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Seanad Éireann debate -
Tuesday, 23 May 2017

Vol. 252 No. 1

Commencement Matters

Seaweed Harvesting Licences

As the Minister is aware, a licence has been issued for the mechanical harvesting of sea kelp in Bantry Bay in County Cork. The licence will cover 1,860 acres of native kelp forest. It was not advertised adequately within the local community and contains no requirement for an environmental impact assessment. I would like to state for the record that I am not at all opposed in principle to the sustainable harvesting of seaweed - in fact, I previously applied for a licence for a small-scale operation. Seaweed is a fantastic natural and renewable resource with multiple uses in agriculture, food, medicine, energy and so on. Fostering the farming and harvesting of ocean resources in a sustainable way is instrumental to the new green economy that will be essential to Ireland as it moves into a post-carbon future.

This licence, however, is an example of how to stop that process dead in its tracks. There are a number of central issues with the agreement between BioAtlantis, the licensee, and the Department. The public consultation has been woefully inadequate. There has only been one public advertisement of the application in the Southern Star newspaper in December 2009, which did not mention the large size of the area under consideration, the mechanical nature of the harvesting or the indigenous nature of the kelp forest in question. Neither Cork County Council nor its western division, which covers the Bantry Bay area, was consulted on the plans. There seems to have been an almost deliberate exclusion of the Bantry Bay Coastal Zone Charter group, an EU-funded organisation designed to protect the bay from exactly such inappropriate developments.

The second issue is the scope of the operation planned. The 1,860 acres are quite massive, the equivalent of cutting down 38% of Killarney National Park.

The Minister of State at the Department of Housing, Planning, Community and Local Government, Deputy Damien English, clarified in the Dáil that the extraction will work on the principle of rotation, but that still means a massive area of the bay will be facing mechanical harvesting in any single period. As a test case this level of harvesting can hardly be considered a conservative approach.

Third, the nature of the harvesting is a grave concern for two reasons. I have already mentioned the mechanical harvesting but I am almost more concerned to learn of the way in which the cutting is to be conducted, namely, the cutting of the stipes of the kelp so fast to the holdfast. Best practice recommendations from the Ryan Institute on environmental, marine and energy research for the harvesting of seaweed states that individual plants should be left with 20 cm of the blade above the stipe to ensure the fast re-growth of the plant and that fertile plants should be left alone as much as possible. This is not what is proposed in the authorised agreement.

Finally, there is grave concern about the potential impact this level of extraction and its methodology would have on the ecology and habitat of Bantry Bay. Bantry Bay is an iconic and complex ecosystem and the kelp plays an essential part in it. It is the home for juvenile lobster and shrimp, a part of the life cycle of sea bass and correspondingly a key resource for species high up in the food chain, birds such as the chough and fulmar and mammals such as the iconic harbour seal. These in turn support various industries, notably the fishing and tourism sectors which are so essential to an area that was badly hit by the recession and only now is getting back on its feet.

The community of Bantry Bay is not taking this lying down. A public petition has been shared extensively and has secured over 4,400 signatures to date. Cork County Council has asked for consultation with the licensee about aspects of the deal and public meetings are planned for later this week. In fact, last night there was another public meeting in the area organised by Coastwatch Ireland and others, which discussed the importance of the bay in terms of local tourism, ecology and fisheries. At the meeting local voices raised concern about the effect large scale kelp removal could have on wave patterns in the bay and the effects on tourism, including diving, kayaking and angling which are now making a return since the recession. Concerns were expressed about the potential future colonisation of invasive species such as Japanese seaweed, which has the potential to move into areas left vacant by over-harvesting. There was a shared anger at the way the licence has been granted and a frustration that local people are not being heeded and that the local democratic structures are being undermined.

There have been nice sounds this week from both of the Fine Gael leadership candidates in their manifestos about protecting and cherishing the environment. While we do not have enough data at present to make recommendations on sustainable levels of seaweed harvesting, it is alarming that the Government could consider an area of this magnitude as an appropriate test bed. This is the same approach we saw the Minister for Arts, Heritage, Regional, Rural and Gaeltacht Affairs, Deputy Heather Humphreys, take with the heritage Bill - cut now, worry later. This is National Biodiversity Week, yet once again Fine Gael is taking an approach to the environment that is dangerously cavalier.

I have already stated that neither I nor my party is opposed to sustainable seaweed harvesting, but the approach we are seeing with regard to the community and the licence is unacceptable. We ask the Minister to reconsider the licence and to take into account the concerns of the community of Bantry.

I am replying on behalf of the Minister, Deputy Coveney. I thank Senator Grace O'Sullivan for raising the matter. Earlier this month my colleague, the Minister of State at the Department of Housing, Planning, Community and Local Government, Deputy Damien English, outlined to the Dáil the background and context to the decision that was made in this case and I welcome the opportunity to provide similar details to the Seanad.

The history of the hand harvesting of seaweed and the uses or further processing that traditionally followed harvesting will be known to many. Over time and particularly in recent years more sophisticated uses have been found for the properties contained in seaweed. This has led to the development of cutting edge bio-pharma and similar businesses based on seaweed. These businesses face many challenges, one of which is the security of supply of seaweed, their most essential raw material. A number of applications were submitted over the years to mechanically harvest seaweed, but this licence is the first to be granted. The Department of Housing, Planning, Community and Local Government does not plan to grant any similar licence before the environmental monitoring data, the provision of which is a condition of the licence, is fully analysed.

The indigenous Irish company that has been granted this licence had previously applied to harvest in Kenmare Bay. At that time, experts recommended that for an application to be approved it should focus on the areas outside of the special areas of conservation, SAC, and should include a commitment to conduct a detailed programme of monitoring. The application to harvest in Bantry Bay, which was originally received in June 2009, met this criteria and was processed in the normal way. Normal public consultation procedures were followed, after which the marine licence vetting committee, an ad hoc group of experts which has, for many years, advised successive Ministers on foreshore related matters, undertook a technical evaluation of the application and recommended that a licence should issue. Approval in principle was given by the former Minister for the Environment, Heritage and Local Government, John Gormley, in 2011. He agreed with the conclusion that, subject to compliance with the specific conditions attached to the licence, the proposal was not likely to have a significant negative impact on the marine environment. The final legal papers giving effect to the decision were completed by the then Minister for the Environment, Community and Local Government, Deputy Alan Kelly in 2014.

The licence is of a trial nature and was granted for a period of ten years, commencing in 2014. It allows for the mechanical harvest of certain kelp species within five specified zones but with only one zone to be harvested in any one year. The planned rotation is four years with the fifth zone being a standby zone to be used only if weather prevents access to a zone in any particular year. On average, less than 1% of the bay will be harvested annually and much of the kelp in the bay will not be subject to harvest at all. The inclusion of a standby zone, which under the lease only comes into play in place of one of the other zones if needed, reduces the overall area for harvest by almost 100 ha to a maximum of approximately 650 ha. The licence is of a trial nature and can provide significant environmental data through a programme of monitoring and control, which can inform further policy development in this area. The agreed monitoring programme is available to view on my Department's website. It includes measurements of the kelp as well other flaura and fauna in both the control and harvest areas within the licensed area before commencement of the harvest. Over the lifetime of the licence, my Department will also receive an annual report on harvesting activities to include the area and quantities harvested and measured regeneration rates of the seaweed. In the event of an unacceptable impact on the environment being observed, the licence allows the Minister to modify or restrict harvest practices and schedules as necessary.

I understand that the Irish company which was granted this licence a number of years ago has, in good faith, made significant investment relating to the proposal. A harvest vessel has already been commissioned. Studies relating to the potential impact of the harvesting and a baseline assessment of flora and fauna in the harvesting site has been completed. Further expenditure will be incurred in regard to the agreed monitoring programme. It is envisaged that the data gathered through the monitoring programme will feed into further policy formulation and proposals in the general area of seaweed harvesting. I expect the information gathered in Bantry to be very useful in this regard.

I thank the Minister of State and wish to point out that we are already three minutes over time on this matter.

It was not the fault of the Minister of State. Senator Grace O'Sullivan took an additional two minutes and because it was about Bantry Bay, I was a bit indulgent. I urge the Senator not to push me now and to be brief with her supplementary question. The Senator has made a very strong case.

I thank the Minister of State for the reply. She said that this harvesting is to secure the supply of seaweed but we are arguing that an environmental impact assessment prior to the initiation of mechanical harvesting is required. That is what the people of Bantry Bay are asking for and that is why they are so outraged at the moment; they feel that their voices are not being heard. Enabling the company to go ahead as is would potentially destroy the resource. We are pushing very strongly for sustainable harvesting of seaweed rather than the annihilation of the kelp seabed in Bantry Bay.

The point is well made.

I have taken note of the issues raised by Senator O'Sullivan, in particular with regard to the public consultation process. The Senator said that the application was only advertised in one newspaper which meant that many local people missed it, despite the fact that it is so important.

I will bring the issues, which the Senator has raised, back to the Minister, including those around environmental impact. I have taken a lot of notes. I will have the Minister come back to the Senator on a one-to-one basis.

Building Regulations

I raise this issue on my behalf and that of Senator Rose Conway-Walsh from Mayo because the families affected are in Donegal and Mayo. Some 18 months ago the Government of the day, which was led by the Minister of State's party, announced the establishment of an expert panel. This panel was to examine the crisis facing a large number of families in Donegal and Mayo in respect of the failure of the concrete blockwork in their homes as a result of the presence of mica, or pyrite as is the case in Mayo. It was to report by 31 May 2016. Here we are a full year after that deadline and that report has still not been published. The families who are crying out for help and assistance still have not received any.

Let me spell out the issues. Regularly, families come to me and other public representatives in County Donegal. They tell us about the dilemma of having a gable or other wall in their house that could fall in on top of their families. That is their reality. If they spend money now fixing and repairing it, they will not get money back through a redress scheme, so they are forced to delay and wait. Some of those families have spent money which they will never get back - money they did not have. Some have gotten a loan while some have used their family's education fund.

This is a failure of the State, of building control legislation and to ensure compression tests guaranteed that the blockwork, the core product in the family home in Ireland, was sound. It was an utter failure of State regulation right through. These families have been failed utterly. I plead with the Minister of State and her Government to publish this report and put in place a redress scheme so that these families have a solution to this devastating crisis. I have met people, grown men, in tears in their own kitchens. Can the Minister of State imagine the heartbreak? The biggest purchase of people's lives is their family home. They are devastated because of the failure of this State to protect their interests and to ensure that those blocks were sound and that the building controls standards were enforced properly. Now they are left with crumbling homes. I cannot urge the Minister of State enough that this needs to be sorted out urgently. People cannot wait any longer.

I am taking this matter on behalf of the Minister, Deputy Simon Coveney. I will reply to some of the issues the Senator has raised after I read this reply from the Minister.

At the outset, I acknowledge the very difficult and distressing situation that certain home owners in Donegal and Mayo are facing as a result of damage to the structural integrity of their homes. The Minister, Deputy Coveney, firmly believes that the parties responsible for the poor workmanship and-or the supply of defective materials should face up to their responsibilities and take appropriate action to provide remedies for the affected house owners. An expert panel on concrete blocks was established in the Department of Housing, Planning, Community and Local Government in 2016 to investigate the problems that have emerged in the concrete blocks of certain dwellings in Donegal and Mayo. The membership of the panel on concrete blocks was formally announced on 6 April 2016 following the announcement of the chairperson, Mr. Dennis McCarthy, on 1 February 2016.

The panel had the following terms of reference: to identify, in so far as it is possible, the numbers of private dwellings which appear to be affected by defects in the blockwork in the counties of Donegal and Mayo; to carry out a desktop study, which would include a consultation process with affected home owners, public representatives, local authorities, product manufacturers, building professionals, testing laboratories, industry stakeholders and other relevant parties to establish the nature of the problem in the affected dwellings; to outline a range of technical options for remediation and the means by which those technical options could be applied; and to submit a report within six months.

The expert panel on concrete blocks has met on 12 occasions since it was first established. A similar number of meetings have taken place with key stakeholders, including affected home owners, elected members of Donegal County Council, local authority officials, industry bodies, academics, public representatives and other interested parties. A substantial volume of information has been provided by affected home owners in both counties, as well as by Donegal County Council. Additional information has also been provided through the consultation process. The panel has concluded its meetings and is in the process of finalising its report, which is undergoing legal proofing. I understand this will be completed shortly. I fully appreciate and understand the urgency of this matter for the affected home owners. The Minister will continue to monitor progress closely. It is equally important for the affected home owners that the final part of the process with regard to the report is completed thoroughly. In this regard, the Minister will await the outcome of the panel’s report before considering what further actions may be required to assist the parties directly involved to reach a satisfactory resolution to the problems that have emerged in the two counties.

The language used in the Minister of State's reply does not tally with the Government's actions. How can it take the best part of five months to legally proof a document? I understand this report was concluded at the beginning of this year. It is not acceptable that five months have been spent legally proofing it. A year has passed since this document was supposed to be published. Families have been faced with impossible choices during that time. This is a real crisis. Senators will recall that the Government rightly responded to the pyrite crisis faced by families in Dublin and north Leinster by putting a redress scheme in place. Such a scheme is urgently needed by families in counties Donegal and Mayo. It is shocking that it has taken so long to legally proof these documents. I ask the Minister of State to convey to the Minister, Deputy Coveney, that people in County Donegal are angry because the Government has failed to get this sorted out and done. I urge the Minister of State to get this report published as soon as possible so that a redress scheme can be put in place for these families.

Like everyone else, I have seen the TV programmes depicting people's homes crumbling around them. Other people, including those who built the blocks, those who built the homes and the county councils that took part in the process of planning these homes, are responsible here. It is not only the Government that is responsible. I understand the Senator's frustration. As I have said in the Dáil Chamber, it is about time this report was given to the relevant people. The reasons these people should get some redress need to come out now. I will relay all the messages outlined by the Senator to the Minister. A great deal of consultation was done and there were many meetings as part of the in-depth process of identifying the needs of home owners and seeing what structural damage had been caused to their homes. All of this took some time. I agree with the Senator that it is time to get on with this process so that the report can be launched. I understand the Minister intends to have the report finished within a number of weeks. This could mean four weeks or it could mean six weeks. I will relay the Senator's message to the Minister and make sure he gets an answer.

Respite Care Services Availability

I welcome the Minister of State, Deputy Finian McGrath.

I thank the Minister of State for coming to the House. I have raised the issue of respite care with him previously, particularly in so far as it relates to Cork. Since the last time I did so, I have been contacted by a number of parents across the country who are having difficulties as a result of what has occurred in the past two or three years in premises where respite care is available and in respect of which HIQA has done inspections and set standards.

I have no difficulty with standards being set and making sure we achieve them, but in some cases facilities have been withdrawn. What I am looking for - it is a very reasonable request - is a national respite care strategy. We should identify, first, the number of people with disabilities being cared for by their parents, their brothers or sisters or their relatives in their own homes, in other words, those not reliant on the State or a State facility for their care. Second, we need to identify the demographics of people with disabilities, the age groups about which we are talking, the numbers between the ages of 18 and 30 years, 30 and 40, 40 and 50 and so on and their changing needs.

The third thing we need to identify is extremely important; it an issue that arises every week at my constituency clinics. I refer to ageing parents who are looking after their children. For instance, one man whose case I have dealt with travels 15 miles a day to put his daughter into the care of a Cope Foundation day facility and collect her every evening. He is 79 years of age and has been doing this for the past 45 or 50 years. He will not be able to do it forevermore. There are a huge number of people looking after their children at home who have been doing it for many years and time is catching up with them. We need to find out their age profile.

Once we have this information, we can plan a detailed strategy, not just for one place but for the entire country. We specifically need to identify facilities which cater for people who require respite care. This is extremely important. As I said to the Minister of State previously, one lady I met recently told me that she slept for a full two days when her adult son was in respite care because of the work she had to do in order to look after him. These are the difficulties such carers face. I dealt with another case in which the parents of a child who is now in her early 20s had to lift her out of bed every morning, wash her, clean her and tube-feed her. They provide care for her 24/7. It is important that we give such parents the support they deserve by making sure there is an adequate respite care service available, not just in one place but across the country.

I thank the Senator for raising the very important issue of respite care services and giving me the opportunity to outline the position on their provision.

A Programme for a Partnership Government recognises the need for respite care services to be developed further. The Government is committed to the safeguarding of vulnerable persons in the care of the health service by providing services and supports for people with disabilities that will empower them to live independent lives in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives.

The provision of respite care services has come under additional pressure in the past few years. I accept the point the Senator made in that regard. Any available development funding has focused mostly on the provision of day places for pupils graduating from school or rehabilitative training programmes. We have prioritised this area because there were huge gaps in it, particularly when I took over my responsibilities as Minister of State. This has led to increased demand for respite care services for these young adults who would previously have accessed them as children. We accept that there is a problem and that we must do something about it.

More children and adults are seeking access to respite care services. The "changing needs" of people with a disability are also having an impact as they, with the rest of the population, live longer. Respite care is not always centre-based and can be provided in a number of ways, for example, as a holiday residential placement, an occasional respite care placement with a host family, overnight respite care in the home and in summer camps which allow people to continue living with their families and in their local communities.

To support these alternative ways of providing respite, funding has been provided to the HSE to provide 185 new emergency residential placements. New home supports and in-home respite care for 210 additional people who require emergency supports has been allocated. This marks a significant change in the way respite services are delivered. The HSE social care operation plan for 2017 aims to provide 182,000 overnight stays in centre-based respite services, in addition to the 41,000 day respite sessions. The HSE acknowledges the difficulty experienced by families in respect of the lack of respite places available and is working with agencies to provide and explore various ways of responding to this need in line with the budget available.

In this regard, an ehealth resource for providers, such as online case management systems that facilitate the effective management and tracking of all residential home support and emergency respite services across the nine community health organisations, is being developed. This will provide a detailed inventory, bed register and map of current service capacity. Each of the CHOs will have in place residential care and executive management committees that will have the overarching responsibility of managing and co-ordinating residential places supports within their respective CHOs

I thank Senator Burke for raising this very important issue. I want to assure him and the House that I will continue to liaise with the HSE regarding the availability of respite care facilities.

I thank the Minister of State. In fairness, he has dealt with the issues I have raised but there are one or two fundamental issues that we need to identify, such as the demographic profile of parents who are caring for children. It might not be a bad idea to seriously consider asking an educational institution, such as a university, to conduct research in this area and collate all of the figures because that has not been done. We still do not know the total number of people who require respite care, their age profile and the age profile of the parents concerned. That is fundamental information that we need to have in place.

All of the information is in different organisations, but there is no national database. One of our educational institutions could take on such work as a research project. The ESRI could take on such work as a project. Long-term planning is of fundamental importance to this area.

I thank Senator Burke for raising these very important issues. I take on board the views he has raised. In regard to the HIQA issues, we all want to improve standards for all services for people with disabilities. We also need some flexibility.

I take on board the Senator's point on demographics and the age profile of parents. It is a fact of life that because young adults with intellectual and physical disabilities live longer than they did 25 years ago we have to plan for that. I will explore the idea of getting a third level institution or some other organisation, such as a group within the disability sector, to conduct research.

I have been in this job for 12 months. My plan was to try to ensure that we have services from the cradle to the grave for families. We have done a lot of work at first and second level, and now we have to put out the fires for the cohort aged 18 years and older. Senior citizens acting as carers is a major issue.

I have travelled around the country and have heard what the Senator has said. I was in Cavan yesterday. I met two families, one of whom had 18.5 hours of respite care a week, which I could not believe because it is the first time I have heard of such a high level of respite care. Another woman only receives six hours a month of respite care. There are inconsistencies, problems and a lack of co-ordination in the system.

We need to determine the facts in order to plan for services. I will bring all of the points discussed back to the HSE. I spoke to a representative as recently as last week about pushing the issue of respite. In terms of the social care disability plan for the next two or three years, we must have accurate information so that we can plan for the services.

Health Strategies

Approximately 40,000 people in this country have Crohn's disease or colitis. I am one of them; I have had this condition since I was 14 years of age. I was diagnosed with it in 1990. As the Minister of State will be aware, the prevalence of this condition is growing and it is very much a condition found in the western world. Alarmingly, most people in Ireland who are diagnosed with the condition are diagnosed between the ages of 15 and 30. In that respect, at least from a diagnosis perspective, it is very much a young person's condition. It is also very striking that cases in Ireland among children have trebled since 2003.

We are not certain of the causes of this debilitating and often life-altering condition but we can be certain of some matters. We know from a research report entitled Gut Decisions, published two years ago, that inflammatory bowel disease, IBD, costs the health service as much as €185 million a year. In Ireland, 90% of patients with inflammatory bowel disease are hospitalised within five years of their diagnosis. The international average is about 85%. A staggering 49% of people who have inflammatory bowel disease have either lost or have had to give up their job as a result of their condition. That is quite a staggering statistic. Behind each and every one of those stories lies a personal story of difficulty, loss and financial consequences.

We also know from talking to medical professionals and from the research undertaken in this area that one of the greatest barriers to the delivery of better patient care is the absence of a sufficient number of specialist inflammatory bowel disease nurses. It is sad to say that, unfortunately, not a single one of the recommendations made in the Gut Decisions report published in 2015 appears to have been progressed or implemented. That is why it is critical that the Government undertakes to explore the idea that we should have a coherent, cogent national strategy to deal with Crohn's disease and colitis. If, for example, we doubled the number of inflammatory bowel disease nurses - currently, there are on 12 wholetime equivalents but we need 24 to 28 - this would remove a great deal of pressure from emergency departments and from our acute hospital care settings.

Last Friday was World IBD day and I joined the Irish Society of Colitis and Crohn's Disease, Professor Colm O'Morain, and other experts in the field to call for the doubling up of specialist IBD nurses. These are, essentially, expert nurses, located unfortunately only in 48% of the hospitals across this country, who are at the end of a telephone and can assist people with their medication, dietary plans and with other very basic interventions, which would prevent a Crohn's disease or colitis patient from having to queue in a cramped emergency department, where there is often a difficulty in terms of accessing toilets, and can manage their conditions much better in what we might describe as a primary care setting or primary care intervention.

We need a coherent national strategy to deal with this condition that is growing in prevalence by the day. One of the first steps we could achieve in doing that is to commit to spending as little as €1 million annually to provide for the doubling up of inflammatory bowel disease nurses.

I thank the Senator for raising this very important issue with which I know he has a personal involvement. He has also raised it over many years. I accept his sincerity and integrity in regard to it. It is an important issue in terms of broader society and the broad planning of our health services. I am delighted that I have been given the opportunity to discuss Crohn's disease and colitis.

Officials from my Department recently met representatives of the Irish Society of Colitis and Crohn's Disease and the Health Service Executive, HSE, about patient care for these conditions. There are two principal forms of inflammatory bowel disease, IBD, namely, ulcerative colitis, UC, and Crohn's disease, CD. There is no current data on the incidence and prevalence of inflammatory bowel disease in Ireland. However, it is estimated that approximately 40,000 individuals suffer with IBD.

Population-based studies from a range of European countries suggest a similar rise in the numbers of new cases in the adult population.

Crohn's disease is a very rare condition. It is estimated that for every 100,000 people, there will be seven new cases of the disease a year. Most cases of the disease first develop in people between the ages of 16 and 30 years, although the condition can affect people of all ages, including children. The disease affects slightly more women than men. The outlook for patients with the disease is highly variable. There can be long periods of remission that can last for weeks or months during which they have no or very mild symptoms, followed by periods during which their symptoms flare up and are particularly troublesome. There is no cure for the disease. However, medication is available that can be used to treat the symptoms and prevent them from returning. Approximately 80% of people with the disease will require surgery to relieve their symptoms, repair damage to their digestive systems and treat the complications of the condition.

Within the acute hospital system, the provision of care for individuals with inflammatory bowel disease is largely undertaken by the gastroenterologist, with individuals who require surgical intervention falling under the care of lower gastrointestinal disease consultants.

While the HSE has no specific programme for inflammatory bowel disease or Crohn’s disease, the work of other HSE programmes will impact positively on individuals with colitis and Crohn’s disease. They include the BowelScreen and endoscopy programmes which contribute to early diagnosis. Given the increased incidence and use of medication, the HSE is working with gastroenterologists and recently established a group to look at developing a model of care for the use of biological agents for the treatment of inflammatory bowel disease. It is estimated that of the 40,000 patients in Ireland with the disease, approximately 8,000 are receiving or require treatment with these agents. This model of care will look at the following areas: the criteria for treatment of inflammatory bowel disease; appropriate prescribing of biosimilars; entrance and withdrawal criteria for the use of these treatments; and appropriate prescribers and centres for treatment. The HSE group developing the model of care has recently commenced meeting and it is anticipated that it will set out the clinical management of inflammatory bowel conditions such as Crohn’s disease and ulcerative colitis. I await the completion of this model of care for the purposes of determining any further action that may be required.

I thank the Minister of State for his reply. It is very interesting that the HSE and his Department are taking the approach that there should be a new model of care in assisting and treating inflammatory bowel disease patients across the country. I appeal to the Minister of State to give serious consideration to the initiative I outlined in my initial contribution, that is, the engagement of 28 inflammatory bowel disease nurses across the country. As I said, less than half of the hospitals across the country have inflammatory bowel disease nurses available to them who could make early interventions in dealing with conditions such as Crohn's disease and colitis to empower patients to manage their condition in a better way. It is the classic no-brainer in terms of spending approximately €1 million each year to prevent people from having to present at the local emergency department and minimise the risk of their having to undergo very invasive and complex surgery. In that context, we need a national strategy to address all of the implications of Crohn's disease and colitis, conditions that are becoming more prevalent. There are also financial consequences for families up and down the country, with job loss being a reality. I outlined the figures which are staggering. Any condition in respect of which 48% of sufferers have reported that they have either had to leave a job or lost a job needs our urgent attention. We need to look at the financial implications and how we can support such families.

I thank the Senator. I take on board his point that a national strategy is needed. With regard to other illnesses and disabilities concerning my portfolio, five or six years ago the Government did not opt for a strategy but now "strategy" is the buzzword. I will bring the Senator's message back to the Minister and HSE.

The bottom line is that the Senator made valid arguments, one being that 49% of those with Crohn's disease lose their job. These are serious issues that have to be dealt with. I will bring back to the Government the simple proposal the Senator put on the table today. We currently have 12 nurses and need 28. From an economic point of view, in addition to a medical point of view, there are practical benefits to taking the pressure off the accident and emergency units by having the 28 nurses in place. Less than 48% of hospitals are not able to cater for those affected and do not have the nurses.

The Senator's points and proposals were very constructive and I will bring them back to the Minister and use them in negotiations with the HSE.

Sitting suspended at 3.25 p.m. and resumed at 3.30 p.m.
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