Keith Swanick - Recent appearances (From KildareStreet.com)
An tOrd Gnó - Order of Business | Seanad debates
Today, the faculty of paediatrics of the Royal College of Physicians called on the Government to abolish the system of direct provision for asylum seekers because the welfare of children is at...
Today, the faculty of paediatrics of the Royal College of Physicians called on the Government to abolish the system of direct provision for asylum seekers because the welfare of children is at stake. The author of the report issued today, Dr. Niamh O'Brien, stated the system is unethical, stigmatising and needs to end. Children in direct provision present with increased mental health issues and over-present to emergency departments with burns. These children are referred more frequently to Tusla than children in other settings. Currently, there are more than 1,800 children in direct provision. The average waiting time in these centres is 14.3 months. While the waiting time has reduced, 14.3 months is still a lifetime for a child. The report's many recommendations include providing increased allowances for school and clothing expenses. I call on the Minister to consider establishing a specialised ring-fenced fund to enable these children to access psychological support. The mental trauma they are experiencing now will be carried forward into their adult lives. I am not sure if such a ring-fenced fund would be provided by the Department of Health or Department of Justice and Equality. Perhaps we could have a debate on this matter in the new year to protect these children and their mental stability and give them easy access to the child and adolescent mental health services, CAMHS. I have often said in the House that general practitioners should have 24-hour emergency access to allow them to pick up the phone to prevent a vulnerable suicidal teenager or adult from going to an accident and emergency department. While the recommendations of increased allowances for clothing and school expenses are welcome, a specialised ring-fenced fund to provide psychological support for these children would be an excellent idea.
Workforce Planning in the Mental Healthcare Sector: Discussion | Joint Oireachtas Committee on Health | Committee meetings
I understand that and I understand there are manpower problems. I totally understand all of this. I understand they are not second guessing clinical decisions. I am only concerned about the...
I understand that and I understand there are manpower problems. I totally understand all of this. I understand they are not second guessing clinical decisions. I am only concerned about the patients and I am afraid people are falling through the cracks who should not be and they are not getting the appropriate services. Sometimes the way the child and adolescent mental health service communicates to families can be seen as flippant to the concerned parents of a teenager who might be in trouble. That perhaps requires a review.
If an appropriate referral is sent in it should be accepted in good faith. This is the problem. People are falling through the cracks. They are being referred to psychological services when...
If an appropriate referral is sent in it should be accepted in good faith. This is the problem. People are falling through the cracks. They are being referred to psychological services when they need psychiatric services.
Does Dr. Finnerty have a comment on the fact that child and adolescent mental health teams undermine professional referrals from GPs that are sent in good faith after assessing a child? The GP...
Does Dr. Finnerty have a comment on the fact that child and adolescent mental health teams undermine professional referrals from GPs that are sent in good faith after assessing a child? The GP would not refer the child to the mental health services unless he or she had a serious concern. Often GPs receive a letter stating the referral was inappropriate and asking whether the doctor had seen the patient. That is totally unacceptable. It happens on a regular basis in Mayo. It undermines the entire service being provided. It also undermines the patient's relationship with the GP because the parent is often copied in on the letter. They have had the courage to come in with the child to disclose whatever needs to be disclosed to the doctor. They trust their GP, with whom they have a long-term relationship. The doctor makes a referral in good faith and then a letter is received by the doctor, with the parent copied in, stating the referral was inappropriate. I do not know about this. People are falling through the cracks. Mental illness that is not dealt with in children and teenagers does not go away, it just manifests later. A review of the structures regarding referrals and accepting referrals needs to be undertaken.
Even accessing the service can be difficult. I am a GP and if I see a teenager who may be depressed or have an anxiety disorder, and I am sure the Chairman will agree with me, I send the patient...
Even accessing the service can be difficult. I am a GP and if I see a teenager who may be depressed or have an anxiety disorder, and I am sure the Chairman will agree with me, I send the patient off and refer him or her in good faith. Often the team reviewing the referral states it is inappropriate. One professional doctor refers somebody who genuinely needs help and the referral is undermined. Sometimes doctors are accused of not even having seen the patient and that they discussed the situation with the parents. That is disgraceful. I have said numerous times in the Seanad, and I have spoken to the Minister of State, Deputy Daly, about it, that access for GPs to a 24 hour emergency phone line to the child and adolescent mental health service with regard to very vulnerable teenagers would be a solution-driven pragmatic approach. It would not be abused. I would probably use it only once a year if I had a case involving a suicidal teenager, instead of sending him or her to the emergency department or having to admit him or her to the adult mental health unit in Castlebar. That unit does great work but it is a dreadful place, particularly for a young person. Undermining referrals from GPs is not good because there is a breakdown of communications between the mental health and community teams. A 24 hour emergency phone line would probably be beneficial and prevent admissions to the acute units.
I understand the Mental Health Commission's remit covers inpatient acute units and patients detained against their will. Does the commission have information on how we compare with international...
I understand the Mental Health Commission's remit covers inpatient acute units and patients detained against their will. Does the commission have information on how we compare with international standards with regard to access to child and adolescent mental health teams?
Ambulance Service Provision | Nithe i dtosach suíonna - Commencement Matters | Seanad debates
I thank the Minister of State for his comprehensive response. While the ambulance is based in Belmullet, if the ambulance is not available locally we have to get an ambulance down from Castlebar...
I thank the Minister of State for his comprehensive response. While the ambulance is based in Belmullet, if the ambulance is not available locally we have to get an ambulance down from Castlebar or Ballina. Returning to north County Louth, I would like the Minister of State to consider expanding the co-operation with the Northern Ireland Ambulance Service. Places such as Omeath are only ten minutes away from Daisy Hill Hospital in Newry and yet ambulances are being dispatched from Drogheda, leading to a response time of an hour and 20 minutes, when it could be a ten- or 20-minute response time from across the Border.
I welcome the Minister of State to the House. He is probably aware of the desperate situation regarding ambulance services in rural areas. Councillor Erin McGreehan from Louth recently raised...
I welcome the Minister of State to the House. He is probably aware of the desperate situation regarding ambulance services in rural areas. Councillor Erin McGreehan from Louth recently raised with me the specific issue of ambulances in the Omeath area of north County Louth. At present no ambulances are operating in this district of the county. It has been revealed that ambulance services in Louth have taken over an hour to respond to emergency call-outs on at least six different occasions in the last year. A freedom of information request has revealed that on one emergency occasion in Louth last year it took an hour and 27 minutes for an ambulance to arrive at the scene. Out of the six occasions where ambulances took more than an hour to respond in the county, waiting times were between an hour 18 minutes and an hour 27 minutes. This is not to do with trolleys backing up and the dysfunctional situation in our emergency departments. Insufficient resources are being directed towards rural areas. What does the Minister of State plan to do, in a holistic fashion, to deal with this issue and ensure that we can get the ambulances to bring the patients to the hospitals in a timely fashion? Ambulance turnaround times measure the time interval from ambulance arrival at a hospital to when the crew is ready to accept another call. In a number of hospitals, the emergency departments are completely overcrowded and this will get worse with the winter flu season approaching. This overcrowding contributes significantly to delays in ambulance turnaround. The lack of resources in rural areas is a different problem. We are not dedicating enough resources to rural locations. If we are serious about reducing the turnaround times, it means that we need to reduce the length of time people are spending in our emergency departments. With that in mind the escalating overcrowding in hospitals being reported by the INMO's figures is of particular concern. We have a long way to go in this regard and the failure to recruit more nurses has exacerbated the issue. I accept that there are challenges in rural areas and that we cannot expect to achieve the same turnaround times as urban areas, but they could be vastly improved. We need to increase the number of ambulances and paramedics, but we also need to support community first responders to help with emergencies in rural areas. Details released under the Freedom of Information Act show that nationally on 123 occasions this year it has taken an ambulance at least an hour to arrive at a life-threatening emergency. Some 26 of these were in Wexford while the longest response time was in Mayo. I thank the Minister of State for coming to Belmullet to visit the district hospital. While I am talking about Louth today, the Erris Peninsula is as big as the entire county of Louth. He will be very familiar with this from his part of the country. We are fortunate to have an ambulance base in Belmullet, albeit an hour and ten minutes away from Castlebar. Rural areas need an increased service. We have a great air ambulance that I have used, thankfully infrequently, as a GP in rural Mayo. Increasing the number of community paramedics and first responders would be sensible and pragmatic, and may alleviate some of the problems we have today.
I will be very brief. I thank the Minister of State, Deputy Bryne, for her comprehensive response and her support for the motion.I compliment the Minister of State on her efforts. I am fully...
I will be very brief. I thank the Minister of State, Deputy Bryne, for her comprehensive response and her support for the motion. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=11&amp;day=13"></a--><!--span class="speakercontinuing">&#93;</span-->I compliment the Minister of State on her efforts. I am fully convinced that she is a very solution-driven, pragmatic, motivated and hands-on individual. On a personal level, I would never criticise her efforts and I appreciate what she has done. It is heartwarming to see the cross-party support for this motion on an issue which really is a national scourge. There are many similarities to the loneliness campaign and the loneliness task force insofar as the drug problem does not discriminate between old or young, rich or poor, urban or rural. As Senator Paul Daly mentioned, this is affecting all of us in every geographical location, including my town of Belmullet. At the end of the day, we are all motivated by the same agenda. We want the welfare of our citizens who are afflicted by the scourge of drugs to be improved, either directly, if they are using drugs, or indirectly, if they are, say, a family member or a victim of crime or intimidation. I agree with many of the points raised by Senators. Senator Ruane referred to the health model. I am totally in favour of the health model, rather than solely taking the punitive approach we have adopted for far too long. In the context of the dual-diagnosis approach, we all know that drugs cause mental health issues, but, as Senator Ruane stated, it is a chicken-and-egg scenario. There are many people with mental health issues who resort to drugs as a form of release. Perhaps those in the medical profession have to hold up their hands up in that regard and accept that they could do better. I also agree that we need to take an alternative approach and look at this matter from another angle. The Senator is right that we need to engage with drug dealers on a community basis. There can be a disjoint between such people and the task force in a locality and it is important the co-ordinator in a locality comes from that locality and is appointed by that task force. If there is a perception that the person is a HSE employee, that sometimes leads to a lack of engagement with the programmes. Of course, Senator Gavan is right that, during the time of austerity under Fianna Fáil, there was a reduction in funding to the task forces in line with other HSE reductions. However, it is also worth noting that the funding has stagnated and there has only been a 1.5% increase in the past five years despite a 28% increase in the overall health budget. Senator Wilson will be familiar with one gentleman, Tim Murphy from the Cavan and Monaghan drug and alcohol services, who stated that his project is in danger of closing by 2020 unless it receives additional resources. Overall, we are all singing from the same sheet. We need to show a unified approach, as we have done today in passing this motion. Ultimately, complacency is not an option and none of us are complacent. I welcome what the Minister of State said and I thank her for her contribution.
I move:“That Seanad Éireann: notes that:- individuals, families and communities throughout the country have been devastated by illegal drugs; - drug-related harm consistently...
I move: “That Seanad Éireann: notes that:- individuals, families and communities throughout the country have been devastated by illegal drugs; - drug-related harm consistently clusters in communities marked by poverty and social inequality; - drug-related deaths in Ireland are at the highest figure ever, increasing from 431 in 2004 to 736 in 2016; - new drugs appear regularly on the illicit market while familiar drugs such as cannabis are becoming more potent; - too many people are living daily with the nightmare of drug-related intimidation and violence;further notes:- the significant increase in drugs offences recorded by an Garda Síochána; - the increase in the value of drug seizures from €29,706,281 in 2016 to €71,859,695 in 2017; - not all drug users are addicts and there has been a significant rise in casual and occasional drug use; - a changing pattern of drug use during the recent economic recovery; - the latest drug treatment figures from the Health Research Board show a 50% increase in the number of cases presenting for cocaine treatment between 2017 and 2018; - in 2018, a total of 10,274 cases were treated for problem drug use; - the number of new entrants to treatment increased from 3,272 in 2012 to 3,962 in 2018; - Ireland is one of six European countries where crack cocaine abuse has increased in the past five years; - every cent spent on illegal drugs funds organised crime; - the reduction in the number of Gardaí assigned to drug units;agrees:- the importance of a public health approach to drug and alcohol misuse is paramount; - there is widespread concern that the partnership approach, which has been at the heart of drugs strategies since 1996, is now in danger of collapse; - community participation and interagency working is crucial to an effective response to an increasingly complex and challenging drugs problem; - there is apprehension and frustration at the failure of Government to meet commitments on community involvement; - investment in drugs task forces has stagnated in recent years with an increase of 1.7 per cent since 2015 compared to 28 per cent in overall health expenditure; - there is a need for comprehensive services in prevention, detoxification treatment and rehabilitation;and calls for:- the Government to act as a matter of urgency to restore confidence in the National Drugs Strategy; - An Taoiseach to appoint representation at a senior level from his own Department to the National Oversight Committee of the National Drugs Strategy; - an increase in the level of funding for drugs task forces and treatment services; - action to be taken against open drug dealing on city streets; - the strengthening of criminal law against the use of children in drug trafficking; - increased investment in the Juvenile Diversion Programme; and - a major education and information campaign to be undertaken on casual drug use.” We are all aware that the drug crisis in Ireland has reached epidemic proportions. Individuals, families and communities throughout the country have been devastated by illegal drugs. Drug-related harm consistently clusters around communities marked by poverty and social inequality. There have been many drug-related deaths in recent years, with the number rising from 431 in 2004 to 736 in 2016. New drugs appear on the market regularly while familiar drugs such as cannabis are becoming more potent. On a day-to-day basis, too many people and families across in rural and urban settings are living with the nightmare of drug-related intimidation and violence. Garda figures show that there has been a huge increase in drug-related offences across the country but also, thankfully, in the number of drug seizures. For example, more than €29 million worth of drugs were seized in 2016 and €71 million worth were seized in 2017. This is a huge and vast amount of money that funds crime. Not all people who use drugs are addicts but there has been a significant rise in occasional drug use. This is a very worrying trend because it often goes hand in hand with psychiatric illness. Even drugs such as cannabis that are not considered potent by some people - I disagree because I believe it is very potent - have serious psychiatric manifestations and can cause psychosis and paranoia. There has been a changing pattern of drug use during the recent economic recovery. The latest drug treatment figures from the Health Research Board show a 50% increase in the number of cases presenting for cocaine between 2017 and 2018. Last year, a total of 10,274 people were treated for problem drug use. The number of new entrants to treatment increased to more than 4,000 in 2018. Ireland is one of six countries where crack cocaine abuse has increased in the past five years. We can never allow ourselves to forget that every cent spent on illegal drugs goes to fund organised crime. There has been a reduction in the number of gardaí assigned to the drugs unit. The Government needs to look at this and redirect resources into the sector. We need a top-down and bottom-up approach to tackle the scourge of drug abuse in Ireland. The importance of a public health approach is paramount. There is widespread concern that the partnership approach at the heart of drug strategies since 1996 is now in danger of collapse. Community participation and inter-agency working is crucial for an effective response to increasingly complex and challenging drug problems. There is apprehension and frustration at the failure of Government to meet community involvement at community level. Investment in drug task forces has stagnated in recent years, with an increase of 1.7% since 2015 compared with 28% in overall health expenditure. There is also a need for comprehensive services in prevention, detoxification and rehabilitation. The Government needs to take this problem seriously and it must act as a matter of urgency in order to restore confidence in the national drugs strategy. My colleague, Deputy Curran, has called on the Taoiseach to appoint senior-level representatives from his Department to the national oversight committee relating the national drugs strategy. We need to increase the level of funding for drug task forces and treatment services. We need to take action with community policing against the open drug dealing that occurs on a day-to-day basis on streets in cities, towns and villages, all of which have been affected by the scourge of drug use. As legislators, it is our job to strengthen the criminal law against the use of children in drug trafficking. We need increased investment in the juvenile diversion programme and a major educational roll out in schools to highlight the dangers of drug use to children prior to using drugs to highlight the adverse mental health and physical manifestations caused by drugs. We know it is a complex issue. Not only does it affect the people who take the drugs, it also affects their loved ones and the communities in which they live. Drug abuse is not limited to particular sectors of society. It is both a rural and an urban problem; it knows no class and it crosses all boundaries. Drugs are far too readily available and, sadly, the age at which young people and teenagers start to take drugs is lowering all the time. That is a very worrying trend. The use of young people as runners by drug gangs is frightening. For many people, taking drugs can lead to a lifetime in mental health services. I saw this myself when I worked as a GP and in psychiatry at St. Ita's Hospital in Portrane. I worked too in the mental health sector in Artane and in the accident and emergency department of Connolly Hospital Blanchardstown. I saw on a day-to-day basis the physical and mental manifestations of drug use. These were the so-called benign drugs such as cannabis. In my opinion, there is no such thing as a benign drug. Drug use leads to anti-social behaviour and to crime, directly and indirectly and more needs to be done. We must tackle our crippling drug problem and we need a major reform in our approach to do that. Sweden is an excellent example of what happens when we take illegal drug use seriously. Drug use in Sweden is just one third of the European average while spending on drug control is three times the EU average. There is a direct correlation between the amount of money spent on drug prevention programmes and the use. For 30 years, Sweden has had consistent and coherent drug-control policies, regardless of which party is in power. It would appear to have adopted a Sláintecare-type approach to the issue with a ten-year strategy so that regardless of which party is in power the policy does not change. There is a strong emphasis on prevention, and extensive treatment and rehabilitation opportunities are available to users. The police in Sweden take drug crime seriously and are adequately funded for this task. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=11&amp;day=13"></a--><!--span class="speakercontinuing">&#93;</span-->This is a timely motion and I hope it will gain the support of the House.
Services for People with Disabilities: Motion | Seanad debates
I welcome the Minister of State to the House. I am delighted to support the motion, on which there is much international research. A 2019 study on the impact of eye clinic liaison officers at...
I welcome the Minister of State to the House. I am delighted to support the motion, on which there is much international research. A 2019 study on the impact of eye clinic liaison officers at various ophthalmology clinics in the UK found that eye clinic liaison officers who had a presence at hospital ophthalmology clinics were valuable for streamlining processes within the clinic, not least for providing continuity of care for patients when they are discharged after medical treatment. That is important, given that people are often lost once they are discharged from the clinic and they return home. Eye clinic liaison officers have also saved staff time at the clinic because they are often responsible for providing emotional and practical support for patients living with sight loss. The study further found that the impact of eye clinic liaison officers may depend on efficient communication within the clinical team, being trusted by other staff and having good knowledge of local and national sight loss support services outside the hospital setting. Eye clinic liaison officers work directly with people with low vision, deteriorating vision, sight loss or impending sight loss and, most important, with their carers. The emotional and practical support is extended to carers and family members of all ages. They provide timely one-to-one support, high-quality information and advice, emotional support and access to other statutory and voluntary services. Eye clinic liaison officers connect people with the practical and emotional support they need to understand their diagnosis, deal with their sight loss and maintain their independence, which is of most importance. They have time to dedicate to people following their appointment in order that they can discuss the impact the condition will have on their life. In July of this year, the National Council for the Blind Ireland, NCBI, highlighted the success of the eye clinic liaison officer service by celebrating the 100th patient referred to the service in a matter of weeks. Mr. Stephen Farrell, a consultant ophthalmologist at Temple Street hospital, stated: [T]he ECLO service is a fantastic addition to our Ophthalmology Unit, it is a much needed resource to the children and their parents attending our service. For hospital staff being able to refer to the ECLO has been really reassuring. The NCBI has stated: ECLOs act as key point of contact, working closely with medical and nursing staff across Dublin eye clinics. ECLOs aim to bridge the gap between hospital and community based services and education providers like ChildVision ... The ECLO service across all three Dublin hospitals are staffed by two qualified NCBI personnel who have extensive knowledge in meeting and responding to the changing needs of ophthalmic patients. The NCBI has stated it aims to have an eye clinic liaison officer embedded in all hospital clinics throughout the country by the end of 2021, with the goal of providing early intervention and support at the time of diagnosis. Ms Elaine Crossan, an eye clinic liaison officer at the Mater Hospital, has stated: [A] diagnosis of a sight condition can be devastating, which can bring enormous practical and emotional consequences and challenges. Many patients report feelings of panic and anxiety. It is my job to act as a key contact point for patients by providing vital information on their eye condition, as well as offering practical and emotional support where and when they need it most. Most importantly, patients now receive the time and support that is essential to them and to their families. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=11&amp;day=13"></a--><!--span class="speakercontinuing">&#93;</span-->Often as doctors we are very good at diagnosing things, but once there is a label put on it, and a treatment and a prescription handed out, we often forget about the patient and that is wrong. That is the vital role of the eye clinic liaison officer, ECLO, as a support not only to the patient but also to the family. The ECLOs are helping prevent avoidable sight loss, which is done by talking patients through treatments and helping family members to understand the importance of compliance with their medication. It has to be said that more than 50% of medication prescribed in this country is not taken properly, so reassurance and embedding in people's minds the message with regard to compliance is of vital importance, and that is another role for the ECLO. This role effectively releases clinical staff to focus on more complex cases. Being co-located with the clinical team enables the ECLOs to receive referrals as soon as possible and to advise acute staff on the appropriateness of a referral to a community-based service. In other words, people and patients do not always have to be seen in the hospital sector. Many patients can be transferred to the community-based sector, thus shortening waiting times and preventing people with sight loss having to travel often on public transport or on poor road networks over long distances. The importance of the ECLO in transferring patients from the hospital sector to the community sector cannot be overemphasised. Given the sharp increase in the number of children with serious visual impairment and blindness, the National Council for the Blind Ireland, NCBI, was keen to further partner with Children's Health Ireland at Temple Street Hospital to support the heightened demand on the system. However, as Senator Conway mentioned, we need to comment on the incredible waiting lists and waiting times for eye care currently. There are more than 60,000 people across the various ophthalmology waiting lists. The outpatient list, as Senator Conway mentioned, is 43,000. The inpatient day case list for ophthalmology procedures is more than 8,000, and the primary care list is more than 15,000. In 2018, the NCBI said that ophthalmology waiting lists had become unmanageable. It said also that more than 75% of sight loss is avoidable and that 40,000 people are missing out on vital, early intervention because waiting lists are out of control. The Government has committed to eliminating avoidable sight loss, but we have seen absolutely no progress on waiting times in the last year. Delays in access to treatment for conditions like age-related macular degeneration, which is the biggest cause of sight loss in Ireland, can cause irreversible sight loss. We have much work to do with regard to the waiting times. I echo the support for this excellent motion. ECLOs are a vital cog in delivering a modern healthcare system and take many ophthalmology patients out of the hospital setting into the community setting, where most of these services can be provided.
I echo the sentiments of Senators Gallagher, Feighan and Marie-Louise O'Donnell on the Cuisle facility at Donamon in County Roscommon, which is very close to my heart and is a vital cog in...
I echo the sentiments of Senators Gallagher, Feighan and Marie-Louise O'Donnell on the Cuisle facility at Donamon in County Roscommon, which is very close to my heart and is a vital cog in providing respite to people with disabilities. I welcome members of the public who are here today to protest and are trying to save the facility. They are from all over Connacht, the midlands and the north west. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=11&amp;day=13"></a--><!--span class="speakercontinuing">&#93;</span-->It is a really good facility. I also welcome the public representatives who have travelled here. The service users and their families really appreciate this facility. It is not adequate for the Irish Wheelchair Association, IWA, to suggest that this service could be outsourced to hotels and that these people could be accommodated there. This fails to consider the wealth of experience that the staff have accumulated in providing care for these individuals over the years. The facilities in hotels might be comparable to the facilities in Cuisle, but that does not take into account the wealth of experience staff members have in looking after these people. I will also comment on the infrastructure. It is a fantastic facility which has a spa, hydro pools and jacuzzis. Much of this infrastructure was made possible by public fundraising over the years. It is a disgrace that it is being closed with only 30 days' notice. This has been parachuted upon staff members and families. There has been no consultation whatsoever. It is simply not good enough. I want to mention the extensive fundraising for this facility that has taken place over the years. I will also highlight the serious questions that need answering. I brought this up in the private session of the Joint Committee on Health today. That is one of the reasons the Chair and members of the committee have agreed to invite the board of the IWA before it to answer questions. There are governance issues at play. We need to talk about the financial arrangements within the IWA, specifically in respect of the Donamon facility. Are there financial irregularities in this regard? There has been no consultation. The Minister of State, Deputy Finian McGrath, has been lacklustre in his enthusiasm to support the users of the service and their families. It is not good enough. This decision has been rushed. There are serious questions to be answered. I look forward to questioning the IWA when it appears before the Joint Committee on Health. It is important that this issue be highlighted. I thank my fellow Senators for their support on this matter.
Disabled Drivers and Passengers Scheme | Nithe i dtosach suíonna - Commencement Matters | Seanad debates
Would the Minister not consider operating the appeals system locally, rather than having people travel to Dún Laoghaire from all over the country?
I thank the Minister of State for his reply but I cannot accept it. I think it is disgraceful. I am sure the Minister of State will agree that this scheme is antiquated. It is antiquated in...
I thank the Minister of State for his reply but I cannot accept it. I think it is disgraceful. I am sure the Minister of State will agree that this scheme is antiquated. It is antiquated in the qualifying criteria requiring people to be wholly without the use of one or both limbs etc. I deal with this every day of the week in my surgery. Not only are the qualifying criteria antiquated, the appeals process is antiquated as well. If somebody is refused a primary care certificate, where can he or she go for an appeal? Disabled people are expected to go to the National Rehabilitation Hospital in Dún Laoghaire for an appeal. They must travel from all over the country, making a trip of four or five hours duration from north-west Mayo or Cork, to sit in front of somebody and be refused again. That is one antiquated element of the scheme. If we are serious about being an inclusive society we need to include people with cognitive impairments, as highlighted by councillor O'Connor. Small changes would save this country a lot of money and make our society a lot more inclusive. We are not asking for a lot. We are asking for people with serious diagnosed cognitive impairment to be considered for this. I do not accept that the Minister of Finance has no plans to change the scheme. I will work with Councillor O'Connor to introduce legislation in this regard. The appeals scheme needs to change and we need to include people with cognitive impairment.
I welcome the Minister of State to the House. I have asked him to come to the House today to discuss the need to expand the qualifying criteria for a primary medical certificate for the disabled...
I welcome the Minister of State to the House. I have asked him to come to the House today to discuss the need to expand the qualifying criteria for a primary medical certificate for the disabled drivers and disabled passengers scheme to persons with severe cases of autism spectrum disorder and severe sensory disabilities. This issue is close to my heart. As a GP, I come across it frequently in my practice and I believe that this scheme needs to be altered. This issue was brought to my attention by Councillor James O'Connor who I welcome to the House today. A constituent of Councillor O'Connor who would have had to spend a small fortune on a vehicle which would be suitable for a child with autism spectrum disorder, ASD, expressed dismay that due to the lack of a severe physical disability her child, who requires constant care and attention, would not be considered eligible for a primary medical certificate. There is a clear and obvious need for the legislation to be updated to account for those with cognitive as well as physical disabilities. The Disabled Drivers and Disabled Passengers (Tax Concessions) (Amendment) Regulations provide a tax relief to those in receipt of a primary medical certificate when purchasing a new vehicle. This was incredibly important legislation when it was instigated. It provides financial aid to families and individuals who are required to make significant monetary outlays to provide transportation or else be significantly constrained. The regulations were intended to help reduce the financial cost of transporting oneself or another when compelled to attend medical appointments, hospital appointments, etc. A family with a child with severe ASD and sensory issues cannot be expected to use public transport. A child with that condition simply would not cope in those circumstances. The daily emotional stress and anxiety that both child and his or her family are being expected to deal with are unacceptable. In some cases, it is unsafe for the driver of the car if the child is exposed to that amount of tension and stress. Persons with ASD tend to have problems with social interaction and communication. Children and young people with ASD frequently experience a range of cognitive, learning, emotional and behavioural problems. If one forces those who are predisposed to sensory overload to use public transport, it is cruel to them and, I believe, cruel to their families. I would ask the Minister to seriously consider what it must take for this mother to transport her children around, one of whom could have a serious emotional episode or so-called "meltdown" on public transport because the child is so overwhelmed by strange people, strange environments, strange smells, strange sights and strange sounds. This is a traumatic experience. I believe that the current scheme is too restrictive and needs to be adapted. Being a full-time carer to a child with ASD is not an easy role. When parents need to be constantly responding to the needs of others with whom it can be difficult to interact, it can affect their own emotional and physical health and their physical energy. Sometimes their own physical well-being is put on the back-burner. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=11&amp;day=13"></a--><!--span class="speakercontinuing">&#93;</span-->A simple act such as waiving the, value-added tax, VAT, or vehicle registration tax, VRT, on a car used to transport children could be a real bonus. It is a small and achievable ask. There is a clear oversight in the legislation. I ask the Minister of State to put forward proposals to extend the qualifying criteria for a primary medical certificate. There is no logical reason that the disabled drivers and disabled passengers scheme covering people with physical impediments could not be expanded to those with cognitive impairments. I ask the Minister of State to seriously consider this and to be sympathetic to my cause.
Assisted Decision-Making (Capacity) (Amendment) Bill 2019: Second Stage | Seanad debates
I welcome the Minister of State to the House. I commend Senator Devine on her work on this area and the Bill that she is bringing forward and also commend Senator Freeman on the vast amount of...
I welcome the Minister of State to the House. I commend Senator Devine on her work on this area and the Bill that she is bringing forward and also commend Senator Freeman on the vast amount of work she has done in this area. I welcome Deputy Pat Buckley to the House and commend him on the work he does in the Lower House with my colleague, Deputy James Browne. As a general practitioner, GP, I am delighted to support this Bill. Fianna Fáil will be supporting this Bill which seeks to ensure involuntary patients in hospitals for mental health treatment will have their advance healthcare directives respected. Currently, involuntary mental health patients is the only group which is excluded from having a living will fulfilled. It is important to ensure that involuntary patients have a voice in their treatment and have their will and preference for mental health treatment fulfilled and respected. I welcome the changes that have come about over the past number of years. As a young fellow growing up in Castlerea where there was a large mental institution, St. Patrick's Hospital with 400 inpatients, in which my father worked as a plumber, I often played up in its playing fields. They had a farm. In thinking of that time and the time from when I was a medical student working in Grangegorman to when I was a psychiatric registrar working under the medical director, Dr. Blennerhassett, in Portrane, the developments must be welcomed. On a day to day basis in the surgery, I am delighted to be treating patients in the community, keeping them in the community and not having to rely on these dreadful institutions where people were locked up inappropriately for many years. The situation is improving and it is great that we are having this debate here tonight. The Assisted Decision-Making (Capacity) (Amendment) Act 2015 provides laws for advance heathcare directives. The Act was signed into law on 30 December 2015 but it is not yet in effect. A living will may be valid and enforceable. By making such a statement, one may have withdrawn one's consent to the specific medical or surgical treatment, for example, as Senator Devine mentioned earlier, a do-not-resuscitate request. It is not possible to state with absolute certainty that such a directive would be enforced because this depends on exactly what it says and whether it addresses the precise circumstances. In some countries, it is possible to appoint someone else to make decisions on one's behalf if one is not capable of making them for oneself. In Ireland, this power is granted via an enduring power of attorney. I see this in my role as a GP but also as a medical officer in a small district hospital. An enduring power of attorney, however, does not specifically allow for the making of healthcare decisions by another person and while one may suggest to one's doctor or hospital that the wishes of certain persons may be considered, one cannot give anyone else any legal right to make decisions about one's healthcare. People can make advance healthcare directives about a broad range of issues, such as the type of medication they prefer, the type of therapies that suit and work for them best and, most important, to treatment refusals - treatments that they do not want - such as electroconvulsive therapy, ECT. Under Irish law, people who are detained in hospital for mental health treatments are specific excluded from legally-binding advance healthcare directives. As a doctor, I find this deeply upsetting and deeply troublesome. That is why I am supporting this Bill today. This exclusion is contrary to international human rights standards, including the UN Convention on the Rights of Persons with Disabilities. The Government has recognised that it is necessary to update the 2015 Act for Ireland to be compliant with the UN Convention on the Rights of Persons with Disabilities, which was ratified by the Government in 2018. In June 2016, the then Minister of State at the Department of Health with responsibility for mental health, Deputy McEntee, publicly stated that the draft legislation to reform the Act would be completed by the end of that year. I understand that delays happen with legislation but since then, numerous dates have come and gone. Numerous dates have been given for publication of the draft legislation and none of them have been met. These delays are problematic given the lengthy duration of the review of the Act and the seriousness of the gaps in human rights protections, both for adults and children, receiving inpatient and mental health treatment. As a GP and as a member of Fianna Fáil, I am happy to support this Bill to ensure that the most vulnerable who often do not have a voice - involuntary patients in mental health institutions - will have their wishes respected. As I stated, it is a basic human right. My party is happy to support this. Once again, I commend my colleague on her work in this area.
HSE Capital Plan 2019: Statements | Seanad debates
I welcome the Minister and thank him for his recent visit to Mayo. There was a fantastic day last Friday in Castlebar with the opening of the Mayo-Roscommon hospice. It is truly a fantastic...
I welcome the Minister and thank him for his recent visit to Mayo. There was a fantastic day last Friday in Castlebar with the opening of the Mayo-Roscommon hospice. It is truly a fantastic facility, full of hope, and somebody described it as a sacred place. It is a facility where the size of a bank balance makes no difference and the facility is there for people in the counties of Mayo, Roscommon and Galway. I also welcome the Minister's announcement last week regarding the funding of the facility for 2020. Fianna Fáil welcomes the proposed developments in the HSE capital plan and hopes it can be delivered on time and on budget. However, the children's hospital debacle and delays in nursing home upgrades demonstrate that the Government's record of timely delivery on key projects is simply not good enough. There are many genuinely important projects listed in the plan that are welcome and which will improve public health care services. However, it is impossible to know why these projects have been selected over others. There is no analysis of the value of the various projects, how investment is being allocated or supply and demand of healthcare services. The plan includes using public money to build private facilities at the new maternity and children's hospital. This directly contradicts the way the Government voted in the Dáil and its public utterances on the matter. The Government has stated that this is the first phase of a ten-year capital investment programme. Over the next three years, there is a commitment to 250 projects across the country, including 480 new beds, 30 new primary care centres, 58 community nursing units and significant investment in mental health and disability projects in the community. The capital plan provides for the spending of just over €2 billion on health capital projects from 2019 to 2021, with €335 million pledged for a wide range of capital projects at individual hospitals and community facilities to provide modern health accommodation and equipment to improve service provision. We all welcome the new children's hospital but the issues surrounding its cost overrun are not going away. The State's chief procurement officers, who failed to flag the spiralling costs of the hospital with the Government, has resigned from the hospital development board. The resignation of Mr. Paul Quinn, who led the procurement reform programme, is one of a spate of high-profile resignations from the board this year in the wake of cost escalation. In a recent letter, the Taoiseach confirmed to Deputy Micheál Martin that BAM Ireland, the construction company involved, is seeking additional money for work not included in the original scope of work. The Taoiseach has refused to indicate how much this would cost the State, claiming that the "individual details of these claims are commercially sensitive". Fianna Fáil has called on the Government to come clean about new potential overruns given the burden it imposes on the taxpayer. We need full transparency around the potential cost overruns because they need to be budgeted for. It is taxpayers' money that could be put to so much good use in the healthcare system. The PricewaterhouseCoopers, PwC, report on the construction of the new children's hospital was a shocking indictment of a badly managed project, one of the most expensive undertaken by the State. Nevertheless, there has been no accountability. Red flags were missed and the public spending code was not adhered to. The project has been poorly co-ordinated and controlled, with fragmentation, poor communication and poor flow of information. It is a far cry from April 2016, when the Taoiseach, who was then Minister for Health, announced that the project would, taking account of contingencies and inflation, cost approximately €650 million. New information supplied to my colleague, Deputy Mary Butler, has revealed that almost a third of nursing home upgrades announced in 2016 have missed their completion date. Once again we can see that the Government is big on promises but maybe behind the curve in the context of delivery. These upgraded, refurbished and new facilities are urgently needed so we can comply with HIQA standards around the country. I was personally disappointed that more investment was not attributed to the district hospital networks but I acknowledge the recent visit by a Minister of State, Deputy Jim Daly, to Belmullet hospital in County Mayo. I am a medical officer at the hospital. I have spoken about this matter many times in the Seanad. The district hospital networks play a vital role in the delivery of a modern healthcare service. They should not be seen as a relic of a bygone era. A failure to invest in the services provided at district and community hospital level is counterintuitive and counterproductive. These hospitals play an important role in step-down facilities, preventing admissions to acute hospitals and facilitating discharges from the acute hospital sector. With appropriate investment in the community hospital network, we can facilitate respite care and GPs and public health nurses can admit patients to these facilities in order to prevent patients from having to go to acute hospital sectors. Many of these hospitals have palliative care beds. There are two at the hospital in Belmullet. These hospitals are a vital cog in a modern healthcare system. I welcome the developments in the mental health facility at Portrane. I worked as a senior house officer at Portrane when specialising in psychiatry. It is a fantastic facility, as it was back then, despite much of the negative connotations in the media coverage relating to the institution. <!--p></p--> <!--span class="speakercontinuing">&#91;</span--><!--span class="speakercontinuing">Senator Keith Swanick:</span--><!--a href="http://www.oireachtas.ie/members-hist/default.asp?housetype=1&amp;HouseNum=25&amp;MemberID=2459"></a--><!--a href="../zoomin?readform&amp;chamber=seanad&amp;memberid=2459&amp;pid=KeithSwanick&amp;year=2019&amp;month=10&amp;day=23"></a--><!--span class="speakercontinuing">&#93;</span-->I had a very fruitful six months there and met some great people. The new infrastructure in Portrane is welcome. I look forward to visiting it. I have visited the children's hospital. I was given a tour by BAM Ireland a few weeks ago. If the Government is interested in controlling costs, there must be a ground up policy. We must tackle the meltdown in our healthcare system. We must get a handle on spending and cost control to prevent the yearly ritual of announcing Supplementary Estimates.