Leaders' Questions

I am seeking some clarity and transparency regarding the future of publicly-run nursing homes. There was a very strong article in last Sunday's Sunday Business Post on what is an impending crisis in terms of publicly-run nursing homes not meeting the standards set down by the Health Information and Quality Authority, HIQA. Some 21 of the biggest publicly-run nursing homes are now at risk of closure due to lack of investment by the State in enabling those institutions to become compliant with HIQA standards. The alarming aspect of this is that no funding has been provided in the 2015 Estimates to bring those 21 homes up to standard. They span 14 counties, six in County Cork alone. We are talking about institutions such as Peamount, Leopardstown Park, Gorey district hospital, Tralee, Monaghan, Nenagh and many others, and of course St. Finbarr's in Cork city, Castletownbere, Bandon, St. Joseph's in Bantry, and St. Joseph's in Millstreet. The bottom line is that unless the standards are met by July, or unless there is some indication of a real commitment to meet those standards, the options are closure of the institutions, a significant reduction in beds, or closure of high-acute or high-dependency units.

The director of the HSE has warned that there is not enough funding there to sort this out. I want to know whether there is a creeping policy of privatisation by stealth. In other words, is it the Taoiseach's view that these institutions will wither on the vine and will close naturally through lack of investment on his part, and that HIQA will have to intervene? HIQA has been very clear in saying that if a centre is not in compliance by July 2015, and if no realistic time-bound, costed, funded plan has been agreed with the authority, then appropriate conditions will be attached to any renewal of registration. We need a bit of honesty from the Government now about what is going to happen.

That would be a first.

I do not know what the Deputy is implying by that last remark.

The Taoiseach should go to Balbriggan.

It is only right and proper that there should be quality nursing home services available for people who have to avail of them, underpinned by a proper system of registration and inspection. Deputy Martin is well aware of the age and structure of many of the older public homes around the country, which have evolved from county homes into other structures such as we have today.

There is no privatisation by stealth going on here. The nurses and personnel who worked in the public homes for so many years gave wonderful service in systems that are inadequate today but served a purpose over many years. HIQA has clearly said that the discussions going on between the HSE and itself arise from public units around the country that are currently registered but due for de-registration in 2015 or 2016. HIQA has indicated that a number of these facilities do not fully meet the standards one would expect in a modern nursing home. That is not surprising given that the age of some of them is in excess of 100 years. There are 119 public nursing homes, as Deputy Martin is well aware.

Over the last years, the capital programme of the HSE has, within the resources available to it, brought a number of the public long-stay units to full infrastructural standards as required by HIQA, and it will continue to invest in long-stay units over the time ahead. Last year, €36 million was allocated in the capital plan for the continued upgrade of public residential facilities and €122.34 million has been allocated for the period ahead. I also understand from the Department of Health and the HSE that there is adequate flexibility for solutions to be found, both within the terms of the existing legislative proposals and through discussions currently going on between the HSE and HIQA, and between HIQA and the Minister of State, Deputy Lynch. The HSE has been working with HIQA over the last months to meet the de-registration requirements of the units involved, and the Department of Health is in regular contact with the HSE on this issue.

It is true to say that the fabric and structure of many of the public nursing homes is very old in the sense that some of them are 100 years old. Efforts have been made over the last years to bring some of them up to the standards HIQA requires. It is true to say they are not all up to standard now. They have been identified by HIQA, discussions are going on between HIQA, the HSE and the Minister of State, and €122 million has been allocated from this year to bring them up to full infrastructural standards. The flexibility within the existing system will hopefully allow for a service to be provided and continue to be provided until the facilities can be brought up to full HIQA standards in the time ahead and the law can allow for that to happen.

That is not a straightforward, honest answer. We just want facts.

Is it dishonest?

People would like to know.

Is it dishonest?

It is not telling the truth to the public concerned. These are very important centres in the communities. I know that questions were asked last week by the Sunday Business Post and others. I have named 21 long-stay facilities. Can the Taoiseach answer a simple question? Have plans been submitted in respect of each one of those 21 hospitals, including Castletownbere, Bandon, Bantry, Peamount, Leopardstown? Has funding been matched to the plans that have been submitted? It is simple, and no-one could give the answer at the weekend. It is all fudged and "discussions going on" and this, that and the other. HIQA had to dismiss any suggestion that there was an amnesty, which the Minister of State had said at the time. The Minister of State herself, to be fair, dealt with this issue in a written reply 12 months ago and said the money was not going to be provided - "Bearing in mind their age and structure, public nursing homes face real challenges and require investment in excess of the funding that will be available in the short to medium term." That was January 2014. Move to November 2014, and we have the Minister of State saying "my Department and the HSE are working to establish the options that may be available in this regard and how we can ensure that older people continue to be looked after." That is the kind of meaningless stuff one gets when no-one has an answer to the problem. We are getting more of it today, with respect to the Taoiseach.

I think the people in those communities, the staff and the communities that depend on the long-stay beds would like to know a very basic answer. Is it policy to upgrade these units? Is the money going to be provided? It has not actually been provided in this year's Estimates. Some €7.3 million has been provided for the upgrade of the nursing homes, while €300 million was asked for by the Director General of the HSE, Mr. Tony O'Brien. He is saying that is what it will take. There has been no publication of a three- or four-year plan, and it has been known for five years that July 2015 was to be the date. There is no public plan that we are going to do X, Y and Z over the next three years in terms of the long-stay beds in these institutions. I think it is a legitimate question - what is really going on behind the scenes?

Give Leo a ring.

The Deputy's sense of righteousness is extraordinary. He wanted to know answers to some questions. I cannot answer the question for him as to whether every one of the 21 facilities he has mentioned have submitted plans for planning permission, whether planning permission has been approved for them, or whether funding has been provided in the budget for each of these 21. I cannot answer that question now but I will find the answer for the Deputy.

The Taoiseach should have that answer now. This has been public knowledge for a long time. That is the problem. He should have it now. There is too much fudging.

The Minister for Health and the Minister of State have all the details about these things.

I said to Deputy Martin that €36 million was allocated in the 2014 programme.

I will give Deputy Martin the extent of the works carried out, completed and brought up to standard for that €36 million in order that we will have it not, as Deputy Martin has suggested, in a dishonest fashion but straight upfront. I will also give Deputy Martin the extent of applications that have been lodged and, in respect of the 21 cases to which he referred, whether planning permission has been granted and whether they are considered to be up to the standard required by HIQA as well as what moneys will be spent on them in 2015. I will give Deputy Martin this in detail so that he will not be able to come to the House and say that anything is being fudged. Everyone understands that of the 119 public nursing homes we have-----

We have been asking for 12 months.

Some of these are 100 years old.

If so, Deputy Martin does not seem to remember it. The fact is that a number of these are not up to modern-day standard.

Tell us which ones.

The Government publicly supports and will continue to support a public nursing home service provided in public homes for people who avail of this service.

They has never been enough money, nor is there enough now. What we must do is decide on the flexibility within the law, which homes can continue to give service for the time ahead----

Will the Taoiseach tell us which ones will close?

-----and how best we can bring the other facilities up to the standard of modern nursing homes such that the people who use them can be comfortable and secure.

Will the Taoiseach tell us which ones the Government is going to close?

The standards that applied years ago when Deputy Martin was Minister do not apply any longer.

We have been looking for the list for two years.

The Taoiseach might add St. Joseph's Hospital, Ardee to that list. I have been trying to get clarity on that for the past 18 months.

Yesterday at the IMF conference the Taoiseach and his Ministers lined up to be patted on the head for the austerity targets that they have achieved but which have inflicted widespread damage to our society and our people.

What about the damage of the bombs?

The Minister for Finance, Deputy Noonan, is reported as saying that the troika did not consider the effects its policies would have on the people. This begs the question: did the Government not tell the troika this? Did the Government not care about the effects it would have on our communities and people? Perhaps the Government did not see this as its responsibility. Madame Lagarde said that it was up to each individual government to decide on the mix of measures. Those in government will remember that Sinn Féin has told them as much many times.

It is also reported that the Governor of the Central Bank acknowledged that it was a mistake for the Government to recapitalise the banks. He is reported as saying that to avoid unsustainable pressure on the Sovereign, the capital should have come from an external source. Again, Sinn Féin told those in government this arís is arís.

What did the Taoiseach say? He said that for his part he would not have "defaulter" stamped on his forehead. Since then, the Taoiseach has surrendered on the issue of retrospective recapitalisation and has committed to repaying every cent of the Anglo Irish Bank debt. The conference yesterday was a disturbing reminder of how the Government has failed to deal with these crucial issues in the past and, perhaps more important, how it continues meekly to serve the interests of the elites.

Meanwhile, the Taoiseach may wish to know that there is support - it is growing rapidly - for the Greek demand for a European debt conference. Neither the Taoiseach nor his Minister for Finance has called for a debt conference. Neither the Taoiseach nor the Minister for Finance has supported that call. Why not? Will the Taoiseach now rectify that situation? Will the Taoiseach now support the call for a European debt conference, which is so clearly in the interests of this State and all our citizens?

First, I was not at the IMF conference yesterday. Deputy Adams's intelligence sources are slightly off.

Then the Taoiseach got his pat somewhere else.

When the troika took over the country after the Government removed itself from the press conference centre some years ago, the main Opposition party said that nothing could be changed from the programme that the troika had set out.

Did that include Sinn Féin?

This Government made arrangements to face up to the challenge with the people. It did so by building a programme which, through the tax system, would allow for jobs to be created and sustained and for our economy to grow. The challenge was accepted and, as was pointed out at the conference yesterday, the real winners and heroes of that challenge are the people.

They are the real losers.

That is astonishing condescension.

Deputy Adams made a point about what he told everyone years ago. He said that those in Europe should go and get stuffed and take back their money with them as well. Deputy Adams said that we had surrendered - an unusual term - the possibility of retrospective payout in respect of the decision made on 20 June 2012. For the information of Deputy Adams, the Minister for Finance has made it perfectly clear that the Government is examining all the options to determine the best option and to get the best result for the taxpayer. This Government did not put any money into Anglo Irish Bank. The previous Administration did, and that is dead money.

It did. What about the promissory note?

What we have tried to do and what we are trying to do is make choices in the best interests of the taxpayer to recover all the money that has been paid into the banks by this Government since it came to office. Deputy Adams will be aware that the State has earned returns of €10 billion from the banking sector. A total of €5.4 billion in income has come from the guarantees, fees and capital investment, while €5 billion has come from the sale of investments in Bank of Ireland preference shares and the sale of Irish Life. The Minister for Finance, Deputy Noonan, has carried out an examination on the potential in respect of receipt of income back to the taxpayer from AIB. As Deputy Adams is aware, from a process of interested competent people, Goldman Sachs, on a pro bono basis, is carrying out that initial survey.


The State's holding in AIB, Bank of Ireland and Permanent tsb is currently valued at €15 billion. That valuation can be broken down as follows: €13.3 billion in AIB, Bank of Ireland equity stands at €1.4 billion and Permanent tsb at €400 million. Therefore, it is not true to say that the Government has abandoned the decision of 20 June 2012.

The Government will decide on the best choice to make in respect of getting back the most money for the taxpayer. That is the main interest of this Government, unlike its predecessor.

I note the Taoiseach has studiously avoided answering my question, which was very simple and straightforward. I will repeat it so that the Taoiseach will get an understanding of it. Will the Taoiseach now support the call for a European debt conference, which is so clearly in the interests of this State and all our citizens? That is what I asked the Taoiseach.

Once again, the Taoiseach attributed a remark to me that I did not make. The Taoiseach has simply refused to negotiate with our European partners. Every time the Taoiseach went there, he prefaced his visit by saying that we will not default. He tugged the forelock. He said we will not have "defaulter" stamped on our foreheads. This was totally contrary to the declarations of "Not an inch", "Frankfurt's way or Labour's way" and "Not a red cent to the banks".

Taxpayers' money has been put into these bad banks and the so-called debt, but it is not debt, it is greedy speculators, financiers and some politicians who created the situation. The Government has amalgamated this private debt with sovereign debt. Now, we have the Commissioner saying this and we have the Minister claiming that the troika did not take account or consideration of how this would affect the people here.

Once again, we have to wait until the Greek people vote. We should not have to wait until the outcome of an election in another state for the Taoiseach to stand up for the interests of the people or indeed for working people throughout the European Union. Regardless of what government Greek citizens elect, the Taoiseach needs to put a debt conference on the agenda of the European Union.

Obviously, the Taoiseach is not blind to the effects, the impact or the social inequality which the Government's policies have inflicted on communities, families and citizens nor to how our social protections have been destroyed. A European debt conference opens up a very real prospect of this State's debt being significantly reduced. It would free up money for health and other public services as well as stimulus for the economy. It is a straight question for the Taoiseach. Will he support, call for or endorse the call for a European debt conference?

No. Will the Taoiseach explain why?

It is not for Ireland to interfere in the issues that are raised in the context of a general election in another country.

These are issues here.

Gabh mo leithscéal.

These are issues here.

Is that a sound of reception or what do I hear?

That was the sound of despair. I had hoped that the Taoiseach would make some sense - stupidly.

The point is, Deputy Adams, that Ireland's position is very different than Greece-----

What about the Taoiseach's remarks regarding Prime Minister Cameron?

Sorry, Deputy, please.

The point we have arrived at now, because of negotiations between the Minister for Finance and the Minister for Public Expenditure and Reform and the troika, is that Ireland is in a very different place than Greece.

We were always in a different place - that is a matter of geography.

While we respect the challenges that face the Greek people in the time ahead, with 25% unemployment, it is their decision who to elect in the forthcoming election. Ireland is now in a position where our capacity to borrow is at unprecedentedly low levels and our growth rate is the fastest in western Europe. That does not mean that the Government is by any means happy, despite the fact that unemployment has fallen for 30 months in a row. We must continue providing stability because stability brings investment, confidence and jobs. The answer to the problems of unemployment, recession, disillusionment and despair is to have an economy that is functioning strongly and where jobs can be created-----

And a government that stands up for its people.

In the context of Greece, Ireland is in a very different position.

They have much less emigration than we have. They have half of our emigration levels.

We now have a strategy and a plan that has been proven to work and that will continue to work in the time ahead. We want to see the country in three to five years' time with an economy that is strong and powering ahead and where jobs can be created for our people.

What about the debt?

Finally, Deputy Adams is wrong again in that the Government here was well able to negotiate with our European colleagues in respect of reducing the level of debt imposed upon us because of the catastrophe arising from the banking debacle. We have had evidence of what happened there from the recent comments coming from the banking inquiry.

Those comments are incorrect.

Of course, Deputy Adams has always put forward the view that everything is positive and rosy from a Sinn Féin perspective. Did I hear somebody say today that Sinn Féin is now a party to removing 20,000 public servants from work in Northern Ireland over the period ahead?


Thank you Deputies. Deputy Maureen O'Sullivan please.

Yesterday afternoon I attended a press conference organised by Justice for Magdalenes Research, supported by Amnesty International, the Irish Council for Civil Liberties and the National Women's Council. They all acknowledged the Taoiseach's apology, its integrity, that it was heartfelt and gave so much hope to the women. That apology led to the work of Mr. Justice Quirke and the recommendations he made in his report which were accepted here in June 2013. The ladies of the Magdalen laundries expected that all of those recommendations and proposals would be put into action.

The Redress for Women Resident in Certain Institutions Bill 2014 is not honouring all that was recommended by Mr. Justice Quirke. For example, he found that a significant number of women faced difficulties managing their affairs, many of whom are living in institutions or nursing homes and he recommended certain things for those women who were lacking full capacity so that the payments would be for their benefit. The Bill, however, makes no provision for the appointment of care representatives to ensure that this happens. Mr. Justice Quirke was very clear in his first recommendation that the Magdalen women would have access to the full range of services currently enjoyed by holders of the HAA, Health Amendment Act, card. A range of services provided by that card are being denied to the ladies from the Magdalen laundries. Such cards are known as enhanced cards. I heard last night, after the press conference, that enhanced cards will be made available but I would like the Taoiseach to confirm today that this is the case for the ladies from the Magdalen laundries because it might require a policy order from the Taoiseach to ensure that this happens.

I thank Deputy O'Sullivan for her comments and I can confirm that for her. I should remind the House that this was a matter that was neglected for over 60 years. This Government listened very carefully to those women who were in the Magdalen laundries. We asked Mr. Martin McAleese to prepare a report on this and subsequently appointed Mr. Justice Quirke to draw up an appropriate scheme for the Magdalen women. The Government is fully committed to implementing in full the Quirke report. Under the scheme, women are entitled to a payment of €11,500 to €100,000, depending on their length of stay. In addition, they receive top-up payments of €100 weekly if they are under pension age and up to €230.30 when aged 66 or over, depending on other State payments. To date, a decision has been made in 87% of cases and 495 applicants have received payments totalling €18 million.

Mr. Justice Quirke also recommended that the women should have access to an enhanced medical card, as Deputy O' Sullivan pointed out. He also specifically recommended that legislation be introduced to give effect to that recommendation. The new Bill to be introduced will provide an enhanced medical card. The legislation is modelled on the Health Amendment Act of 1996. The Bill was published in December and is expected to be introduced in the Dáil later this month.

I note the statements to which Deputy O'Sullivan referred, attributed to the Justice for Magdalenes group, suggesting that the Redress for Women Resident in Certain Institutions Bill 2014 only provides regular medical cards to the women as opposed to the HAA card recommended by Mr. Justice Quirke. To be clear, Mr. Justice Quirke in his report recommended that the women receive medical services equivalent to those provided to the holders of HAA cards. He also pointed out that not all of the services described in the guide may be directly relevant to the Magdalen women and any comparable guide for the Magdalen women would require suitable adaptation. The new Bill is similar to the 1996 Act and specifically provides for GP and surgical services; payment for drugs, medicines and medical and surgical appliances; nursing services; home help; dental, ophthalmic and aural services; counselling services; and chiropody and physiotherapy services. There will also be no requirement to pay the statutory charge for public acute hospital in-patient services.

The 2014 scheme is focused on the medical needs of the women under the scheme. Many of the services are accessible through referral by a doctor or nurse. The only substantive services that are not included under the new scheme are non-conventional therapies. The HSE funding of expenditure by Positive Action on complimentary therapies such as angel healing, emotional freedom techniques and dancing the spiral led to severe criticism and Positive Action itself was wound up in May 2014. The Minister does not wish to see the important medical supports that will be provided by the enhanced medical card undermined in any way by the inclusion of controversial, unconventional therapies. I hope that answers Deputy O'Sullivan's question.

It is good that the Taoiseach has confirmed that the enhanced card will be available to the ladies from the Magdalen laundries but it is a shame that once again, stress and tension was brought into their lives because of the fact that they were not clear on that point. They have acknowledged what has been done to date and progress has been made, there is no doubt about that. Why can we not get it 100% right instead of 60% or 70%, so that all of the outstanding issues are addressed?

The McAleese report was disappointing because it had a very narrow remit. I listened yesterday to many stories from the ladies from the Magdalen laundries which were not covered by the McAleese report, which was also pointed out by the UN Committee Against Torture. There are issues outstanding and as the Government is making progress, it should go for 100% progress instead of falling short. Those ladies deserve much more.

I thank Deputy O'Sullivan for her comments. In many cases, this information was already in the public domain but I hope I have clarified it for the Deputy and the women who were concerned now.

In respect of the last portion of the Deputy's question concerning other women in Magdalen homes, elements of that are being addressed under the mother and baby homes commission of investigation that was set up by the Minister for Children and Youth Affairs, particularly in respect of women who were in Magdalen homes who were exiting State services or State support.

In respect of the Deputy's question about the enhanced medical card and the services provided, I hope the position will be absolutely clear for those women who were the subject of the report on Magdalen homes and in respect of whom the State wanted to be as generous and flexible as possible in providing a wide range of services. These women are getting on in years and deserve recognition and support from the State.