Leaders' Questions

I raise the question of how we are treating elderly people in our hospital system and the complete absence of dignity in such treatment. We were all appalled last week when we heard the story of Gerry Feeney, who spent more than five days in the emergency department in Beaumont and was denied the basics of daily living, such as eating, dressing, bathing and getting out of bed, when he was moved to the geriatric ward. Essentially, there was an absence of dignity at the end stage of his life. A number of us have come across an extraordinary letter written by a specialist registrar in emergency medicine in Beaumont hospital, some of which was reported in the media this morning. This individual, who has experience in many hospitals across the country, wrote that the emergency department at Beaumont is unequivocally the most dangerous unit in which he worked. He described it as a poor starting point that critically unwell patients, who have the misfortune to need acute unscheduled care, have their care delivered on chairs. Similarly, he could not fathom how patients on trolleys in front of the nurses' station could ever be regarded as an acceptable solution. He suggested that exposing these patients to sleep deprivation over a period of 24 to 48 hours in a noisy and chaotic emergency department is the equivalent of a health care Guantanamo. He has regularly witnessed elderly patients actively deteriorating and developing delirium during their time in this no-man's land. He thought it a sad indictment of the system that such practices form an accepted part of the day-to-day operation of emergency care in the hospital. He also made a number of disturbing points about heart-breaking apologetic conversations with patients.

While he pointed out that there is a need for a change of culture in Beaumont, I put it to the Taoiseach that last week the Minister for Health stated unequivocally to the Joint Committee on Health and Children that he needed more resources for the fair deal scheme, home care packages and home help provision for elderly people. We are aware of the link between delayed discharges and the chaos in emergency departments across the country, particularly in Beaumont.

The Deputy should ask a question. We are way over time. There is a two minute limit.

The Minister said that he made the Taoiseach aware of the budgetary issues and that a spending plan could be brought forward later in the year. Does the Taoiseach intend to act now? The Gerry Feeney case arose some weeks ago and that doctor's letter was written in December.

I ask the Deputy to co-operate with the Chair. He is over time.

Will the Government make the decision to provide the necessary spending plan to take people out of their misery and give some dignity back to elderly people in our hospitals?

The Minister commented on the case of Mr. Feeney and the situation that arose in regard to him. This is not the first time I have seen letters from medical personnel working in hospitals. We had many cases over the years of doctors, consultants and specialists writing letters about the difficulties in the health system. It is not an acceptable situation. The Minister responded to the issue this morning on national radio. He has established a task force to deal with delayed discharges and the situation that has arisen in a number of hospitals, some of which have traditionally been worse than others in the sense of being able to deal with delayed discharges and beds being blocked. The Minister has pointed out that when he worked as a young doctor in Beaumont hospital, the situation was equally bad even though it was a time when there was a lot more money. That is not to say the situation is in any way acceptable, however, and for that reason the emergency task force dealing with the question of delayed discharges and access to further beds is critical. As Deputy Martin pointed out, there is clearly a link between people who have had treatment in hospitals, the insufficient availability of accommodation for them and delayed discharges. The result is that back-ups build at the point at which people require admissions.

The prioritisation of home care services for those who require discharge to their own homes is one area. In regard to the provision of transfer care beds, the HSE has approved more than 1,000 places across the country since 6 January 2015. It is also in the process of opening a number of public beds across the country. Some 173 are being targeted and community health care organisations are currently sourcing staff and making arrangements to deal with this as quickly as possible.

We have been a waiting a long time for them already.

These include eight of 16 beds opened in Clontarf orthopaedic hospital, with the remainder to open in the coming weeks. Cuan Ros has the potential to provide 25 additional beds. In respect of St. Vincent's in Fairview, agreement has been reached to proceed with the opening of beds subject to staffing. Twenty beds are available in the Royal Hospital Donnybrook on a temporary basis, with five currently open. In Ballinasloe, County Galway, work is underway to commission additional beds, to a maximum of 25 in this unit. In Merlin Park in Galway city, five additional beds were opened last week. In Ballina District Hospital, there is potential to open ten beds, with five targeted immediately.

It cannot get staff.

In Heather House in Cork city, the remaining four beds are now open. In Farranlea Road in Cork city, ten beds are opening incrementally. In Killybegs, an additional eight beds are available as needed. It is not a satisfactory position but the emergency task force established by the Minister continues to work diligently on this matter.

The Taoiseach said that the situation is not "satisfactory". That is a mild word given the content of the letter from the specialist registrar and the experience of people attending emergency departments. The Minister for Health told the Joint Committee on Health and Children last week that additional resources are needed for the fair deal scheme. He outlined two realistic options, namely, reprioritising spending or bringing forward a spending plan later this year. He also outlined a third, pretending the problem will go away in the summer, which he indicated is not really an option. The latter is a total nonsense which few people believe. This is the same man who three months ago said he had a realistic budget and expressed the hope that matters would become more manageable in October, particularly for those working at the front line. How naive was he last October? The bottom line is that matters have not become more manageable; they have become worse, as the Minister himself has acknowledged. Yesterday he agreed it is undeniable that the system is struggling. The Taoiseach can sort this out.

Will the Deputy put his supplementary question?

We are well over time. I am getting into trouble with other Deputies for running over time because they are not getting the same coverage as Deputy Martin.

The Minister said he cannot make the decision on the spending plan on his own.

Please put your question.

He said that it must be done in conjunction with the Cabinet committee on health and the Economic Management Council, the members of which are fully appraised of the situation since last November. Does the Taoiseach accept that the funding levels are not adequate to deal with this situation in the coming months, including in respect of delayed discharges and their impact on emergency departments, to take people out of their misery and bring some dignity back? Funding is part of the answer to that. The Minister has said as much. Will the Taoiseach now take the decision, as Head of Government, to do something about it?

Is Deputy Martin criticising him or standing by him?

That would be a question for Deputy Deasy.

As Deputy Martin will be aware, if money was the solution to the problems in the health system they would have been sorted long ago. He had some responsibility for that himself in a situation which did not work out. This is the first year in a number of years in which there was a substantial increase in the allocation for the health Vote. Some €500 million was allocated to cover an overrun from last year, as well as an additional €150 million as an increase in the budget for this year.

They are false budgets.

As part of the collective responsibility of Government, every Minister signed off on his or her respective budget. The HSE submitted its service plan which is now being implemented. Clearly, there are challenges in that, which is why the Minister established the task force to look at the fair deal scheme, the review of which is being brought to him very shortly, and at the question of opening 1,000 beds across the country to deal with delayed discharges so people who are treated in hospital have the opportunity to have suitable accommodation and beds made available while they recuperate.

It is an absolute disgrace.

The number of citizens lying on trolleys in hospitals this morning stands at 520. Within my constituency, there are 40 people on trolleys in Our Lady of Lourdes Hospital. Conditions in the emergency department at Beaumont Hospital are now so bad that a senior emergency department doctor in a letter to hospital management and the HSE described them as the equivalent of health-care Guantanamo. According to Eilish O'Regan in the Irish Independent this morning, the letter was written in December and prior to the escalation of the current crisis. The doctor says that critically ill patients are receiving blood transfusions on chairs and heart attack patients are regularly treated on chairs. He struggled to get a trolley for a man with liver failure while two patients with advanced cancer were doomed to sit on chairs for 24 hours. He had to resuscitate a patient who suffered a cardiac arrest after being placed in an annex corridor.

A HSE report shows that there are 705 hospital patients who no longer need to be in hospital. They should be discharged to nursing homes, rehabilitation beds or their own houses with home care packages. However, the Government will not put the money into that. Age Action Ireland has described these patients as prisoners of the State. Will the Government now prioritise a solution to this crisis by immediately increasing the number of step-down beds and ensuring the fair deal scheme is adequately funded? Will the Taoiseach speed up funding for house adaptations and home help packages?

I have already read out details on some of the 1,000 extra beds that are being opened across the country and set out the fact that the Minister is awaiting the finalised review report in respect of fair deal. The number of elderly people over 65 years of age this year is 604,000 and that will rise by 100,000 in the next five years to over 700,000. A task force has been established by the Minister to look at the question of delayed discharges and step-down facilities and the issue is being addressed through the opening of 1,000 beds nationally.

As I said to Deputy Martin, this is not the first time we have had letters written by senior medical personnel about the conditions they find in hospitals. Even if one had the money to allocate in the morning, one would still have a problem with the range of available accommodation, which is acutely a problem at Our Lady of Lourdes and the general region there. To deal with delayed discharges, we are opening 1,000 beds, but clearly there are challenges at which the task force is looking. This is the first year in a number of years that there has been an increased allocation in the health Vote and rightly so. The health service plan submitted by the HSE is being implemented.

Trolley numbers are generally higher in the morning. The Minister commented on that this morning. Generally, they reduce substantially during the course of the day and go back up again during the night period. This is a matter that is being focused on as an absolute priority by the task force set up by the Minister and I hope it can be managed effectively in patients' interests in the time ahead.

I do not know what the Taoiseach means when he says this is not the first time that a person involved in medical services has written a letter like this. I do not know what he means when he says the Minister commented on the matter this morning. The Minister is not just a commentator.

He is a passenger.

People will be outraged at the contrast between the conditions endured by patients in emergency departments on the Government's watch and the Comptroller and Auditor General's report that HSE managers are claiming public money for nights in five star hotels, flights for guests and alcohol on trips. The audit report also found that a former retired employee was rehired on a contract of six hours per week for a salary of €156,000. That should be compared with the plight of those citizens who are prevented from going home because the Government cannot give them the financial support for a home care package or basics like a grab rail or other appliances. It is little wonder that people are angry or cynical when they hear the Taoiseach and his health Minister. The Government allocated a mere €25 million towards extra nursing home beds under the fair deal scheme. In my constituency, the Government closed public beds.

Look at the Royal Victoria Hospital.

The Tánaiste is telling us how our recovery-----

I ask Deputy Adams for a question.

Cuirim an cheist anois. The Tánaiste is telling us that a recovery in public finances means the Government will make long-term investment, but there has not been one word about the hospital crisis or the 24,369 patients who are awaiting elective surgery for more than six months. Contrary to what the Taoiseach claims, his Minister did not respond to this matter this morning. He waltzes on as if he were a health commentator or a spectator.

Deputy Adams is stealing Deputy Micheál Martin's line. He is plagiarising his ideas.

Let us focus on a solution. The current health budget is entirely unrealistic and insufficient to deal with the crisis. Getting medically discharged patients home or into nursing beds will relieve all of that by giving them the protections they deserve as citizens. I ask the Taoiseach to refrain from smart alec remarks and to try to deal with a solution to resolve this problem. For once, the Taoiseach should be a problem solver.

I thank Deputy Adams. Yesterday, he commented that the solution to water was to have a general taxation scheme to provide a proper water service. By that, he means an increase in income tax and commercial rates and the introduction of a land tax.

The Taoiseach is playing election slogans while people are being treated on trolleys.

We can talk about water some other time.

Deputy Adams might comment on that at the weekend when he has the opportunity.

The money for water has to come from pockets one way or the other. It cannot be "magicked" up.

When he is up in Derry, he might also say that he regrets the closing of 20 beds in the Bangor area as announced on television last night.

Why does the Taoiseach not come up to Derry?

Deputy Adams always has the solution, which is more money. Without reading the detail, I will comment on a draft audit report I have seen from the HSE.

The Taoiseach has only 17 seconds to do it.

The report was circulated to members of the Seanad.

The Taoiseach's time is up.

It is a draft audit and obviously the HSE must follow the process through.

If the Taoiseach had abolished the Seanad, he would not have seen it at all.

Deputy Adams should believe me that if it is not acceptable, moneys paid in the wrong should be paid back and people who were not authorised to travel should reimburse those things. It is a draft report and obviously the HSE must answer to the Comptroller and Auditor General in respect of it. I have referred to the fact that the Minister for Health is one of the few Ministers who is dealing with the real problem here following on the difficulties that were tackled by the former Minister, Deputy James Reilly.

If he is one of the few, then the rest of them are not. What are the rest of them doing?

Will the Taoiseach publish the list of the Ministers who are not doing their jobs?

We had a situation over here when the Minister for Health of the day, Deputy Micheál Martin, refused to accept any responsibility for the health budget at a time when €16 billion was being spent on it. He said "I have no responsibility for my Department and for the expenditure". At least, Deputies Varadkar and Reilly faced up to the problem and hopefully we will get it under control for every patient in the country.

(Interruptions).

Only three Ministers are doing their jobs. There are 12 not doing their jobs.

You sir, Deputy Martin, refused to accept any responsibility despite the fact that you were spending €16 billion of public funds.

(Interruptions).

Deputies should sit down and not get excited. They will all be needing health care in a minute if they continue to be excited.

We will not get it.

I call Deputy Tom Fleming.

There is a huge issue, particularly in rural Ireland, concerning the eligibility of marginal land and commonage for direct EU payment.

There is an intensive and what I regard as an over-zealous inspection campaign being carried out by Department inspectors on, by and large, hillside, mountain and commonage land under the commonage framework plan. This inspection campaign is governed by unfair methods. There is a need for a method that is favourable towards farmers who are finding it very difficult to maintain an existence and a living on this marginal ground. In assessing their farming activity it must be carried out within the EU criteria laid down. Farmers have adhered to their responsibilities diligently. Now the same Department is coming back to imposing very unfair penalties on farmers who have adhered to very good practice according to the letter of the law. They have been the custodians of the land and developed traditional farming methods during the years. They maintain stocking rates and take account of weather conditions to try to make a living and maintain the family land.

A question, please.

They have played a very significant part in their local economies because they are the ones doing business with local stores, shops and post offices and are trying to keep local schools open.

Will the Deputy, please, put his question?

They are a very important element of rural Ireland.

I am sorry, but the Deputy is over time.

I apologise, a Cheann Comhairle, but, as the Taoiseach is well aware, there are severe implications in terms of penalties.

I appreciate that, but there is a time limit.

Will the Taoiseach look seriously at adopting Article 4(1)h of EU Directive 1307/2013 and make a submission to the European Commission to try to resolve many of these matters? Article 4(1)h has been adopted in Wales, for instance and would ensure compliance with all of the various EU directives involved. There is flexibility in the measure. Will the Taoiseach take this on board and ensure an application is made to the European Commission?

I am not sure whether the Deputy is talking about eligibility for the GLAS scheme or whether it is a particular problem on upland commonages or marginal land. There were a number of teething problems in the introduction of the new GLAS scheme in terms of the eligibility requirements in that over 50% of active farmers should be on commonages.

It is not about the GLAS scheme but the single farm payment.

Is the Taoiseach so out of touch?

He is out of touch again.

Will Deputies, please, stay quiet?

It is a question of planners and who should pay for the plans submitted.

The Minister of State, Deputy Simon Harris-----

The Taoiseach does not need any help.

This is Deputy Tom Fleming's question. Will Deputies, please, show respect to him as he wants to hear the Taoiseach's answer? The Taoiseach to continue, without interruption.

The Minister for Agriculture, Food and the Marine, Deputy Simon Coveney, met IFA representatives and farmers involved on marginal land on a number of occasions. Recommendations were sent to the European Commission in respect of approval of the scheme. In so far as I understand it, the vast majority of the issues raised were sorted out and the scheme is open for applications from farmers to draw down funding in keeping with the eligibility criteria. Where commonage or marginal land is involved, there are conditions governing eligibility for payment in terms of extent of usage by farmers and so on. I am not sure whether Deputy Tom Fleming is referring to particular instances in his constituency, but these are matters that have received a great deal of attention from the Minister for Agriculture, Food and the Marine. I understand most of the matters raised have been resolved-----

They have not been sorted out.

-----and that the European Commission has been happy to approve the scheme to enable farmers to draw down funds.

(Interruptions).

The Minister of State, Deputy Simon Harris, is spending too much time in America.

Please allow Deputy Tom Fleming to ask his question.

We all welcome the GLAS scheme and hope maximum payments will be made to all those farmers who are submitting applications, but that is not the core issue. Will the Taoiseach ensure clear and objective criteria are set for the assessment of eligibility? Probably the best formula to adopt is Article 4(1)h, to which I referred. There is a lack of flexibility and a hardness to the attitude being adopted. A hatchet job is being done on many of the farmers concerned. The worst aspect is retrospection. Many will be ruled as being ineligible to receive any payment, which will further ensure the decimation of rural Ireland. We are all aware that meetings are being held up and down the country. Deputy Michael Fitzmaurice is very proactive in this respect.

A question, please.

Farmers and their families are in a very stressful state. We are not talking about the Golden Vale or the plains of County Meath.

Big ranchers in County Meath.

(Interruptions).

I am talking about the west. This issue has serious implications and there will be the abandonment of land. The landscape is our great tourism asset. The farmers concerned are doing a very good job in their farming practices to protect the landscape of Ireland. We do not want to lose this significant part of our tourism product. I, therefore, ask the Taoiseach to intervene with the Minister for Agriculture, Food and the Marine and take immediate action. The farmers concerned are very fair and have been struggling against all the odds, as the Taoiseach is well aware. I ask him sincerely to resolve this issue and address it as a matter of urgency.

I have met many of the farmers concerned.

Big farms in County Meath.

I think the Deputy is talking about St. Anne's Park in Clontarf.

That is not funny; it affects County Mayo, too.

I am not sure whether it is marginal land.

(Interruptions).

Deputy Mattie McGrath can work his way through the Technical Group and become a spokesman, but in the meantime he should stay quiet.

In response to Deputy Tom Fleming, the fact that the scheme is now open for applications-----

(Interruptions).

There cannot be freedom of choice. There are rules and conditions governing these schemes which must be adhered to.

It is a question of eligibility for all schemes.

It is not just a case of Deputies Michael Healy-Rae and Mattie McGrath saying a person can apply and draw down moneys under the payment scheme. There are conditions and regulations that must be followed, but they have to be clear, effective and achievable. I think that is what Deputy Tom Fleming is referring to.

Take a look at the Welsh model.

It affects farmers in County Mayo, too.

The Minister for Agriculture, Food and the Marine has spent hours dealing with these issues with the IFA and other farming groups.

He is spending too much time in Brussels.

Will the Deputy, please, stay quiet?

We hope the scheme to which Deputy Tom Fleming refers can operate effectively in order that the practices mentioned will not be lost and that farmers can legitimately draw down the payments due to them under the conditions applying to the scheme.

On a point of order, I did not hear one word of the Taoiseach's response to Deputy Gerry Adams's supplementary question.

There is no point of order; I do my best to try to control the noise level.

It is unfair and does a disservice to the Dáil. I could not hear one word. I do not know whether the Taoiseach answered the question because of the racket that was going on.

I appreciate that, which is why I try to control proceedings, but I cannot go and physically restrain them. All I can do is appeal to them from the Chair. I want to tell the Deputy something - they are not doing themselves any favour because the public watching will get on to our offices to complain bitterly about them. Those who continue to shout are not doing themselves any good because they are heard and seen on television.