Leaders' Questions

This week, the Health Service Executive service plan for 2017 was published. The introduction reads well as it references expanding services and improving the quality and safety of services but when one drills down through the figures, it does not read well at all. In fact, it is another work of fiction. We have highlighted consistently in recent years that the HSE service plans are not built on solid foundations. That has been more or less admitted by many people who have commentated on them. The headline increase is €459 million, but when the demographics and salary increases are taken into account, there is €61 million available to expand existing services or bring forward new services. That is €61 million across the entire health service, and of that €61 million, only €9 million has been made available for the acute hospital system.

Every day of the week, we hear people ringing in to radio stations to complain about the treatment meted out to their parent or other loved one in emergency departments. Waiting lists are at an all-time high. People are not able to access outpatient appointments for gynaecological, orthodontic or orthopaedic services. Across the board there are substantial increases in every area. This HSE service plan suggests it will address all of these issues with an additional €61 million for all services across the State.

We have to have an honest assessment of where we are going in terms of the provision of health care. We talk about improving the quality and safety of services but we are facing a crisis in every area of health. Our hospital system is not functioning. It is not capable of delivering even emergency care at this stage because consistently people are waiting in ambulances outside emergency departments. There is a lack of capacity and not enough consultants, midwives and nurses. In every aspect of the health service we are facing huge difficulties in providing basic care. To put that in context, Mr. Tony O'Brien, the director general of the HSE, stated recently at the health committee that within the next number of years, the health services will be unable to deliver any elective surgery. Effectively, only acute services and nothing else beyond that will be provided.

This HSE service plan is a work of fiction but, unfortunately, it is turning into a nightmare in emergency departments. Even at this late stage, will there be an acknowledgement from the Government that in talking about expanding services we have to fund those services? We cannot go on with this pretence and depend on a workforce of 105,000 to deliver health care in unsafe environments while being unable to deliver the basics across our hospital system.

The first point I would make in response to the Deputy is that next year will see the highest health budget that has ever been allocated and, thankfully, we have an economy that can deliver that increase. That should be acknowledged because without that increase, we would not be maintaining current services. With that increased budget we can maintain current services and deliver new services. The increases amount to more than €1 billion since last year. That is a significant increase.

In terms of what the HSE service plan looks to deliver, it is to maintain existing levels of service and some new service development while also providing for the increase in need that arises from a growing and ageing population. Clearly, we have to have targeted service improvements.

There is no doubt that we face a major challenge. Everybody across the House knows the challenging situation we are facing as a result of the increased population, higher numbers of elderly people and all the demands that arise from that. It is extremely dismissive of the Deputy to describe the service plan in the way he has done, given the level of detail contained in it, including the commitment to improve services and the increased budget. Of course the HSE has to manage that budget and ensure it is put to the most effective and efficient use.

I agree there are unmet needs. We must work continually to meet the current demands, but I want to point out to the Deputy some of the initiatives that will be delivered next year under the new service developments provided for in the service plan. They include disability services, including provision of places in day centres for school leavers with a disability, which have long been a source of concern; hospital service developments, including the new national children's hospital; the medical card for recipients of the domiciliary care allowance; improved access to and increased funding for older people to home care packages; improvements in the national ambulance service delivery; and better access to mental health services. All that is spelt out in the context, for example, of acute hospital day case numbers where the expected activity level in 2017, at well over 1 million, is 4.2% above the figure for last year.

As the Deputy is aware, additional funding has been provided to address waiting lists, and that will lead to improvements, including the reduction of the number of patients on trolleys. There will also be increased services in the community. For example, the activity level for home care packages, including the delayed discharge initiative, has shown huge improvements already this year, and the Deputy knows the waiting list for the fair deal scheme has been reduced to four weeks. This time last year we were very concerned because the waiting list was ten, 12 or 14 weeks. It is now down to four weeks, and the delayed discharge issue has been dealt with. It is on its way to improving.

I admire the Tánaiste's defence of this work of fiction but the reality is that the only thing this HSE service plan will deliver is longer waiting lists. The Tánaiste referred to additional funding of €61 million across the entire health care system over and above the headline figure, but she cannot stand up in this House and say with credibility that she will deliver on what is outlined in the HSE service plan. The point I am making is that this has been consistently the case in this House in recent years. The allocation of €61 million will not address the overcrowding or the shortage of consultants, midwives, nurses and other allied health professionals.

It is a bit late for that now.

It is simply not possible to sustain the activity that we are currently providing. The Tánaiste pointed out that there will be a 4.1% increase in activity across the acute hospital system, but an additional €9 million is being provided to fund that extra activity. That is simply not plausible. If the Tánaiste would accept, even at this late stage, that the funding in this HSE service plan will not deliver the health care we expect across our services next year, we could at least address some of the underlying problems.

I have acknowledged that given the increasing population, the increased numbers of elderly people and the increased demands on our acute hospitals, the HSE will have to manage the pressures on the system in the most efficient and best possible way. The point I am making is that the highest health budget ever will be allocated next year and so improvements will be made. There are particular pressures such as those the Deputy has mentioned, including in emergency departments.

The Deputy should know that the HSE special delivery unit team was on a site visit in Galway yesterday, working with University Hospital Galway, with a view to supporting the efforts to reduce the pressures on its crowded emergency department. As part of the winter initiative, the emergency department in Galway has been identified by the HSE as needing additional support. It is working in the areas still experiencing pressures such as Galway and Cork. Already, we have seen improvements where that kind of work has been undertaken, for example, in Beaumont Hospital where we have seen the numbers being reduced. We have to continue that sort of intensive work with emergency departments, and there are various management initiatives that can be undertaken to improve the situation. That is being done, despite the current pressures. Every effort is being made to deal with the particular issues. Under the winter initiative, extra money is being allocated for the Mercy hospital in Cork, with the provision of 18 step-down beds, which should improve patient flow in that hospital.

All of this work is being undertaken. Of course, the Deputy is correct in that the challenges faced by the health service are enormous. However, we can deal with them in a better way this year because of the increased funding.

Right across the State, there are 700,000 people living in private rented accommodation. As a result of the housing crisis, the vast majority of them are under immense pressure. In the face of constant rent increases and an absence of supply, they are just about getting by. In truth, many of them are not getting by. Four families become homeless each day. Many more are on the brink. More again live with the constant fear, the constant worry and the constant stress of the prospect of another rent hike. The antics of Fine Gael, and its colleagues in Fianna Fáil, yesterday and today, just before Christmas of all times, has only added to this. Fine Gael has added to the stress and anxiety of those families. Fine Gael has done nothing to alleviate the fears of renters. Fine Gael acts, as ever, only in its own interests. That has been the hallmark of its term in office, one that has been characterised by cynicism, inaction and incompetence. We have had another fine example of that here this morning - Fine Gael and Fianna Fáil playing politics with the roofs over people's heads. Fine Gael calls it "new politics", but it looks like old politics to me. Whatever Fine Gael calls it, I will tell the Tánaiste this much: it is bad politics.

The reality is that struggling renters desperately need relief and certainty. The best and only way to achieve that is to link rent reviews to an index such as the consumer price index. That is not only Sinn Féin's view. It was the view of the cross-party Committee on Housing and Homelessness, including its Fine Gael and Fianna Fáil members. It is a position widely supported by tenancy advocacy organisations, homeless charities and housing policy experts. Instead of supporting hard-pressed tenants by supporting that position, Fine Gael and its friends in Fianna Fáil are now engaged in cynical political games. Despite knowing the detail of the plan brought forward by the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, long before it was launched, Fianna Fáil is now moving desperately to distance itself from that plan, and not out of any concern for renters. It seems that Fianna Fáil just wants to get one over on Fine Gael. The ill-conceived plan that the Government has come up with will heap greater pressure on renters. It will result in unsustainable rents getting further out of control. In simple terms, this means that there will be more homeless families. That is the reality.

The Government's intransigence is motivated, for Fine Gael's part, on a desire to get one over on its partners in Fianna Fáil. That is the real face of so-called new politics - Fine Gael and Fianna Fáil doing their own thing while hard-pressed renters and families are stuck in the middle. I appeal to the Tánaiste to take a step back from this charade and the nonsense surrounding it. I ask that the party-political games stop. I understand that the legislation is to be taken today. In that spirit, I ask everybody to accept Sinn Féin's amendment to link rent reviews to the consumer price index and to give tenants a real sense of security. If the Government does that today, we will support it because that is a real proposal to address the real crisis and would mark an end to the silly party-political games.

The only interest that the Minister and the Government have in respect of this issue is to ensure that we provide a stable and balanced rental market. We want to do that so that we can look after tenants so that they have certainty and to ensure that there is supply. That is what is needed. Stereotyping the response the Government is making to this issue does not get us anywhere. We all have to work together to ensure that we deal with the issue. We have to ensure there is supply. There is no point taking actions that will reduce supply. We want to increase supply and ensure it is maintained. The approach of the Minister has been to do that. What will happen now for tenants is that instead of facing increases of 15% or 20%, these will be limited to a maximum of 4% in the coming years.

As already stated, the reason we have taken this approach is for stability in the market so that tenants can rely on the homes that they are in, that they can manage the increases, that they will not be the kind of increases that we have seen in recent years and that landlords will continue to make homes available to rent. That latter point is important as well. There is no point denying this and saying that we do not want to see people continuing to invest and making homes available to rent. That is important.

We, as a Government, are supporting social housing. There are billions of euro extra going into social housing. We are seeking to increase the supply of social housing by investing €5 billion, we are ensuring, by means of a fund of €200 million, that local authorities can support the development of private housing and we are dealing with a challenging homelessness situation. It is a combination of all of these actions that will stabilise the housing market. As a result of the fact that the economy is improving, we are in a position to do as I have outlined. That is the approach the Government has taken. The description Deputy McDonald has given in respect of these initiatives is inaccurate and stereotypical. It does not deal with the reality of the actions that are needed in order to provide the stability people need.

If the cap fits, the Tánaiste should wear it. If the Government does not wish to be stereotyped as one which is utterly out of touch and utterly indifferent to the struggles of renting families, it should stop behaving in that way. This is not a complex matter. The antics, as they have played out in recent days, confirm for families watching that, when it comes down to it, tenants are not the Government's concern. Fine Gael's political position certainly bothers it greatly - we know all of that - but it is quite prepared to play games on this issue.

Investors in rental property are making a handsome return on their investment. All of the data reflect that. Fear not for the investors. The Tánaiste might consider the renter family which just about makes its rent now. Where will it get the additional 4%? Where will it get the additional 12% over three years? What about those areas, in the commuter belts and elsewhere, that are not part of these stressed zones? What about those families? Has the Government given one moment's consideration to that? No, it has not.

It seems Fine Gael wishes to give the impression of action involving itself and Fianna Fáil. The way to resolve this is to link rent reviews to the consumer price index. It is transparent, it is fair, it is what will work and it is what the Government would do if it had the interests of tenants and hard-pressed families at heart.

If Deputy McDonald had read the strategy, she would know that the issue in question is dealt with in the context of areas that will be covered by the rent predictability measure.

Sometime in the future.

There is a clear pathway laid out as to how that will be dealt with. The Minister has said that the Housing Agency, having discussed matters with a local authority, will suggest an area for consideration and then the Residential Tenancies Board, which has all the data on rents, will assess whether the criteria apply to the area.

How many families will be homeless at that stage?

That will be done in a speedy and effective way early. In the new year, they will get on with doing that work.

Far from the description Deputy McDonald has given in respect of the strategy, as I have already said, it is detailed in terms of the security that will be brought and given to both tenants and landlords. It looks at the supply issues and deals with them because we have to increase the supply. It also deals with standards, which the Deputy has not mentioned, and ensuring that these and the quality and management of rental properties and accommodation is kept high. Furthermore, it expands the powers of the Residential Tenancies Board. When one has the combination of those methods, we will arrive at a point where there is greater protection for tenancies, which is what both Deputy McDonald and I want , and where there will be greater stability.

Nero fiddles as Rome burns.

No, action.

I put it to the Tánaiste that both her party and Fianna Fáil have been involved in an utterly despicable and dishonest charade around the issue of rents that impacts upon the well-being of tens of thousands of people affected by the rental crisis.

Precisely 10,000 renters in crisis situations contacted Government agencies between June and December this year, due to plans by landlords to increase their rent on the spurious basis of relatives moving in, plans to sell the house or for some other unjustified reason. The roofs over the heads of these tens of thousands of people are in question, yet this Government and Fianna Fáil engage in an elaborate and despicable charade in which they pretend to be representing the interests of tenants when, in fact, they are arguing about how much profit landlords can make from the misery, anxiety and insecurity of tenants. That is what they are arguing about. The Government fought tooth and nail against bus workers who asked for a 4% annual wage increase and workers who want their pay to be brought back to the 2009 level, but somehow it thinks it is acceptable that landlords, who have already achieved rents in excess of 2009 levels, should have a 4% increase every year for the next three years, bringing already unaffordable rent levels up to the outer stratosphere as far as ordinary workers are concerned given the wages they earn.

I can give some examples. According to Dún Laoghaire-Rathdown County Council, the average rent for a three-bedroom house in south Dublin is €2,280 per month. The average wage is approximately €34,000 per year, with net take home pay per month being approximately €2,400. Already, therefore, approximately 90% of an average worker's income is required to pay for a three-bedroom house in Dún Laoghaire-Rathdown. The Government thinks it is acceptable to increase that rent by 4% next year, 8% the following year and then up to 12%. How are people supposed to pay that when, at the same time, the Government resists their demands for pay increases, saying they are unaffordable? The Government and Fianna Fáil, which agrees with the Government that this is acceptable, are doing nothing other than catering for and pandering to the insatiable greed of landlords, vulture funds and financial and property speculators, and care nothing for the tens of thousands of people who fear for the roofs over the heads of their children and families. It is utterly shameful.

I repeat that our primary goal is to protect tenants and ensure there is supply in the rental market. The Deputy appears to want the Government to run the private rental market entirely. He should acknowledge that this is a dramatic intervention. It has never been done previously. The goal is to protect tenants. There has never been this type of intervention to provide certainty for the people to whom the Deputy refers. The goal of this policy is to provide certainty to people who are renting. There are 150,000 people renting properties in Dublin and Cork and this is the beginning of a strategy to give them greater certainty. That will be continued with the work of the Residential Tenancies Board, the Housing Agency and local authorities. The goal is to provide certainty.

With regard to the examples the Deputy quoted, clearly the way to deal with that is to have greater supply. We must increase supply to deal with the housing situation. In the amendments on Report Stage, we are seeking to give greater certainty to people who rent. This has never been done before. It is the right thing to do, given the pressures in the rental market. We wish to move ahead today and finalise those amendments so we can provide that. Clearly, however, many other actions must be taken within the housing strategy to increase supply, and I have listed the range of areas the Minister is leading on to ensure a greater supply. The Deputy saw what was in the ESRI report yesterday. The report warned against inappropriate intervention because it would destroy supply. We have no wish to destroy supply for the very people of whom the Deputy speaks. We wish to ensure there is a constant and stable supply, and the actions the Minister is taking, after much consultation and discussion, will lead to that situation. We accept that we must take action, but it must be targeted and efficient and it must work. The Minister believes, having conducted a great deal of consultation very carefully with all of the stakeholders across the system, that this is the right approach so we can protect tenants and maintain the supply that is required for current and future renters.

What tenants did he speak to?

The only certainty the Government is offering is the certainty of unaffordable rents, more evictions and exorbitant, extortionate profits for landlords. The Minister thinks that for people who currently cannot pay existing rents, a 12% increase over the next three years will somehow provide them with some type of comfort or certainty. It will offer them nothing but the prospect of eviction and the complete unaffordability of the most basic requirement of human beings and families, which is a roof over their heads. How the hell is somebody on average earnings or, God forbid, on less than average earnings in south Dublin to pay even the existing average rent of €2,280 per month for a three-bedroom house? Then the Minister thinks it is acceptable to increase the rent by 12%. It is not possible. The Government is trying to square a circle that cannot be squared, which is to get people who are only interested in making profit to provide housing for people whose income is unable to match market prices. The only way it can be done, as we have said repeatedly, is by the State providing local authority, low cost housing. That is what is required, not pandering to landlords' greed.

The Deputy's solution would create further problems for the very tenants of whom he speaks. The supply would dry up if we followed the suggestions he is putting forward. They simply will not work. He presents them as if they are some type of magical solution, but they are not.

I am telling the Tánaiste that they cannot afford those rents.

They will drive people out of the market. The very people who seek rented accommodation will not be able to get it-----

Where will they go?

-----because supply will be a huge problem. We are taking a targeted and careful initiative. The goal is to ensure there will be a stable investment environment to protect the existing stock. We must protect the existing stock of rental accommodation. There is no point taking actions that will not protect that existing stock because if it is not protected people will have to leave that accommodation as it will be sold and they will be unable to stay in it. We simply must deal with that issue. These are targeted interventions to deal with the situation. Of course, other initiatives, including affordable housing, are also key to solving the housing problem and the money has been allocated to ensure they happen. There is a report today that already 18,000 houses have been built this year, which is ahead of all the predictions.

The evictions and hopelessness will continue.

As the Tánaiste is aware, a large number of older people in hospital are well enough to be at home, provided they have adequate support, but they cannot be discharged as there are no options of care available to them. Since 2008, home help hours have been cut by 1.6 million hours. During that time there has been an increase of 160,000 in the number of people over the age of 65. Supporting older people to age at home is undoubtedly the best option, and there is widespread evidence to indicate that older people prefer to stay in their own homes. This vision was included in the last programme for Government and is part of the national positive ageing strategy and the Health Service Executive, HSE, service plan. Home care packages are key to implementing this vision.

Last September, the Irish Nurses and Midwives Organisation, INMO, trolley watch reported that there were 7,551 people on trolleys across the country. That is an average of 251 patients per day awaiting admission for inpatient treatment. This figure will very likely increase as the severe winter weather approaches.

Investing in home care packages is a major part of solving the hospital trolley crisis and overcrowding in emergency departments.

The charity ALONE recently conducted a cost comparison on the various options for caring for older people. The cost of an acute hospital bed is between €800 and €900 per day. The cost of providing home help three times a day is between €50 and €70. In other words, the money spent on keeping one person in an acute hospital bed would enable 18 elderly people to remain in their own homes with home help support in place.

A home care package would cost approximately €400 per week compared with paying €6,300 to keep that patient in an acute hospital bed for one week. For every €10 million the Government invests in home care packages, 480 elderly people could be enabled to remain in their homes with home help three times a day, seven days a week for an entire year. If these 480 people were to remain in acute hospital beds for one year, it would cost the Government €157,248,000. If we were to enable these people to stay in their homes with the support of a home care package it would cost the Government €9,984,000 and the Department of Health would save €147,264,000.

I ask the Government to take meaningful steps to alleviate the current crisis that exists in regard to our elderly in need of home help and home care packages. Currently, more than 4,000 elderly and ill people are waiting for home help and home care packages. This needs to be addressed as a matter of urgency.

I also raise the issue of the privatisation of the home help service, where the people, women mainly, who carry out this fabulous service are being replaced by private companies. Is the privatisation of this service a departmental guideline for the future?

I agree with the Deputy about the importance of home care packages. Home care services are critical to support older people to stay in their homes and communities and maintain their independence. The Government has increased investment in this very important service. The suggestion that there has been a cut in home help hours, and some people have suggested that, or home care packages is not the case. There has been increased investment and there is increased money available right across the system. For example, in the Revised Estimates earlier in the year, the Government provided an additional €41.4 million for home care on top of the original €330 million, and a further €23 million for the winter initiative and €10 million for new developments were also agreed for 2017. Therefore, there is increased investment. There is an increase from 10,437,000 to 10,570,000 in the number of home help hours for next year. There has been an increase from 15,450 to 16,750 in the number of people in receipt of a home care package. The number of intensive home care packages is being maintained at 190. Any suggestion that there is a reduction in these services is not accurate.

As the Deputy knows, and as I have said in the House earlier, that issue of delayed discharges is being dealt with. There are 100 fewer people waiting now than earlier in the year and the improvements are continuing in that area.

In terms of personal assistant services and home support hours for people with disabilities, the levels of those services in place have been maintained in 2016 and further money will be provided for them in 2017.

I take the Deputy's point that these are critical services and that we need to continue to invest in them, but given the resources available, there has been increased investment. That will mean more elderly people will get those home care packages, which I agree with the Deputy are vital.

I thank the Tánaiste for her reply. While I welcome the money that was allocated in June of this year, the need for funding is urgent. The most frequent inquiries I receive in my office, and I presume the same is the case for every other Deputy, relate to home help hours and home care packages. It has been Government policy since 1960 to support older people to stay at home for as long as possible. For this vision to become a reality, we need to have increased investment in home care packages and the home help service.

As I mentioned, for every €10 million the Government invests in home care packages, the Department of Health will save €147,264,000. Not only would this be a win for the Department in that it would be following through on its policies and it would also involve a huge financial saving. I repeat my call to make proper funding available to allow elderly people to vacate acute hospitals and return to their homes with the necessary supports to enable people to remain in their homes.

The bottom line is that this service is not reaching the elderly people who need it. The Taoiseach, in replying to the first Dáil question I tabled since I was elected to this House, told me that extra investment would be made and that people would not be left without a home help service. The situation is now worse than it ever was. I know that for a fact. Any Deputy working in his or her constituency knows that is a fact. The situation has got far worse. Regardless of what level of investment the Government is making in the service, it is not reaching people on the ground.

I know an elderly gentleman in west Cork who is 86 years of age, who has worked all his life for this country and cannot get a home help service. He has been told by the HSE that it cannot provide a home help service delivered by its people and that it will arrange for a private company to provide the service. The private company phones his family every night to tell them that it will not be able to provide cover for this man the next day, yet the people providing the home help service in the area have told me that they are quite willing to provide that care. There is a problem with the delivery of the service and it needs to be resolved.

The Deputy might forward us the details of that individual case. I will cite one example of where there are improvements. As of yesterday, nobody in Cork hospital or Kerry hospital due for discharge was delayed because of a lack of home care funding. That is a fact.

That is not the issue.

Those are two hospitals where there were no delayed discharges. As a result of the increased investment, extra home care packages are available to Cork University Hospital and other hospitals. In a situation where demand continues to grow, challenges remain in managing home care budgets. Of that there is no question. The additional money that has been invested gives greater flexibility to local managers to manage the home care budget in the interests of those who need it most. Clearly, prudent management of available resources is still needed but there is that increased investment. The revised level of service, for example, that has been provided this year is 10.57 million home help hours and 16,450 home care packages. That will increase by a further 300 in 2017. That is not to say that there are not perhaps individual cases such as the one the Deputy described where it can be difficult to access home care packages, but there is increased investment, increased availability and greater flexibility for the managers to make the most appropriate decisions for the people who need home care packages.