Leaders' Questions

I want to discuss the situation in our hospitals, particularly our acute hospitals. Nobody could deny that there is a state of chaos in some of our major hospitals this morning. In Beaumont, outpatient waiting lists have increased in the last few months by a thousand percent. A 33-bed surgical ward was closed last week, which will drag more patients onto waiting lists-----

That is Deputy Kelleher's job.

-----and the situation there has been described by consultants as a war zone. At University College Hospital Galway and in Merlin Park University Hospital this week, more than 850 people were informed that all outpatient rheumatology clinics for July and August had been cancelled and that emergency outpatient appointments would be dealt with on a case-by-case basis. There are already 1,500 people on waiting lists at Merlin Park for outpatient rheumatology appointments.

When a person is diagnosed with rheumatoid arthritis, there is a 12-week window within which there is a chance of dealing with the condition if he or she gets treatment. If it goes longer, perhaps to two and a half years, which is the length of time people are spending on the waiting list at the moment, the patient's chance of beating that condition are severely restricted. In UCHG, all elective surgery has been cancelled until the end of this month.

Deputies Naughten and Fitzmaurice highlighted that yesterday. We are led to believe that further cancellations of elective surgery will take place at UCHG. Is it acceptable that 850 people will be told this week that their outpatient rheumatology appointments will be in December? Is it acceptable that in the case of rheumatology, a consultant has gone on maternity leave this week and will not be replaced until September, which demonstrates a complete lack of planning? Is it acceptable that the appointment of a new rheumatology consultant to Manorhamilton, which was promised by the Taoiseach in December, still has not taken place? Is it acceptable that a consultant attached to Beaumont, one of our key hospitals, would tell a patient, as happened this week, that he or she would be better off having urgent surgery at a private hospital because at Beaumont he or she would have to wait for 14 weeks? That patient was lucky enough to have health insurance, which allowed access to the private hospital. What is going on in our key hospitals and what is the Government doing about it?

It is chaos. There is no health service in the west of Ireland.

Was the Government not going to get rid of that?

-----that due to consultant staff shortages, a number of rheumatology outpatient clinics in Galway University Hospital are being postponed during the months of July and August this year. New appointments will be scheduled as soon as possible and urgent patients will continue to be seen. Clinics in Manorhamilton will continue as normal. The hospital has issued a statement, as one would expect, saying that it regrets the undoubted inconvenience this situation causes to patients and their families.

I did not see the Minister for Health issuing a statement on that.

I echo that. There are currently three consultants in Galway University Hospital covering outpatient clinics, a day ward service in Merlin Park, and an emergency medical intake and a consult service at Galway University Hospital. A locum consultant will take up a post in September, an extra consultant for Galway University Hospital will take up a post in October 2015, and an additional registrar is being assigned to rheumatology and will commence in July 2015. From 1 October, there will be four consultant rheumatologists at UCHG. Patients are being notified that their appointments have been postponed and they will receive new appointments as soon as possible, as is right.

They could be dead.

When extra medical staff is in place, the extra outpatient clinics will have to be held and will be held. Emergency patients will continue to be seen on a case-by-case basis. The national recruitment service is actively recruiting hospital staff and consultant posts are continually being approved for filling. That is what is happening at the moment in terms of the response. The HSE has advised that 38 acute consultant posts were filled in 2014 in HSE hospitals and that 36 have been filled so far in 2015. There is a great deal of progress. Recruitment for 193 consultant posts is in progress. This is being carried out in conjunction with the Public Appointments Service. It is true that there are specialties in which there are international shortages and which have traditionally been difficult to fill. Regardless of the salary scale, some of these posts are extremely difficult to fill, but I think the Deputy will see and the House will agree that significant progress is being made. Obviously it is a matter of regret if people's appointments are postponed. The response should be quick and humane, and we should ensure, as I know the hospital will, that those clinics are held and those patients seen as soon as possible, consistent with the need to carry out the recruitment process.

Eight months to fill a maternity vacancy.

The consultants that are currently in Galway are not full-time rheumatology consultants. Two of them are in general medicine as well. That means we have one and a half consultants.

Second, the vacancy that has arisen and that has driven the total closure of the clinic at Merlin Park - it is not just that appointments have been cancelled; outpatient appointments at Merlin Park have been entirely shut down - is a maternity vacancy, which was notified and which should have been planned for. That child will be born and we wish him or her well, but a degree of planning would have put a locum consultant in place. Some 850 people have had their appointments cancelled. These 850 people will join the other 1,500 people-----

-----who are waiting for a rheumatology appointment at Merlin Park. Ireland is a no-go zone for consultants. We are having serious difficulties filling consultant vacancies.

They were driven out.

No matter how many budgets the Government is putting forward, people are not planning this properly. The Minister said the HSE had informed him, but I contacted the HSE about this on Tuesday evening and was told it was not a matter for the HSE but for the Saolta hospital group. When I contacted the Saolta hospital group yesterday morning, its so-called communications department said it was not aware of the issue, in spite of the fact that 850 people were getting notices. It is not a case of appointments being postponed; somebody who had an appointment on 7 July is now being told the appointment is on 14 December. They are being told, "Yes, you are in pain; yes, you have an appalling condition, but you will wait until 14 December for an initial investigation".

The Minister of Health must comment on what is going on at Beaumont.

He cannot allow one of the main hospitals in the country to be as it is at the moment.

We need serious action on consultant recruitment. We need great urgency. It is clear that these hospital groups, which were created by the Minister and the former Minister, Deputy Reilly, are not fit for purpose.

Go up to Beaumont for an hour and have a look.

The Minister, Deputy Varadkar, is too busy tweeting.

I am not trying to say there are no difficulties.

We have been listening to this for four years.

I have not tried in any way to stonewall the Deputy's questions or say there are no difficulties, and neither is the Minister for Health saying so. There have been interventions in this regard.

The Minister for Health only comments on it.

I gave a list of real measures that are currently being taken, particularly in regard to the recruitment of consultants. The Deputy acknowledges that we have had difficulty in achieving this. The Minister acknowledges that. However, real and tangible efforts are being made and achievements are being secured in respect of the recruitment of consultants.

There are difficulties in Beaumont, but to ensure the record is absolutely clear, the only ward that is closed in Beaumont is St. Damian's, the kidney ward, which needs to be upgraded. Those are the facts of the matter. It will reopen.

There has been a 1,500% increase in the waiting list. That is a fact.

I am just giving the Deputy the facts.

The 1,500% increase is a fact.

The Minister has the floor.

The ward will reopen in the autumn. It needs to be upgraded, it is being upgraded and it will reopen in the autumn. If it could be done more quickly than that, it would be.

What about the waiting lists?

It is being achieved as best the HSE and the hospital concerned can manage. Regarding the Galway situation, I have pointed out to the Deputy the difficulty regarding recruitment. I will be straight with him on the rheumatology situation there. The hospital is trying to secure a locum for the summer, but it simply has not been successful in doing so.

The Deputy is correct. It has not been possible to secure a locum but real efforts are being made.

It is not as if they did not have notice.

There is nobody more concerned and more engaged with this issue than the Minister himself and the HSE directors and managers involved in this issue.

We accept that there is a difficulty but significant progress is being made. Deputy Calleary makes no reference to the legacy of the policies, including health policies, of the previous Government. He makes no reference, of course, because it would not suit his case-----

The Government had four years.

-----to the economic collapse which has such an impact on all public services, including the health service.

They were giving away money.

As one of the more reasonable Deputies on the opposite side-----

One of the many reasonable Deputies.

It is not reasonable to leave 2,500 people waiting for an rheumatology appointment.

-----Deputy Calleary must give some credit to the achievement of this Government in turning around a shocking economic context and success in managing-----

Is there anything reasonable about it? The Minister should hang his head in shame.

-----to keep and maintain a health service, which has difficulties and problems to which he referred and which I do not deny, but which is making real progress in the interests of the patients who it is there to serve and the wider community.

Today is the last day that lone parents whose youngest child is seven will receive the one-parent family payment. Next week 30,000 lone parents will transfer onto the new transitional jobseeker's allowance and more than 10,000 of these parents will have their weekly payments cut, some by as much as €87. It is a great pity that the Tánaiste and Minister for Social Protection, Deputy Joan Burton, is not here in the Dáil this morning. She had a lot to say about social welfare fraud yesterday. She should know that if anyone is guilty of giving two fingers to their neighbours, it is, in fact, the Tánaiste and, indeed, the Minister, Deputy White, as they introduce the eighth successive cut to lone parent families. The overwhelming majority of these parents are women. Many are in low-paid, insecure jobs. Many are living in or at risk of poverty. All are struggling to raise their children in the most difficult of circumstances.

In 2012, the Tánaiste promised that this cut was dependent on "there being a system of safe, affordable and accessible child care in place, similar to what is found in the Scandinavian countries". Deputy White may recall her making that commitment. The Tánaiste stated that without affordable and accessible child care, "the measure will not proceed", and she was quite definitive in that regard. The average cost of child care per week is €167. In Dublin, it is even higher than that. In many communities child care is simply not available. When Fianna Fáil first cut child benefit, the Labour Party rightly decried the cut as anti-woman and stated it highlighted the lack of influence that women held in Cabinet, and yet here the Labour Party is in government introducing a measure that is anti-woman and, indeed, anti-child. The Labour Party is doing exactly what it condemned Fianna Fáil for doing when the Labour Party was in opposition - little wonder that some of the Labour Party's backbenchers are up in arms. My question is quite simple. Will the Minister, Deputy White, and the Tánaiste keep the promise made in 2012 when introducing this cut and in the absence of accessible and affordable child care, will they, as Government, now reverse the decision to push thousands of one-parent families into poverty?

First, lone parents have been at a much greater risk of poverty primarily due, as Deputy McDonald will be aware and will have to appreciate, to them being absent from the workforce for most of their working life, and that is an issue that is being addressed here in these reforms. That scenario is not a good one for a parent and it is not a good one for a child. The reforms that are taking place here are aimed at addressing this social inclusion, poverty and long-term welfare dependency issue. That is what is being addressed in these reforms.

I accept that a number of issues have arisen during this reform process and those issues have been addressed and substantially resolved by the Tánaiste. For example, we have addressed the carer's allowance issues by ensuring that a lone parent caring for his or her child continues with the current arrangements. We have ensured that those back in education can continue to access their SUSI maintenance grant while retaining their underlying payment. We have introduced the back-to-work family dividend that will support lone parents back into work over two years. The real objective here is to get lone parents as far as possible back into the workplace. Lone parents automatically have their family income supplement, FIS, payment re-rated. We have asked the Labour Market Council to engage with employers to ensure that they are aware of the reforms and that they offer, where possible, extra hours that work for lone parents and recognise a situation that a certain cohort of those affected will have to address. We have kept the income disregard for working lone parents at €90 per week. We have introduced a number of child care options. We also introduced the jobseeker's transitional payment in recognition that more work needs to be done in this area.

There is an interdepartmental group, which the Minister for Children and Youth Affairs, Deputy Reilly, has formed, examining the child care issue that the Deputy raised. That is an issue. We have more work to do, as a Government and as a country, on the child care aspect. That is true not only for lone parents but for families generally. Something to which we, as a country, must face up is that we definitely need to improve that area as soon as possible.

The Tánaiste recognises the sacrifice and contribution that lone parents make to raising their children. The State provides one-parent family payment income support up until the youngest child reaches the age of seven and no other country in Europe has an arrangement like that in place.

We introduced the jobseeker's allowance transition payment, which supports lone parents with children over the age of seven and up to the age of 14. Such parents do not have to be available and genuinely seeking work, but they have to engage with their local Intreo office on activation measures. When we say that people can be directed to go to the Intreo office, commentators might say that is not enough and it is not a sufficient answer. However, it could be part of the answer for lone parents where they can get genuine support, where they can have employment counselling and where they can as far as possible be supported to get back into the workplace because that is what we want. The best route out of poverty, as I hope the Deputy will agree, is employment. That is what we seek to achieve here.

I am glad the Minister stated what we all know, that is, the extent to which single-parent families are at risk of poverty. He will be aware, not alone of that but that studies have reflected the fact that lone-parent families disproportionately suffered, under both the previous Government and, indeed, his own, in an era of austerity and cutbacks. We also know that many of those families live in poverty or at least are at risk of poverty. Deputy White acknowledges that. Let me acknowledge that a return to the workplace to good quality, secure employment is a desirable outcome for anybody. Let us just acknowledge that, move beyond that routine excuse that we hear from the Administration and deal with the facts.

I do not know whether the Minister has met many of the families, in particular, the women, who will be affected by what he calls reform but what are, in effect, cutbacks. They want to know from him how it is that they will make up the €87 a week that they will be down. Aspirational talk here about return to work will not compensate these families and these women for a cut of that magnitude - that is the bottom line here. Although the Minister has made all of the worthy points about what we should and might do in respect of child care, it does not address either the following core point, that the Tánaiste, Deputy White's leader and second-in-command of the Government, made a definitive commitment that this cut would not go ahead in the absence of quality and affordable child care. The Minister and I, and the mothers and fathers of this land, particularly those parenting alone, know that such a system of child care simply is not available.

Will the Labour Party, the Government and the Tánaiste keep their word and reverse this cut? Will the Minister shed some light for those families to whom the Government will cut €87 on where they are to find that money? They are already struggling and at risk of poverty.

We have expanded the child care system. We subsidised 25,000 child care places for low-income parents. However, I accept that child care services and facilities should improve as soon as possible. This is why the Minister, Deputy Reilly, has an interdepartmental group examining how best to do that. Our child care system is nothing like what we want it to be or what it should be. I accept that it should be improved and enhanced. I hope that this is what will emerge from the group.

What use is that to these families now?

What of the fair deal scheme review?

Clearly, a resource issue is involved. We must find resources in order to expand child care. As the economy continues to recover and as more people work or are available to work, which is a good thing, access to child care will put pressure on them. This is something that the current Government, for the remainder of its life, and the next Government, whichever parties comprise it, will need to address as a priority. The Minister's group will assist this Government and the next in ensuring that we put in place a more robust and expansive system of child care.

What of the Tánaiste's commitment? That is the question I asked.

The Minister to conclude.

On the Deputy's question regarding the legacy of poverty for lone parents, she is right about the position. While there have been significant levels of State spending on lone parents and improvements have been made to the one-parent family payment down the years, it is still the case that lone parents are considerably more at risk of consistent poverty than the population as a whole. It is against this backdrop-----

That the Government is going to cut their incomes again.

-----that these reforms are being introduced. What has been done to date has not been successful. The Deputy agrees that a job is the best route out of poverty. We must not only ensure that we do not maintain a dependency on welfare, as I assume that no one, including the Deputy, wants that, but we must help to motivate and facilitate people in accessing the workplace-----

These people are already in work.

They do not need more motivation.

That is an insult.

-----and getting more hours where they already work and ensure that the system supports them-----

Answer the question as regards the Tánaiste's commitment, please.

-----they are listened to when they attend at Intreo offices and so on-----

He is commentating.

-----and their individual situations are addressed. This is the humane way to do it-----

There is nothing humane about the cuts to these families.

-----and the best policy approach to a difficult situation that people are facing.

National and international studies suggest that 25% of the population will have mental health difficulties at some point in their lives and that 44% of people in Ireland have had a direct experience of mental health problems. On average, European countries allocate more than 20% of their total health spend to mental health services and supports whereas the Irish figure, as we are well aware, is a lowly 6%. In addition, the 2010 staff moratorium has disproportionately impacted mental health services. They represent just 9% of the health care workforce, but accounted for 20% of the 1,500 posts lost through the moratorium of recent years.

The report by Mental Health Reform examined progress since the publication of A Vision for Change, the 2006 blueprint for the development of psychiatric services. The report noted that a shortage of staff was leading to lengthening waiting lists, particularly for young people with mental health difficulties who needed to be seen by child and adolescent mental health teams. The report highlighted how the waiting list for child and adolescent mental health services, CAMHS, had increased to 2,866 people in January, representing an increase of more than 8% on the same month in 2014. A total of 429 children were waiting for longer than one year to be seen by services. One in five children's admissions to mental health institutions was made to an adult psychiatric ward in spite of Government promises to end this practice. In 2014, the figure was 89 children. In 2013, it was 98. These are damning statistics. Of the 15 children who were involuntarily detained last year by order of a court, nine were sent to adult units.

Last year's 40% cut to the mental health budget reflects the Government's lack of commitment to mental health services while the €15 million withdrawn from the service to prop up other ailing services within the HSE has not been restored as of yet. This major deficit has led to additional problems in community care, which is in a fragile situation. Deputy Fitzmaurice has explained to me that it is in a state of collapse in the west, given the significant pressure on staff that has meant that patients are not being seen properly. My county has the same difficulties.

The 2011 programme for Government states, "We will endeavour to end the practice of placing children and adolescents in adult psychiatric wards." Will the Government ensure that this practice is addressed, appropriate facilities and specialised services are made available in the short term and the €15 million removed from mental health services by the HSE is restored immediately?

In line with the programme for Government commitment, the priority demonstrated by the Minister of State, Deputy Kathleen Lynch, and the Government has been to modernise our mental health services, notwithstanding the severe resource constraints of the past four years in particular. What we are seeking to do, and have done to a great extent, is to prioritise new resources to underpin the implementation of A Vision for Change.

The Deputy pointed to an issue. That is his role and I respect that. I accept that deficits and issues remain to be addressed, but the Deputy must accept, and I hope that the House will accept it also, the fact that the Government has provided an additional €125 million and 1,150 posts for mental health services between 2012 and 2015, comprising €35 million and 416 posts in 2012, €35 million and 477 posts in 2013 and €20 million for the recruitment of 251 posts last year. One can always say that this is not enough and that more needs to be done. I will have a respectful debate with the Deputy about that, but he should please acknowledge what has been done as well as the priority that has been accorded to this matter.

The Government needs to focus on the patients.

Patients are being turned away.

The Minister is forgetting about the patients.

Please acknowledge the fact that the Minister of State, Deputy Kathleen Lynch, in particular has made this a central priority and ensured that real progress has been made.

The Minister has lost it now.

Discussions are taking place between the Department of Health and the HSE on the final allocation of an additional €35 million that was provided for mental health services in budget 2015. I expect that the allocation will be finalised in the near future.

The sustained investment in mental health services by the Government since 2012 has enabled the HSE to recruit staff who are more suited to the development of a community-focused mental health service, which has been every Deputy's objective as we seek to improve services. This additional money and resourcing have provided for the requisite change in the mix of staff, in particular allied health professionals, across community mental health teams in line with A Vision for Change.

As of the end of March, 397 - 95.5% - of the 416 posts approved in 2012 and 405 - 85% - of the 477 posts approved in 2013 were in place. Of the 251 posts allocated in 2014, 50 staff have started and a further 70 posts are at various stages in the recruitment process.

The Deputy will accept that some of these processes take time. That is the actual picture.

The admission of children to adult psychiatric hospitals is an issue that the Deputy raises fairly. We have to acknowledge that this issue has to be resolved. It requires the allocation of resources and those resources are being applied. It is clear from the 2015 HSE service plan that this issue remains a key priority. As Deputies will be aware, reducing the number of children admitted to adult psychiatric units has been a focus of HSE mental health services over recent years. There were 89 admissions of children to adult psychiatric units in 2014. The Deputy might fairly say that this was 89 too many-----

If it is a small number, it can be tackled.

-----but I would point out that the number had reduced from 247 in 2008. These are the actual facts. The Deputy raised some facts. He has to acknowledge that these are also facts.

The focus should be on the patient.

The Minister was asked a question.

It was worse when the Deputy was in government.

As a former Minister of State at the Department of Health, the Minister, Deputy White, has a particularly good insight into the health services in general. I am sure the Minister and his colleague, the Minister of State, Deputy Kathleen Lynch, are well aware of the need to secure proportionate amounts that are justifiable in the Department of Health. The Minister of State, Deputy Kathleen Lynch, is doing her utmost, but she is battling against the tide in many respects as she tries to fulfil her psychiatric responsibilities in the Department. The Government has to be realistic about this matter. It needs to give a proper slice of the cake to mental health services. For historical reasons, mental health services are starting from a very low financial base. It is not right that it accounts for such a low proportion of the overall health budget. This is reflected across the country, including in my county of Kerry. The staffing problems in the Kerry mental health services are caused by the lack of nurses on the ground and the continuing retirements. Staff numbers are continuing to decline. For every two nurses being taken on, three are retiring. Overtime is being paid for, but this is an expensive option. Many health nurses are unemployed, have emigrated or are working as care staff in private nursing homes. They cannot get jobs as registered psychiatric nurses with the HSE locally. That is not proper. The mental health services in County Kerry need a minimum of 25 whole-time equivalent nursing posts as a priority to end overtime and ensure services are fully staffed. I will mention one major item in this context. The HSE spent approximately €3 million on a state-of-the-art four-bed high-observation psychiatric unit at Kerry General Hospital to deal with, treat and manage patients with challenging and disturbing behaviours. The four-bed specialised unit was completed last December but remains closed because the HSE does not have enough nurses to staff it. I ask the Minister to bring this matter to the attention of his colleagues, particularly the Minister of State, Deputy Kathleen Lynch, and the Minister, Deputy Varadkar, and ask them to address it urgently.

Sometimes the facts and figures obscure the real human situations that lie behind the health issues and demands that many people have. This is particularly true in the area of mental health. When we are accused of failing to deliver or not addressing the real issues that exist, we have to give the House the facts and figures. I make no apologies for doing that in this case. I will give some examples of the work being done by this Government. I ask the House to acknowledge that the full mental health budget for 2015 will be approximately €792 million. Some of this year's money will be spent on additional resource officers and priority actions. A new suicide prevention strategy was announced by the Minister of State, Deputy Kathleen Lynch, with the Taoiseach yesterday. Some €2.75 million is being allocated for additional resource officers. I emphasise the word "additional" in that context. Additional resources of €2.7 million are being provided for child and adolescent inpatient eating disorder development. This is a real issue that comes up. I am sure Deputies come across queries and issues raised by constituents in this regard. Additional resources of €2.5 million are being provided for child and adolescent teams in day hospital. The great Jigsaw project is being given €2.4 million for the development of additional centres in Cork and Dublin. An allocation of €3 million is being made for additional resources for additional mental health and intellectual disability services. An allocation of €1.1 million is being made this year for additional resources for additional mental health services for homeless people. An additional €700,000 is being provided for additional Traveller mental health services. I ask Deputies to acknowledge that these issues are being addressed by the Department, the Minister and the Government.


Let them eat cake.

There is a nervous laugh from the other side every time I make that point.

It is not nervous at all.

Of course the job of the Opposition-----

Why are people ringing us up to say they cannot access services?

-----is to point up gaps in services.

This is all baloney. The Minister should answer the man's question instead of giving obscure figures.

If we are to have any hope of making-----

The Minister is using figures and facts to obscure the issue.

-----progress in the area of mental health services, we have to agree on what are the basic requirements.

The first requirement is space for people.

The Government and the Minister of State, Deputy Kathleen Lynch, have made enormous progress in this area, particularly at a time of constrained resources.

The Minister is codding himself.

It is difficult for the Members opposite to accept the facts I have set out.

If the Minister goes down to look at the mental health services in the west, he will soon see what is going on.