Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Thursday, 1 Oct 2020

Vol. 271 No. 7

Nithe i dtosach suíonna - Commencement Matters

General Practitioner Services

I welcome the Minister of State, Deputy Butler to the Seanad. I thank her for coming in to answer these questions. The first Commencement matter has been raised by Senator Kyne.

I thank the Cathaoirleach for selecting this important matter for this morning's Commencement debate. While I want to focus on the Westdoc service today, this issue is related to the broader matter of general practice in Ireland.

As we know, general practice in Ireland is under severe pressure and is facing major challenges. We do not have enough GPs and after many years of service and dedication, many of our GPs are approaching retirement age. We did not train enough GPs and we do not have the supports in place to ensure that GPs open or join practices in Ireland once trained.

We do not invest adequately in primary care services in Ireland and a much greater portion of our overall health budget should be invested in primary care. The funding should recognise the unique relationships between GPs and their patients. It should prioritise care in the community and strive for outcomes that avoid ever having to attend crowded emergency departments or acute hospitals. Sadly, despite some progress in the last 18 months, particularly in the increase in the number attending GP training courses, communities across the country continue to lose their GPs. Areas such as Corrandulla and Oughterard in Galway, among others, have been left without a service or with a diminished service, forcing local people to travel to attend a GP.

As this only relates to weekday GP services, the situation in respect of out-of-hours services is even more troubling. Despite the efforts of GPs serving in Moycullen, Rosscahill and Oughterard other areas, local GPs are still not included in the Westdoc service, the out-of-hours GP service for the west. The local GPs serving the Moycullen, Rosscahill and Oughterard areas are working flat out to provide a service out of hours and at weekends for their local communities. The HSE is currently, and I must emphasise that this is during a pandemic, providing locum cover on a one-in-five basis but only in the short term with no commitment to maintaining this provision into the future.

In many areas, over 90% of doctors are covered by out-of-hours services. In the area that I am talking about, the eastern part of Connemara, that coverage is barely over 60%. It is unfair, unsafe and unsound. The local community and GPs deserve better. More funding must be provided to Westdoc for its expansion in order that all communities are covered and have certainty of a comprehensive GP service 24 hours a day, seven days a week.

I have been contacted by Moycullen and Oughterard GPs, who have been refused entry to Westdoc and have requested intervention. To put this into context, they say that when they are on call, they are on call for 48 hours every fourth weekend and every fourth night, as well as providing full weekday services. As one can imagine, that is a very onerous task for them to undertake, both physically and mentally in terms of their own well-being, but also in relation to that of patients. A more sustainable model needs to be put in place and the funding must be provided for access to the Westdoc service for this local area.

This is my first time to speak in this fantastic Seanad Chamber. I took Commencement matters in the Dáil yesterday, but I think at times we forget that this is such a fantastic building. I am pleased to be here.

I want to thank Senator Kyne for raising this important issue and I am taking this matter on behalf of the Minister, Deputy Stephen Donnelly. There are huge challenges to meet in respect of the provision of GP and out-of-hours services, particularly in rural areas. Please be assured that the Government is committed to enhancing primary health care services throughout the country, including out-of-hours GP services. The development of primary care is central to the Government's objective to deliver a high quality, integrated and cost-effective health service.

GPs contracted under the General Medical Services scheme are required by their contract to make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside of normal practice hours. While there is no obligation on GPs to participate in GP out-of-hours co-operatives as a means of meeting the contractual requirement, such services facilitate the provision of GP services outside of normal surgery hours and help to spread the burden of this provision.

I take on board the point made by Senator Kyne that some doctors have applied to join the out-of-hours co-operative, and I will take that back to the Minister. I find it hard to understand why, when there is a shortage of doctors, they are finding it difficult to access a co-operative. It is strange.

The HSE provides substantial funding to support the out-of-hours co-operatives, including the costs of triage nurses, call centres, treatment centres, drivers, cars and receptionists. This amounts to more than €90 million per annum and helps to ensure that, to the greatest extent possible, urgent care needs are met in the primary care setting.

The Westdoc co-operative is owned and managed by a group of participating GPs who provide out-of-hours GP services in the community healthcare west region, covering counties Galway, Mayo and Roscommon.

Funding for the service is provided through a service level arrangement with HSE community healthcare organisation, CHO, 2. In 2020, this organisation received almost €3.9 million in funding through this arrangement. In 2019, in addition to the funding allocated through the service level arrangement, HSE primary care operations allocated an additional sum of €150,000 to CHO 2 for the provision of extra staffing for the GP rota in rural areas. I understand that CHO 2 engaged directly with Westdoc to ensure that this funding was allocated to the area of greatest priority within that service, extending weekend cover in north Connemara, south Connemara and Achill.

It is acknowledged that the Westdoc service does not extend to certain rural areas within the region, and that additional funding would be required to extend the service that is currently being provided. I understand that this places additional pressures on GPs in the area.

I assure the House that the Government is committed to ensuring that existing GP services in these areas are retained and that general practice remains an attractive career option. I want to ensure that patients throughout the country continue to have access to GP services, including out-of-hours services, and that general practice is sustainable in all areas into the future. We will continue to monitor and review services across the country to that end.

Measures to improve recruitment and retention in general practice have been implemented in recent years. The agreement reached in 2019 on GP contractual reforms and service developments will result in an increase in expenditure on GP services of €210 million annually by 2023. As the agreement sets out, increased capitation fees have been introduced, and there will be additional increases in the coming years. Enhanced supports for rural GP practices have been introduced under the 2019 agreement, including a 10% increase in the allowance for rural practices and a 28% increase in dispensing fees paid to GPs.

I thank the Minister of State for attending the House and for her reply. Like all Members, I know she recognises the importance of rural GP services. The importance of sustaining rural communities and providing services to them may seem like a broken record, but the GP is at the heart of that. When people retire after a long number of years, they may have 30 or 40 years of service in a community, it can be difficult to find a replacement. The area I have raised is not remote; it is seven miles from Galway city. I live in Moycullen and it covers Rosscahill and Oughterard. It is an increasingly built-up area. Doctors are under pressure. If there is an additional retirement in the coming years without the provision of adequate services, will a young doctor come into that? Would he or she decide to operate a weekday practice and, at the same time, commit to the every four weekends and 48 hours during the week in addition to the normal daytime service? Finding new doctors to come into a situation like that is onerous. There is a demand and, more important, a need in an expanding area. I welcome the provision of additional funds in 2019, which I fought for, but it was not directed to the area that I raise today. I welcome the Minister of State's commitment to bring the issue to the Minister. I will push it at local level to try and secure additional funding for Westdoc and get admission to the doctors serving the Moycullen, Rosscahill and Oughterard areas.

I acknowledge the important role that GPs play in the delivery of our health service and their commitment to providing a responsive and high-quality out-of-hours service to patients. This has never been more visible than in recent months but at any time it is a key strength in the delivery of healthcare. The Senator is quite right that GPs are the beating heart of most communities, and it is a significant source of comfort to residents to know that there is a GP close at hand. I accept that retaining GPs in practices is a major challenge; it is something I have witnessed in my constituency where a GP left and a new GP only replaced that person three years later. I understand that the demands of the out-of-hours commitment has been particularly challenging for GPs in rural areas and CHO west where there are gaps in the Westdoc service. The Minister acknowledges that. I reiterate that the Government is committed to ensuring that patients throughout the country continue to have access to quality GP services and I will bring the Senator's concerns to the Minister.

Vaccination Programme

I welcome the Minister of State to the Chamber and thank her for attending to address my question.

My Commencement matter relates to the lack of provision to administer the flu vaccine in locations other than general practice surgeries and community pharmacies. The reason I raise this issue is related, in part, to the provision by the HSE that children aged between two and 12 years would be able to receive a free flu vaccine from mid-October, which is new in 2020-21. This welcome development comes on the tail end of much talked about difficulties in staying safe during the return to school for over 500,000 primary school students. I believe the restrictive manner in which the vaccine is to be administered will lead to an undesirable overcrowding of GP surgeries and pharmacies, as well as a lower uptake than would otherwise be the case.

While GP surgeries and pharmacies have done terrific work throughout this country's fight against Covid-19, and continue to do so, they are not designed to be mass vaccination centres, especially when the matter of social distancing is considered. Additionally, there exists a shyness among the public to visit these places unless absolutely necessary out of fear of contracting the virus. This fear, founded or unfounded, exists and is particularly prevalent among older members of society who are, unfortunately, at an increased risk from Covid. These individuals are also at increased risk from the flu, which is responsible for 500 deaths, on average, each year.

We are, therefore, left with a state of affairs whereby people aged over 65 years who stand to benefit most from the flu vaccine are among the least likely to wish to visit the places where it would be administered. Would it not be of great benefit to these people and many others to make use of the various outreach hubs that exist in their communities, for example, parish halls, community halls or even workplaces? These venues could be occupied for a time by existing HSE teams in order to flatten the curve, to use the Covid slogan, of visits to GPs and pharmacies. In the same vein, given that the vaccine is being offered to so many people of primary school age, why have the Department and HSE not opted to utilise the existing framework of the HSE school vaccination teams, which are long established and have been used to great effect? I have been in contact with pharmacists regarding this matter and I am informed that there is legislation with the Minister which would allow for this. What stage has the legislation reached? When can we expect it to be implemented in order to prevent pharmacies and GP surgeries from being overrun?

I thank Senator Keogan for welcoming me to the Seanad and congratulate her on being selected to become a Senator.

The Senator has tabled a very important Commencement matter. She mentioned older persons and I am very conscious that this is International Day of Older Persons. This discussion is also timely as we face into a winter with Covid-19, the winter vomiting bug and the winter flu. I am delighted to be here to respond.

We are all aware of the impact that Covid has had on our healthcare system and communities. In the coming winter months there will be additional pressures on the health system and its providers. The Government believes that increasing wider access to the winter influenza vaccine is a high priority and is needed to protect members of society, especially the most at-risk groups, and to help mitigate the impact on the health services as the pandemic evolves. I would like to announce the introduction of a new service development that will allow for the influenza vaccination to be supplied and administered by appropriately trained pharmacists at locations other than on the premises of the retail pharmacy business, which is exactly the point the Senator raised.

This extension of current practice will enable pharmacists to provide vaccination services to a greater number of patients. By providing for an off-site vaccination service, it will also remove some potential practical barriers such as capacity within the pharmacy premises due to social distancing recommendations and other public safety measures, which are in place at this time. It also has the potential to greatly increase uptake of the influenza vaccine in all the groups who can avail of the vaccine free of charge, in particular those in the at-risk categories as well as patients wishing to access the service privately. This will help to alleviate some pressures and concerns around personal safety that patients may feel, particularly during these very challenging times.

Potential locations where pharmacists may wish to provide this service may include in a person's car or home, a residential care home or a car park, including a drive-through service similar to Covid-19 testing services. They may also be administered at a business premises, a school or other childcare facility or a community or sports hall, as the Senator mentions.

This amending legislation, which has been signed into law, underpins this new service development and it is envisaged to be in place for the upcoming flu season. In support of this practice extension, the Pharmaceutical Society of Ireland, PSI, is drafting additional guidance to support pharmacy owners, superintendent pharmacists and supervising pharmacists. These guidelines will enable the delivery of a safe and effective vaccination service off-site from the pharmacy premises. This guidance will be considered by the PSI council in early October and it is envisaged that it will be then rolled out nationwide.

It is also important to note that there is no limitation in regulation to the places where a GP may administer a vaccine and the only restrictions that existed applied to pharmacists. I am delighted to say the Irish Pharmacy Union is fully supportive of this new service practice. I take this opportunity, on behalf of the Minister, Deputy Donnelly, to thank the PSI and relevant stakeholders for their assistance and support in the development of this service extension.

I thank the Minister of State and I welcome this initiative, as well as the support given by the Irish Pharmacy Union in rolling out the programme nationwide and providing these outreach services. There are 1,800 community pharmacists in this country so we need to consider how we can work with them in rolling out the HSE winter plan and how best we can serve our communities. These are an untapped resource for the HSE and Department. I am delighted to see the pharmacists are welcoming this initiative for administering the vaccine.

The 2020-21 influenza vaccination season will be the tenth year that pharmacists have been permitted to provide a vaccination service to patients on pharmacy premises. It is considered appropriate to build on the existing good practice and patient trust to further develop this service in order to meet the evolving healthcare needs of the public. The Senator is quite right that the community pharmacists are an untapped resource and offer a fantastic service in all our communities.

The Minister, Deputy Donnelly, is looking forward to seeing how this important service extension will be delivered and he is very hopeful it will have a positive effect on increasing access to the winter flu vaccination. It is important to acknowledge and appreciate the crucial role that pharmacists continue to play in our communities and healthcare system. I thank the Senator again for raising this very important matter.

Vaccination Programme

I welcome the Minister of State to the House and thank her for coming to address this matter. It is my first opportunity to formally congratulate her on her appointment so I wish her the very best of luck.

This topic continues from the matter raised by Senator Keogan, specifically the availability of the flu vaccine in GP practices. A number of GPs have contacted me, including my own GP, who have received their first delivery of the vaccine this year. The national cold chain service, which supplies the vaccine to GPs, has indicated that general practices can only receive an amount equivalent to last year's order. We are all aware of the current circumstances and conditions, and there is promotion of a programme to administer this vaccine to target groups. The numbers that were available last year will be insufficient this year.

The practice I mention had 240 vaccines per fortnight last year. It received 240 vaccines on 21 September but they were all used five days later. The practice will not receive another order until 5 October. With this in mind, something must be done to loosen the supply.

Given the year that is in it, we cannot base orders on last year's numbers. There is no comparison between the two years. Target groups aside, it has been estimated that uptake by GPs' own patients alone is double last year's rate. This will create a significant issue. We all know people who attend for ordinary check-ups or unrelated ailments and decide to have the flu vaccine. If it is not available and they are told that the next order will come in on, for example, 5 October, there will be queues outside GPs' clinics that day. That is the very thing we wish to avoid.

Will the Minister of State address this issue? It must be dealt with urgently. We are in flu season and people have already started getting the vaccine. The weather has changed to autumnal. Whatever flu strain there will be this year, it is probably not too far away. This is an important matter. GPs do not have an issue with administering the vaccine to target groups, a process that is funded by the HSE, but they are finding that they must use their private vaccine supplies to do so. This incurs a major cost on GPs' practices, but cost aside, it will place further constraints on their supplies for their own patients.

Before I call the Minister of State, and since I have not had the opportunity to do so yet, I will formally congratulate her and welcome her to the House.

I thank the Leas-Chathaoirleach and the Senator for their kind words.

This is an important issue, and my answer almost follows on from the previous Commencement matter. I thank the Senator for raising the issue. Seasonal influenza poses a significant challenge to vulnerable patients, the healthcare system and, in particular, the hospital sector. That challenge has never been more pronounced than it is this year, given the backdrop of Covid. To mitigate as much as possible the pressure on the health services that would result from a coincidence of the winter flu season and a resurgence of Covid-19, there will be an expanded provision of the seasonal influenza vaccine this year. All of those in the at-risk groups aged from six months up, including all those over 65 years of age and all healthcare workers, will be able to access vaccination without charges. All children aged from two to 12 years, inclusive, will also have access to vaccination without charges. Vaccines will be administered by GPs and pharmacists as in previous years.

The expanded programme will ensure that those most vulnerable to the effects of influenza will have access to vaccination without charges. By providing vaccination to those most at risk and those most likely to require hospitalisation if they contract influenza, it is anticipated that the programme will see a reduction in the number of influenza-related hospital admissions as well as a reduction in the overall spread of influenza in the community. Recently, I read a report from Australia where influenza numbers had flattened completely this year. It is being attributed to the good practices that we are all carrying on every day - wearing our masks, washing our hands and keeping our distance. I hope that the situation will be similar in Ireland, but we do not know.

The HSE has placed orders for 1.35 million doses of a quadrivalent influenza vaccine for the forthcoming winter compared with 1.1 million doses last year. However, I take on board the Senator's point about GPs only being allowed to order the same quantities as they ordered last year and that their supplies had run out within five days. I will bring that fact to the Minister.

The vaccine will be made available to all persons in an at-risk group from six months up other than children aged from two to 12 years, inclusive. The HSE has ordered 600,000 doses of the live attenuated influenza vaccine, which is delivered via nasal drops rather than injection, to be made available to children aged from two to 12 years, inclusive. In all, 1.95 million doses have been ordered this year compared with 1.1 million last year.

The first deliveries of influenza vaccines to all sites, including GPs, pharmacists and nursing homes, started on 17 September.

For comparison purposes, in 2019 deliveries commenced on 16 September.

For the initial deliveries, the quantities of influenza vaccine delivered were based on one third of the total ordered last year. The quantities of vaccine made available will be increased in line with the amounts received into the country. Approximately two thirds of the total contracted quantity of adult and paediatric flu vaccines are expected to be delivered to Ireland by the end of this week, the week commencing 28 September, and 100% of both will be delivered before the end of October. Vaccines will be made available to GPs and pharmacists promptly following receipt in the country. Deliveries of the nasal vaccine used to be used for children are on schedule and have not been delayed.

The HSE is satisfied that the number of doses procured is sufficient to meet demand in the at-risk groups, and vaccination of these groups has commenced. The vaccination programme for children is expected to commence from mid-October. Deliveries of the private supply of the vaccine are expected to commence at the start of October. Although it is difficult to estimate demand among those not in the at-risk groups, the Health Products Regulatory Authority medicine shortages framework has not been notified of any shortages affecting the Irish market in relation to flu vaccines. The vaccination campaign will be accompanied by a comprehensive communications campaign to encourage the greatest possible take-up.

In order to answer the Senator's concerns, which I understand, I assure him that supplies will roll out much more quickly as they come into the country. I will follow up on the matter after the Senator's supplementary comments.

I thank the Minister of State for her comprehensive reply and I broadly welcome the fact that the number of vaccines coming into the country has increased to the best part of 1.95 million based on the Minister of State's answer. The kernel of my query is about the distribution of those vaccines to the GPs. It is vitally important that the Minister, Deputy Stephen Donnelly, or the Department intervene at this early stage with the supply companies to ensure they are not still working off the 2019 numbers for what GPs can receive. It is all well and good to have the vaccines in the country but it is down to the distribution. It is vitally important that the GP services are not held back by being tied to the numbers they used last year, which is what the supply company is going on at the moment.

As we know, influenza can be a serious illness for people in the at-risk groups, which can lead to hospitalisation and even death. To take on board the Senator's point again, the quantities of vaccines made available to sites will be increased in line with the amounts received into the country. I take on board the Senator's point, however, and I will bring it back to the Minister. When people have the mindset that they would like to get the vaccine now before the weather changes, it is important that sufficient quantities are there. As I said, I will raise that matter with the Minister.

Those who are not covered by the publicly funded vaccination campaign can avail of the vaccination on a private basis. The Government has not been notified of any shortages affecting the Irish market in respect of the flu vaccines. We have gone from 1.1 million vaccines last year to 1.95 million this year, which is almost 2 million. Hopefully that will be a sufficient quantity and that includes 600,000 children.

Nursing Home Accommodation

I welcome the Minister of State to the House. It is a beautiful Chamber, as the Minister of State has said, and it is lovely to be here. The matter I have raised is the need for the Minister for Health to make a statement on the situation regarding St. Mary's Centre Telford, Dublin 4, and the care of persons currently depending on the centre's services, along with his Department's plans to prevent such future situations arising in Irish nursing and care homes.

I know the Minister of State will be well aware of the situation but I will briefly outline it. St. Mary's Centre Telford on Merrion Road is a disability care facility for persons with disabilities, namely, women with sight disabilities and on the same complex, it also comprises a nursing home. There were previously over 50 residents in the nursing home.

They have, over a very short period of time, been moved or relocated with significant adverse effects on many of them and their families. There are 18 persons still resident at the care facility, many of whom are very vulnerable and who have been living there for some time. Both of the facilities on the site are run by a company owned by the Sisters of Charity. Two members of that order are the sole shareholders of the company and the order owns the land.

The company owned by the Sisters of Charity just a few short months ago moved to close both facilities and is seeking liquidation of the company running the care homes. The matter is before the High Court and there may be another hearing today on it. There was a hearing on Monday at which former employees of the facility and residents sought to appoint an examiner to try to keep the premises going and maintain some sort of consistency of care for the residents who are still there. The judge refused that application and the law firm representing the former employees and the residents says that it may appeal. That matter is before the courts. I have met many of the former employees. Over 80 people were originally employed at the facilities. I have also met some of the residents who are still there and some of the families that were so severely affected when the closure announcement was made. There has been extensive coverage of this matter in the press. Hot Press in particular has been very good and has covered the matter extensively. Indeed there is an article in today's edition of Hot Press by Shamim Malekmian dealing with this issue. She speaks about the really serious effect this is having on very vulnerable persons and their families.

There is no doubt but that the Sisters of Charity, the order involved, has not dealt well with this, to put it mildly. There has been a shameful lack of care shown for the residents and staff involved. The unions involved are seeking to secure adequate redundancy payments for the former staff. That in itself is a significant issue and the company has not behaved well towards staff; nor has it behaved well towards residents. The order stands to gain enormously in monetary terms from the sale of the land which may be consequent upon this liquidation.

What is the State's involvement and why am I seeking a ministerial response? The Minister for Health clearly has a duty of care to these residents and arguably to the staff also, who have cared for residents through the Covid-19 crisis and who continue to care for the remaining residents. The HSE has funded the home extensively and Dublin City Council has an involvement too. I have, through Councillor Declan Meenagh, submitted questions to the council about its role. The council paid for the construction of the care facility and the housing for the 18 women who are currently still there. I understand that the provisional liquidator has suggested that the order might rent a premises to the HSE or extend the lease to ensure that women are not put out on the street. There is clearly a role for the State here. Whatever happens in the court with the order and the liquidator, the State has an obligation to those involved. It is in that context that I ask the Minister of State to make a statement on the issue today.

I thank Senator Bacik for raising this issue in such a constructive manner. Obviously, for the service users and some of the former residents and their families, this has been very challenging and difficult. A key principle underpinning Government policy is to support older people to live in their own homes with dignity and independence for as long as possible, with the correct wraparound supports. In recent years there has been a shift of focus in healthcare provision towards home care. Home support services are key in facilitating older people to remain at home. Of course, there will always be people whose needs are best met in a residential care setting or other supported housing model like the services provided at St. Mary's Telford nursing home.

The Department of Health is aware of the difficult decision taken by the board of management of St. Mary's, which is owned by the Sisters of Charity, to close. On 23 July the HSE was advised that St. Mary's was placed in voluntary provisional liquidation by order of the High Court at the request of the board of directors. The HSE advised that this was not an expected or anticipated action and was contrary to what the board and management had advised the HSE up until the previous week. Provisional liquidators were appointed and they contacted the HSE regarding client and staff welfare on 27 July.

It is understood that HIQA was also aware of this issue at the time. There were 19 nursing home clients and 22 disability clients in residence at the centre at the time. All residents have now transitioned from the nursing home element of the service, while 18 remain in the disability element.

At the High Court hearing of 8 September, an application was made on behalf of a group of employees, former employees, residents and their families to consider putting the company into examinership. The application for receivership was rejected by the High Court in a ruling delivered this week, on 28 September.

The HSE is working with the provisional liquidators and continues to provide them with funding to enable care provision to be maintained for the remaining clients at the centre. As of 3 September, the HSE has also commenced on-site engagement to review the service. The HSE is committed to supporting service provision and assistance in respect of client care at the request of the provisional liquidators, who are legally fulfilling the role of provider at this point. I understand that an independent advocacy service was utilised where residents required and consented to such representation or assistance.

The HSE remains conscious of the vulnerability of the residents at the centre of this issue and of the anxiety and stress these circumstances has caused for them and their families. I can only imagine how the residents, who were not expecting this news, would have felt. Some residents who have dementia need the familiarity of the building in which they live. To have to change can be very challenging for many. It is hoped that continued engagement will substantially alleviate this anxiety and stress. I thank the Senator for raising this very important issue.

I thank the Minister of State for her very strong reply. I have raised this matter in the Seanad a number of times but I am grateful to the Minister of State for responding so directly on it. Clearly, there is an issue with regard to the provision of care to vulnerable persons beyond the specific issues affecting St. Mary's. In the context of St. Mary's, I am grateful to the Minister of State for setting out the background. I am shocked, although not surprised, to hear just how little notice was provided and that the HSE was only advised on 23 July that St. Mary's was to be placed in voluntary provisional liquidation. This action was not expected or anticipated. Indeed, it was contrary to what the board of management had advised the HSE up until the previous week. That is shocking and shameful and shows just how shamefully the Sisters of Charity and related companies have behaved towards residents, staff and the State in respect of this issue. Let us not forget that the Sisters of Charity owe the State approximately €3 million in unpaid redress so there is a broader context to this matter.

I thank the Minister for State for setting out the ongoing steps the HSE has taken to engage with those who are still dependent on the continued existence of the facility for their home. I hope that engagement will continue in order to ensure that provision is made for those vulnerable residents and that the uncertainty they currently face, which has caused them so much stress and trauma, will be resolved by some sort of clear provision for their future care. I hope the Minister of State will bring that message back to the Minister, Deputy Stephen Donnelly. I would be really grateful for that. I remind the Minister of State once again of just how much stress, trauma and upset this issue has caused people.

I thank the Senator very much for her answer and for the constructive approach she has taken on this matter. As she has quite rightly said, this centre is these people's home from home. It is where they have spent many years of their lives. Their families have gone through many challenges because, as the Senator correctly stated, the HSE advised that this action was neither expected nor anticipated and was contrary to what the board of management had advised.

To reiterate, an independent advocacy service was utilised where residents required and consented to such representation or assistance. This service continues to support the families. This action was undertaken solely by the former board of directors. Provisional liquidators have been appointed and the HSE has confirmed that it is working closely with them and with HIQA to ensure that all remaining clients are cared for appropriately. That has to be the outcome. All remaining clients must be appropriately cared for. I will follow up on this because I am very concerned about it.

These 18 clients have to find their new home from home. It is very important that it happens safely and swiftly, and that there is not too much uncertainty. What they need now is clarity and certainty. I will follow up with the Senator.

Flood Prevention Measures

I am sure the Leas-Chathaoirleach, given his strong links to County Roscommon, will have heard the debate about Lough Funshinagh on many occasions. I thank the Minister of State, Deputy Sean Fleming, for coming to the House to discuss this matter.

Lough Funshinagh is a special area of conservation, SAC, in County Roscommon. It was once known as Ireland's amazing disappearing lake. There were reports going back to the 1950s and 1960s that the lake actually disappeared in a short space of time. The most recent word of the lake disappearing is from 12 or 13 years ago, when, in the space of two days, the lake dried out. When this happened, thousands of fish were lost, bird life that thrived around the water was stressed and lost, and much of the flora and fauna was damaged.

For some time, there has been a national debate about Lough Funshinagh, mainly because of the damage that has been done to farm lands and farm sheds, and the threat to housing and livestock. An OPW report was commissioned four years ago which gathered information from Roscommon County Council and the Geological Survey of Ireland and that report is now coming to light. The report is not good news for the locality or for the 45 farmers affected. Basically, one of the solutions spoken about is the making of a drain from the lake to the River Shannon at an estimated cost of €1.5 million. However, the report suggests this would not be good from an ecological perspective.

I want to point out that the lake is 4 ft. higher today than it was this time last year, so we can see the problem. Its expansion has destroyed the flora and fauna, and the fact it is now a special area of conservation is something of a joke. We all have to be very careful about SAC areas but due to the lack of action, the flora and fauna, including the fish life, has been damaged. There is a need for a cost-benefit analysis in that we are looking at a cost of €1.5 million to construct a drain from the lake to the River Shannon.

If there is anything positive in the report, and it is hard to find positivity in it, it acknowledges that at least two families will have to be moved out of the area and that the State will have to take on that responsibility. Of course, that is if people want to move.

I ask that the Minister of State go back to the Minister on this. For now, we need to have a meeting of local people with local representatives, and I have been speaking to Councillor Laurence Fallon and other councillors. We need to further discuss the issue to see if we can make progress.

The most important point is that this lake continues to expand. It may not end with damage to 45 farms, roads and houses. If the lake continues to expand, we are going to have to take immediate action.

I thank the Senator. Seconders are not necessary in this context, but were they required, I would happily second this Commencement matter. I ask the Minister of State, Deputy Fleming, to respond.

I am speaking here as a representative of the Minister of State, Deputy O'Donovan, who has special responsibility for the OPW. I thank the Senator for raising this matter, and I am pleased to provide an update as best I can.

I am advised by the Minister of State's office that, following severe flooding during the winter of 2015-16, Roscommon County Council applied, in 2018, to the OPW for funding under its minor flood mitigation works and coastal protection scheme for a study at this location. Approval and funding was given to Roscommon County Council to undertake a study in July 2018. The council subsequently appointed Malachy Walsh and Partners to carry out this commission. The purpose of the report was to review the ecological constraints associated with the proposed flood protection options at Lough Funshinagh and Lough Cup; identify the European sites, namely, special areas of conservation, SAC, and special protected areas, SPA, which may be within the zone of influence of these options; determine the direct and indirect effects of the flood prevention options on the conservation objectives of the European sites affected; establish the nature of the statutory environmental reports required to accompany a future planning application for the flood protection options and provide indicative costs; and provide a conclusion on the viability of the options proposed.

The report was submitted to the OPW, which carried out a review in July 2020. It was a two-year process, but one should understand that it took time to procure the company directly involved which did the work, and extensive work had to be carried out due to the fact that SACs had to be identified and there were issues with flora and fauna, which the Senator mentioned.

The study looked at seven flood mitigation measures, of which six fall below a cost-benefit analysis of 1:1, which is a standard index used by the OPW to ensure that when work is carried out, both the cost and the benefit for the community are clear. There is significant uncertainty that the one remaining cost-effective scheme proposal will solve the flooding problem of the property, and it has been concluded that the property is likely to remain at residual risk of flooding. There is no cost-effective solution to manage this residual risk, with the current emergency management of flood levels being managed by pumping. This option is, therefore, not considered to be economically or environmentally sustainable. After all, pumps cannot be used indefinitely.

Following the OPW's review of the flood analysis report on Lough Funshinagh, the property owners who have applied for the voluntary homeowners relocation scheme will now be advanced through this scheme. Those who apply, therefore, will be advanced.

The OPW also understands, however, that there will remain a risk of prolonged flooding around the lough, and have advised that it remains open to Roscommon County Council to make an application under the minor works flood mitigation and coastal protection scheme, should additional measures be identified in the future that meet the scheme criteria to mitigate flooding.

I also understand that at a special meeting of the municipal district of Roscommon County Council on Monday last, 28 September, the elected members were advised of the current situation with regard to Lough Funshinagh. The council has requested a meeting with officials from the Minister of State's office and now that the Senator has raised this issue today, I will provide a commitment that a meeting will be held in the near future. It is important that this matter be brought to the attention of the OPW by the Senator at the national level, to complement the work carried out by the municipal district at local level. I look forward to that happening. The Minister of State, Deputy O'Donovan, said that there is a number of people involved and there may be an opportunity for some of those people to be involved, depending of the make-up and structure of the meeting, if appropriate. It is essential that the Oireachtas representative and members of the municipal district attend the meeting, which I hope will take place.

The Senator referred in his contribution to a very unusual, although not unique, situation. He began by talking about a disappearing lake but, as he went on, he was talking about an expanding lake. It is very unusual that a lake would be disappearing for decades but is now starting to expand. That is due to climate change issues and is a very particular scenario. I look forward to working with the OPW, the council, public representatives and the families involved on this scheme.

I will not labour my point any further. I thank the Minister of State for a very open and frank exchange on the issues I have raised. It is good to know that a meeting will take place. There are two things that should be borne in mind. First, the lake continues to expand, by 4 ft in one year, despite all that has been done to address the problem. Second, I know it is a peculiar argument to make but the reality is that because the lake is associated with a SAC, the flooding has led to the destruction of flora and fauna. Unless we can get some way around this issue and do something extraordinary, we cannot act on what is happening. The SAC aspect is a major issue. We have an extraordinary situation of a lake that used to disappear but is now expanding and we cannot get a solution to it.

I thank the Senator for his closing comments. He has highlighted the difficulties in regard to the SAC. The most important concern is the people living in family homes, the farmers and the landowners who are directly affected, as well as the environmental issue. I thank the Senator for raising the matter.

Covid-19 Pandemic Supports

I welcome the Minister of State to the Chamber. The Covid-19 crisis has had a devastating effect on many thousands of companies and employees throughout the State. To assist with the dramatic fall-off in revenue, the previous Government approved the introduction of the temporary wage subsidy scheme, TWSS, which has had a hugely positive impact in keeping employees linked with their companies and providing much needed cash flow support for companies to enable them to continue to trade through what has been, and continues to be, an exceptionally difficult time. Since its introduction, more than 65,000 firms have availed of the TWSS. That amounts to almost one third of all employers, according to the 2019 figures. More than 660,000 jobs have been directly supported over the period, with a value of payments made to date in excess of €2.8 billion.

On 1 September, the TWSS was replaced by the employment wage subsidy scheme, EWSS, with payments being made at two flat rates of €203 and €151.50 per employee, depending on gross weekly pay. No subsidy is paid for employees earning below €151.50, which I will deal with presently. One of the main advantages of the EWSS over its predecessor is that it is open to new employees. Under the TWSS, companies that had to hire additional staff to meet requirements of social distancing and enhanced cleaning rotas did not have access to support. I acknowledge this change, which certainly is a huge step in the right direction.

However, unlike its predecessor, under which payments were made promptly within the week in which the claim was submitted to Revenue, the EWSS is paid on a monthly basis. This is having a negative effect on the cash flow of SMEs throughout the country because it can take between four to six weeks to get a refund of moneys owed under the scheme. In my own county of Waterford, I recently met representatives of Dungarvan and West Waterford Chamber of Commerce and local publicans who expressed to me in the strongest terms possible that the changes are having a detrimental impact on cash flow and resulting in the forced closures of some businesses and the early laying off of seasonal staff in others. Many businesses, particularly in the tourism and hospitality sector, are operating with a reduced capacity and a reduced turnover but the same outgoings. The lifeline offered by the EWSS is critical but if refunds are only being paid on a four to six-week basis, then one must question whether the scheme is having the desired effect of assisting with the cash flow of businesses.

As the Minister of State is aware, many people in that sector are paid on a weekly basis and businesses are being put on the back foot due to delays in payments. This matter needs to be addressed urgently. To put it plainly, if it was not broken, why did Revenue and the Department try to fix it?

On the employees who are below the €151.50 threshold, and the fact that no flat-rate subsidy is available to them, these are employees who are perhaps students who are availing of weekend work in small companies. Those companies that are giving the students the bit of work are effectively being penalised because they are not reaching the €151.50 threshold. Perhaps the Minister of State could take on board the possibility of introducing a third subsidy at a lower rate of €75 to assist in those companies which only have employees on that rate.

I thank Senator Cummins for raising this issue, which, as he pointed out, is a significant one for many smaller businesses due to the cashflow implications.

The EWSS is an economy-wide enterprise support that gives a flat-rate subsidy to qualifying employers to preserve the link between employee and employer and to support the firm's viability insofar as is possible. The design of the EWSS reflects the changing environment around the Covid-19 pandemic which has shifted from crisis mode to one of living alongside the virus, in line with the recently announced Resilience and Recovery 2020-2021: Plan for Living with COVID-19. It important to emphasise that the EWSS is a subsidy to the employer, unlike TWSS, which was an income support to the employee paid via the employer. The payment under the TWSS was listed on the person's payslip. Some people did not like the stigma of that on their payslips, but it was there to show that it was coming directly to the employee.

The EWSS is a lump-sum grant to the employer based on the number of employees who qualify. It is not geared to any particular employee. It is based on the number of employees. A company may submit that it has two staff in a category or ten or 50 employees in a category, as the case may be. It is a subsidy to the employer to keep the business open and to maintain links with the employees. In that situation there is no direct reference on any of the payslips for employees in that situations because it is not based on the individual employee situation, it is based on the employer's overall position.

As the Senator has mentioned, the timeline of payments under the EWSS has also moved into line with regular monthly payroll returns to Revenue, which has always been the case for companies dealing with the latter. We had the shorter timescale because we were in the height of the emergency with many more people on the pandemic unemployment payment and the TWSS payments. It was essential that we had emergency payments on a weekly basis. Having to make returns weekly increased administrative work for all the businesses involved. Now we are trying to get to living with Covid in the longer term, and trying to get employers back to the ways they have always operated in making monthly returns to Revenue.

When businesses make their returns to Revenue on the 14th of the month following their payroll payments they generally get the subsidy payments turned around within two days of receipt of the payroll submission, which is the 16th of the month. Depending on the pay date used by the employer it may be as short a turnaround as 16 days but it could be up to six weeks in some cases, which is the crux of the issue. Those companies with monthly payrolls have the two week period delay. Where it had been a weekly payment, now it depends on the start of the employer's pay date. As of 30 September, some 37,165 employers had successfully registered for the scheme. There was a look-back at seasonal entrants and new employments, with 2,700 people who were not eligible under TWSS now in receipt of the EWSS payment. This is an improvement for new hires or seasonal workers back in the scheme. I would consider this to be a benefit.

There are various grant schemes that could help the cashflow of smaller businesses, including the restart scheme and the restart grant plus scheme. The Senator referred to the tourism, hotel and hospitality sector.

The stay and spend scheme is in operation from today. I advise everyone in a locality, if he or she cannot travel to another county, to get out in a county where it is safe to do so and spend money in a restaurant with his or her family at the weekend. This would create extra business at local level. Revenue will provide a tax credit for those people next year.

I appreciate the Minister of State's response, but I would like him to consider those sectors with particular cash flow issues, namely, tourism and hospitality. People in those sectors are mainly paid on a weekly basis. While I appreciate that people who are paid on a monthly basis are not facing this scenario, the very businesses that we are trying to assist have a cash flow issue and are citing this as a major concern. I ask that the matter be addressed. Businesses are willing to put the extra work in on the payroll side if Revenue can, on the other side, pay on a weekly basis, as was the case with the temporary wage subsidy scheme. This issue needs to be addressed. Otherwise, more situations will arise than have been outlined to me in my county of Waterford. Yesterday, the Chawke Group cited this issue as one of the major reasons for laying off 300 staff. I urge the Minister of State to take it seriously and address it as urgently as possible.

I thank the Senator. He hit the nail on the head in everything he said. There is a cash flow implication. It is a good scheme for many people, but for businesses, the cash flow crisis could be fatal. It is important to remember that. While I am not in a position to give a commitment, we will ask Revenue to examine the scheme's operation. Revenue will quickly see the scale of the payments it will make every month or so versus the scale when they were being made on a weekly basis. If some operational measure can be introduced, we will ask about it.

I have spoken to the Ministers for Finance and Public Expenditure and Reform about the issue this week. They are aware of the difficulties. Cash is king. People do not look at their profit and loss when they go into work every morning.

They want to know what they have in the bank account and who they can pay this week. I understand that. Although it does not mean there is a solution, we are fully aware and are examining the matter carefully.

I thank the Minister of State.