Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I wish to share two minutes of my time with Deputy Michael Conaghan. I do so because the issue I raise is not party political in nature. All public representatives in the Dublin South-Central constituency, especially those who represent the Ballyfermot area, share the same view on it.

The Aisling Clinic is one of the oldest drug treatment clinics in Dublin and the second largest such clinic in the city. Some 120 people avail of its services daily and 150 people attend on a weekly basis. While the service provided is second to none, it is somewhat chaotic because the building in which it is located has never been fit for purpose. For this reason, no one will demand that the clinic be kept open forever. However, we demand that a service be provided in the catchment area of Ballyfermot, which has one of the largest heroin problems in the country. An alternative site in the area has not been offered.

At a meeting last week, public representatives and some of the service users were informed that two centres in the Cherry Orchard Hospital complex would be more than suitable to be exchanged for the Aisling Clinic. Such an exchange would allow a vital service to be maintained in the community and adjacent to a new mental health centre located on the hospital site. Further, a new primary care health centre is due to be transferred to the site. It would be logical, therefore, to retain all services on one site. We must also ensure those who use the clinic's drug treatment services remain free from harm. Many of them are concerned that trouble may occur if the service is transferred to Clondalkin or the south inner city where some of them have clashed with people using the local services. It is also possible that some users may disengage from drug treatment. I appeal to the Minister of State to review the proposal to close the Aisling Clinic in March and consider using alternative sites on the Cherry Orchard Hospital complex. I ask that some of my time be given to Deputy Conaghan.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Unfortunately, that is not possible. I must act strictly in accordance with Standing Orders, under which Deputies must submit a request before 10 a.m. As Deputies Ó Snodaigh and Joan Collins are the only two Deputies who raised this topical issue, I am not in a position to do anything.

Michael Conaghan (Dublin South Central, Labour)
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May I explain the position? I submitted a matter for discussion yesterday.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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It was not submitted today.

Michael Conaghan (Dublin South Central, Labour)
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I was not aware that was necessary. I understood one submitted the request and waited until it was reached by the Ceann Comhairle.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I am sorry but I cannot help the Deputy. To do so would create a precedent.

Michael Conaghan (Dublin South Central, Labour)
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I was not aware of the rule.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I understand the Deputy's position.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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Deputies Ó Snodaigh, Conaghan and I attended a meeting in Ballyfermot last Thursday night arranged by service providers and clients of the Aisling Clinic. Those present were confused, angry, concerned, anxious and stressed by the decision to close the centre by the end of March. It appears a follow up plan has not been put in place for after the closure. Some service users will be asked to avail of the services of their general practitioners, while others will be sent to St. Stephen's Hospital, another centre in Clondalkin and a new health clinic which is being built. Many of those present expressed the view that using the new clinic would put client confidentiality at risk. The Aisling Clinic provides counselling for clients and their families and a wounds clinic and mental health services are available on campus. Confidentiality is at the top of the agenda of those who use the centre.

The Aisling Clinic has been in operation for 21 years which means the average age of clients is probably the highest of any such centre in Dublin. Some users started attending the centre when they were 17, 18 or 19 years of age and are now in their late 30s or early 40s. This group is very attached to the centre and reliant on its medication and counselling services. I was shocked to learn of how the clients of the clinic have been treated as a result of the decision to close the centre. The meeting heard that units 4 and 5 of Cherry Orchard Hospital could be used to maintain the service provided by the Aisling Clinic.

On behalf of Deputies Conaghan and Ó Snodaigh, the users of the Aisling Clinic and people of Ballyfermot, I appeal to the Minister of State to have the decision reversed. People are concerned that the closure of the clinic could result in many people in the area becoming highly dysfunctional, especially as 83% of the users of the service live in Ballyfermot. I await the Minister of State's response.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputies Ó Snodaigh and Joan Collins for raising this issue, which is a matter of concern to all local Deputies.

The Aisling Clinic is located in the grounds of the Cherry Orchard Hospital in Ballyfermot. The centre provides a range of integrated addiction services for those affected by substance misuse, in particular, polydrug use. The services available at the clinic include general practitioner, nursing and counselling services; pharmacy; methadone maintenance; needle exchange; and community welfare officer services. The opening hours of the clinic are from 9 a.m. to 7 p.m. between Monday and Friday and from 10 a.m. until 1 p.m. at weekends. At present, 190 people affected by problem drug use attend the Aisling Clinic day programme and 67 attend the evening programme. The services currently operate from a small four bedroom house on the grounds of the hospital. This accommodation is considered inadequate and inappropriate for this number of patients. It is planned to demolish the premises in 2013 to facilitate the construction of premises to accommodate new inpatient child psychiatry services on the site of Cherry Orchard Hospital.

The Ballyfermot primary care centre is nearing completion and the Health Service Executive addiction service has been requested to have a presence on the site by 31 March this year. The area available in the centre is not sufficient for the large number of patients attending the Aisling Clinic. In view of this, a HSE led working group has been established to examine the options available for the delivery of the addiction services elsewhere. The objective of the group is to achieve a seamless transition to the appropriate site. Its membership is comprised of clinic personnel, namely, the pharmacist, nurse, general practitioner, administrator, senior general assistant and rehabilitation worker. The group, which meets twice monthly, is to report back to the area operations manager with recommendations on the available options by the end of April.

I am aware that clients of the Aisling Clinic may be concerned about the implications for their treatment arising from the plans to transfer the service to alternative accommodation. I have been assured by the HSE that the transition to the new arrangements will not result in a disruption of services. The HSE service plan for 2012 envisages that the health of the population will be managed, as far as possible, within a primary care setting. Those with additional or complex needs will have plans of care developed with the local primary care team, which will co-ordinate all care required with specialist services in the community. Notwithstanding developments at the Cherry Orchard Hospital site, we should seek to integrate drug services in primary care. This will be a challenge. However, if a local GP treats a person's ingrowing toenail, there is no reason he or she should not deal with other aspects of a person's care. If a person who requires ongoing care for arthritis also has a problem with addiction, there is no reason he or she should not attend his or her local GP and receive services for both problems, ideally through a primary care team.

The plan contains a specific target on the development of protocols signposting referral pathways between specialist addiction services and primary care services. The location of the addiction service is not the key issue. The central issue is to ensure that clients with alcohol or substance misuse disorders will have access to appropriate interventions and treatment and rehabilitation services. A client centred approach is key to providing a continuum of care to problem drug users to enable them to address their health needs, as well as their general social, housing, educational and employment needs. This integrated approach is also recognised in the report of the national substance misuse strategy steering group which recommends the establishment of a clinical directorate to develop the clinical and organisational governance framework that will underpin treatment and rehabilitation services.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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The logic of the Minister of State's response is that the services provided by the Aisling Clinic should be retained on-site in the Cherry Orchard Hospital or, at least, in the Ballyfermot area. She noted that services should be linked to a primary care centre and referred to a continuum of care to address general social, housing, educational and employment needs. If one is in Ballyfermot, one is in the Dublin City Council area and there is a council office down the road. The local employment service is in Ballyfermot, not Clondalkin.

There is a logic here, which is why we are appealing to the Minister to intervene and ensure that the Aisling Clinic does not close in March or April, but remains open until such time as a suitable site is found for the cohort of recovering drug addicts and alcoholics who attend this clinic. There is quite a number. There is not sufficient capacity among the local doctors or pharmacies to take on these clients. They have already taken on a quota. There are 120 people from Ballyfermot attending this clinic daily and 150 who attend it weekly. That is the scale of the service offered by the centre and the challenge for the Minister and the HSE is to locate these services in Ballyfermot.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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I have taken on board the points made by the Minister. A group has been set up comprising existing clinic personnel. I note there is no service user in that group to discuss how it impacts on service users or any change in the seamless transition.

I make the same appeal as Deputy Ó Snodaigh. A number of people use the service in Ballyfermot and the local area office is located there. There is a cohesiveness in Ballyfermot in terms of the service it gives in the community. I appeal to the Minister to keep the centre open until everything is addressed, including the concerns of the service users. It was pointed out to me that most general practitioners, GPs, will not see drugs clients after 9 a.m. That is a change from having a service in place to give the person 100% support, with all the facilities on the campus. To be put into a situation under a GP is a retrograde step for the people concerned. I ask the Minister to keep the centre open until another site is found for it. Units 4 and 5 would appear to be ideal.

Róisín Shortall (Dublin North West, Labour)
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I accept the points made by the Deputies. This issue just came to my attention this afternoon. I have been in the Chamber since 2.30 p.m. today so I did not have a chance to research the matter. I am told there is no plan to move all of the services to Clondalkin and Dr. Steeven's Hospital, so that is not being proposed. I do not have any information with me regarding the possibility of using Units 4 and 5 in Cherry Orchard Hospital but I will pursue that on behalf of the local Deputies and see if there is any possibility of them being brought into use.

I do not know why 31 March is the deadline. The group that has been set up has until the end of April to report, so there should be no question of services being suspended in the interim. We must ensure services are protected and that the needs of clients are catered for properly. I will examine this matter and revert back to the Deputies concerned.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I apologise to Deputy Conaghan that I could not allow him to raise his matter, but I am sure he will understand. It was a misunderstanding on his part.

Michael Conaghan (Dublin South Central, Labour)
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It was my understanding that one could leave the notice in for the week and it would be reached.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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No, it must be submitted each day. Sometimes people are not available the next day so the Member must submit it each day.

Michael Conaghan (Dublin South Central, Labour)
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Okay.