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Dáil Éireann debate -
Tuesday, 17 Jan 2012

Vol. 751 No. 4

Leaders’ Questions

After the budget the Taoiseach said in the House: "One tries to protect those who are vulnerable, isolated and caught in a trap." Nothing could be further from the truth as the detail of the budget has shown the exact opposite. The pupil-teacher ratio will rise significantly this year with the proposed removal of approximately 450 posts from DEIS schools, up to 800 career guidance positions and hundreds more from small rural schools across the country. The burden of the costs is such that students most in need of support will be hit.

Despite an independent evaluation of the DEIS scheme, which highlighted the great progress made, the Minister for Education and Skills, Deputy Quinn, recommended as long ago as September that the scheme be cut. He said he could not find "any objective and equality grounds" for retaining it. In the past few days, however, he has reflected on this. He has realised that his decision was wrong and said: "I'm out of practice. We're getting back into the business of trying to do this. It's very difficult to adjust these kinds of things, you're dealing with calculations and assumptions." This admission explains a lot because it is obvious the Government looked only at the figures and amounts that could be saved and coldly dismissed the social cost of the cuts and decisions affecting children in education.

I visited St. Laurence O'Toole's school, a small school of 60 boys and eight teachers, in the inner city this morning. It told me that if the cuts go ahead, it will lose five teachers. Scoil Íosagáin in Farranree in Cork will lose up to 13 teachers. Scoil Padre Pio, on the north of Cork city, will lose five. The latter two schools are both Breaking the Cycle schools.

Could we have a question, please?

The Taoiseach will have to admit that the evaluation shows the enormous progress that has been made under the DEIS scheme. Does the Taoiseach agree tremendous progress has been made and can he outline to the House the mechanism the Government now intends to deploy to reverse the cuts to DEIS schools?

I sympathise with those concerned on the tragic loss of life in Glandore and hope the efforts being made will conclude what is a great tragedy for the families of those involved.

I am well aware of the beneficial impact of DEIS schools on pupils. As Deputy Martin is aware, the Minister for Education and Skills set out, following his analysis, that he should receive a report from his Department inside the next four weeks that will consider the impact and benefit of DEIS schools in bands one and two and determine what savings can be made within his Department's Vote for 2012 to alleviate, where possible, the problems that exist. The Minister has clarified his position on this and I expect that the report will be brought to the Government within the next four weeks.

There can be no question of any reversal of the overall figures. They have been voted through by the House and the Government. The Minister, Deputy Quinn, has set out that if he is to find alleviation measures, they have got to come from other locations within the Department of Education and Skills Vote. The Minister will present his report to the Cabinet and to the public when he receives it in the next four weeks.

I have visited a number of DEIS schools over the years. Some cases have been more beneficial than others. I have seen the impact directly upon numbers of students who have benefited greatly. Given the circumstances that can apply in any DEIS 1 or DEIS 2 school, as the Deputy is aware, there can be a greater impact in some cases than in others.

I join the Taoiseach in sympathising with all those affected by the terrible tragedy in west Cork.

With regard to the specifics of this issue, I am very disappointed with the Taoiseach's reply because he is saying there is no question of a reversal. Given the implication and the indications from the Minister, there seems to be a tendency or a pattern whereby when an issue reaches a certain critical point, the Government says it will review and look at it. This is why I raise it again today having raised it in the House on 14 December. The teachers and the schools involved want specifics. When the Taoiseach says he is looking at something, what does that mean? Will he reverse it? Will he change it? Can those schools look forward to a significant change in the proposals that are currently before them? For example, can a school that is facing the loss of five teachers seriously hope, and not just hope but be assured, that this will not turn out to be the case?

How can the Taoiseach not reverse a situation where a school can lose up to half its complement of teachers? The Taoiseach should not second-guess this scheme. There has been independent evaluation of DEIS 1 and DEIS 2.

We are over time.

As a principal said this morning, it is a showcase for the rest of Europe in terms of its impact on literacy, numeracy and school planning and, given the success of the approaches adopted by the DEIS schools, has been rolled out across all schools throughout the country.

Thank you, Deputy.

If the Minister says it is wrong, it should be reversed. I want specifics on this from the Taoiseach. What does he mean when he says he is looking at it? Will he outline to us a mechanism that would involve the schools themselves, the Department and everybody collectively involved to change and reverse this decision?

What I mean is that the decision was made here and €158 million extra was granted for 2012 for additional facilities, including for primary and second level schools included in DEIS. That involved additional teaching posts, funding for school books and extra capitation funding.

Do not mislead the House. No DEIS school is getting an additional teacher.

If the Deputy lets me answer his question, I will. The Vote allocated to the Department of Education and Skills for 2012 will not be changed. The Minister for Education and Skills, if he wishes to bring alleviation measures into this segment, has got to find other savings within his Department Vote. I hope that is clear.

I want to get your position. You are Taoiseach.

This is not a case of attempting to reverse a budget that has been voted on and put through by the House. A range of issues have been brought to my attention, even in the past two days.

The teachers think it will be reversed.

For instance, why is that if a principal teacher in a primary school wishes to join the Irish Primary Principals' Network, IPPN, the subscription for that comes from board of management funds?

What about the CE schemes?

What about the disability cuts?

If anybody wants to join any organisation, they pay their subscription.

That is a minor issue compared to schools losing teachers. The Taoiseach should come back to the issue of DEIS.

Will the Deputy please desist?

The Minister is looking at all of this. Deputy Martin should remember we are talking about very big organisations. There has been an acceptance under the overall arrangements for the Croke Park agreement of the situation in so far as the professions are concerned. One has to find money to run the services. The Minister for Education and Skills has now committed to having a report received in the next four weeks. If there are alleviation measures to be found, they must be found within the Department of Education and Skills Vote. I hope that is very clear.

The Taoiseach is hurting the most vulnerable in the community. He has to change it.

Tá Sinn Féin leis an Taoiseach agus leis an Teachta Martin maidir leis an tubaiste millteanach a tharla ag an deireadh seachtaine. Tá ár smaointe le teaghlaigh na hiascairí. Beidh pobal an cheantair faoi dhobrón ar feadh tamall. Caithfear tacaíocht a thabhairt dóibh agus d'iascairí na hÉireann. I join the Taoiseach and Deputy Martin in extending solidarity to the families of the fishermen who are lost at sea off the coast of Cork. Our thoughts are with their families.

The Minister for Health proposes to close between 550 and 900 public beds in community nursing homes this year. Some homes will close entirely. The Government's plan, to which the Labour Party has signed up, has been unveiled and will mean the loss of acute hospital beds, cuts to community mental health and disability services, 3,300 staff cuts and a fall of 500,000 in the number of home help hours, and the planned bowel cancer screening programme has been put back to the end of the year.

These are the Taoiseach's choices. It is his Government's plan, its strategy and its programme. This confirms that the health and welfare of people is to be sacrificed by Fine Gael and Labour in pursuit of a failed economic strategy that is destroying public services, employment and economic growth. The people, particularly vulnerable elderly people in nursing homes, are in the grip of fear and some despair, including in my own constituency in nursing homes at Drogheda and Ardee. Staff, elderly patients and their families want clarity. The plan is short on detail. I have yet to hear of any proposal from the Minister for Health or the Taoiseach to bring this forward for discussion here. Will the Government provide this detail, including identifying those community nursing hospitals that will be closed?

Over €13 billion has been allocated for the health budget for this year, which will be a very challenging year. Clearly, this will require serious analysis of the structural changes that have to be made. What do we in this House want in respect of our health service? We want a service that is provided for people as close to them as possible, that deals with their medical needs as quickly and efficiently as possible and to the highest standard possible, based on the most efficient cost, as distinct from what they have in their pocket.

We can pretend things are going to be as they were, when person after person has pointed out for years the inefficiencies that have been contained within the health structure. The Minister, Deputy Reilly, is not afraid to tackle this problem. We must get to a point where the Government's objective of having universal health insurance made available for every person, treated on the same basis, at the end of the Government's term, is brought into being. This means focusing now on the provision of primary care centres, whereby people do not have to go to accident and emergency in the first place and there is a clear emphasis on community care.

Why is it that up to 40% of people who are assessed for long-term geriatric care are never asked where they would like to be? The vast majority of people I come across, and who we know of from all over the country, want to stay in their own homes for as long as possible. We do not want a situation where people are being sent from acute care hospitals directly into long-stay institutions. We can either continue with what we had or we can change it. We are going to change it. We want a situation where people go from acute hospitals into step-down centres until they are better and can go back to their own homes, backed up by proper home care packages and community care-----

The Government is closing them all.

This is Enid Blyton stuff.

-----and stay in their own homes until such time as they may have to move to an institution.

There is no home help.

The home care packages for 2012 remain at the same level they were in 2011.

Until the money runs out.

Will Members stay quiet, please? It is Deputy Adams' question.

The Minister has already ordered a review of the fair deal programme where people are looking at this from a very sensitive point of view. The HSE clearly believes there are still inefficiencies in the area that need to be looked at. This year, €35 million has been ring-fenced for the whole area of mental health, which had become sidelined for so many years. A further €15 million is allocated for general practitioner cards for those who have a long-term illness. It is not all doom and gloom. I admit this will be a very challenging year for the health services, in particular for hospitals that are carrying over a deficit or overrun from last year, given the budget for this year. We can pretend things are all right but they are not. We have to change the structures and provide a health system we believe is in the best interests of our people, young and old alike. That is the objective of this exercise. It will not be without challenge but it is necessary in order to have a proper health service for all our people.

I asked the Taoiseach a specific question about identifying those community hospitals which are to be closed. He dodged the question and answered questions that were not asked. I am not pretending everything is all right - on the contrary. This does not add up. The Taoiseach says there is a focus on community care. Why then cut 500,000 home-help hours? If there was a focus on community care he would not do that. This is just an appalling vista.

The Taoiseach asked what everybody in the House wants from their health service. What the Sinn Féin party wants is equality, not only in our health services but in every aspect and sector of life in this so-called republic. Nothing can be more iconic in what is going wrong at present than to see elderly people in their beds on picket lines. That is what we are doing. The most vulnerable elderly people are out in the cold on picket lines campaigning to have their nursing home space reserved and protected.

I do not want to see any person in the category mentioned by Deputy Adams out on the streets. Elderly people were out before when a decision was made about medical cards. They were very articulate and vociferous and knew exactly where the sore point was. Some of those people were in wheelchairs. I do not want to see that, nor does the Deputy.

The Minister for Health, Deputy Reilly, has already visited a number of community nursing homes and is now involved with those communities in looking at the imaginative and creative ways in which they want to assist in the provision of extra facilities in order to keep open some of the community facilities and nursing homes that might be in danger of closing down.

You are going to close them.

It happened last summer.

The figure mentioned in the HSE plan, which will be debated in the House, is for 555 beds. Some nursing homes will close.

They are targeted.

Some of these are very old and would require very substantial investment-----

Before Christmas the Taoiseach said he would close more.

-----to bring them up to the standard required today. Some will close because there are better facilities available for the people who live in them. I understand the community pressure that comes from people not wanting to have to move from a location where they may have been a patient or resident for some time.

It is their home.

Yes, it is their home and we want to make their home as comfortable as can be.

(Interruptions).

The Deputy does not want people to be in a home that is not designated as fit and up to safety standards-----

After years of underinvestment.

-----and where there clearly is waste in the system.

This will leave them with no home.

The Minister has met with a number of communities already to discuss how some of these homes might be kept open.

The Deputy asked me for lists, names and locations of homes that may close. That is an issue that was debated in the Chamber. I do not have a list in front of me of homes designated for closure-----

That is for the Taoiseach's colleagues.

-----simply because the Minister is involved with the communities to discover the situation in the homes in question and to discuss their future. Communities are focused on wanting to retain these homes and are prepared to back it up. They are giving much more co-operation than are many Members of this House.

On behalf of the Technical Group I offer my deepest sympathy to the families of the fishermen who died at Glandore Harbour in west Cork and to the fishing communities of Ireland and Egypt. It was a very sad day, in particular because the incident happened only 2 km from land.

I raise the issue of our health service and the debate about front-line services, particularly in regard to the announcement yesterday about the proposed cuts of €700 million in 2012. I nearly choked on my cornflakes this morning when I heard the Minister for Health saying there would be no cuts to front-line services.

(Interruptions).

What planet is the Minister living on? Is he really serious? Does the Taoiseach agree with him that when €700 million is removed from the HSE budget there will be no cuts to front-line services?

Is the Deputy sure it was not a microphone?

How can the Government provide services to our senior citizens when it closes 555 beds in community nursing hospitals? What are these people going to do? Will the safety of older people be compromised?

Looking at the Government's proposals of today and yesterday, does the Taoiseach accept that more than 600 people will lose their home helps? Does he accept there are cuts of up to 10% on disability front-line services? Does he accept there will be a reduction of 7% in child protection services? Does he accept there will be fewer day care services, respite and personal assistants for people with disability and that there will be no increase in home care packages in 2012?

Are all these not front-line services? How can a health service be run without having the resources and the staff to provide the services?

A Deputy

Hear, hear.

The Minister, Deputy Reilly, faces the reality in which we live in this country in 2012. He is not one to shirk his responsibility, being both a medical practitioner and Minister for Health. He wants to see that the very best level of health service is provided for all our people. That will not happen-----

He has a funny way of going about it.

-----unless there are serious changes made to the structure and the way in which the health service is run and provided for. I do not accept that elderly people will be compromised nor do I accept many of the assertions the Deputy made.

The HSE plan has been published and approved by the Minister. Details of it need to be examined and teased out. The Minister has identified areas where there will be savings and where targeted savings will be achieved. There are to be further reductions in numbers but we do not yet know the actual figure. The initial assessment was for a very high level of retirements of the order of 4,500 but I understand this is now anticipated to be in the region of 3,200. The Minister has increased the drugs payment scheme monthly threshold by €12 and various measures to reduce drug costs are included in his programme for 2012.

Next year the introduction of legislation to allow public hospitals to raise charges in respect of all private patients, even if they are not in a designated private bed, will add greatly to the capacity of public hospitals to deal with their business. There will be extra efficiencies built into the targets for disability, mental health and child care services. I do not accept the assertions made by the Deputy.

As I noted in reply to Deputy Adams, this will be a very challenging year for the health services. I commend those workers in the health services who have bought into the very necessary changes that are coming so that we can and will provide a health service of which we can be proud, for our young, not so young and elderly alike. The end objective is to have that service available to people of all categories, as close as possible to them, as efficiently as possible and based on their medical requirements, as distinct from what they have in their pocket. That involves primary care centres, home care packages, community relationships and the changes to the structures that are set out in the programme approved by the Minister. This plan will be debated in the House and we can go into it at greater length if the Deputy so wishes.

The Taoiseach stated he does not accept my figures. These figures come from the Minister and his proposals and were given to me by the service providers. As a backbencher I deal with the reality of sick and disabled people every day.

In the past the Taoiseach promised to cut waste in the health service, something all Members support, just as we strongly support reform. Is the Taoiseach not taking his eye off the ball? Will the Taoiseach accept that groups such as the Carers Association and the Irish Senior Citizens Parliament share these concerns about the cuts to elderly health services? What will happen to those elderly people who live at home but depend on local hospital provision? Does the Taoiseach accept patients did not cause this economic and banking crisis? Why should they have to pay for it?

For once and for all, will the Taoiseach put to rest the claim that under these proposals his Government will cut the 34 en-suite beds for cystic fibrosis patients at St. Vincent's University Hospital to 20 beds when the patients and their families were promised they would not be? If it is not the case, why are his backbenchers expressing strong concerns on this matter to the Minister for Health, Deputy Reilly?

Deputy Finian McGrath is aware the Health Service Executive, HSE, national service plan, published yesterday and authorised by the Minister for Health, has a budget of €13.317 billion for 2012. As outlined in the plan, a minimum number of 555 nursing home residential beds may close in 2012 — 111 in HSE Dublin mid-Leinster, 105 in HSE north east, 180 in HSE south and 159 in HSE west. These figures are indicative. The Minister for Health is engaged with communities about the viability of several existing homes.

It should also be noted the service plan includes an additional €55 million for the nursing home support scheme in 2012, equivalent to what it was in 2011.

It will dry up quickly.

We will see about that.

Consequently, it is anticipated there will be 23,611 people availing of the scheme this year, an increase of 1,200 from 2011.

The figures in the HSE service plan have been set out by the Minister for Health. I do not accept Deputy Finian McGrath's assertions that elderly people will be left aside and neglected or there will be a disruption of the magnitude as described by him in many services.

We will wait and see.

I cannot give Deputy Finian McGrath a definitive answer on the cystic fibrosis services at St. Vincent's. The Minister for Health will respond to him on that.

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