Dáil Éireann debate -
Tuesday, 20 Feb 2007

Vol. 631 No. 6

Leaders’ Questions.

Mr. Kenny

This issue is somewhat like a recurring decimal. Today the figures from the Irish Nurses Organisation show that 392 patients are on trolleys across the State. This is not unique, as last week there were 383 on trolleys. On Wednesday there were 378 on trolleys. In October 2004 the Minister for Health and Children announced a ten point plan to deal with accident and emergency departments with great fanfare. Seventeen months later, in March 2006, while still Tánaiste, she declared the crisis in accident and emergency units to be a national emergency. Today, however, nearly 400 patients remain on trolleys across the State.

It has come to the point where Beaumont Hospital has issued a statement asking people not to attend its accident and emergency unit except in emergencies, because of the extreme pressure on its services, as 52 patients wait for admission. This is appalling. The hospital now has more than 100 patients waiting for a bed to become available in a more appropriate post-acute setting. It is advising people not to attend its accident and emergency services.

We have had ten years of this from Fianna Fáil and the Progressive Democrats. We have had overcrowding, the spread of infectious diseases, hundreds of patients on trolleys every month, the figures for which are massaged, while operations are cancelled every year. Some 29,000 people are on waiting lists. They have been failed by the Government.

It is about time politicians in the Government parties, particularly Members, were exposed to what is happening because they are secreted away. I will go to Beaumont Hospital at 6.30 p.m. today and invite the Taoiseach to come with me. Let us get stuck in traffic if we must. Let us go to the accident and emergency unit and meet the patients waiting on trolleys who must put up with the remnants of what was supposed to be a world-class health service. I challenge the man of the people to come with another and examine this issue.

The Taoiseach

I understand Beaumont Hospital is having a bad day. If Deputy Kenny is going around chasing ambulances, it is a bad way to be. The Health Service Executive continues to report significant improvements in the number of patients awaiting admission as compared with the same period last year.

Mr. J. O’Keeffe

One would not want to be in a bad way.

Mr. Howlin

The Taoiseach sounds like Comical Ali.

The Taoiseach

The average number of patients on trolleys awaiting admission in February to date is more than 50% lower than in February last year. However, a small number of hospitals, particularly Beaumont Hospital, are having difficulties in the delivery of accident and emergency services. There have been on average 19 patients per day awaiting admission at Beaumont Hospital during this month. At 8 a.m. today 40 patients were on trolleys in the hospital awaiting admission, five of whom were waiting longer than 24 hours. However, it is still a considerable improvement on last year; the plans have led to improvement. However, it is outside the range of what the HSE is trying to achieve. Out of 52 hospitals, I understand four are in that position.

One of the main problems affecting Beaumont Hospital is the unacceptably high number of patients awaiting discharge to a more appropriate setting. The HSE is working with the hospital to address the issues involved. The hospital has taken a number of steps to alleviate the situation in its accident and emergency department, including opening a five-day ward over the weekend, which is helping.

In fairness to the HSE, those working on the winter initiative and on delayed discharges, the figures are substantially down. Beaumont Hospital has a significant number of beds, 138 in total, occupied by patients whose discharge has been delayed. This effectively means they do not have a location. They cannot go home. Out of 550——

Dr. Cowley

A total of 27 are waiting for beds at Mayo General Hospital——

The Taoiseach

In reply to Deputy Kenny——

Dr. Cowley

——14 of whom are hidden away in a transit lounge.

The Taoiseach

——out of the 552 there are 130——

Dr. Cowley

Some 27 people are waiting for beds at Mayo General Hospital.

An Ceann Comhairle

I ask Deputy Cowley to resume his seat.

Dr. Cowley

One man has been waiting for nine days in the accident and emergency department.

An Ceann Comhairle

If the Deputy does not resume his seat, he will leave the House.

Dr. Cowley

Old-age pensioners cannot get a bed.

An Ceann Comhairle

The Deputy will have to leave the House.

Dr. Cowley

It is unacceptable that 14 patients are on trolleys.

An Ceann Comhairle

There is no place for discussion. Leaders' Questions cannot be interrupted in this fashion.

Dr. Cowley

Some 27 people altogether are waiting, 14 of whom are hidden away in a secret ward. One man is waiting nine days for a bed.

An Ceann Comhairle

I move: "that Deputy Cowley be suspended from the service of the Dáil. Is that agreed?

Mr. F. McGrath

Not agreed.

Dr. Cowley

It is unacceptable that——

Mr. Kenny

I do not need Deputy Cowley's advice——

An Ceann Comhairle

I ask Deputy Kenny to resume his seat. The Chair is dealing with disorder in the House.

Dr. Cowley

Some 27 people are waiting for a bed in Mayo General Hospital.

An Ceann Comhairle

Deputy Cowley is to leave the House.

Mr. F. McGrath

It is not agreed.

An Ceann Comhairle

If the matter is not agreed, a vote will take place on the issue tomorrow morning. Deputy Cowley is to leave the House.

Mr. Rabbitte

We will vote tomorrow to cause him to leave.

Dr. Cowley

It is unacceptable that 27 people——

An Ceann Comhairle

It is not appropriate to come in and disrupt Leaders' Question in that fashion. The Deputy should show some respect for the Parliament.

Mr. Kenny

Deputy Cowley is unlikely to become leader of the Fine Gael Party.

We had a relatively mild winter. Thanks be to God we did not have bird flu. There does seem to be a mild outbreak of influenza which is causing this problem. The Taoiseach has not answered my question or accepted my challenge. Last Friday a 90 year old man was admitted to the accident and emergency department at Mayo General Hospital having fallen in his house. At 1.40 a.m. on Saturday his 81 year old wife was contacted by the hospital to state the patient was being sent home. She has difficulty looking after herself, never mind looking after her husband. This is not the world-class service we were promised.

In a case from Galway, an 86 year old woman must wait two years for a seat which will allow her take a bath after she was placed on an emergency list by the Health Service Executive. In a case from County Cork, an appointment was made for a person on 15 July 2008. In heavy black print the letter states that if the person concerned is unable to attend, the outpatients' department should be notified on a number given in order that another patient may benefit. This is what we are at.

I repeat again that I will go to Beaumont Hospital this evening, which is not far from the Taoiseach's constituency. People have been told not to attend the accident and emergency unit because services are completely overstrained. Is the Taoiseach prepared to come with me to see what is happening on the ground there? I will give him backing if he takes appropriate action to sort out these matters.

Mr. F. McGrath

The Taoiseach lives in Dublin North-Central.

The Taoiseach

Deputy Kenny is going to Beaumont Hospital at which I am a regular visitor and at several other hospitals. In the past few weeks I have been in hospitals in all of the provinces, as I am sure the Deputy also has. I am well aware of what the position is. I am also well aware that Beaumont Hospital is having a difficult day. I have given the Deputy the figures.

I must tell the House that the improvements over last year are enormous. More than 50% down is the number of patients waiting——

Mr. Allen

Falsified figures.

The Taoiseach

In reply to Deputy Kenny——

Mr. Allen

Massaged.

The Taoiseach

——the figures are extremely good across all the teaching hospitals, as well as other hospitals. I see the figures every day because I get the chart from the Minister for Health and Children. Of the 52 acute hospitals, about six have difficulties. The others are managing very well and the HSE is actively assisting them.

A range of areas around Beaumont Hospital operate the HSE d-doc system in north Dublin in centres in Swords, Hartstown, Ballymun, North Strand and Coolock. This is helping dramatically. Approximately 8,000 patients have been seen under the scheme. The HSE rolled out 90 of the primary care teams last year, with 120 this year.

A number of improvements have been made in the minor clinics, the rapid access clinics which were part of the plans of Minister for Health and Children, Deputy Harney. They now open five days a week from 9 a.m. until 6 p.m. Referrals are taken from hospitals, including hospitals in the north inner city and Beaumont Hospital. The service will be extended to accept referrals from the other teaching hospitals and a wider network of general practitioners. To date, the service has supported almost 200 patients and is targeted to provide a service for 2,000 per annum. These measures are all hugely helpful.

A home service for patients from the five participating Dublin hospitals, as well as James Connolly Memorial Hospital and GPs in the north city and county area is available from 8 a.m. until 10 p.m. There are community intervention teams. A whole range of points put in the action plan by the Minister for Health and Children are now operating very effectively.

Mr. Broughan

Not in Beaumont Hospital

An Ceann Comhairle

Allow the Taoiseach, without interruption.

Mr. Allen

It is a bluff.

The Taoiseach

The number of flu patients is up this week. I have given the figures for Beaumont Hospital.

This House should at least acknowledge the huge commitment, effort and success of the staff in the field every day doing a very good job and getting us through the winter with an excellent service.

Dr. Twomey

It is the Government's commitment we are worried about.

Mr. F. McGrath

We need more beds.

Ms Lynch

More beds.

The Taoiseach

The HSE has published the results of its national survey on the experience of patients using accident and emergency departments. The survey was carried out by the Irish Society for Quality and Safety in Healthcare with the RCSI and MORI Ireland. Some 76% of patients were satisfied with their experience in accident and emergency departments and 86% of patients with a choice of service would choose the same accident and emergency department.

A patient who reported he or she received less information, advice and pain relief than it was felt required were more likely to be dissatisfied with the service. Some 50% of patients who needed to be seen by a doctor were seen within one hour of the initial assessment.

Mr. Gormley

Statistics.

The Taoiseach

A further 25% were seen within three hours. While there might be problems on a daily basis and we can all run around waiting for the day to go to a hospital when it is experiencing problems, thousands of staff are on the ground doing an excellent job and I commend them for it.

Mr. N. Dempsey

Hear, hear.

Mr. Allen

Nobody said they were not.

Mr. J. O’Keeffe

The Government is the lot not doing a good job. It is time to go.

The Taoiseach

They are doing their best.

Mr. J. O’Keeffe

Time to go.

Mr. Allen

The Government has no answers.

Mr. F. McGrath

It has not delivered in ten years.

Mr. Rabbitte

I wish to raise the 28th Amendment of the Constitution Bill, which I received this morning. Other Deputies would have received it somewhat earlier. What clarity can the Taoiseach provide on its processing from here?

I understand there are seven propositions encompassed by the Bill. There are actually eight but one is the simple transfer of a section from the existing article of the Constitution to the new proposed article. Of the seven propositions, two are related to criminal law, with the other five related to issues of the upbringing or custody of children, welfare, care, guardianship, adoption etc.

Does the Taoiseach accept that these are two easily distinguishable and separate issues? One issue relates to criminal law and the protection of children from sexual predators and the other relates to the welfare of children. One has been the subject of detailed examination by the All-Party Committee on the Constitution. There is a consensus on the question of the zone of protection for children among all parties in the House.

The other five proposals have not been the subject of any such discussion, although there is a necessity to tease out their implications. They are complex and there has been no national debate, which would appear to be required.

I remind the Taoiseach of the Whitaker review of the Constitution in 1996 when the question of a prohibition on two different questions of substantive different effect was discussed. Consideration was given as to whether it was permissible or if there should be a prohibition on two such different questions being taken in a single vote. The review of the Constitution concluded it could rely on the good sense of the Oireachtas to separate two such distinct issues.

When my colleague, Deputy Howlin, was being briefed by the Minister of State with responsibility for children, it was also Deputy Brian Lenihan's view. It was certainly his view in 2001 when he was chairman of the All-Party Committee on the Constitution. As I understand, he has been stating he has an open mind on that issue.

We have not had the opportunity to discuss this in the House. The Labour Party agrees to proceeding as soon as possible with the absolute zone of protection for children and allowing adequate time for a national debate on the other five matters, which would make sense. This could be done in conjunction with the general election, for example, or sooner if the Government so wishes. We should take the issue and dispose of it as all parties in this House are agreed on the necessity to protect children in those circumstances and allow an opportunity to debate the other bundle of issues.

The Taoiseach

I have been fair, frank and open about this. I would be very glad to hear the Deputy's conclusions. He stated last week that if we published the legislation, he would examine it with legal and other advisers and give his view on it.

The outline of the legislative proposals lists four areas of legislation which can be addressed under the particular amendment, with legislation relating to sexual offences. A great deal of work has been done by the Joint Committee on Child Protection in this area and, in general, the Government accepts its recommendations.

That explains our position on the two issues that remain outstanding before legislation can be finalised. Yesterday we went through all the issues and the Minister of State, Deputy Brian Lenihan, went through all the points in great detail afterwards. We listened to the Opposition's comments.

Our view is that all these issues need to be dealt with. The Deputy has stated that five of the issues are not contentious. There are seven issues — the Deputy says eight — and six are not considered contentious. Some people may think two are contentious, although we do not. We believe we can engage on the matter and I would ask the Deputy to arrange for his spokespersons to enter into arrangements with us to consider the issues.

We would rather have one question but we are not absolutely embedded in that position. It is our preferred view and we believe it could be done. It does not create a difficulty. I have already given my view on timing. It is possible to proceed as we have proposed and we have been advised to do so in this fashion. There is no difficulty and we have cross-checked it with a large range of people, as have people in various organisations in the field.

We will listen to views and I have stated that we want consensus before we can go forward. I do not want to indicate that my position is the only one and that I will not listen to anyone. I am not saying that. Six of these issues do not create a difficulty and I cannot find anyone who would raise them as a problem. If there is a wish for a discussion on the other two we will have it.

Mr. Rabbitte

My point is not that six of the proposals are uncontentious and two are contentious. Rather, my point is that they are distinctly different. It is claimed that some relate to the rights of children, with the others concerning the protection of children. The Joint Committee on Child Protection was referred to by the Taoiseach.

I am not even asserting that two issues are contentious as I have not concluded so for myself. These issues have not been debated. There has been no national discussion on them.

Given that the genesis the situation was last May and that the time that has passed is not the fault of this side of the House, does the Taoiseach see merit in proceeding with the two amendments on the zone of protection for children and the issue of soft information immediately or contemporaneously with the general election so that both can be put to the people as quickly as possible?

I do not claim to speak for all parties in the House, but they are of a like mind, as demonstrated at the joint committee. We could proceed on that basis and provide adequate time for all those who want to discuss complex and complicated issues relating to the family and the balance of rights between children and the family. We should be more concerned about getting this right than doing it in a hurry. Is there not merit in there being two separate questions?

An Ceann Comhairle

The Deputy's time has concluded.

Mr. Rabbitte

The Taoiseach seems to be saying he is not wedded to a single question. The Whitaker review considered the question of whether there should be a provision prohibiting the submission of a Bill containing a number of proposals for amendments with different substantive effects for decision by the people in a referendum by means of a single vote. It concluded that while there should not be such a prohibition, one could rely on the common sense of the House to distinguish into separate questions where matters have different substantive effects. That is manifestly the case in this instance and there is a strong argument for dividing the issues.

The Taoiseach

I have listened to the arguments and I will not get into an argument on this because I want to try to get agreement on it. It did not start last summer. Some of the other issues were raised in the Judge Catherine McGuinness report of 1993, moved onto the constitutional review of 1996 and into the debate on the Children Acts between 1996 and 2001. Other issues formed part of the adoption review, which has gone on for a long time. There are different issues concerned with trying to help the rights of parents and families.

The wording, we believe, strikes a balance between the rights of children and the rights of parents and families by replacing Article 42.5, which contains, according to our advice and constitutional advice, limited protections for children, with a new dedicated children's article. It contains a number of different, substantial and practical elements, all of which will protect the rights of children. None will undermine the role of parents or the constitutional safeguards for the family. We have been careful in all our discussions to try to define these.

Many people who have examined this and been involved with it believe it is commendable to have such a balance. As the Deputy knows, there is a broad view. I accept that people need time to examine the wording and that they cannot do it the day following publication, but I ask the Deputy to examine the wording, take his advice and to come back to us.

We believe we can do this in an integrated way. I accept that some people have argued that, perhaps, there is an alternative to putting it into one question with this wording. The people working for the Government on this came to the unanimous conclusion that this was the best way to do it, but I am not saying that there are no other views. We are prepared to listen to those views and, as soon as the Deputy has had a chance to put those to us in discussion, we will be glad to listen.

I would like to try to deal with these issues during the current Dáil or, if they have not been dealt with comprehensively and fully, to bring them as far as we can. The House must reach an agreement on how best to do that. This is our proposal and it is our view that we could take the Bill through, but if the Deputy wants to talk to us, as he obviously does, we are open to that.

Mr. J. Higgins

Could we have a modicum of honesty from the Government regarding the legal costs of tribunals? Last week, the Taoiseach's deputy, the Tánaiste, gave a brazen display of hypocrisy regarding the costs of the planning tribunal, posturing as a defender of the taxpayer and taking a leaf out of the Taoiseach's book of pretending to be the Opposition while holding responsibility for what is happening.

Mr. J. Brady

There is no Opposition.

Mr. J. Higgins

Thanks to letters acquired from the Department of Finance by the Irish Daily Mail via freedom of information requests, we know that eight years ago, the Tánaiste, who was then the Attorney General, demanded of the Department of Finance a doubling of the daily rate of lawyers’ fees in the planning tribunal.

Mr. F. McGrath

Hear, hear.

Mr. J. O’Keeffe

He is a bloody hypocrite.

Mr. J. Higgins

The Department's officials stated the Taoiseach wanted the same and demanded full resources.

Mr. F. McGrath

Answer that.

Mr. Quinn

Benchmarking.

Mr. J. Higgins

What do we know of the Tánaiste? In his three years as Attorney General, five years as the Minister for Justice, Equality and Law Reform and, decades previously, time in the Four Courts representing his clients whenever he managed to take the silver spoon or silver foot out of his mouth, he commanded massive fees. We did not hear a peep about the ruinous cost of fees not only to tribunals, but to ordinary working people who are priced out of getting justice because of the greed emanating from certain sections of the barrister class.

With a brass neck, the Tánaiste appeared to be posturing as a defender of the taxpayer last week. We know the sight of cameras and microphones triggers seismic tremors deep in the Tánaiste's psyche——

An Ceann Comhairle

The Deputy's time has concluded.

Mr. J. Higgins

——and uncontrollable vocal emissions pour out.

Mr. J. O’Keeffe

Delicately put.

Mr. Rabbitte

One could trade them internationally.

Mr. J. Higgins

When the Tánaiste goes on rant-about, would it be too much to ask media editors that rather than behaving like apostles on whom tongues of fire have descended when he speaks, they would bring some critical analysis to bear on what he says and check the record?

Deputies

Hear, hear.

Mr. J. Higgins

Last week, they lost a golden opportunity to unmask a blatantly dishonest posture. Rather than encouraging further posturings by wall-to-wall coverage——

An Ceann Comhairle

It is not appropriate to cast reflection on a Member of the House or anyone else. The Deputy is sailing close to the wind.

Mr. D. Ahern

He is at it all of the time.

Mr. F. McGrath

The poor Tánaiste.

An Ceann Comhairle

I ask that Deputy Joe Higgins treat Members with some respect.

Mr. Kehoe

The Ceann Comhairle feels sorry for the Tánaiste.

An Ceann Comhairle

Policy is fine, but personality is not.

Mr. J. O’Keeffe

He is quoting facts.

Mr. Rabbitte

There is no Standing Order against preventing a Member from shooting himself or herself in the foot.

Mr. F. McGrath

The poor Tánaiste, leaker of the year.

Mr. J. Higgins

This is the same Minister for Justice, Equality and Law Reform who, three nights ago, stood up and dared to attack me and Independent Deputies as being supporters of a slump coalition. I would not worry about his sensitive nature.

An Ceann Comhairle

This is not a discussion about Members.

Mr. Allen

The only thing slumping is the Progressive Democrats Party.

An Ceann Comhairle

The Deputy's time has concluded.

Mr. F. McGrath

Injury time.

Mr. J. Higgins

Does the Taoiseach take responsibility for the monstrous costs involved in these tribunals because he failed to curb them, does he admit that the scandal of cost was raised with him and the then Tánaiste, the Minister for Health and Children, many years ago by myself and other Deputies and what does he propose to do to allow the investigation into corruption, which must be unmasked, to continue while curbing these outlandish fees for which the taxpayer will be liable?

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach.

The Taoiseach

The answer to the Deputy's question is that, yes, several years ago, we increased both the staffing and fee levels of the tribunals. In 2004 we introduced new legislation to increase the number of judges and to attempt to speed up the modules. We did this when the tribunal indicated it would not finish its work until 2016. At that stage we introduced a new regime which ends at the end of this month. The Minister for the Environment, Heritage and Local Government is in discussions with the tribunal as to how agreement may be reached on the modules and the fees for the future.

Mr. J. Higgins

What has the Government concluded as regards the planning tribunal, for example, in terms of how long more it should run? Has this been discussed and has a decision been made by Government in this regard? How is it proposed to curb the legal costs? The Taoiseach has not given the House notice of any specific measure to place a limit on the legal costs which are bearing down on the taxpayer.

I remind him this is a much wider issue, involving justice for ordinary working people, and the poor, who simply cannot afford going to court and risk the enormous fees that may fall on their heads should they be unsuccessful. It is an extremely serious issue, not just for the taxpayer, but as regards working people generally. Taxpayers have inadvertently made several millionaires out of lawyers in the tribunals in recent years, but they themselves cannot afford to darken the doorway of the Four Courts should they need to go there because they cannot risk the costs. What concrete measures is the Taoiseach proposing today to curb this ruinous level of costs in tribunals and for people generally?

The Taoiseach

The Government is dealing with a number of the tribunals as regards costs. We must reach a conclusion because the dates are up shortly for some of these. The date for the planning tribunal is 31 March, and it is clear for a variety of reasons that its work will not be finished on that date or for a long time afterwards. The Minister for the Environment, Heritage and Local Government, Deputy Roche, is trying to reach a conclusion as regards what modules are outstanding, how long they are likely to take and what to do about costs. It is not just a question of the planning tribunal. This must be dealt with as regards other tribunals as well. It will take a few weeks and this is being negotiated between the tribunals and the Minister, Deputy Roche.