Dáil Éireann debate -
Tuesday, 26 Apr 2005

Vol. 601 No. 2

Leaders’ Questions.

An Ceann Comhairle

Inview of the near habitual overrun in recent times, which on a given day can create a perceived lack of balance, I feel obliged once again to remind leaders of the strict time limits laid down in Standing Orders for Leaders' Questions. The time limits are as follows: the leader of the party, two minutes; the Taoiseach, three minutes to reply; leaders' supplementary question and the Taoiseach's final reply, one minute each, with an overall time of seven minutes.

As I readily acknowledged previously in correspondence, Leaders' Questions is regarded as one of the more visible and lively features of Dáil proceedings, enabling topical issues of the day to be raised early in the sitting day. In the spirit of the relative spontaneity of the procedure, as Ceann Comhairle, I rarely intervene at Leaders' Questions. However, in view of the overrun in time, I ask the leaders to co-operate with the Chair in ensuring that the time limits laid down by the House are adhered to. It is not necessary to remind the House that Leaders' Question Time is confined to the leaders of the Fine Gael and Labour parties, the designated leader of the Technical Group and the Taoiseach. All contributions by others by way of interruption are not in order.

Mr. Kenny

Let me test your edict, a Cheann Comhairle.

The Taoiseach will no doubt recall the furore around the country when it became known that the Government had signed on with the IRA for the early release of the killers of Detective Garda Jerry McCabe. I welcomed at the time the Taoiseach's withdrawal of this offer. Does he agree with the Garda Representative Association that the circumstances in which these killers are currently held in the Grove section of Castlerea Prison is completely inappropriate for the murderers of a serving garda? Can I remind him, in particular, that in his report of 25 February last, the Inspector of Prisons uncovered a shocking situation. He outlined that these prisoners appear to be running their own show in Castlerea, living in bungalows and ordering take-away meals. What steps has the Government taken in the two months since the report was published to clamp down on a situation where these people were effectively giving the two fingers to the McCabe family, the Irish Government and the Irish people?

The Taoiseach

I will try to be equally brief. The Provisional IRA prisoners have been detained in the Grove area in Castlerea since 1999, which is an open prison. I understand from everyone involved that it cannot be described as living in luxury. The McCabe killers, together with the other prisoners in Castlerea, are under no illusions that they are in prison. The governor is totally in charge in all prisons, including Castlerea. It is a matter for the governor to determine the duties of prisoners. It is entirely inaccurate to say that these prisoners are in control of the prison. The fact is that the murderers of Detective Garda Jerry McCabe are in prison. They will remain there for the duration of their sentence and, to the best of my knowledge, there are no proposals to change this.

Mr. Kenny

The Inspector of Prisons said in his report that a house in the Grove area has only two occupants, but they will not allow anyone else to share it unless they are attached to their organisation. How can it be the case in an open prison that a group, or members of a group, can determine who else the governor of the prison should put into a particular area? Can I remind the Taoiseach what the Minister for Justice, Equality and Law Reform said arising from a Dáil question last July? He said he had inherited the circumstances that obtain in the Grove, presumably from his very vociferous predecessor, Deputy O'Donoghue. Were the prison arrangements for these murderers ever the subject of discussions between Government representatives and members of the Sinn Féin Party? Will the Taoiseach give an assurance that the decision to locate these prisoners in the Grove area of the Castlerea prison was not the result of any secret deal with the leadership of the Sinn Féin Party?

The Taoiseach

The leadership of the Sinn Féin Party has argued vociferously since the signing of the Good Friday Agreement that the McCabe murderers should be let out under that Agreement. We have gone all the way to the Supreme Court to reject that. There were many attempts for us to come to an arrangement regarding this matter. I have explained to the House previously that the Government was once prepared to make such an agreement. There was no secret deal involved. Many prisoners have been moved out of the prison in Portlaoise over the years and in this case a number of prisoners were moved as well. When all the other prisoners were released in 1998 and 1999, the McCabe killers were the only remaining prisoners in this category held in the jurisdiction. Everybody else had been released. There might have been some INLA prisoners.

Quite frankly, we have moved to a position in which the McCabe killers are not being released. Any argument regarding where they are is a matter for the governor of the prison. The GRA never once raised this issue with me on the occasions on which it met me.

Mr. Rabbitte

Has the Taoiseach seen the appeal from the INO for him to declare a national emergency because of the crisis in accident and emergency wards throughout the country? Does he intend to respond to this request made in extremis by the INO? It is manifest that the Taoiseach’s Minister for Health and Children does not have the competence to deal with the crisis.

Many accident and emergency wards throughout the country are at breaking point. The relevant figures have been adduced in this House more than once. My colleague Deputy Howlin tells me about the circumstances in Wexford General Hospital, which was stretched to the limit. Thirty-five patients were on trolleys in what is a mid-sized to small-sized hospital. Deputy Costello advises me that an elderly patient in the Mater Hospital has been on a trolley for five days and five nights. This is the picture that obtains in most accident and emergency wards. The Health and Safety Authority warns that being in an accident and emergency unit could be a danger to one's health and safety. That is how serious this matter is.

Should this matter not be given overall political priority? The Tánaiste announced on the day the Estimates were published, 18 November 2005, that we would begin to see the "benefits" of her ten-point plan this spring. She has now revised this statement by saying she remains extremely hopeful that we will see measurable results by autumn 2005. The problem is going from bad to worse. The Taoiseach's Ministers are divided every which way. The Minister for Defence, Deputy O'Dea, jumped in to get one up on the Tánaiste by announcing facilities in St. Bricin's, which has turned out to be unsuitable according to the Health Service Executive Eastern Region.

Mr. F. McGrath

More hot air.

Mr. Rabbitte

In the absence of Máire Geoghan-Quinn, there is nobody to slap him down and send him back to the Curragh.

Mr. O’Dea

The mudguard has got it wrong again.

Mr. Rabbitte

Nobody seems to be capable of controlling the crisis in accident and emergency units. The INO has pleaded for the Taoiseach to intervene.

The Taoiseach

I have noted what the INO has said. Progress is being made on the implementation of the ten-point plan. The Tánaiste, her key officials and, increasingly, the Health Service Executive are spending considerable time trying to deal with this particular aspect. Many actions are being taken, including the freeing up of the acute beds and the efforts to improve the patient flows. I receive a report daily on what is happening.

Mr. Howlin

It is not working.

Mr. Broughan

Does the Taoiseach ever enter an accident and emergency unit? He should check them out for himself.

The Taoiseach

Improvements in the accident and emergency service are expected in the coming weeks as patients——

Mr. Broughan

First-hand experience is needed.

Mr. Howlin

It is just not working.

The Taoiseach

——ready for discharge from acute hospitals are placed in more appropriate care settings. The Health Service Executive is working with hospitals to deliver these measures as quickly as possible and to ensure the investments announced are being sustained.

Mr. Howlin

Ambulances were sent to Waterford from Wexford.

An Ceann Comhairle

Deputy Howlin's leader is well able to handle this question.

The Taoiseach

The HSE has completed its programme of inspections in the 11 hospitals.

Ms Burton

The problem lies with the Chairman's leader.

The Taoiseach

The HSA has acknowledged that the hospitals are fully engaged in the process of——

Mr. Howlin

Two separate discussions.

The Taoiseach

——-addressing health and safety——

Mr. Howlin

The Taoiseach is living on a different planet.

The Taoiseach

——in their accident and emergency units. As I stated, I believe all——

Ms Burton

It is waffle.

The Taoiseach

I do not believe that €70 million amounts to that.

Mr. Howlin

It is not working.

The Taoiseach

The home care packages——

Mr. Howlin

It has never worked.

The Taoiseach

——and the buying of beds from the private sector are progressing.

An Ceann Comhairle

I ask Deputies to refrain from interruption and to allow the Taoiseach to continue.

Mr. S. Ryan

It is very difficult.

The Taoiseach

We are contracting out long-term nursing care beds and providing acute medical units for non-surgical patients at Tallaght, St. Vincent's and Beaumont hospitals. We are ensuring that access to GPs is provided outside normal working hours. All of these measures are being implemented.

Mr. Howlin

It is having no impact.

The Taoiseach

They are having a sizeable impact in most of the hospitals.

Mr. Howlin

The Taoiseach should come down to Wexford.

Ms McManus

Where are they having an impact?

Ms Burton

Most of the——

An Ceann Comhairle

I ask Deputy Burton to allow the Taoiseach to speak without interruption.

Mr. Howlin

None of the Government Deputies turned up at the protest.

An Ceann Comhairle

If Deputy Howlin does not desist, the Chair will have to deal with him. I call on Deputy Rabbitte to speak.

Mr. Rabbitte

For the past eight years the Government has been promising that something might work. In spite of the ten-point initiative, announced with great fanfare by the Tánaiste and greeted by the media, which alluded to her unparalleled courage in taking on this problem, nothing has changed. The problem ought to be considerably less acute at this time of the year than it is. Not even the publication of the capital programme has been managed by the Tánaiste. She is locked in combat with the Department of Finance regarding its publication, which has been promised week after week. Meanwhile, real, live patients are enduring acute stress and distress under circumstances in accident and emergency units that would not be tolerated in any advanced country in the western world. The Taoiseach tells us after eight years in Government what he might do about it.

It is clear the Tánaiste allowed herself to be talked into doing a job by her party for which it appears she does not have the competence. Her having spent too long talking to American chief executives lead her to believe that all she had to do was enter the Department of Health and Children and exercise a certain managerial competence for it all to fall into place. It has not fallen into place but into ruin and decline in certain acute areas of the health service. There is no hope in prospect. I ask the Taoiseach again whether he will respond to the INO's request for him to intervene personally.

The Taoiseach

The Government works on these issues so there is no need for me to intervene personally. Everybody is involved.

The home care packages try to improve the flow in those hospitals that have a difficulty. These are mainly the Dublin hospitals and a few others around the country. The packages will free up an additional 500 beds occupied by older people. The only way to deal with this issue is to try to free up beds, including in private facilities.

I am the first to admit that there are problems but the figures I receive on a daily basis indicate that there are improvements. Yesterday's figures indicate that there was nobody on a trolley in Waterford. There is a problem in Wexford——

Mr. Howlin

Thirty-five are on trolleys.

The Taoiseach

No, it is 28.

Mr. Howlin

It is 35. I was in the hospital.

An Ceann Comhairle

Deputy Howlin should allow the Taoiseach to contribute.

The Taoiseach

If the Deputy can count better than those who produced the official figure, then it is 35.

Mr. Howlin

I was there.

The Taoiseach

I am giving the Deputy the official figures. If he does not want to——

Ms McManus

The Taoiseach is massaging the figures.

An Ceann Comhairle

The Taoiseach without interruption.

Mr. S. Ryan

Will the Taoiseach join Deputy Broughan and me in Beaumont Hospital? Does he know where it is?

The Taoiseach

The number of people on trolleys in accident and emergency units is as follows: seven in Cork University Hospital, three in Tralee, four in the Mercy in Cork, six in Drogheda and zero in Louth, Monaghan and Navan hospitals. There are some——

Mr. Crawford

It is zero full stop.

The Taoiseach

I am just making the point.

Mr. Quinn

The Taoiseach is beginning to sound like Comical Ali.

An Ceann Comhairle

Deputy Quinn is no longer leader of his party. Deputy Rabbitte is the only one entitled to submit a question.

The Taoiseach

The country does not stop on the outskirts of Dublin.

Mr. Howlin

It certainly does not.

The Taoiseach

The Irish Nurses Organisation may point out to me that there is a problem in certain hospitals, which I know, but it could also point out there are many hospitals where there is no problem.

Mr. Howlin

The Taoiseach is doing nothing about it.

Mr. Crawford

Nothing is the word.

The Taoiseach

Deputy Howlin knows in his heart that people moved to Waterford because there was no problem in Waterford that day. Was that not a sensible thing to do? Did he want more people in Wexford?

Mr. Howlin

The Taoiseach seems to think people should go to Cork or somewhere else. They would spend another one and a half hours in an ambulance.

The Taoiseach

It is nice to see Deputy Howlin has turned up today. He has not been here for weeks. I have answered Deputies Rabbitte and Howlin.

An Ceann Comhairle

The Chair wishes to put the House on notice that seven members of the Labour Party interrupted the Taoiseach today. The Chair will not tolerate that behaviour and will be obliged to ask Members to leave the House. It is not possible for a Member on either side of the House to be frustrated in making his or her contribution. For the benefit of Deputy Burton, the Chair is totally independent of all political parties in this House.

The Taoiseach

It happens every week.

Caoimhghín Ó Caoláin

Last week I asked whether the Taoiseach is an ostrich and of course he did not reply. His reply to the questions from Deputy Rabbitte a few moments ago confirms the answer to that question. He told the House on this most pressing issue of accident and emergency units that where there is nothing, there is nothing.

When he said there was zero people on trolleys in Monaghan General Hospital he showed that he knows nothing about the reality despite the fact that I, and others in this House, have continually told him there is no accident and emergency unit at Monaghan General Hospital. That is why there are no patients on trolleys at that hospital.

At the start of this week 249 patients were on trolleys in accident and emergency departments. If the Taoiseach and the Tánaiste and Minister for Health and Children were seriously addressing this crisis they would recognise that hospitals such as Monaghan General Hospital, and others for which the Taoiseach said there were zero people on trolleys, have beds beyond their requirement that are not occupied and should be used to relieve the overcrowding in neighbouring hospitals. The Taoiseach must recognise the issue in Monaghan General Hospital relates to the overcrowding and intolerable situation at Cavan General Hospital.

Is the Taoiseach aware that the Irish Nurses Organisation has called on him to do something specific, not just to intervene? It has called on him to declare a national emergency in regard to our health services. Is he conscious of that position and will he spell out exactly what he and the Tánaiste are doing to address this crisis instead of repeatedly trundling out the same mishmash reply prepared for him in his Department, with the aid of the Department of Health and Children? The Taoiseach must face up to the reality and give the answers we and the people who are suffering need.

The Taoiseach

Yesterday there were just over 200 people in accident and emergency units awaiting beds.

Mr. Rabbitte

There were 249 people.

The Taoiseach

The official figure for yesterday supplied by the Department of Health and Children is just over 200, not 249.

Mr. Rabbitte

I would not rely too heavily on the counting in that Department.

The Taoiseach

Every year 1.25 million people pass through accident and emergency units. Many hospitals which have accident and emergency units deal satisfactorily every day with emergency cases. In approximately six hospitals the numbers are consistently large. I have pointed out to the House on many occasions the type of actions being taken in accident and emergency units, including putting in large numbers of medical and nursing staff resources, capital and other facilities that will help.

There are several hospitals where problems are caused by the inadequate flow of patients from acute beds back home or elsewhere, and of those from accident and emergency units who need to be moved into beds. They cannot——

Ms O. Mitchell

We know that.

Mr. Rabbitte

We know that. The problem has existed for five or six years.

The Taoiseach

The Department of Health and Children and the Health Service Executive state that the hospitals require other beds in order to rectify this problem. We have put together several action points to assist in this, which are being implemented. Buying beds from the private sector for step-down care is one measure and yields approximately 500 beds. Another point is to install acute medical facilities in hospitals where there is a continual problem, for example, Tallaght Hospital, St. Vincent's Hospital and Beaumont Hospital. I have previously spoken about facilities for beds and temporary beds being considered for the Mater Hospital.

We are also trying to establish GP out-of-hours services in the regions of these hospitals. All these measures are under way. Resources have been made available for capital equipment and for staffing, although the staffing issues have been dealt with. These improvements are under way. Until those actions are completed and properly implemented we will not be on top of this issue for the four or five hospitals that have a continual problem. In other areas, such as Limerick——

Ms O’Sullivan

There is a problem in Limerick.

Ms Hanafin

Not this week.

The Taoiseach

I go through these figures every week but there is no problem in Limerick Hospital this week. There is no problem in Galway.

Mr. Broughan

That is what the Taoiseach's spin doctors say.

Ms O’Sullivan

I spoke to someone who spent a night on a trolley.

The Taoiseach

There is no problem in Cork. There is a problem in Dublin and Wexford. I have outlined the measures we are taking. There is a capital issue in Wexford which is being studied too.

Ms Burton

Is there a war between the Department of Health and Children and the Department of Finance?

An Ceann Comhairle

Deputy, this question was asked by the leader of Sinn Féin and is not a Labour Party question. I ask the Deputy to behave herself and allow the Taoiseach to speak without interruption.

The Taoiseach

If the Irish Nurses Organisation wishes to work with us to resolve these problems, as I hope it does, the Government will work with it.

Mr. Rabbitte

It is working night and day.

Caoimhghín Ó Caoláin

In the course of his reply the Taoiseach said "the staffing issue has been resolved". How does he expect the Irish Nurses Organisation to respond to that claim? The staffing issue has not been resolved. That is one of the key problems that needs to be addressed but has not been addressed because there is no improvement whatsoever in the service.

Is the Taoiseach aware that the Irish Nurses Organisation has indicated that 100 beds could be brought on stream in accident and emergency provision in Dublin but are being held up because of a "black hole" in bureaucracy between the Health Service Executive and the former Eastern Regional Health Authority? Is he aware when he says Galway does not have a problem that Galway has a repeated overcrowding problem yet 60 beds in the University Hospital there remain closed?

The recent report of the Health and Safety Authority states that overcrowding has led to an unsafe environment for staff and patients. What action is the Taoiseach taking to address that dreadful situation?

The Taoiseach

The Health and Safety Authority, following its report on accident and emergency services in 11 hospitals, is working with the Department of Health and Children and the Health Service Executive to resolve some of the problems it highlighted. The problems involve capital issues, cleanliness and the provision of new facilities and equipment, details of which I gave last week. Obviously the position has not changed since last Wednesday.

There has been a substantial increase in staffing in accident and emergency departments in recent years and in the number of nurses and supervisory nurse positions. In the five or six hospitals where there is a problem, we will continue to work with the Irish Nurses Organisation and the hospital management. The Health Service Executive is working daily on this issue to try to overcome the difficulties in the four of five hospitals that continue to have a problem.