Dáil Éireann debate -
Wednesday, 1 May 2024

Vol. 1053 No. 3

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

More than 11,000 patients waited on hospital trolleys last month. University Hospital Limerick again had the highest figure of any hospital in the State, closely followed by University Hospital Galway. The trolley crisis is now a year-round emergency. Our hospitals are under enormous and sustained pressure. Yesterday the Minister for Health, Deputy Donnelly, announced that a HSE support team is to be deployed to University Hospital Limerick. This hospital is in a state of constant crisis, with an emergency department pushed to the brink every single day. A HSE support team is welcome but it is a drop in the ocean when it comes to what University Hospital Limerick needs. It will not alter the hospital’s needs.

The hospital needs 288 extra beds. It needs to hire 200 vital staff, including 20 emergency Department nurses, and it needs the Government to lift the recruitment embargo immediately. This embargo is very dangerous. The system is at breaking point, yet the Government, with its eyes wide open, is choosing to block the hiring of healthcare staff. By imposing and maintaining this embargo, it has chosen to make a bad situation worse. The consequences of the embargo are felt right across the health system. It has consequences for stroke victims. The head of the national stroke programme, Professor Rónán Collins, has said the service is no longer able to adequately staff stroke units, that one in three stroke victims does not get a stroke unit bed and that stroke patients are getting less than half of the recommended therapy time. It has consequences for those in need of mental health care. The Government keeps the embargo in place and the psychiatric care system now has 700 vacancies. Peter Hughes, the general secretary of the Psychiatric Nurses Association, has said the recruitment embargo is seriously impacting the delivery of services, especially services for children and adolescents.

It does not stop there. Radiographers and radiotherapists cannot be hired to deliver the national cancer strategy. The HSE, as the Taoiseach knows, has sought an additional €20 million to deliver the strategy this year. How much did the Government give it? It gave zero. Public dentists cannot be hired, which means 100,000 children are not getting the dental treatment they need. Multidisciplinary teams needed to treat patients at home, in nursing homes and in community care settings cannot be hired. The service is understaffed and under great pressure. I could go on and on. The Government's recruitment embargo is layering crisis upon crisis. While it refuses to directly employ the healthcare professionals our system needs, it is spending a fortune on hiring agency staff. Government spending in this area has more than doubled, to €650 million. You could not make this up. Under the Government, young doctors, nurses and healthcare professionals are being educated and trained to emigrate. The message sent to those who have already left is not to come back, even though we need them now more than ever.

A Thaoisigh, tá an cosc atá agat ar earcaíocht sa tseirbhís sláinte contúirteach, agus tá impleachtaí thromchúiseacha aige d’othair. Caithfidh tú fáil réidh leis go beo. I have outlined for the Taoiseach the very real consequences of his recruitment embargo. It was wrong to impose it in the first place. To keep it in place is now counter-productive, damaging and dangerous, so I ask him to scrap it immediately and allow our health services to hire the staff they so desperately need.

The Taoiseach

I thank the Deputy for raising important issues relating to our health service. She has touched on a number of topics and made a point about recruitment that I want to respond to as well. She began by referencing University Hospital Limerick. I, too, welcome the decision by the Minister for Health and the HSE chief executive yesterday to send a specific support team to Limerick to help to deal with the current pressures that are being experienced in that hospital and the mid-west region more generally. This team will begin its work immediately and over the next four weeks, it will help to devise a number of actions to ease overcrowding and pressures that are being experienced in UHL. The team is made up of Ms Grace Rothwell, the national director of acute hospitals, Ms Orla Kavanagh, director of nursing and integration at Waterford University Hospital, and a very eminent and, I think, respected individual by Members across this House, and the retired emergency medicine consultant, Dr. Fergal Hickey from Sligo. The team will work with the team in place in the hospital to manage patient flow and to de-escalate the current pressures being experienced.

The reason we are doing that is that we acknowledge the issues, despite very significant investment in that hospital. Those include staffing at the hospital increasing by more than 1,200 since the end of December 2019, going from 2,800 staff to more than 4,000 at the end of March, which is a 43% increase in staffing levels in University Hospital Limerick, including 162 more doctors, 53 more hospital consultants, 447 more nurses and midwives and 119 more health and social care professionals. These are large numbers of additional people working on the front line. Despite their exceptional work and hard efforts, many of us in this House and I, as Taoiseach, have significant concerns about UHL. We eagerly await the report from retired Chief Justice, Frank Clarke, about what I think will be instructive recommendations on how to proceed.

More generally, the Deputy talked about the recruitment embargo. A recruitment embargo would suggest that nobody is being recruited and gives the impression that staff numbers are not growing in the health service. Of course, as she and I have discussed many times over the past few weeks, they are. When you talk about an embargo, you are actually talking about asking the health service to hire more doctors, nurses, speech and language therapists, occupational therapists, more people to work in disability services and more people to work in our mental health services. There will be more people working in each of those areas at the end of this year than there were at the end of last year. We are also saying there has to be some reality and some correlation between the funding given to any public organisation and the number of people it employs. Actually, for anyone watching at home, please know that this Government has given the health service enough funding to hire 2,268 additional people this year. When disability services are included, for which the Minister of State, Deputy Rabbitte, has responsibility, the Government has provided funding to hire 3,000 additional people this year. Unless we want to adopt an approach where we bring the Ministers for Justice and Education in and tell them they do not have a budget anymore, living within a budget and having some correlation between a workforce plan and a budget is something that many taxpayers watching will see is a responsible thing to do.

We have significant challenges with overcrowding. In a number of hospitals, we have seen significant improvements over the course of this year and last year. Now, the Minister for Health, with the HSE, is eager to see how the good practices in terms of patient flow can be embedded in some of the hospitals, particularly UHL, which are not going nearly as well.

Deputy Mary Lou McDonald

The Taoiseach may well talk about living within budgets. He is hardly a poster boy for that. I quoted the €650 million a year on agency staff. I could also quote the €140 million a year on management and legal consultancy at peak in 2022. Heaven forbid that I would go near the €2.2 billion on his children's hospital that has yet to be delivered.

The Taoiseach

The Deputy will be at the opening.

Deputy Mary Lou McDonald

Save the homily on living within budgets for someone else. The facts are these; at University Hospital Limerick, as was confirmed to the Oireachtas committee, every single day, there are patients who are deemed sick enough to require admission who cannot be admitted. That is the reality day-on-day.

Deputies

Hear, hear.

Deputy Mary Lou McDonald

The hospital does not have enough beds or the required level of staff. The Taoiseach quoted a figure of 2,268 additional posts. He knows full well that in previous years, that has been as high as 7,000. The system is stripped bare. I have set out the facts for him. These are facts from people on the front line with regard to dental services, mental health capacity, and all across the system, yet the Taoiseach insists on this embargo. I have asked him to lift the embargo and I put it to him again that that needs to happen. It is foolish to imagine that this embargo is a money saving device. It is not. The Government's spend on agency staff and outsourcing reflects that fact.

Deputies

Hear, hear.

The Taoiseach

Am I to take from that that the Deputy does not believe there should be any cap on recruitment in the health service at all?

Deputy Mary Lou McDonald

No.

The Taoiseach

You can hire whatever you want whenever you want. Is that this week's Sinn Féin health policy? If it is, can the Garda Commissioner hire whoever who he wants? Can the Minister for Education? I am just wondering where this ends.

Deputy David Cullinane

The Government did not have an embargo in place last year.

The Taoiseach

For a party that now aspires to be in government, Sinn Féin has to tell people what it is going to do every year. This year, we are very honest-----

Deputy David Cullinane

The Taoiseach should read our budget, so he can see what we proposed.

Deputy Mary Lou McDonald

You do not let young women die on trolleys or lying across chairs. That is what you do not do.

An Ceann Comhairle

Please let the Taoiseach answer.

The Taoiseach

I am looking forward to-----

Deputy Mary Lou McDonald

That is my policy. You do not allow young women to die in a hospital, lying on chairs. How is that for a policy?

Deputies

Hear, hear.

An Ceann Comhairle

Please let the Taoiseach answer without interruption.

The Taoiseach

Sinn Féin does not actually develop policy. Its Members just shout. What they actually need to do is explain to people how they would reform the health services. I thought we had an all-party agreement in this House called Sláintecare about how to do it and I thought Sinn Féin signed up to that too.

Deputy Donnchadh Ó Laoghaire

Is the embargo in that?

The Taoiseach

You think that, every single year, you can just promise people everything and anything without actually showing them how it will be delivered. I ask people listening at home to please not fall for the misinformation, disinformation and noise.

Deputy John Brady

Look at our actual health budget.

Deputy David Cullinane

The Taoiseach is distracting.

The Taoiseach

Some 2,268 more people will be hired into the health service this year-----

Deputy David Cullinane

It was 7,000 last year

The Taoiseach

-----and probably more than the 2,268. When disability services are included, 3,000 people will be hired into the health service this year. That is important. I am quite sure when the national children's hospital is built, the Sinn Féin Deputies will want to be at the opening and will see how good it is for children's health in this country.

Deputy Róisín Shortall

The details that emerged during the inquest of 16-year-old Aoife Johnston were horrific. She did not need surgery; she needed an antibiotic. Instead of receiving the care she needed, she was left to die. On the night that Aoife lay dying, one doctor was trying to manage 191 emergency department patients. Medics at the inquest described the emergency department that night as a war zone and grossly dangerous. Consultant Jim Gray described the emergency department that night as a deathtrap and said it is still a deathtrap. The Minister may have been taken aback by Dr. Gray's remarks but I do not think anybody in the mid-west area was.

UHL is consistently the most overcrowded hospital in the country. It is overcrowded all the time. Today, we learned that last month, it had nearly twice as many patients on trolleys as the second most overcrowded hospital, which was Cork University Hospital. The Minister for Health has conceded that chronic overcrowding means the hospital is not safe. That is what a deathtrap means; it is unsafe. I know the Taoiseach will tell me about the resources that have been invested in UHL, as he has just done, and plans to increase capacity, but additional bed capacity is not coming onstream fast enough. A new 96-bed unit, which is really a 71-bed unit, will come onstream next year. Another 96-bed unit is to be delivered in 2028 and that is if there are no delays. People in the mid-west cannot wait that long, and they should not have to. They do not have to. A fully operational 53-bed hospital in Limerick city, the landmark Barrington's hospital, has just come on the market with a guide price of €12.5 million. This presents a unique opportunity for the Government to act decisively and speedily to at least address part of the problem in UHL.

Aoife Johnston and many others were failed by the State. We cannot fail any more people in that way. Was the Government alerted in advance to the sale of Barrington's hospital? Is the State considering buying the hospital or is it investigating if this is an option? Finally, if the Government is not interested in buying the hospital, why not?

The Taoiseach

I thank the Deputy for raising this issue. I certainly will not disagree with her in any way about how disturbing the testimony was at the inquest.

I am conscious every time we discuss the issue in this House, rightly so, of Aoife Johnston's family. I express my deepest sympathies to her family, who have been devastated by her loss. My thoughts are with her family after what has been an unimaginably difficult and painful time.

I did hear of some changes that have happened in the hospital and it is worth briefly putting them on the record of the House. When the head of the HSE spoke yesterday about the emergency department, he talked about the fact that the number of doctors there since the time of Aoife's death has gone from 26 to 47, the number of emergency consultants has gone from ten to 15 and the nurse staffing levels in the emergency department have increased not only to safe staffing levels, but beyond it.

I also want to be very clear that when it comes to all of our emergency departments across the health service, they are exempt from any recruitment pause or anything else in that space.

I do fully accept that there is an urgent need to inject more capacity into the health services in the mid-west. I am truthfully not aware of the issue concerning Barrington's Hospital, but I will check for the Deputy because when Members make constructive suggestions in this House that is what they deserve to happen. I will certainly talk to the Minister for Health about that and see what his view, and that of the HSE, is on it. I am happy to come back to the Deputy directly in regard to it too.

I take her point that the work needs to come on track even faster. We have already seen 150 new beds opened in the UL Hospitals Group since January 2020, 98 of which are at University Hospital Limerick. As she alluded to, work commenced last year on a new 96-bed ward block. I am told it is expected to be open next year. This first block will add an additional 71 new acute beds to UHL. As the Deputy rightly said, the remaining 25 of the beds are replacing existing beds from the so-called Nightingale wards that require replacement and refurbishment to be in line with regulatory requirements.

Preparatory work has also commenced on a second 96-bed block. All steps are being taken to accelerate that. All 96 beds in that second block will be additional for the hospital, comprising 48 medical beds and 48 surgical beds. The Minister visited the hospital again recently and he met with doctors, nurses and senior managers. He announced a further package of interim or quick measures to try to provide capacity in a number of ways, including procuring community beds, 20 further step-down transition beds, rehab beds in County Clare and 16 additional fast-build beds. The opening hours of the region's three acute medical assessment units at Nenagh, Ennis and St. John’s are due to be extended to 24-7 on a phased basis. GP and advanced nurse practitioner on-the-door services are also being provided for the emergency department. I say that by way of, I hope, conveying a view that the Government is doing everything and anything it can right now to try and expand capacity, both physical capacity in terms of beds and infrastructure but also through alternative pathways of care.

Deputy Róisín Shortall

I thank the Taoiseach. I am not suggesting that acquiring Barrington's Hospital is going to solve all the problems by any means but it will make a significant contribution to expanding capacity. It is an existing operating hospital and could be brought onstream very speedily. I welcome the fact that the Taoiseach will pursue that further.

Other critical things obviously need to happen in regard to UHL. The UL Hospitals Group is the only hospital group in the country that does not have a model 3 hospital. That has been a serious oversight in recent years. I ask that consideration would now be given to designating one of the other hospitals in the group as a model 3, as a certain amount of emergency department work could be carried out there if it had such a designation.

The recruitment embargo is having a significant impact on service delivery in UHL because there are not adequate numbers in certain professions. I again ask the Taoiseach to have a look at that and not just talk about global numbers, as specific professions need additional staff.

I hope he will come back with a response on those three issues: Barrington's Hospital, the need for a model 3 hospital to be included in the group, because that would make a very significant difference, and the staffing embargo.

The Taoiseach

I certainly will come back to the Deputy on those three issues. I will liaise directly with the Minister for Health and revert to her then.

I take the point about global figures and the need to make sure that we do not just use them and that we get under the bonnet. I would just say on the recruitment issue that I have endeavoured to do quite a bit of that in relation to UHL. By any objective standards the level of additional staff in UHL, relative to other hospitals, has been significant. That leads me to raise two other issues, not to be provocative but because they also merit consideration. One is how the hospital actually operates. There are serious issues in that regard and that is why we are sending a support team in. I think the Deputy Shortall is a believer in looking at all aspects of the hospital. That is important. The second - I have not checked on this in a few days - is that I believe this hospital also has one of the lowest uptakes of the new consultant contract. The contract has made a real difference in terms of separating public and private and it is disappointing to see some hospitals with a particularly low uptake. I would add those two other items to the three items the Deputy raised.

Deputy Peadar Tóibín

In July 2023, I asked the Minister for Justice how many asylum seekers were coming from Britain through the North of Ireland into the South of Ireland over the past five years. At that stage, approximately 66% of those were making applications to the International Protection Office. The Minister stated in her reply to the parliamentary question that the question about what routes they used to come into the country was not asked of the asylum seekers. I thought this was a stunning answer: that a Minister in charge of this particular issue would not ask basic questions of individuals coming into the country.

I asked the same question in October 2023 about how asylum seekers were getting into the State, and the Minister for Justice did change the answer a little bit. She told me that the information is not recorded. I asked the same question again two weeks ago and she again changed the answer a little bit. She said that it was not possible to extract that information from the data. It is astonishing that we have such a system when so many people are coming into the country. They are applying to the International Protection Office, but the staff of the Minister for Justice are not asking them how they came into the State.

It is not the only question that was not asked. After 14 migrants were found in a refrigerated container in Rosslare, just narrowly managing to escape with their lives, I asked the Minister how many vehicles are checked at ports across the country. She said that statistics are not available on the number of searches that are carried out on ports.

I also asked the Minister for Justice how many applicants to the International Protection Office have gone missing in the State in the past five years. Again, incredibly, the Minister stated that the requested statistics are not recorded in a manner to allow for that information to be extracted.

For nearly three years I have also been asking a question about how many people who have come into the country who have had a deportation order made against them have had that deportation order actioned. Incredibly, I have been told that 85% of those deportation orders over the past five years were never actioned. I asked what happened to these people and I was told that most of these people had voluntary deportation orders. I then asked the question of whether there was any confirmation that these people had left the country. The Minister said "No" and that we have no facility at the ports of exit to be able to confirm the exit of these individuals. She said that in some cases the Garda Síochána may have information about this but they were not able to confirm that either. That was in the reply to the parliamentary question.

Shockingly, we have this crisis on our hands, that has been developing over the past number of years. A large part of that crisis is as a result of the Minister for Justice not knowing what is happening within the Department. That is incredible. I believe it has led to a significant increase this year in the number of people coming into the country. It has also led to a situation where the Tánaiste rebuked and contradicted the Minister for Justice this week. Now, it has also led to a breakdown in relationships with the British Government. Emergency legislation is being introduced to deal with this matter. I understand it is to allow for people to be returned to Britain. The British Government is refusing to accept that it will apply the legislation, which it says cannot be enforced. How is the Government going to make the British accept the new returns policy in the legislation?

The Taoiseach

I reject out of hand the Deputy's hypothesis relating to our migration situation in this country. The reason we have seen a very significant increase in people coming, not just to Ireland but right across the European Union is multifold. None of them have anything to do with the name of the Minister for Justice of any country. That is very clear. Anybody with any understanding of migration patterns across the European Union, Ireland, the war in Ukraine and the likes, would very quickly arrive at that conclusion, but that does not make for a good social media video.

The Minister has taken a number of actions that have very significantly improved our migration system in real time. We have had to improve it in real time, because we have gone from a relatively small number of people – a few thousand every year – to a much larger number, coupled on top of that with the Ukrainian humanitarian response. The Deputy can look at the work that has been done on processing times. We know that faster processing times are the most effective way of making sure we can provide certainty to those who have a right to be here, because migration is, by the way, a good thing, and integrate them into the community.

However, it also allows us to tell those who do not have a right to be here that they do not have that right and need to leave. Faster processing times is the key to making progress the world over.

The Minister has also made decisions in respect of the designation of countries as safe countries. A significant decision was made by her in recent days around the country from which the highest proportion of people are coming. They are going on a fast acceleration list for processing. That country happens to be Nigeria currently and I have no doubt that over the coming months, there will be significant progress. A total of 100 gardaí who were doing desk jobs relating to immigration will be freed up and put on the front line, working with the PSNI and also working on issues such as deportations. That will make a real difference.

We live on an island that has an open border. Every party in this House values that and agrees with the approach, as do the overwhelming majority of people in the country. It is important for peace and prosperity, and is absolutely something we all cherish and guard. That does mean we do not count the number of people who come over the Border on an hourly or daily basis, or ever. That is not the same thing as suggesting we do not see trends that appear in the International Protection Office and it is a responsible Minister, doing the job well, who decides to have an informed debate on migration and to put that information into the public domain. Anything less would have been irresponsible because instead of people just asking repeatedly, "What about the airport?", which was the mantra in this House for a few months, we now realise it is not just about the airport, passport checks and gardaí at the feet of aeroplanes, although all of that has happened; it is also about asking how we can work more closely with the PSNI and the Garda and how we can work more closely on the common travel area with the UK, which we both value. The common travel area has been there for a long time. How do we work together in that regard?

We have seen a significant increase in deportations. In fact, 173 people had departed the State under various mechanisms by 26 April. Biometric processing is done for everybody who comes to our International Protection Office. In respect of the United Kingdom, all we are looking to do is to clarify our own laws to enforce an agreement that is already in place. I am proud to lead a Government that honours its agreements and I expect our nearest neighbours will do the same.

Deputy Peadar Tóibín

One of the basic tenets of management is to measure what is happening. If we cannot measure what is happening, we cannot manage the situation. If I were to open a sweet shop on Main Street in Bray, I would need to know what is happening within that sweet shop or it would go bust. Despite myself and others trying to get the Minister to focus on measuring what is happening, there was a refusal to do so until two weeks ago. The most recent reply to a parliamentary question I asked of the Department stated it was not able to extract the information from the data. That is a flashing neon light suggesting incompetency.

The Taoiseach mentioned deportations. More than 7,000 applications have been refused in the past year but deportations have occurred in fewer than 100 of those cases. We saw last week under the Dublin III regulations that in only three of the 188 cases in which decisions were made was a person transferred.

We have legislation that has never been used. We are going to amend the legislation, yet the British are still refusing to accept returns. I am asking the Taoiseach how the Government will enforce that. Otherwise that emergency legislation is a distraction from fixing the situation.

The Taoiseach

The Deputy has a better understanding of how to run a sweet shop in Bray that he has of migration policy because this Minister does measure metrics and talks about them to this House.

Deputy Peadar Tóibín

I have replies to 15 parliamentary questions that say the opposite.

An Ceann Comhairle

Please, Deputy.

The Taoiseach

I will come in and buy a lollipop from the Deputy in Bray.

Deputy Mattie McGrath

The sweet shop is closed.

The Taoiseach

Processing times are down and deportations are up. The numbers of countries on the safe country list are up. More gardaí are being freed up. We are working with our European colleagues because we recognise that this island on its own cannot solve migration issues. We must have effective policies in place around returns, which is a word I do not like, by the way, when we are talking about human beings, but there have to be effective agreements in place across the European Union. When I go to the European Council, these are the sorts of issues that politicians across Europe are talking about, working together to ensure we have effective plans in place.

Deputy Peadar Tóibín

Are they enforceable?

The Taoiseach

I have no interest at all in this country being used as a pawn in British politics. We have an agreement in place. It is called a standard operating procedure for processing and transferring asylum seekers between the UK and Ireland.

Deputy Peadar Tóibín

How is it enforced?

The Taoiseach

I ask the Deputy to stop interrupting. The agreement has been in place since 2020 and it sets out the procedure. It is an operational guide that is rooted in the following legislation of this country: the International Protection Act 2015 and Part 18 of the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Act 2020, which the Deputy may or may not have voted for. In the UK, the relevant pieces of legislation are Part 11 of the immigration rules and the Asylum and Immigration (Treatment of Claimants, etc.) Act 2004. Countries should honour agreements they sign up to and our country will honour ours.

Deputy Richard O'Donoghue

I will take the Ceann Comhairle back to my maiden speech when he was also in the Chair. My maiden speech related to UHL. What disappoints me is that it has taken four years for the Opposition to finally stand up and join me over UHL. It has taken four years for Opposition Deputies to stand up officially and talk about UHL. Because an election is coming, they are all jumping all over it. The Social Democrats mentioned UHL today but I have not heard its Deputies mention the hospital once since I came into the House. Sinn Féin is at it again today. For the four years since my maiden speech, I have asked for help but I have not been helped.

I am going to give the House a small history lesson on UHL. Jessica Sheedy was 18 years of age. She went into UHL on 8 May 2018 and died there on 11 May. Aoife Johnston went into UHL at 16 years of age and died there. That is the record of this Dáil with respect to fixing a problem in UHL. The only way the Government is going to fix UHL is to start at the top. I asked for the resignation of the CEO at the start. I do not believe that any medical person should be in charge of any hospital. A business person should be in charge with a board set up of medical staff. Why do I want the CEO to be a business person? I want that because business people are not conflicted and are not giving their jobs to their buddies who cannot do the job. They are not protecting their buddies when they do not do their jobs. If we put in a CEO from the private sector and who is accountable to the board of all medical staff, we can fire them if they do not get results. That has been the problem in UHL and all the other hospitals that have not performed properly. The person at the top cannot be fired. That is the problem. The Government wants to fix the problem; I am giving it the solution. It should put in a business person who is accountable to the people of Ireland and it should put in a medical staff that is accountable to the person who is in charge. If the board does not do its job, it should be held accountable by a person who is not conflicted by his or her connection to medical circles. That has been the problem. The CEO who was appointed in UHL was appointed by then Minister for Health, Deputy Varadkar. That was who she was appointed by. That person was also involved in the Galway scandal when a person died and paperwork went missing. No accountability has been the problem.

An Ceann Comhairle

Please, Deputy.

Deputy Richard O'Donoghue

That is a matter of public record. It is written on the papers.

An Ceann Comhairle

It might be, but the Deputy is getting into extremely dangerous territory. We are not entitled to make any accusations or implications in respect of the professionalism of any individual, whether he or she is leading a hospital or in any other profession.

Deputy Richard O'Donoghue

Okay. I will take whatever comes down the line on this. People are dying in that hospital. If it was your daughter or son, would you be sitting here and pulling me on the same thing? Would you? Four or five years down the line, there has been no change.

An Ceann Comhairle

Thank you, Deputy, your time is up.

Deputy Richard O'Donoghue

Two young people have died and there has been no change. That is the problem with UHL.

The Taoiseach

I thank the Deputy for raising an issue about which he clearly, and understandably, feels passionate. Without wishing to make Opposition parties in this House feel uncomfortable, I do not doubt that all parties raise this issue on a regular basis. I do not doubt the bona fides of anybody on any side of this House in respect of wanting to see progress in healthcare and in respect of UHL. That should be the starting point for any civil debate or discussion we have.

I agree with the Deputy on the broader point about the fact that doctors and nurses in this country are regulated. Many other allied healthcare professionals are regulated through CORU. They all have various accountability structures if something goes wrong. I do not think in any scenario that the role of management should be discounted. I agree on that much. I am talking more broadly than about any specific case. I share the view that there are many parts to the health service. There is clinical care. There is also the responsibility of Government around capacity, resources and policy.

I get that. However, there is also a responsibility on those who are paid a very decent wage on a day-to-day basis to do their job too. Any fair look at any situation in the health service has to look at all the aspects.

What I certainly have no doubt about with regard to UHL is that alongside the very harrowing and disturbing evidence that was heard at Aoife Johnston's inquest, we will now see the Frank Clarke report, which I believe is due in the next few weeks. The hope of Government is that it is due this month. The fact that the former most senior judge, a former Chief Justice, is carrying out that report I hope gives the Deputy an indication of how seriously we take this issue. The Deputy has heard colleagues talk about and question me on this today, and there is an issue around bed capacity in the mid-west. That is accepted. We need to continue to grow it. We all need to look at innovative ways to do that quickly, and we are. There is a need to continue to grow the workforce in UHL and contrary to some charges in this House, that is happening and will continue to happen. However, there is also a need to look at pathways within the mid-west and how we use all the various parts of capacity to help serve the people of the mid-west. Alongside all those extra resources, beds and staff and improved pathways, there is also the need to know the place is being well run and safely run. It would be foolish of any of us to prejudge the Frank Clarke report. I have no knowledge of what is in it. I can certainly tell the Deputy that we are going to take it very seriously, however, because you do not send in a retired Chief Justice to do a job and then not take any recommendations that flow from that very seriously.

Deputy Richard O'Donoghue

I hope that what the Taoiseach is saying is that Jessica Sheedy will not have died in vain and that somebody else's life will be saved. However, that was 2018. Now, we are talking about Aoife Johnston. Where are we going? There has to be accountability within the hospital system. The other thing the Government has to look at is how much has been spent on legal fees fighting these cases and more over stuff that could have been fixed in the past five years if people had put up their hands and apologised. Bernard Gloster came out the other day and apologised. It is the first time the HSE has actually said it was sorry. Anyone can make a mistake but if we learn from the mistake, we are moving forward. The mistakes are being covered up, however, and legal bills of €50 million and €60 million are being spent on budgets the Taoiseach is talking about that could be used to improve the hospital system.

UHL was the best training hospital in this country. My own sister trained there many years ago; she is now retired. It was the best. Now, people go anywhere bar there because they are afraid and in fear of their lives. It is not right for any person to avoid a hospital and say they might not get the care or that when they get in, they might not to get the care they need. Getting them into where they need the care is the problem.

The Taoiseach

The Deputy pointed to a couple of issues. We are all very proud of the work being done by staff in the hospital. The Deputy is right to make that point. Staff working on the front line in UHL are doing extraordinarily good and important work in providing the very best care they possibly can to the people of the mid-west. We are not in any way, shape or form moving away from the very difficult and painful situations that have arisen in that hospital. I acknowledge that many people have had very excellent outcomes thanks to the dedication of the care. We intend to continue to grow the number of people working in the hospital. There is no recruitment embargo with regard to emergency departments or the population there.

When we look objectively at the number of people who work in the hospital, the budget of the hospital and the bed capacity of the hospital now versus a couple of years ago, all those have moved in the right way. I accept that we need to move more quickly on that and that we need to be innovative and challenge ourselves with regard to interim solutions.

More broadly, on the issue of open disclosure when things go wrong, we have legislated in this House, through the patient safety Act, to try to create that culture so that when an incident happens - I am not talking about a specific one - people can share information, admit mistakes and engage in open discussion. There is a need for accountability, however.