Nithe i dtosach suíonna - Commencement Matters

Catalan Referendum

I welcome the Minister of State.

I thank the Minister of State for coming to the House to reply to this matter. I ask him to imagine a situation where the Leas-Chathaoirleach was arrested and put in prison for two years and was then sentenced to 11 and a half years for the crime of arranging a parliamentary debate. This is what has happened to the speaker of the Catalan Parliament. We all know the history of what has happened over the past couple of years and how the Catalan people voted in their millions for independence on 1 October 2017. We were all shocked at the scenes of Spanish state police brutally destroying polling booths and hitting elderly frail people. My party had four witnesses who saw that first hand.

After that shocking display of state violence and repression, a number of Catalan leaders were put in pre-trial detention. We heard on Monday how nine of them have been sentenced to between nine and 13 years in prison. The former speaker, Ms Carme Forcadell, faces 11 and a half years in jail for allowing a debate on Catalan independence in parliament. The former vice president, the equivalent of our Tánaiste, Mr. Oriol Junqueras, faces 13 years for peacefully seeking independence for his nation. Several ministers have been sentenced to at least nine years. We now have a new warrant for Carles Puigdemont, who has been living in exile for the past few years, as are others who have been involved. The Spanish state has tried to have them arrested and extradited but it keeps losing these cases because the charges they face have no basis. They are ridiculous charges of sedition and rebellion.

The European Union is supposed to stand for certain important values, such as democracy, freedom and human rights. Recently, we heard the European Commission quite rightly condemned the Polish Government for interfering with its judiciary and we have heard it speak out directly against the awful migration policies of the Hungarian Government.

However, there is a conspiracy of silence when it comes to what is happening in Catalonia. No one wants to say anything. Peaceful people have been imprisoned and sentenced to between nine and 13 years. All they did was arrange a peaceful referendum. The equivalent of the Leas-Chathaoirleach has been imprisoned for arranging a debate in a parliament. This is a watershed moment for the EU. How can it have any credibility to speak about freedom, dignity and human rights when it turns its backs on the Catalan people and this horrific repression?

The Minister of State is standing in for another Minister today, but I hope that he will agree that dialogue is the way forward. Currently, we are consumed by Brexit and are hopeful of a good outcome. That hope is based on dialogue. The Spanish state has set its face against dialogue and has set itself on a course of imprisonment and repression of the Catalan people. Where is our Government in all of this? What message can the Minister of State give to the people of Catalonia? What message speaking of human rights and freedom can we hear from him? It would mean much to the Catalan people if he were to acknowledge that dialogue must be the way forward. I hope that he will give a message that, at least here in Ireland, we remember the values of free speech and democracy and that we value the right of the Catalan people to have their say on their future.

I thank the Senator for raising this matter. The Government follows closely developments in Spain, which is an important EU partner and a good friend of Ireland's. Irish people know Spain well. After Britain, it is the country to which we travel most. Furthermore, cities and towns across Spain are home to many Irish people and many Spaniards visit and live in Ireland.

Upholding the rule of law in all its respects is a key underpinning of all democracies. The question of Catalan independence remains a deeply divisive and contentious issue in Catalonia and the rest of Spain. Yesterday, the Spanish Supreme Court announced its verdict in the cases of 12 Catalan pro-independence leaders. We are all aware of reactions across the spectrum of opinion in Catalonia and elsewhere in Spain. We also note the Spanish Government's statement on the matter. We respect the separation of powers in Spain as in Ireland and it would not be appropriate for me to comment on a case ruled upon by the Spanish courts.

More generally, the Government's position regarding Catalonia remains that the constitutional and political arrangements in Spain are matters to be determined by its own citizens through its own institutions in keeping with the rule of law. The Government respects the constitutional and territorial unity of Spain, and just as we would expect other countries to respect our courts, we respect the decision taken by the Spanish courts.

Our ambassador and officials based in the Irish Embassy in Madrid continue to monitor developments. They are in constant contact with our Government and are monitoring the situation as regards demonstrations so as to provide suitable travel advice to Irish citizens. We respect people's right to gather and express freely their opinions, but we share the calls for calm, moderation and respect for others so as to allow those who live in Catalonia and its many visitors, including from Ireland, to go about their daily lives without disruption, including being able to travel freely to and from airports and train stations or by car. The freedom to express contesting views is essential in any democracy but differences of opinion must be contested with full respect for the law and the rights of all citizens. This is the foundation that underpins and protects most modern democratic societies.

The Government continues to support a resolution to the current situation that is based on democracy and the rule of law.

I am disappointed with the Minister of State's response.

Democracy cannot by its nature be seditious. The Minister of State called for calm and moderation and for respect for others. I support that call but if we are going to respect other people then surely we need to call out that it is wrong to imprison people for arranging a debate in a Parliament or for expressing their will peacefully within the state in which they live. If we cannot call out what is happening in Spain in terms of the open repression of the Catalan people then where are we in terms of the values we seek to preach and believe in? I call on the Minister of State to at least acknowledge the need for dialogue to resolve this situation. Surely he can agree with me on the need for dialogue between the Spanish state and the Catalan Parliament to resolve this situation.

As I stated in my opening remarks, the question of Catalan independence remains a deeply divisive and contentious issue in Catalonia and in the rest of Spain. It is through democratic processes in full respect of the law that differences of opinions must be contested. Upholding the rule of law is the foundation that underpins and protects our democracies. The problem presented to the Spanish Supreme Court was a legal and constitutional issue. We should be wary of simplifying a complex issue. As we expect other countries to respect our legal system, we respect the independence and integrity of the Spanish courts. What happens in Catalonia matters to us here in Ireland, as evidenced from Oireachtas interest in developments there. The Government supports all efforts aimed at facilitating reconciliation. We remain of the view that it is for all Catalans and Spaniards to arrive at a shared view of what steps within their laws and domestic institutions best support a process of resolution of divisions.

Home Help Service

I welcome the Minister of State, Deputy Finian McGrath, to the House. The home help scheme is under pressure. As the Minister of State will be aware, two weeks ago the Irish Independent reported a harrowing story regarding a 70 year old woman who spent 105 hours on a trolley in Limerick hospital and her family's expressed fears that she would die if a fire started. This is the direct result of a lack of investment in home help hours and step-down nursing support facilities. The HSE figures reveal that 79 patients have been stuck in public beds for six months due to a lack of step-down facilities and home help hours; by mid-September 745 patients had not been discharged despite being medically fit, which is staggering, and that over 1,000 people were added to the home help waiting list in the last four months, with the waiting list now at 7,300.

As recently as the last two weeks, local Councillor Joe Flaherty and I met representatives of a newly-formed carers group in County Longford who passionately articulated the frustration of carers, their families and the wider community. The system is broken and the patients and their loved ones are paying the price. The group provided me with details of several cases where additional hours have been approved but the families have been told the additional hours cannot be commenced before Christmas owing to an embargo. The hours have been approved but they are not being provided which, in the main, is the issue.

There are two distinct groups of carers in crisis. There are patients who have access to family carers and patients who do not have families to care for them. The latter cohort is the worst affected as in many cases they receive no care. We routinely hear, as I do in my practice, of patients left soiled or lying on a floor, perhaps unconscious or with a broken limb after a fall, until such time as a neighbour or a good samaritan calls to the House. In regard to family carers, the real risk for them is the absence of an effective home care structure and, subsequently, family burn-out which, in turn, leads to further illness in the home and additional expense on the system rather than a saving.

These families are tired, frustrated, upset and disillusioned with a system that has failed them. The most troublesome and worrying trend about which the new carers' advocacy group told me was that they had been warned not to complain or their existing hours would be cut. It has reached the stage where many carers are afraid to speak out. If that is true, it is a fundamental injustice and extremely worrying. I seek clarification on the matter from the Minister of State.

There is a clear and obvious need for an advocacy group for family carers, independent of the HSE. It should be positioned to articulate and champion their concerns. As I mentioned, I met the group in Longford two weeks ago. I met a woman by the name of Majella Meade who has been battling illness since 2014. She tried to balance her recovery with her work in caring for her patients. However, the toll was too much and she had to give up the job she loved. Sadly, her father passed away in May this year but not before living an additional 18 months with his family. The priceless extra time was thanks to the care and love of his family. The health of Majella's mother, Mary Jane Meade, deteriorated after her husband's death. She has vascular dementia and requires full-time care and supervision in the home. The family has a carer who calls for one hour each day, five days a week. If Majella wants to go to the shop or see the doctor because she has her own health needs, she has to rely on a neighbour to help. The community nurse in Longford has provided great support for the family.

The family have been assessed and it was proposed that they receive three calls per day and two over the weekend, but that has not happened. If it had, it would have meant a major improvement. However, the family heard that there was an embargo on extra hours and, therefore, a delay because of budget overruns and overspending on the national children's hospital. We need to ensure that once hours are allocated, they are honoured and that people receive the care they need. There is a shortfall in the number of carers, but we need to ensure the qualifications of carers are up to speed. The most important point on which I need clarification concerns families being threatened with the loss of hours if they do not put up and shut up. If that is true, it is a disgrace. We need clarification on that matter and perhaps an investigation.

I thank the Senator for raising this important issue. I will respond to some of the issues raised and also follow up on them. I share the Senator's views on the valuable work carers do in our society. Home supports enable older people to remain in their own homes and communities, as well as facilitating timely discharge from hospital. The Government has made investment in home support services a priority. Progress in this area is reflected in the additional funding made available in recent years, with the budget growing from €306 million in 2015 to nearly €446 million in 2019. More than 50,000 people benefit from this service at any one time. As outlined in its national service plan for 2019, the HSE maximises the utilisation of current resources. It prioritises those who require discharge from acute hospitals. Significant resources and services in 2019 have been targeted to facilitate timely egress.

In winter 2018-19 the focus was on reducing the number of delayed patient discharges through mobilising the additional resources made available and ensuring social care measures were deployed effectively to enable older people to move to a more appropriate care setting, including step-down or transitional care in their own home, with the requisite supports.

When talking about home support, we must also recognise the support provided for people with a disability. That area is part of my portfolio. The HSE is fully committed to maximising the provision of health and personal social care services for people with disabilities, including home support services, within available resources, empowering them to live independent lives. In its national service plan for 2020 the HSE expects to deliver 3.08 million home support hours to more than 8,000 people with a disability.

That is an increase of 150,000 hours on last year's target. Therefore, it is a significant investment. I also acknowledge that in some cases access to home support services may take longer than we would like. However, the HSE has assured the Department that people on the waiting list are reviewed as funding becomes available to ensure individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local line staff who know and understand the client's needs and undertake regular reviews of those care needs to ensure the services being provided remain appropriate.

The HSE welcomes and encourages feedback from its clients on home support delivery. I emphasise that it is not HSE policy that a client's existing level of service be reduced on receiving a complaint. If a client's needs change, the client or the carer can request a review by contacting the local health office. In line with the commitments given in the programme for Government, we have made improved access to home support services a priority in budget 2020. An additional investment of €52 million is being made in 2020 which will support the provision of over 19.2 million hours of home support. That is 1 million hours more than the 2019 target and represents a substantial increase in service provision.

While the existing home support service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of citizens. The Department of Health is developing plans for a new statutory scheme and system of regulation of home support services for older people and adults with a disability. Included in the investment is dedicated funding for the testing of the new statutory home support scheme in 2020.

I appreciate what the Minister of State said about the figure of €446 million and the 50,000 people who are benefiting from it. However, the population is getting older and people have more complex health issues that require more care. Will the Minister of State give a commitment that vulnerable persons for whom home care is sanctioned will be allocated hours and receive them within a dedicated timeframe, be it three or six months? Can we put something down in that regard?

I know that it is not HSE policy to penalise carers' families when they complain, but the reality is that they are afraid to complain because they have been threatened with this. It is not HSE policy, but it is the reality. I implore the Minister of State to examine the matter in further detail. I can give him more details after this debate, if he wishes. The issue is that it is a bullying tactic being used by some who work in the HSE. I would hate the most vulnerable persons in our society to be disenfranchised if that is the case.

I accept the Senator's point about carers. Home supports enable older people and people with disabilities to live as independently as possible, as well as facilitating timely discharge from hospital. The Government has made improved access to home support services a priority in the budget. In 2020 an additional investment of €52 million is being made which will provide over 19.2 million hours of home support. That is a crucial investment.

To respond on the two issues raised by the Senator, having a dedicated timeframe is a sensible proposal which I will convey to the HSE and the Department of Health. If we are putting in €52 million and providing 19.2 million hours, we must see results and a timeframe for families and carers. That is something I will include in the follow-up on this matter. While the home support service is delivering crucial support for many throughout the country, we accept that it has to be improved to meet the changing needs of citizens, including the complex needs mentioned by the Senator. Because this is a debate I have in the disability sector, I like the way the Senator spoke about the two categories - family carers and those who do not have any family member at all. I have the same problem with adults with intellectual disabilities. I have to bring those who receive no home support to the top of the queue when it comes to fighting for funding.

While the administration of the scheme will be centralised, the delivery of services will be co-ordinated at a local level in line with the person's assessment of need. A core component of the scheme and testing phase will be the implementation of interRAI as a standardised system tool for determining need under the new scheme.

With regard to the Senator's remarks about bullying, bullying is unacceptable in any service, whether a service for those with a disability or a service for senior citizens. We cannot tolerate it. When people have legitimate complaints, they have to feel free and relaxed about making such a complaint. This is particularly true for people who are looking for services relating to care, disabilities, or senior citizens. Those are very important things. That is a second issue on which I will return to the HSE in order to see what is going on on the ground in some places.

HSE Properties

I thank the Minister of State, Deputy McGrath, for coming to the Seanad on this important issue. On Saturday last I attended the Architecture at the Edge festival. It took place on the campus of the former St. Brigid's Hospital in Ballinasloe, County Galway. I sincerely thank all those involved in that really fantastic event. Professor Oonagh Walsh provided a really great insight into the history of the hospital and the hugely significant role the Connacht Asylum, or St. Brigid's Hospital, played in the development of the town and region after its opening in 1833. At its peak, the hospital accommodated more than 2,000 patients, before the main campus eventually closed in 2013.

That is the history part; our focus now needs to turn to the future. Having taken the opportunity to walk around the grounds at the weekend, I was really taken aback at the rate of deterioration of the hospital buildings, particularly over recent months. It will not take too much more vandalism before we begin to lose these buildings forever. It is important to say that the people of Ballinasloe are very proud of the role St. Brigid's Hospital played in supporting people and in the history of their town. The current state of the premises, however, is of major concern to the people of the area. It is against that backdrop that we need to work on repurposing these buildings and the land in order to see St. Brigid's campus once again become a key part of the economic development of the town and wider region. That is a really important point in terms of its history. St. Brigid's Hospital was important to the economic development of the town and wider region. We need to now ensure that these buildings are brought back into use so that they can contribute to the economic development of the town and wider region.

Our immediate priority needs to be securing the old buildings. As I have said, with each month that passes, their conditions deteriorate. This will ultimately lead to higher restoration costs. In the longer term, we need to have an achievable vision for the future of the campus. We have a very good example in the redevelopment of the Grangegorman campus, of which I am sure the Minister of State is very aware. We need to see a similar priority given to the St. Brigid's site. I look forward to hearing from the Minister of State in this regard.

I thank the Senator for raising this very important issue and for giving me the opportunity to outline to the House the future plans for the site of St. Brigid's Hospital, Ballinasloe. I also thank and commend the Senator for her work on health and disability issues more generally in the Seanad over recent years. Over recent years, the Health Service Executive, HSE, has consolidated the services on the St. Brigid's Hospital site as part of the transition to community-based mental health services in line with A Vision for Change.

A development programme has focused on vacating the main building complex and developing fit-for-purpose facilities on lands adjacent to, but separate from, the main campus. This has resulted in a significant portion of the St. Brigid's Hospital site and lands being surplus to HSE requirements. Oak Grove House is the last building on the campus still in service but I understand that replacement purpose-built accommodation is currently being developed. Once this last building is vacated, the HSE intends to proceed with the disposal of parts of the St. Brigid's Hospital site and lands that are surplus to requirements.

The HSE is a prescribed stakeholder under the protocol for the intra-State transfer of State property assets and the protocol for the intra-State sharing of property assets, as advised by the Department of Public Expenditure and Reform. These protocols set out three options for disposal of assets: the transfer to another public body or State agency; open market sale, subject to favourable market conditions; or other uses such as community and voluntary use will be considered only if points one and two do not materialise.

Any proposals for the disposal of surplus property assets must be considered in the context of the capital funding available to the Department of Health and Government policy relating to the use and management of State property assets. In this context, the HSE is required to obtain value for money when disposing of surplus property assets and the proceeds are reinvested in delivering much needed healthcare infrastructure. In preparation for the disposal of the assets, in 2018 the HSE invited expressions of interest, together with business plans, from relevant State bodies, stakeholders and local authorities. The Office of Public Works, OPW, requested an extension to the deadline in order to complete a report on the potential future use of St. Brigid's Hospital site and lands. I understand the report has recently been completed and is currently being reviewed by the property management section of the OPW. Pending the outcome from this process, the intention would be to develop a proposal and seek approval to proceed with the transfer or disposal of the asset, in line with State property protocols.

The use of the sales' proceeds from the disposal of St. Brigid's Hospital will be subject to sanction from the Department of Public Expenditure and Reform. It would be intended that the proceeds of the sale of this property will be invested in much needed mental health and other facilities in addition to the very significant Exchequer funding required to maintain and improve health infrastructure.

Senator Maura Hopkins: I have a number of questions arising from the Minister of State's response. We are aware there is a shift in providing community mental health services. Similar to the issue raised in the previous Commencement matter there are challenges with the staffing of these community mental health services. I ask that the Minister of State would note this, especially in the context of the Roscommon-Galway services.

Is there a timeframe with regard to Oak Grove House being the last building on the campus, and which is still in service? Replacement accommodation is being developed and perhaps the Minister of State will indicate the timing for that. The Minister of State said the report is currently being reviewed by the OPW. Do we have a timeframe for that report and will its content be made public?

These buildings are very important for what could be an economic regeneration of Ballinasloe and the wider region. Ballinasloe is very well located. It is near to two motorways. It has access to Dublin and to Shannon Airport. It has rail links and high-speed broadband. Surely, the State should be trying to bring those buildings back into a place where they can support the economic development of the region. I ask the Minister of State to raise it at Cabinet level that this is an important priority for our region. It is important the Minister of State does whatever he can to emphasise this with the Minister for Public Expenditure and Reform, Deputy Donohoe. We need those buildings to be repurposed.

We also need to ensure they remain within State ownership to allow for the economic regeneration of the town.

I thank the Senator for raising this important issue. The HSE has made a significant investment in community-based mental health services in the Ballinasloe area to facilitate the reconfiguration of services away from the acute setting of St. Brigid's Hospital, in line with A Vision for Change. This has resulted in a significant portion of the site and lands being surplus to the requirements of the HSE. Pending the outcome of engagements with the OPW on the potential future use of the site and lands, the intention is to proceed with the transfer or disposal of the asset in line with State property protocols.

I take the Senator's point on the shift and the challenges with staff. These are important issues. I do not have the details on the timeframes but I will follow up with her. She has raised important issues, particularly that of Oak Grove. We need to see where we are going with that. I need to get more clarification on that from the Department and the HSE. Government policy, as set out in A Vision for Change, is that the proceeds from the sale of the older mental health assets, such as St. Brigid's Hospital, will be reinvested in new developments in the area of mental health. That is important. I understand the new replacement accommodation is being developed for the mental healthcare services previously provided on the St. Brigid's Hospital campus.

Another important point the Senator raised, which has to be taken into consideration, is economic regeneration, particularly in the Ballinasloe area, and the repurposing of buildings. These issues will be taken into consideration as well and we have to ensure this happens. These developments are in line with the best international practice for the reorientation of assets from a hospital-based focus to the modern structures and facilities required for enhanced community-based service provision. I will raise the issues the Senator mentioned about the site and the plans and timeframes for same with the Minister of State at the Department of Public Expenditure and Reform, Deputy Moran, the Minister for Finance and Public Expenditure and Reform, Deputy Donohoe, and officials from the OPW and the Department of Public Expenditure and Reform.

Sitting suspended at 3.12 p.m. and resumed at 3.30 p.m.