County Monaghan, I would like the Minister of State to give some clarity on the status of all those projects, particularly with the primary care centre promised for the St. Davnet's complex in Monaghan town. This is a project that has been earmarked for some time but has been dogged by delay after delay. I would like the Minister of State to confirm to me this morning that this project will proceed without delay and will be delivered on time and that no other health projects in County Monaghan will be affected or delayed by the cost overruns in the children's hospital.

I thank the Senator for raising this issue and for giving me the opportunity to outline to the House the capital projects under way in County Monaghan. The HSE has advised that projects to deliver a primary care centre and an upgraded mental health residential unit on the St. Davnet’s campus in Monaghan town are under way. The north Monaghan primary care centre will be developed by way of a major refurbishment of Blackwater house at St. Davnet’s campus in Monaghan town.

The appointed design team is engaging in pre-planning meetings with Monaghan County Council's planning department. The project is expected to be completed by the end of 2020. In addition, the HSE is extending and refurbishing a building on the St Davnet’s campus to provide accommodation to allow for the decanting of services that utilise some of the space in Blackwater house. This upgraded residential mental health unit is under construction and is a key enabler for the primary care centre development project. These developments will enable staff to deliver optimal quality care and treatment in facilities which afford dignity, respect and privacy to all.

Funding for these development projects in Monaghan has been included in the Government’s Project Ireland 2040 policy initiative, announced last year. This provides €10.9 billion for health capital developments, including both national programmes and individual projects, across acute, primary and social care. The delivery of these projects and programmes, including developments in County Monaghan, will result in healthcare facilities that allow for the implementation of new models of care and for the delivery of services in high-quality modern facilities.

The new children’s hospital is a vital and much-needed project and the Government has examined the funding pressures associated with delivering this important project. In meeting these funding pressures, the Government has examined all projects and programmes across Government and has made adjustments to ensure that the much-needed new children's hospital will be delivered and will facilitate the delivery of the overall investment programme as set out in Project Ireland 2040. The Government provided an additional €75 million of capital funding in 2019 towards the increased costs of the new children's hospital. The summer economic statement provides a capital expenditure reserve of up to €200 million in 2020 to accommodate the funding requirements for the new children's hospital and the national broadband plan. This will allow my Department and the HSE to finalise a multi-annual capital plan.

The health capital allocation in 2019 is €642 million for the construction and equipping of health facilities. This represents an increase of €224 million on last year's capital provision for the public health sector. This Government will continue to invest in the public health sector and will deliver the new children's hospital and a wide range of health capital projects in hospitals, social care and the community.

I thank the Minister of State for his response and I look forward to the delivery of the primary care centre and other health projects on time and without delay in County Monaghan. Last year, the Minister, Deputy Harris, made a comment that he proposed building new hospitals to take on elective surgery to deal with the long waiting lists, despite the fact that small hospitals such as Monaghan Hospital could do more. Clearly, projects will not go ahead because of the cost overruns and I would imagine that building new hospitals to deal with elective surgery would be one of the projects that will not proceed. Surely the Minister of State would agree that maybe we should have a second look at our smaller hospitals to see exactly what additional capacity they have and what additional work they could do to deal with the ever-increasing length of waiting lists that people are suffering on at the moment.

We can keep going around in circles all day long and we can challenge every single project that is proposed by the HSE and say it is not going to happen because of the children's hospital, but I have just outlined in my answer that there is an additional €75 million included this year to allow for the increased costs associated with the children's hospital. Next year, there is a €200 million additional reserve included in the summer economic statement to allow for any increased costs associated with either that or the national broadband plan, so there is no reason for us to challenge and question continually the validity of the building programme. A total of €10.9 billion has been committed to delivering those projects. In the grand scale of things the children's hospital is a tiny and minute fraction of that overall project. The idea that we can politically continue to challenge the sustainability and viability of every promised delivery will not continue to stand up to scrutiny into the future.

I assure the Senator again that the two projects he is concerned about are on track, will be progressed and are progressing. Meetings are taking place with Monaghan County Council as we speak on that front. That development will continue.

These small hospitals are very important. I recently made a visit to Bantry General Hospital for a minor procedure and it is an amazing little hospital that does tremendous work. I am sure the Minister of State will make sure that Bantry General Hospital is kept going as well because only for it there would be long waiting lists in south Kerry, west Cork and Cork city. I thank the Minister of State for that. That is an unexpected observation which I am sure he will not mind.

Those are wise words from the Cathaoirleach.