Leaders' Questions

The health system is in a terrible crisis right now. It is a human resource crisis, with nurses leaving the system on a consistent basis and up to 75% of graduates leaving the country. Accident and emergency departments are in continual crisis. There is a general human resource shortage across the board in respect of doctors, psychiatrists, therapists and many more.

The latest waiting list figures reveal a dramatically worsening situation in all the categories and in all the hospitals. There are now approximately 666,000 patients on a waiting list - a national record, and dare I say, a national scandal. The number of outpatients waiting for 12 months or longer is more than 109,000. The total outpatient waiting list has 473,000 people. The total number of inpatient and day cases is 85,000 plus. Then there is the pre-admit list of 26,000, plus the 61,000 on the planned procedures list, which do not get into the official lists. We have shocking waiting lists for diagnostics, for endoscopies, CT scans etc. and most shocking of all, there are 10,000 children who have been waiting for more than 12 months for an appointment in the Dublin hospitals.

If one goes through the categories by hospital, Waterford, for example, needs serious attention. The outpatient list in Waterford of those waiting over 12 months is up 443% since 2014. I do not know what is going on there but it is incredible. Its inpatient waiting list is up 159%.

Since the change and the downgrading and undermining of Waterford hospital, the waiting lists have soared in that hospital. For outpatient waiting lists, the Mater hospital is up 55%, St. Vincent's hospital is up 56%, Louth is up 96% and Limerick is up 108%.

A commitment was given that the National Treatment Purchase Fund, NTPF, would be given back responsibility for waiting lists. That has not happened yet. The NTPF has not started its work yet and I want to know why. In the last year when the NTPF was operating, it provided operations for approximately 33,000 patients. It facilitated approximately 200,000 patients in all up to 2010 and the median waiting time was down to 2.4 months. There seems to be an incredible inertia and lack of urgency attached to the crisis in waiting lists and the situation is getting worse. When will the Government show some urgency in tackling what is clearly an unacceptable crisis in terms of people waiting for urgent appointments and surgery?

The Government has shown priority in the funding it has allocated to the health area for 2017 which, as the Deputy will be aware, is €14.5 billion. The Government allocated €20 million to the National Treatment Purchase Fund for 2017, rising to €55 million in 2018. Last December the Minister, Deputy Harris, granted approval to the National Treatment Purchase Fund to dedicate €5 million of its funding to a day case waiting list initiative with the aim of ensuring that no patient would be waiting for more than 18 months for a day case procedure by 30 June 2017. In excess of 2,000 cases will be managed through the process and those patients are already receiving appointments.

In order to reduce the numbers of long-waiting patients, the HSE was asked to develop the waiting list action plans for 2017 in the areas of inpatient, day case, scoliosis, and outpatient services. Those plans have now been finalised and will be acted on shortly. The HSE and the INMO both agree that the time patients spend on trolleys waiting for beds has decreased. I acknowledge the work front-line staff have put into that initiative. Notwithstanding those improvements, the figures are too high and the Department continues to work with the HSE to identify further measures that can be taken.

In respect of Deputy Micheál Martin's comment about nursing and midwifery, management has committed to increasing the nursing and midwifery workforce in 2017 with 1,208 additional permanent posts; the conversion of agency-employed staff into HSE direct employees; maternity leave cover; offering all graduating nurses and midwives full-time contracts; a career break scheme; 130 additional undergraduate places this year and offering nurses and midwives improved educational opportunities and career pathways.

The HSE has developed an inpatient day case waiting list action plan with engagement from the Department and the NTPF. The plan focuses on reducing the number of patients. It is estimated that there are 39,000 patients to be treated by the end of October 2017 and the plan sets a target to remove approximately 75% of those patients from the waiting list, that is, 29,000 patients, through a combination of normal hospital national service plan-funded activity, as well as resourcing and outsourcing initiatives utilising the remaining €10 million of budget 2017 funding. That represents a 30% increase in activity, which demonstrates the priority attached to it.

Our hospitals are now carrying out four times more procedures on patients aged 65 and over, and twice as many in the under-65 age group since 2000.

I thank the Taoiseach.

This is my final point, a Cheann Comhairle. In 2016 alone there has been a 4% increase in inpatient and day case activity over 2015. Last year, almost 1.69 million patients received inpatient or day case treatment in hospitals, which is an increase of almost 40,000 on the previous year. That demonstrates the urgency and priority attached to the issue, while admitting that the waiting lists are too long. Serious action is being taken to address those problems.

Twelve months ago the Government agreed in the confidence and supply agreement to re-establish the remit of the National Treatment Purchase Fund to deal with waiting lists. Nothing has happened since then. The €20 million has not been spent by the NTPF and we are now into May 2017.

Those are the facts. There has been a lack of urgency. We all saw the scoliosis crisis but it should not have to have been revealed in such a telling and effective manner on RTE. There are still more than 4,500 children who have been waiting in excess of 18 months for an appointment in the three children's hospitals in Dublin. It is scandalous. We are talking about all-time records. The former Minister for Health, now Senator James Reilly, got rid of the National Treatment Purchase Fund. We are back to the same massaging of figures that he engaged in, widening the timelines and saying that the Government will concentrate on those waiting more than 18 months.

The National Treatment Purchase Fund should be restored. Rather than micromanaging it, we should get its systems back into play with the forensic way in which it tackled waiting lists in the past. Too many people, in particular too many children, are waiting far too long. The execution and delivery of a resolution to these crises is simply not happening in the health area. Waiting lists and times are getting longer every time the figures are published. There is no appreciable gain or sense that the Government is getting on top of the issue.

In the negotiations and discussions we had about the formation of a Government, it was agreed, indeed at the Deputy's own suggestion, that the National Treatment Purchase Fund would be restored. The restoration was costing €20 million for 2017, rising to €55 million for 2018. It is not true to say that nothing is happening. The NTPF has now commenced the initiative of €5 million for the day case waiting initiative which was approved last December. It is expected that in excess of 2,000 patients will receive treatment under this initiative. They will thus be off that waiting list.

In respect of the outpatient waiting list, it is estimated that there are more than 190,000 patients who fall into this category. The plan sets a target to remove over 50% of these from the waiting list, that is, in excess of 95,000 patients. That represents around 5,000 extra patients or a 5% increase in activity since last year in that particular patient cohort.

In respect of the NTPF and the inpatient day case waiting list action plan, we hope to have 39,000 persons treated by the end of October. The plan sets a target to remove 75% of these patients from the waiting lists, that is, more than 29,000 patients between the normal hospital service plan funded activity, as well as insourcing and outsourcing initiatives utilising the remaining €10 million of the budget for 2017. The money is being spent and is making serious inroads into the numbers, as I have already outlined, on the initiatives undertaken by it.

I understand that documentation has been given to the Committee of Public Accounts by Mr. John Barrett which completely contradicts and undermines the account given by Commissioner O'Sullivan last Thursday about her conversations with Mr. Barrett over financial irregularities in Templemore. This latest development today comes after contradictory statements from Commissioner O'Sullivan and the executive director of human resources, the aforementioned Mr. Barrett.

Why will the Taoiseach not end the never-ending crisis and scandal surrounding the senior management of An Garda Síochána? This latest controversy follows scandals involving homicide figures, the falsification of 1 million breath tests, and the 14,700 unsafe convictions for driving offences. The Taoiseach will recall that all of this was preceded by allegations of a smear campaign against the brave whistleblower Sergeant Maurice McCabe.

I am also concerned about the Taoiseach's refusal to act on detailed information which I gave him 18 months ago about the killing of Garda Tony Golden and other issues arising from that dreadful event. The Taoiseach and his Government have resisted all attempts directed by these matters to bring in the deep-rooted reforms that are required. The Taoiseach may say he is bringing in reforms now, but he has done so with extreme reluctance and only after serial scandals. His reforms do not go far enough. The last Government led by the Taoiseach voted against a detailed submission by Sinn Féin for root and branch reform of An Garda Síochána, including an independent policing board similar to that proposed by the Patten Commission in the North.

Let us be clear, the Taoiseach was not on his own in all of this. Way back in 2005, Teachta Ó Snodaigh made the same case to a Fianna Fáil-led Government and to the then Minister, Michael McDowell. At that time, Michael McDowell argued that there was not a level of corruption, incompetence or bad faith within An Garda Síochána which would warrant this. The Taoiseach made exactly the same argument ten years later. Now, in 2017, he has reiterated his confidence in the Garda Commissioner. The Commissioner's position in untenable. It is not easy to understand why the Taoiseach will not remove her from office. There is no rational explanation. The majority of parties in Leinster House want the Commissioner to go. The Taoiseach needs to act in the best interests of An Garda Síochána and for the sake of the people of this State. The Commissioner needs to go now. Will the Taoiseach finally accept this reality and relieve Nóirín O'Sullivan of her duties as Commissioner if she refuses to resign?

As Deputy Adams well knows, the Committee of Public Accounts is removed from the influence of the Oireachtas. I am not aware of the papers he to which he refers being given to that committee. They have certainly not come into my possession, nor should they if they were given directly to the Chairman or a member of the Committee of Public Accounts. I have confidence in the Garda Commissioner to do her job. This morning, the Cabinet approved the nomination of Kathleen O'Toole, the chief of police in Seattle, to chair the review body dealing with An Garda Síochána. She is an outstanding person of great experience in both legal and policing terms and has a deep understanding of the situation that applies here in Ireland. I expect that nomination to be ratified by Cabinet next week. In addition, the Cabinet also approved the terms of reference for the investigation into Project Eagle this morning, a matter which has been raised by Members on a number of occasions. Following receipt of further observations from the Fianna Fáil Party and from Deputy Wallace, I took those observations into account and had approval given for the terms of reference for that investigation. These actions are being taken by Government in respect of matters of public concern.

I expect Garda Commissioner O'Sullivan to do her job. She is expected to appear again before the Committee of Public Accounts. I understand that she is to go back for further discussion with the committee later this month or next month. I am not quite sure of the date.

I referred previously to the sad, unfortunate and tragic death of Tony Golden. I told Deputy Adams that there are two parallel investigations ongoing in respect of that murder. All of the evidence that Deputy Adams gave to me and to the Tánaiste and Minister for Justice and Equality has been transferred to those dealing with the matter. Obviously, it is important that the investigations into this sad and tragic case are allowed to be followed through on and that they take the information that the Deputy supplied into account. As to whether that information can stand up, it is not for me to comment on its veracity. I am sure the Deputy would not have given it to me without a good reason to do so.

The big problem for many people is that no one in the upper echelons of this State is ever held to account. I know that politicians might get their comeuppance at an election if that is the will of the electorate. However, the big issue is the lack of accountability on the part of bankers, financiers, developers, senior public officials and policymakers. People are asking who is held to account in the context of the mistreatment of children, women and people with disabilities, the homelessness crisis, the health service and the administration of policing and justice. The Taoiseach's Government retained the right to appoint the Garda Commissioner. It did not have to do so. It could have accepted the motion Sinn Féin tabled. That is why I ask the Taoiseach to remove the Garda Commissioner. We have a situation where Fianna Fáil says it has no confidence in the Commissioner but that it supports the Government, which continues to express confidence in her. This is not new politics. This is more of the same old story. The Taoiseach has set his face against removing the Commissioner. He has just said he has confidence in her. Have he and the Fianna Fáil leader discussed this issue?

The answer to the last question is "No".

Today we saw yet another damning piece of evidence, in the form of the daft.ie report, of the abysmal failure of the Government to deal with the spiralling rental, housing and homelessness crisis. The report shows that rents have jumped by a record 13% in the past year - €134 per month on average over the course of a year - guaranteeing to escalate that crisis and lead to more emergency situations, more evictions and more people in homeless accommodation. Typically, the Taoiseach or the Minister says that the Government inherited this, that it takes time to deal with the problem and that the Government is on it.

I will cite a very concrete example of how decisions the Government made in the past six months have contributed directly to this shambles and the hardship that follows. Robin Hill, a development of apartments in Balally in Sandyford, was originally built by the McEvaddy brothers in 2008. The development, which consists of 52 apartments, went into NAMA at some point. For most of the time it has been in NAMA, at least 15 and possibly as many as half of the apartments have been empty while the housing crisis spirals out of control. In May 2016, Dún Laoghaire-Rathdown County Council asked whether it would purchase 15 of the vacant units. It was told that it could only buy the entire block. Shortly after the Project Eagle scandal broke in September, NAMA agreed the sale of Project Gem, which included these apartments, to the vulture fund Cerberus. The sale, which was one of the biggest sales of property in the history of the State, went through. Since then, Cerberus has moved to start evicting the tenants in a block that is still half empty. Of the 21 remaining tenants I have met, five are to be evicted in June. Others whom Cerberus feels it cannot evict straight away have been told they must pay an extra €250 per month in heating and hot water charges that were previously included in the rent. They were never charged for that previously. In other words, this is a back-door rent increase of about 20%.

These empty units are sitting there while we have record numbers in homeless accommodation with evictions to follow. This would have been avoidable if NAMA had not sold this development to a vulture fund but had given it to the local authority as it requested and if the Minister for Housing, Planning, Community and Local Government had ensured his Bill before Christmas included a provision to prevent new owners from evicting tenants when apartments are sold, as we warned would happen, or finding back-door ways to ratchet up rents. Is it not the truth that the crisis is avoidable and has resulted from the Government's policy failures?

No, it is not the truth. The problem here is the supply of houses throughout the country. Anyone can understand that there is real pressure in certain segments of the housing sector. The Deputy can nod his head if he likes. I read a report this morning that said that 49 houses priced between €400,000 and €700,000 were snapped up inside a day by those who could afford them. There are no difficulties in certain areas.

It is true to say that there is a serious issue here. A total of 40,000 vacant units have been bought by the State in the past five years. If the Deputy had given me the details of the situation about which he spoke, I could probably have given him an accurate answer but I can say to him that the report about rental prices and rent pressure zones shows that rent inflation has slowed over the past quarter. The rate of increase in Dublin rents between quarter 4 of last year and quarter 1 of this year was significantly lower than the rate of increase over the year. Quarterly inflation registered in quarter 1 of 2017 was 0.7% in south County Dublin, 1.4% in west County Dublin, 1.6% in north County Dublin, 1.5% in north Dublin city, 2.1% in Dublin city centre and 1.4% in south Dublin city. I am sure the Deputy will be interested in the figure of 0.7% for south County Dublin.

There is also strong rent inflation in the commuter counties. The increases are placing huge pressure on tenants, particularly those seeking new accommodation. The Daft.ie report notes that rent increases faced by sitting tenants have generally been lower than for those seeking new accommodation. Rebuilding Ireland and the Government's strategy for the rental sector state that severe shortages in supply in key locations are driving these rent rises. That is why the housing programme prepared by the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, emphasises the need to deal with the question of supply. On several occasions in this House I have given details of the initiatives, opportunities, Government action and money that is being provided for local authorities and both public and private developers to deal with the housing supply issue. There are cases of objections and this, that and the other but this is the real issue that Government is trying to address. Deputy Boyd Barrett knows as well as I do that to go from 90,000 houses being built per year to less than 9,000 takes some recovery. The Deputy mentioned NAMA acquiring properties. It was a portfolio worth €80 billion. NAMA will have done its job when it gives the taxpayer approximately a €2 billion-plus surplus within the timescale involved. Those who acquire those houses are subject to the law of the land.

The Taoiseach's figures are all wrong.

The number of vacant properties since 2011 is 40,000. The action taken by the Minister in respect of the second point raised by Deputy Boyd Barrett was on foot of legal advice received from the Attorney General.

A fantasy figure has just appeared, namely, that the State has apparently purchased 40,000 houses. The more accurate truth is that NAMA has flogged off thousands of homes or, worse, as the Balally example indicates, has sat on empty properties in public ownership and when local authorities sought to purchase them, it refused and chose to sell them to a vulture fund instead. The vulture fund is now moving to evict people, bypass the Minister's totally inadequate legislation and ratchet up the rent on tenants it cannot immediately evict. I suspect, and the tenants fear, that they will be evicted in phases because under the Tyrrelstown amendment, no more than ten tenants may be evicted at one time, which is leading to landlords evicting tenants en bloc. That is almost certainly the case and the Taoiseach allowed it to happen by selling apartment blocks. How many more Balallys are there? How many more in Project Gem? How many more people will get eviction notices from vulture funds to which NAMA sold properties at a massive discount rather than give them to the local authorities. There are 50,000 empty properties in Dublin. The Balally situation indicates why there is a supply problem in spite of that. That is the real issue. It is not an absolute supply problem, it is a man-made one resulting from the behaviour of NAMA and the vulture funds, which are sitting on empty properties, evicting people to inflate property prices and rents and make more profit from the misery of those they evict or who cannot afford to rent such properties.

Let me clarify what I meant when I said that 40,000 properties have come back into use.

That is not what the Taoiseach said.

That is not what was said.

I take the Deputy's point. One thousand properties were purchased by the State at a cost of €203 million.

That is 39,000 fewer than the original figure the Taoiseach gave.

The others are through the normal churn of reconstructions, sales, local authority purchases and so on.

It is almost like a figure for breathalyser tests.

The Minister will soon launch the strategy for the return of vacant dwellings to habitable use. There are approximately 34,000 vacant units in Dublin. There is a list of vacant apartments and dwellings to be returned to use.

What is the Taoiseach going to do for these people? He should enforce a compulsory purchase order on those apartments.

Even Deputy Boyd Barrett understands that these apartments cannot be returned to a habitable state overnight in order to be allocated to people.

The Taoiseach could start that process.

Some properties have been vacant for years.

Deputy Boyd Barrett has pointed out to me in the past number of weeks that people have been sent 10 km or 12 km to hostels or hotels because the local accommodation was unsuitable.

The strategy that the Minister, Deputy Coveney is to introduce in the next couple of weeks is to deal with that very issue.

The State was sitting on empty properties.

Vacant units, apartments and houses in the Deputy's area and every other area have to be the subject of a strategy to return them to habitable use for people in order that they can raise their families in them.

I want to begin with a quotation that is relevant. It comes from a writer-director who wrote "The generation that won ... Independence lives in the ideas we honor, the architecture we preserve and the battlefields we yet can save.” This is quoted at the start of the report from the Moore Street consultative group, which was presented to the Minister for Arts, Heritage, Regional, Rural and Gaeltacht Affairs, Deputy Humphreys, on 29 March, 2017. Someone said to me recently that we are much better at recognising defeats than victories. I acknowledge the victory and success that came with the report from the consultative group. The Minister had set up that group in late September 2016, part of which is made up of representatives from Fine Gael, the Labour Party, the Green Party, Sinn Féin, People Before Profit and from the Independents. There are other Deputies and councillors on the group, as well as 1916 relatives, the Save No. 16 Moore Street committee members and the Moore Street traders. Under a very able chairman, we went through a public consultation process, submissions, expert advice etc. At the end of the process we were all on the same page. We all agreed and we all endorsed the report and the vision for the development of the Moore Street battle site as part of a historic cultural quarter to capture that moment-in-time experience such as that in Kilmainham Gaol and other places and to capture the sense of what it was like for those who evacuated the GPO and for those who lived and worked on Moore Street. It would also recognise the fact that five of the signatories spent their last few hours there. We all endorsed the proposals to preserve the streetscapes, the lanes and the regeneration of the Moore Street market for the traders. There has been so much progress and so much success, with very clear recommendations that can be realised. These recommendations have been laid out, starting with the State - as the custodian of our history and heritage - and then the advisory group, under an independent chairman with the resources to do the work. The Minister response was to state she was fully supportive of the constructive approach and that she wants to see the work of the group being built on "so we can progress to the next stage". I want to know what exactly that means in real, practical terms in order that we can move on the recommendations of the report within the clear timeframes. We know there have been years and years of neglect and decline and of indifference to the battlefield site. There also has been indifference to the difficulties to the livelihoods of the Moore Street traders. When will phase two begin, what are the Government plans in this respect and has the report come to Cabinet yet?

It means that agreement is required. Obviously there are a number of different parties here; the State, the city council and private property owners. The Government made a decision by the end of 2015 to purchase Nos. 14 to 17 Moore Street and to keep the site permanently in the State's hands for people to understand the historic importance of the buildings and their part in Irish history. This was an important decision, at considerable cost, made by the state and the State now owns it. Clearly, emerging from the side door of the GPO and turning left, moving down towards Moore Street and up towards the Rotunda are - as I have often said - the lanes of history. Dublin City Council has a responsibility here also and elements of the buildings on either side were private property. As part of the overall sensitive and comprehensive centenary commemorations, the Government has set out to ensure that the Nos. 14 to 17 Moore Street national monument would be restored in the most sensitive way possible, given the circumstances that apply around it. There was not agreement about that. It is impossible to proceed with a proper structure and a plan unless there is agreement. Agreement always requires compromise from the set positions that people may wish adopt. I recall being involved centrally in saying that this building must be purchased for the people and for the use by the people for all time. I thought that it might have been of some assistance in the overall programme.

There was disagreement about the extent of the buildings purchased given the importance of all of the buildings in that street, and whether and how one might restore the laneways up to the Rotunda where the formal surrender actually took place. I will have the Minister, Deputy Heather Humphreys, respond to Deputy O'Sullivan about the current position and the extent to which further progress can be made. She will appreciate that there has been a considerable measure of progress made, the site being within the north inner city, where the State has taken an interest in dealing with issues of neglect for many years. I hope we can have agreement on an outcome between the different parties involved, namely, the State with its responsibility in so far as the national monument is concerned, Dublin City Council, the planning authorities and private enterprise. Together, we may come to a solution that would enhance the area while retaining the context of this historic location and the part it played in a seminal moment in Irish history, which helped us on our way to economic and political independence.

There has been a lot of agreement, on which we should start to build. The Taoiseach is a cyclist and knows that if he keeps cycling, he will build momentum but if he stops, he will start to wobble and will eventually fall off the bike. The consultative group has been doing a lot of cycling. We have been building up momentum and should keep going with it. The Government owns the structure at Nos. 14 to 17. There has been considerable money spent on protecting and securing that structure. It would be much better if the money could be going into the restoration but we do have to keep the structure secure for the foreseeable future. I would like a commitment on that.

The Moore Street traders have played a major role on the committee. Their livelihoods have been under severe threat in the past years and will remain so with the works that are to come on stream. It is imperative that we make a start. Could we have a date for the meeting on the next phase and the appointment of the chair?

I recall speaking to experts in restoration about the structural condition of the building. It was clear that we could not proceed to do sensitive restoration work without the building being structurally sound. It is for experts and engineers to determine how that should be done. I take the Deputy's point. There is a measure of agreement here. Having made a major move in purchasing Nos. 14 to 17 for the good of the people of Dublin and Ireland for all time, I would hope that we could build on that agreement in determining what the next appropriate and proper step should be. I will consult with the Minister, Deputy Humphreys, and come back to Deputy O'Sullivan.

I had genuinely thought that we might have been in a position to have Nos. 14 to 17 restored and opened to whatever small numbers could go through at any one time, as part of the restoration of the GPO, Kilmainham, the military archives and so on. However, because of the situation that arose it was not possible. The good thing is that it has been purchased and is now owned by the State. It is secured and that at least is an important point from which we can move towards a conclusion in the interests of the city and the country, and not least of those who live in the locality.