Topical Issue Debate

Planning Issues

Deputy Bernard J. Durkan

I thank the Leas-Cheann Comhairle and the Ceann Comhairle and their respective offices for affording me the opportunity to raise once again the stalled development of the town centre in Naas. This has been a blight on the town for almost ten years now and I think everyone has tried their best to move the development onwards and get the works rolling and restarted once again. It is especially timely to mention the fact that Naas is the county town of Kildare. It always has been a busy and very important market town. For reasons outside the control of local administration, the downturn in the economy affected it very severely, and the cranes that were there at the beginning are still there. I hope this is the last time I have to raise the issue of the immobile cranes on the horizon in the town of Naas.

Since I last raised the issue in the House, there have been some positive developments but they are extremely slow. Despite countless meetings and discussions in recent times with the local authority, the legal people, NAMA and the receiver's representatives, who have all been helpful and positive in what they have to do, one matter is outstanding. I refer to the legal issues concerning rights of way, which I am glad to note are now at least going to the High Court for resolution. While this might take some time, it is to be hoped that we will see these issues resolved before the end of this year.

In the meantime, it is important to use the time available to all administrators, including the Minister and the local authority, to assess the situation once again in order to ascertain whether further planning permission is required. For instance, if all planning permissions relating to the site have to be renewed, that will take some considerable time. Therefore, I ask that in the downtime we have, while awaiting the outcome of the remaining issues, the local authority and the Minister engage with a view to clarifying, at least - I hope ensuring - that planning permission is not required or that part of the development can proceed without new planning permission. As we all know, there is always the danger of long delays in cases of developments of this nature. At this stage, what is important is that nothing falters from here on. We cannot afford that to happen. There are about five prime sites within the town boundaries - the main one to which I refer and four others - all of which are available. It was sad that the major commercial development moved outside the town. It was not the local authority's decision, but rather An Bord Pleanála's, to move the development outside of the town and with it bring the footfall that is the necessary lifeblood of every commercial centre in the country.

I ask the Minister to use his influence with the local authority and seek its full co-operation in speeding up the administrative procedures now required as a matter of urgency. If this is done now in the downtime we have, I think we can look forward to an early and positive start of the development at the town centre in Naas, with obvious consequential benefits for the entire area.

Minister of State at the Department of Housing, Planning, Community and Local Government (Deputy Damien English)

I thank Deputy Durkan for raising this issue again. It could be the fifth or sixth time we have debated it-----

Deputy Bernard J. Durkan

It is about that.

Deputy Damien English

-----so I understand and appreciate the Deputy's eagerness to have the matter resolved. I have seen the site and understand even from the point of view of having passed through the town how important it is that this site be developed or resolved one way or the other. I, therefore, understand Deputy Durkan's and the council's desire to keep raising the matter at every opportunity they can in order to keep pushing it. However, as indicated in previous replies, the management of the stalled development in Naas is a matter for Kildare County Council in the first instance. Furthermore, with processes under way involving both NAMA and arbitration, it would be improper for me, as Minister of State, to become involved. It is not appropriate to accept representations on this issue as, under section 30 of the Planning and Development Act, the Minister is precluded from exercising any power or control in respect of any case with which a planning authority or An Bord Pleanála is or may be involved except in very specific circumstances, which do not appear to apply in this case. Nonetheless, I am informed that Kildare County Council continues to do everything in its power to influence and encourage NAMA to offer the site in question for sale as soon as possible. The council has been notified that a receiver has been appointed in respect of the town centre site.

As previously outlined, and subject to a satisfactory planning approval, there is no impediment to accessing the site or to appropriate development of the site. Kildare County Council recognises the strategic importance of the site in question and will continue to support and work in partnership with any stakeholders involved in its redevelopment. I will pass on the Deputy's suggestion to Kildare County Council that it might be able to progress or respond to the planning questions in parallel with the legal issues that are developing because that makes common sense. I am not in a position to instruct the council in any way in this regard but I will pass on the Deputy's thoughts and advice on the matter. We can have that conversation with the council.

During the past 18 months, Kildare County Council has initiated and supported a number of projects with the strategic objective of ensuring that the social and economic development of Naas is protected and enhanced. This work is underpinned by the work of the Naas roads and transport steering group, the URBACT group and the Naas Regeneration Group.

Kildare County Council has also received the approval of the National Transport Authority to prepare a traffic management study for Naas which will form one element of a strategic social and economic plan for the town.

Having talked to Deputy Durkan, I have no doubt but that he is very frustrated by the length of time it is taking to get this matter resolved and I know that the local authority is doing all it can within the parameters of its role and recognising the due process necessary in respect of the receivership, etc. I am hopeful that, with the appointment of the receiver, there will be further progress to resolve the matter and facilitate the development of this strategic town centre site as quickly as possible and the resolution of the other legal issues that are developing.

Deputy Bernard J. Durkan

I thank the Minister of State for his reply. As I have said before, it is like "Waiting for Godot", to the extent that I almost expect Godot to turn up at some stage in the not-too-distant future. I know the Minister cannot instruct the local authority but I suggest that the Minister might consider at a certain time encouraging and facilitating the local authority and inviting it to a meeting at which these issues could be discussed, with a view to applying sufficient encouragement to try to emphasise the urgent necessity to get the project moving once again. The reason for this is simply as follows. According to the old saying, as the Leas-Cheann Comhairle knows, "live horse and you'll get grass". However, if one waits too long for the grass to grow, the horse will die. We need this to move forward now. Ten years is long enough. The town is now beginning to experience a little bit of a recovery following the downturn in the economy, and it would be hugely important and hugely beneficial if it were possible to identify the positives, effecting investment in the town being one of the major positives. It would not be a great idea to have to wait for another year or two while the administrative works are carried out. The construction works on the town centre are already substantially complete and there is a huge issue regarding whether or not there will be a need for further planning permission.

I do not wish to delay the proceedings of the House. I thank the Minister for coming into the House to reply and I appeal to all concerned, all the bodies - we all know who they are: ten years is long enough. Godot or no Godot, we need to apply pressure from all sides to bring about a speedy resolution to something that has confused and frustrated us up to now.

Deputy Damien English

I agree with Deputy Durkan that we, as a planning Department, must do all we can to make this happen. If we can help in any way with planning queries or other issues surrounding this matter, and if Kildare County Council seeks our help in that regard, we will be able to engage with the council. There is no problem whatsoever facilitating a meeting if needs be. If there are any planning or interpretive planning issues, our planning team, headed by Niall Cousins, is there to be able to deal with them. We can engage if we can help with that at all. Wearing my urban regeneration hat, I can say we want to see buildings such as this one which have been lying idle for a long number of years brought back into use as this enhances the town overall. If we can help under that heading, we will. While we cannot get involved in site-specific issues surrounding the planning and the legalities of the matter and so on, there is absolutely no doubt but that where we can help, the door is open to try to do so as best as we possibly can. We will have more meetings with Kildare County Council on general housing issues and other issues. As at previous meetings, I will raise this issue with the council for discussion. I know from talking to Kildare County Council that it also wants this resolved. Its staff look out the windows of their office and can see the site most days so I think they understand the importance of it and want to have it developed as well. I hope that will happen quite quickly.

Home Care Packages Provision

Deputy Frank O'Rourke

I welcome the opportunity to discuss home care packages, home help hours and dementia care at home with the Minister. The purpose of these supports is to maintain someone in the surroundings they are most comfortable in at a particular age in life when they might be suffering from a particular illness or sickness. It exists in order that such people can be comfortable, happy and content in the surroundings they are most familiar with. When home care packages work well and the scheme is in place, we can see the positives and the advantages they bring, but there are problems. We need to identify those problems and we need to deal with them comprehensively. Otherwise the home care packages will not meet the necessary requirements of the end user. Ultimately that can have a detrimental effect on everyone involved.

There is a problem with the application and assessment process at the moment and I am going to highlight certain examples. When the assessment is being carried out by the home care package team, my understanding is that the level of dialogue with all the stakeholders is not taking place to the extent that it should. One of my constituents is holding up a bed in a hospital because different experts and medical professionals have recommended that that person needs 21 hours of home care support to help support the family and friends in the home. Currently, only 13 hours are allocated. There is a lack of connection and dialogue between the relevant stakeholders to put the appropriate home care package in place for that person. That is not a recommendation from me or from the family. The people who are qualified to do this should be engaging with each other in order that the best package available is put in place to help that person in their home environment. That person is in hospital holding up a hospital bed which others cannot access, and in the meantime the person cannot be at home in the environment in which they are most comfortable. That is a problem, a disconnect, and something that needs to be addressed and dealt with during the application and assessment process. This is causing a problem.

There is another problem with the delivery of service by service providers, where some are to provide the service to provide to the end user but it is not being provided. I met the HSE recently about another case. Seven showers per week were allocated to a particular person. Everyone thought it was happening. Three months later the family contacted me to ask why it was not happening, and it was during that meeting I found out that while the showers had been allocated, the family did not know it had been put in place and the end user was not getting the service. That is another issue of communication and disconnect and a lack of follow through. The real loser here is the end user. There is no follow-up with the service provider to see if it is carrying out the work. There should be follow-up with the HSE when the service is allocated to check in with the end user and make sure that the service is in place, if the person is happy with it and if the service provider is carrying out the service to the highest standards.

In another case involving a change in service provider, a lady who is severely disabled has not had a shower in eight weeks. She has had a bed bath, but has not had a shower in eight weeks. One service provider reckoned the environment was okay to carry out the work and another service provider said that it was not okay. The user is caught in the middle. There is a serious problem of disconnect, and a lack of engagement and consultation. The problem is that the end user is suffering, and that is the issue that needs to be addressed and discussed in this debate.

Minister of State at the Department of Health (Deputy Jim Daly)

I thank the Deputy for raising this issue. The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. Home care is an increasingly important part of the supports for enabling older people to remain in their homes and communities for as long as possible and for facilitating their discharge from acute hospitals. The HSE has operational responsibility for planning, managing and delivering home and other community-based services for older people. Services are provided on the basis of assessed health care need and there is no means testing. The HSE, working within its available resources, has sought to maintain and, where possible, expand the range and volume of services available to support people to remain in their own homes, to prevent early admission to long-term residential care and to support people to return home following an acute hospital admission. The demand for the home help service and for additional supports through the home care package scheme continues to grow in parallel with the increasing numbers of older people. Many more of our older people with complex care needs are now being maintained at home, leading to increased demand for additional levels of service and for services outside of core hours of Monday to Friday.

The overall funding for services for older people in 2017 is €765 million. This includes about €373 million for the direct provision of home care. The HSE’s national service plan provides for a target of 10.57 million home help hours, 16,750 home care packages and 190 intensive home care packages for clients with highly complex needs. The HSE has progressed a range of measures to improve home care provision overall, to standardise services nationally and to promote quality and safety. National guidelines setting out standard procedures for providers of home supports were introduced in 2011. A procurement framework for home care services came into effect in 2012. This requires service providers to meet defined minimum standards applied to services procured by the HSE. The tender arrangements are reviewed regularly and the current arrangements which commenced on 1 September 2016 will run for a period of two years. The Deputy will be aware that arrangements for home care have developed over the years with a significant local focus, and there is considerable variation in access to services in different parts of the country. There is a need for a uniform approach to assessment of need, and the HSE is in the process of introducing a single assessment tool across home care. The single assessment tool is a comprehensive IT-based assessment used to ensure that every person being assessed for support services has access to a standard and thorough assessment, regardless of where they live or who is doing the assessment.

Home care is monitored on an ongoing basis, to ensure that activity is maximised relative to individual clients’ assessed care needs and within the overall available resources for home care and having regard to demand throughout the year. Arrangements for home care have developed over the years with a significant local focus, and there is considerable variation in access to services in different parts of the country.

The programme for partnership Government includes commitments to increase funding for home support services, to improve these supports, to introduce a uniform home care service in order that all recipients can receive a quality support, seven days per week where possible, and to review the management, operation and funding of national home help services.

I assure the House that the Government is committed to promoting care in the community for older people in order that they can continue to live in their homes for as long as possible. On 6 July, the Minister for Health, Deputy Harris, and I announced the opening of a public consultation on home care services. The purpose of this is to allow all those who have views on this topic to have their say, including older people themselves, their families, and health care workers. The Department wants to find out what people think about current home care services and would also like to hear the public’s views on what the future scheme should look like. I strongly urge all those with an interest in home care services to make a submission to the consultation.

I would appreciate it if Deputy O'Rourke would clarify one point. When he talks about the services that have been allocated and not delivered, is he talking about private home care services or is it the HSE which is in charge? I am concerned about that.

Deputy Frank O'Rourke

I do not doubt the Minister of State's commitment. I want to highlight the issues to get better delivery. The issues I am speaking about involve both the HSE and private companies. The HSE is ultimately responsible. I am concerned that there is no follow through to ensure there is a delivery of service. That is the problem. We cannot have accountability without that follow through. If people are aware that they are accountable for having a service delivered and checks and balances are carried out to ensure the end user is getting the service that was awarded, it is only then we can ensure an improvement. The only person who is important and relevant here is the end user. We will not have an improvement if people believe there is no consequence for inaction and that the issue can simply be fudged. That is the problem. All the cases I highlighted to the Minister of State are individual cases where there are problems with the delivery of service, including with the assessment and with appropriate home care packages being put in place, agreement among the clinical and medical people, and the delivery of that service. In the programme for Government it was identified that this is an area the Minister of State wants to improve

Despite the additional funding in several cases it has not improved over the past six to 12 months.

The Minister of State might need to consider the direct funding model if there is a problem in delivering the service and the family or end user is suffering. They may need direct funding to put the service in place that best suits the needs of their loved one, their time and flexibility. That works well in other places. The end user needs to be listened to because it is not a case of one size fits all.

Deputy Jim Daly

The Deputy's points are very interesting. His latter point is a kind of money follows the user approach so that the user can employ his or her home care with the same budget.

I encourage the Deputy to encourage his constituents to avail of the public consultation because this is the first time the Department has assessed what is happening nationally. While the objective is to bring about a better universal scheme that is accessible to all with equity and fairness at its heart it also gives us the chance to examine the existing scheme. There is no consistent national regulation of the current scheme. It would be deeply troubling if resources are being allocated and paid for but not delivered. That is a management issue that I need to take up with the Health Service Executive, HSE, to ensure that people are getting at the very least the limited resources allocated to them. People are not satisfied with the resources being allocated but they should at least get full value for what has been allocated to them. If the Deputy has details of any particular case I would be very interested in following it up to see whether it is private home care or HSE care and what we can learn from that.

The Deputy mentioned dementia. I met with the Oireachtas Joint Committee on Health this morning which is working actively in this area and that ties in with supporting people with dementia in the home and having a dementia liaison person to assist them. There is a lot to be done in this area and I am confident we can make progress working together.

I intend to lead that from the front for as long as I am in this office to get a scheme up and down the country. It could take up to two years to get the kind of scheme I want to see which gives everybody access to the home help they need but that is not a reason for us to take our eye off the ball in the intervening two years to ensure we do have full accountability for the existing service. While it may not be perfect we have to ensure it is the best it can be.

Special Educational Needs Staff

Deputy Michael Healy-Rae

I raised this matter two weeks ago during Questions on Promised Legislation and got no reply from the Taoiseach. That is why I am raising it today. I thank the Minister of State at the Department of Health, Deputy Finian McGrath, for visiting the excellent facility in Beaufort in County Kerry. I requested him at that time to do so and was very glad that he did. He also called to other facilities in County Kerry.

Students with profound special needs or requiring round the clock medical attention are being forced to miss days at St. Francis Special School in Beaufort, County Kerry as the HSE provides only general nursing hours there three days a week. At least two students living in constant danger of medical emergencies cannot attend St. Francis Special School on Tuesdays and Thursdays in the absence of general nursing care. Funded entirely by the Department of Education and Skills with St. John of God's as its trustees, St. Francis Special School is dependent on the HSE to provide the vital medical assistance its students need. While many students benefit from individual nurses the general nursing service is crucial to the delivery of education at St. Francis Special School. Currently, however, it is provided only on Mondays, Wednesdays and Fridays and staffed by two part-time nurses. Parents are also seriously concerned about the loss of physiotherapy, speech and language therapy and occupational therapy hours that occurred under the HSE's reconfiguration plan. They signed up to this in 2013 on the understanding that the service they were then giving would be fairer for all students in the mid-Kerry area, students in St. Francis Special School and those in mainstream schools with less profound needs.

It is crucial that the absence of general nurses at St. Francis Special School on Tuesdays and Thursdays is rectified and that nurses are provided on these days. Children should not have to remain at home on those days. It is simply wrong. I compliment the staff at the school from the bottom of my heart. They do excellent work but they are not trained medical experts and can only do so much. I ask the Minister of State please to ensure that on Tuesdays and Thursdays general nurses are provided for St. Francis Special School in Beaufort. This is of vital and paramount importance.

I want also to highlight the fact that the structure in Beaufort is coming under attack because of the policy on congregated settings adopted in 2011. I have said before in the House that this policy should be changed because if new people are not allowed to enter the excellent facility at St. Mary of the Angels, whose campus includes St. Francis Special School, over time the facility will close. That will also affect St. Francis Special School. I have said on numerous occasions that one shoe does not fit all sizes. The Government should change this policy to allow St. Mary of the Angels to take in admissions again because when a centre like that is closed by stealth, a centre of excellence is closed. Beaufort and St. Francis Special School are centres of excellence. The personnel, the management, teachers, nurses, the staff working in the kitchens and those taking care of the personal needs of the patients make it a real centre of excellence. I would like the Government to acknowledge that and revisit the congregated settings and deal with the issue I have raised, to provide the necessary nursing care on the days when the nurses are absent.

Deputy Jim Daly

I thank the Deputy for raising this issue. I am aware that St. Francis Special School is situated on the grounds of St. Mary of the Angels and I understand that there are 55 children enrolled in the school with needs varying from moderate to severe.

A new extension, opened in September 2015, facilitated some of the then existing classrooms to be converted into specialised physiotherapy, speech and language and occupational therapy facilities, including a dedicated art room. This is very positive as it means that a multidisciplinary team on site has played a huge part in enabling each pupil to achieve his or her true potential.

With regard to the particular issue raised by the Deputy, I am aware that, in 2013, HSE Cork Kerry reconfigured children's disability services in Kerry to children's disability network teams with access based on need, in line with national policy. I am advised by the HSE that the specific need within the school was recognised on foot of an assessment of need, which took place some 18 months ago. The assessment was undertaken by the public health nursing service on which the existing resource provision of three days nursing has been based. The current nursing arrangement has been facilitated from primary care services.

A more recent assessment by the public health nursing service has indicated increased complexity of care needs for the children attending the school. The initial recommendation was to increase the service from three to five days per week. The HSE has informed me that a review of this assessment is under way to examine the additional level of resources that may be required to address these complex needs and to set out what the overall requirement will be. It will also look at how the existing allocation of nursing support may be optimised to meet the changing needs of the children.

I fully recognise the concerns of parents whose children are unable to attend the school on a full-time basis. I sincerely hope the HSE can progress this assessment as speedily as possible and find a resolution that will have a positive outcome for these children. This Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives.

I can advise the Deputy that €8 million in additional funding was invested in 2014 and 2015 to fund 200 additional posts to support the implementation of the national programme on progressing disability services for children and young people under 18 years of age. A further €4 million in additional funding was provided for 75 therapy posts in 2016.

Deputy Michael Healy-Rae

St. John of God's has recently written to families with family members in St. Mary of the Angels requesting the payment of additional money every month. One family has paid €400 per month for the last 20 years and is now being asked to pay €195 on top of that, which will leave them struggling. What will St. John of God's do if the family cannot pay? They cannot tell their children to leave the facility.

I would sincerely love to catch a hold of the person in the HSE who dreamt this whole thing up a number of years ago of using the word "reconfiguration" rather than the simple, ordinary and down-to-earth word "cut". Any time the HSE has spoken about reconfiguring something, it means it is going to cut the service and its funding. However, it does not use that ordinary common word. Rather, it uses the highfalutin term "reconfiguration of services". The person who first said that would want to be given a good shaking for ten minutes to bring him or her down to earth and to show that a reconfiguration is the same as a cut. It is certainly not enhancing a service and it is doing nothing to improve things. It is a cut. A cut is a cut, not a reconfiguration. It is not the Minister of State's fault. I do not direct this at him. I direct it at those hiding within the HSE who dreamt this up with their spin doctors a number of years ago. They were allowed to get away with it by politicians in this House at the time who should now tell them that there is no such thing as reconfiguration. It is a cut. Those words are being used by the Minister of State here now because, quite simply, he was told to use them by the HSE. The Minister of State and his colleagues should be telling the HSE that they never again want to see a memo from the HSE containing the word "reconfiguration" on it because it is rubbish. The HSE should be told to stick it and change it to the word "cut". At least then we could see exactly what is being said.

I appreciate the Minister of State's response. I have raised the issue with him and I give him a commitment that I will continue to raise it in the House to the best of my ability as it is right to do on behalf of the children and their parents and grandparents.

Deputy Jim Daly

I thank the Deputy. I must differ somewhat with him on the word "reconfiguration". It does not always mean a cut. One of the better examples of reconfiguration was the reconfiguration of cancer services in Ireland. Everybody must accept that the reconfiguration and delivery of those services nationally was one of the more outstanding successes of politics and the HSE working together. While it was difficult and a lot of people had to make a lot of difficult choices, in the fullness of time, which is the best place to be to judge, we see that it has been a reconfiguration story of which we can all be proud. In respect of cancer services, it is something that has mattered a great deal to a lot of us on a personal level. As such, I take issue with the Deputy notwithstanding his entitlement to his own opinion. I do not agree that reconfiguration is always a bad word.

On the specific issue, I have given the Deputy the best answer the HSE and I can provide. The HSE has acknowledged that there is a need for additional nursing here and it is looking to see what level of resources are required. I will ensure the HSE speeds up its assessment of the increased need and try to get this up and running for the children in that school. It is the least they deserve. I thank the Deputy and the Leas-Cheann Comhairle.

Health Services Provision

Deputy Marc MacSharry

I thank the Minister of State for taking the time to take this matter today. I very much hope he is aware of the issue of the many children throughout the country who are suffering from juvenile arthritis. The need for these children to see a paediatric rheumatologist is extremely urgent. As things stand, Ireland has the equivalent of 2.5 paediatric rheumatologists available whereas international best practice indicates that we ought to have six. Children are routinely waiting for up to two years while in chronic pain without being dealt with or seen notwithstanding the fact that they ought to be monitored every three months after that. I recently brought the Irish Children's Arthritis Network, a group of parents, to the House and we had the opportunity to meet the then Minister of State at the Department of Health, Deputy McEntee, standing in for the Minister, Deputy Harris. Unfortunately, little or nothing has happened on foot of that. The HSE has given a response which, pathetically, refers to competing priorities. If we are not prioritising the health of children, we have our priorities all wrong.

The situation with juvenile arthritis is such that if these growing children are not seen and monitored at optimum levels, they will be left to take medications and drugs which are in fact biological agents with very serious and negative side effects. As they are growing, the condition leads to skeletal deformity. For our response as a nation to be to refer to competing priorities is just not good enough. The 2.5 consultants are a half-time consultant in Temple Street and two consultants at Crumlin children's hospital. That level of appointments is four below what it should. We ought to have six nationally. The consultants we have are saying they do not have the staff, the capacity or the resources to do what they, as physicians, know is international best practice. It is what they want to do and cannot do but yet we refer to competing priorities.

The response from the HSE indicates that we prioritise adult rheumatology services with the resources going in that direction. While nobody wants to see those people suffer either, young and growing children should be the priority. If they are not seen in a timely fashion and monitored in the way I have said, they will develop skeletal deformities and other problems. If we are simply talking about pounds, shillings and pence, which we should not be, that will inevitably cost the State more in the longer term as larger and more significant surgical and other interventions and care will be required. The State will be expected to provide that.

There are 1,000 children nationally who are affected in this regard. There will always be more as more are born. It is in every county. I think of a specific family in Grange, County Sligo. My own cousin has a daughter who suffers from arthritis. I am very well briefed on the challenge. While it is a case of loaves and fishes in the Department of Health to try to have enough resources to meet all demands and needs, there is no one alive, sick or healthy, who would not understand and commend us as a nation on prioritising children. I appeal to the Minister of State to intervene and to immediately seek to employ additional paediatric rheumatologists to bring us up to six consultants. We should then begin to provide outreach services in the larger university hospitals nationally to prevent so many children having to travel. In the first instance, let us get these children seen, if necessary with the benefit of the national treatment purchase fund.

Deputy Jim Daly

I thank Deputy MacSharry for raising this matter and giving me the opportunity to update the House on paediatric rheumatology services. Juvenile idiopathic arthritis is the most common inflammatory disorder of childhood. I understand that there are more than 1,000 children under the age of 16 in Ireland with the condition. Demand for this national service has grown dramatically in the last decade with patient numbers having increased by almost 400% since 2006. Rheumatology continues to be one of the most rapidly growing services within Our Lady’s Children's Hospital Crumlin and now accounts for the highest number of medical day-care patients seen at the hospital annually.

The Minister for Health is aware that there are challenges in meeting the growing demand for services and that waiting lists for access to paediatric rheumatology services are a particular issue of concern. The HSE constantly works towards improving access to rheumatology services. The Children's hospital group has confirmed that the two paediatric rheumatology consultants in Crumlin have been taken off the general medicine roster, which has facilitated a greater focus for them on rheumatology services. While nurse recruitment remains a challenge for Crumlin, the theatre closure situation is slowly improving, which will have a positive impact on access to joint injections for Crumlin patients.

In terms of services at Temple Street hospital, I understand that a staff member has recently been accredited as an advanced nurse practitioner in pain and rheumatology and that the hospital intends to utilise this new role to develop a nurse-led clinic to run in parallel with its new patient clinics. The need for a third rheumatologist post is acknowledged. Paediatric rheumatology service development will be considered in the annual Estimates process in the context of competing priorities for limited service development funding.

The development of the new children’s hospital and satellite centres provides an opportunity to progress operational integration of the three existing children’s hospital rheumatology services and to plan for the appropriate provision of these services well in advance of the move to the new facilities. The new children’s hospital will provide a wide range of physiotherapy, occupational therapy and hydrotherapy services to children with juvenile arthritis, with clinical examination rooms in the outpatient department and day beds in the day-care unit specifically available for rheumatology. The national model of care for paediatric health care services recommends a hub-and-spoke model in the context of paediatric rheumatology. The new children’s hospital will have a central role in the national model of care. It is proposed that rheumatology consultants will provide outreach clinics to Cork, Galway and Limerick, providing greater local access to services for patients outside the Dublin area.

In February, representatives from the Irish Children’s Arthritis Network met the Minister of State, Deputy McEntee, to discuss services for people with juvenile arthritis. This group also met the CEO of the children’s hospital group in June to discuss current and future services. The Deputy may be aware that the Minister for Health is also meeting representatives from Arthritis Ireland tomorrow to discuss paediatric rheumatology services.

I assure the Deputy that the Department of Health is aware of the challenges facing children with juvenile arthritis in accessing rheumatology services. We are working with the HSE to bring about further service improvements as soon as possible.

Deputy Marc MacSharry

It is nothing personal but I am afraid the prepared reply given to the Minister of State is insufficient in the extreme. It was I who arranged the meeting with the Minister of State, Deputy McEntee. In fact, it was to be with the Minister for Health, Deputy Harris but it had to be cancelled at short notice as a result of the demands of the leadership campaign that was under way within Fine Gael at the time. It was only when I demanded that alternative arrangements be made that the then Minister of State with responsibility for mental health, Deputy McEntee, stepped in to listen to concerns. As I said, very little happened on the back of it.

I will refer to a couple of things the Minister of State, Deputy Jim Daly, said. He indicated that rheumatology continues to be the most rapidly-growing service within Our Lady's Hospital. That absolutely is not the case. It might have the most rapidly-growing demand but, with two consultants there, we are not expanding the service. We need to aspire to having six consultants in place.

The Minister of State mentioned that a third consultant may be considered under the Estimates process. We need to push the bar higher. Six are required. Last month and, again, this month, people who are in the system and going for follow-up appointments have had scheduled appointments cancelled and put back until an unknown date in 2018. These are growing children with, as I said, skeletal deformities and they continue to be obliged to take these biological agents that have very bad side-effects.

The Minister of State mentioned the new children's hospital. For God's sake, when will that be built? We really do not know. The project is ten years in the making so far. These sick children will be adults by the time it is built and the effects of not being seen in a timely fashion will have crystallised, so that is unacceptable.

The Minister of State indicated that a hub-and-spoke model is the way forward. I agree but at present we do not have a hub. How can we even dream of such a model without having the optimum number of consultants and nursing staff in place?

Finally, and this was really insulting, whoever wrote the Minister of State's reply did not realise that the Leas-Cheann Comhairle and I are from the north west. The outreach services are to be provided in Cork, Galway and Limerick. The north west has been forgotten yet again. Sometimes I feel that central government feels that the north west voted to leave the European Union and, indeed, the Republic of Ireland because, yet again and as usual, that corner of the country, which comprises 30% of our landmass and which has a population of 300,000, has been cast aside. That is not acceptable.

The Minister of State indicates that he can assure me that the Government is aware of the challenges. We are all aware of the challenges. The stones on the road are aware of the challenges. When will we embrace some of the solutions that I am putting forward?

Deputy Jim Daly

I cannot answer the Deputy's question about when progress might be made. As he is aware, much of what is contained in the reply relates to the future. I accept what the Deputy is saying on the development of a new children's hospital. We have to be ambitious for that hospital and to ensure that we have the full complement and range of services that the children deserve.

I am familiar with the particular issue the Deputy raised. A good friend of mine suffered from the relevant condition for many years. It is a very difficult illness to deal with and one that presents many challenges. I accept the point the Deputy makes about the challenges it presents into older life and that it can cost an awful lot more in later life in light of the surgeries required if an early intervention is not made. I also accept what the Deputy says about prioritising children. I very much agree that we should be prioritising services for children, earlier interventions, etc. The Deputy may rest assured that I will feed that back to the Minister and the Department, as well as his concerns about the fact that issues relating to the north west were not addressed in the reply.

Deputy Marc MacSharry

I thank the Minister of State.

Sitting suspended at 4.35 p.m. and resumed at 5.15 p.m.

Dáil Éireann debate - Wednesday, 12 Jul 2017