Leader's Questions

I am sure the Taoiseach will agree that the health and well-being of our democracy is inextricably linked with the health and well-being of our Defence Forces. A recent study by the University of Limerick, Workplace Climate in the Defence Forces, which follows on from a study in 2015, illustrates a very worrying trend, pointing to a crisis in our Defence Forces, our Army, Naval Service and Air Corps. Morale is very low. The value system to which those in the Defence Forces once adhered is being steadily eroded. Stress is ever present. Work-life balance is an issue, as is the safety of personnel on duty. There are dysfunctional turnover levels according to the research. There is an absolute crisis regarding the retention of personnel, which is a serious issue for our Defence Forces.

Pay and conditions feature strongly in the research. As a subset of that, duty pay emerged as a particularly contentious issue. When commuting and child care costs are taken into account, it actually costs soldiers more to be on duty than they get paid. Officers commenting on the implications of pay levels said that pay is directly impacting on turnover levels of privates and that those with the most potential are leaving. That is a very significant cost in investment, training and so on. Some of the comments in the report highlight this. For example, in the context of the Air Corps, some of the following comments reflect the concerns of the enlisted ranks: "We are short 50% in a technical unit"; "We can't do things safely. We need to say no to outputs."; "We are double and triple jobbing. That would be illegal in the private sector"; "It keeps us up at night ... is this safe ... we are signing off on people who don't have experience". Members of the Naval Service said: "With the limited time and increasing workload we are only half doing jobs"; and "We were given an 8th ship but only have the number of people for 7".

As for the Army, there is a similar expression and articulation of issues around safety and so on. I raised last week the concerns of the wives and partners of Defence Forces personnel about lack of morale. All of this adds up to the need for a comprehensive response from Government to the wide range of issues facing the Defence Forces and the crisis they are in. It is not just about the Lansdowne Road agreement, but about much more in terms of the overall climate and conditions. It is important that a review emanates from Government.

I asked the Taoiseach two weeks ago about the need for access by RACO and PDFORRA to the industrial relations machinery of the State. The Taoiseach did not have an answer then. I would appreciate it if the Taoiseach would give me the Government's view about access for the Defence Forces' representative bodies to the industrial relations machinery. Finally, does the Taoiseach accept there is a crisis in the retention of personnel in our Defence Forces?

On behalf of the Government of Fine Gael and Independents, I note our immense respect and regard for the Defence Forces and our pride in the work they do whether as an aid to the civil power, the 2016 commemorations, ongoing commemorations such as Sunday's national day of commemoration and its work in the Mediterranean to combat human trafficking and rescue people from the boats that are leaving Libya. The Cabinet approved just this morning a decision to extend the mission in the Mediterranean to allow further participation in the Operation Sophia arrangements, as well as Operation Pontus in the Mediterranean. That will also, of course, require a resolution of the Dáil, which we propose will take place tomorrow. This is being done at the request of the Defence Forces, who want to do more and to continue to be part of the mission in the Mediterranean. They want to do more to rescue refugees and combat human trafficking. The approval of additional operations and the provision of resources to carry them out are testament to and evidence of the Government's commitment to our Defence Forces. It will, of course, happen under the triple lock. There is a UN mandate in place, Government approval issued today and we will ask the Dáil to approve the motion tomorrow. I hope we will have full support across the House for the decision.

Even during the darkest periods of the recession, the Government continued to recruit to our Defence Forces. Many more people apply to become members of the Defence Forces than we have places for. There is still real and huge demand for people to join the Army, Naval Service and Air Corps, although there are, of course, difficulties in retaining people at certain levels. Pay is negotiated as part of collective agreements with public service trade unions and representative organisations, in this case PDFORRA and RACO. The weekly Defence Forces payroll of 5 July saw an increase of 2.5% from 1 January 2016 for annual salaries up to €24,000 and a further 1% for annual salaries between €24,000 and €31,000. A further increase of €1,000 a year occurred on 1 April this year on annualised salaries up to €65,000. That is due to be paid to members of the Defence Forces from 19 July. In addition, recent adjustments to salary scales will significantly benefit general service recruits and privates who have joined the Defence Forces since 1 January 2013; the so-called "recent entrants". They will receive increases in their pay packets ranging between 8% and 24%. As such, no one can dispute the fact that salaries and take-home pay are increasing again for our Defence Forces. We accept, however, that in certain areas it is difficult to hold on to people in management roles and those with particular skills which are valuable in the private sector, including, for example, air traffic controllers. We may need to look at those as specific issues.

The Taoiseach made the same comment last week about recruiting so many applicants notwithstanding the terms and conditions in place. He is in denial as, it appears, is the Government about the crisis. This is not just about Lansdowne Road. I compare what the Taoiseach just said with what Army personnel are saying. There are high rates of mental health issues in the Defence Forces and more than half of members have a second job just to be able to make do.

An Army private soldier is cited as saying, "I have to live with my parents along with my wife and kids." One member said, "Stress is being caused by geographical and financial issues." Another said, "I am driving from Cavan and in mortgage arrears. I am double jobbing and doing the job of CO's." The report cites another as saying, "We are commuting from XXX to XXX every day, that's ... €120 on diesel a week." I do not know if the Taoiseach has read the entirety of the report - he may not have - but it is quite shocking in terms of what it is revealing about the very low morale in our Defence Forces and the sense of crisis - not difficulties - about retention. This is at all levels and not confined to specialists or specific types of jobs. The turnover is across all levels. As I said earlier, it relates in particular to privates who are leaving within a short space of time.

The wives and partners who came to see me about three or four weeks ago did not need this survey.

Tá an t-am caite.

They told me the story through their real life experiences. The fundamental thing that comes out of this report-----

Tá an Teachta thar ama.

-----is the sense of disconnect between how soldiers, Naval Service personnel and Air Corps personnel on the ground feel and what leadership-----

One minute is not two minutes.

-----the Department of Defence and, ultimately, Government may think. That disconnect is again revealed in the Taoiseach's response.

That is two minutes.

Will the Taoiseach address the earlier questions that I put to him first time out?

What I also said, which the Deputy did not acknowledge today or some weeks ago when he raised it, is that pay restoration is now under way in the Defence Forces. Pay restoration is occurring across the public service. As I mentioned, pay restoration is happening at all levels, but it is happening in particular for those who were recruited since 2013, who are often referred to as recent entrants. There is pay restoration of more than 20% in some cases. That will continue because we have repaired the economy and are able to balance the books. As the number of those in employment is rising and incomes are rising, we are able to start giving something back, including back to those in the Defence Forces. They will continue to see their salaries rise in the coming years, not just because of pay restoration but because we are reducing payroll taxes such as the universal social charge. They will also see more help with the cost of living, which is an important issue for everyone. For example, in a few weeks' time, the universal child care subsidy will come into effect for anyone who has a child between six months and three years of age. Things are now, at long last, going in the right direction for people across all levels of our public service.

To give an idea of the level of interest in becoming a member of the Defence Forces, 4,000 people applied for the cadet intake for 2017. There is huge interest in becoming a member of the Defence Forces.

Retention is the issue.

There is high turnover in the Defence Forces but the turnover in defence forces across the world is high. It is not particular to Ireland. However, we acknowledge that there are issues which will have to be examined around retention in particular areas where there are special skills.

Go raibh maith agat, a Thaoisigh.

In terms of PDFORRA and RACO, the representative organisations, the Minister of State, Deputy Kehoe, met them on the climate survey recently and he will meet them again on Thursday. Any disputes that occur between the Defence Forces and representative organisations are dealt with through the existing systems and arbitration.

Until such time as the House decides to extend supplementary questions from one minute to two minutes, we cannot allow this slippage. I call Deputy McDonald.

I have raised the chaos within the health service with the Taoiseach many times. This chaos has human consequences. This afternoon I want to put one name and one face to some of these consequences. Earlier I informed the Taoiseach's office that I wanted to raise with him the case of Olivia Harte. Olivia is 41 years of age and from County Leitrim. She is the mother of two young children, Colette and Ronan. She suffers from an aggressive form of Parkinson's disease. Olivia is currently in the intensive care unit of Cavan General Hospital. She has been there for the past seven months. Olivia has been on delayed discharge since January and remains in hospital six months after she was ready to go home. Olivia is on a ventilator most of the time and on oxygen to allow her to eat yoghurt or drink smoothies for short periods during the day. She is fully cognitive with a memory that would put most of us to shame. She can walk a short distance with assistance but she is physically very weak. This is Olivia's reality and it is lived out in the clinical surroundings of a medical facility while her two small children play at her bedside. I think everyone here, and beyond here, will feel the intense sorrow of that image.

The team at Cavan intensive care unit, for whom the family has nothing but praise, says that Olivia should be at home with 24-hour nursing care for her needs. However, Olivia cannot go home to her family because the HSE has refused to fund a home care package. Olivia applied for the intensive home care grant following her discharge, but this was turned down on 3 May last due to funding. To add to her sense of despair, she was informed on 14 June that her application for the older person's home care grant was also rejected. These rejections have taken their toll.

I raise this issue with the Taoiseach as a last resort for this family. Olivia celebrated her last birthday, her tenth wedding anniversary and both of her children's birthdays in Cavan intensive care unit. She wants to go home to her family. This is a human and instinctive need that everyone will understand. We all need to be in the company of our loved ones and to feel the comfort of familiar surroundings, particularly if we are sick or vulnerable. In its 2018 pre-budget submission published today, Family Carers Ireland states that for too long home care has been underfunded, inconsistent and inequitable. We are spending €11 million less on home care than we did in 2008. At the beginning of May 4,500 people were waiting for home care packages. Vulnerable citizens must be provided with long-term care in their homes when needed. Olivia is just one of those citizens. Will the Government give Olivia the dignity of being able to return home to her family by funding the home care package she so desperately needs?

The Deputy will appreciate that I do not have specific details on individual cases to hand. There are no patient files on my desk, and even if there were, it would be inappropriate to discuss patient information in this House. I know from my previous work as a medical doctor the difficulty and enormous barriers there can be to providing 24-7 nursing care with ventilation at home. It is difficult to provide and is not as straightforward as a normal home care or intensive home care package.

With regard to the general issue, the number of delayed discharges, where people are in hospitals waiting on home care packages to go home, has fallen considerably in recent years. It peaked at approximately 830 in 2014 and has now fallen to 537. There is still a long way to go but we are in a much better position with regard to delayed discharges generally than we were two years ago. The budget for home care packages and home help has been increased this year to €367 million. That is providing 10.5 million home help hours and 16,750 home care packages this year, an increase from 15,000 last year. Some 1,750 more people will get home care packages this year than did last year. In addition, funding has been retained for 190 intensive home care packages, which is a considerable number.

As regards individual cases, I cannot say why that individual was not approved for an intensive home care package or one of the additional home care packages that are now being funded, but I will ask the Minister for Health to follow up on the matter with the Deputy.

I can tell the Taoiseach why Olivia is still in one of only three intensive care unit beds in Cavan General Hospital. She is there unnecessarily and is aware of that. She is very distressed by it. The reason she is there is that the HSE, despite the medical advice and view that she ought to go home, refuses to fund the home care package.

I beg to differ with the Taoiseach. It is incredibly appropriate that he would address himself to Olivia and her family, and do so beyond statistics and figures. This is a young mother who is very sick. She has a six year old and a seven year old and for the past seven months they have been in and out of hospital, playing at her bedside. She wants to, and can, go home. The single barrier between her and her home and family is the HSE and its failure to fund the requisite care. I ask the Taoiseach, as the head of the Government and as a person, to give a commitment today that he will ensure the HSE will release the funds required in order that Olivia can go home.

She is a sick woman who has asked me, as a matter of last resort, to ask the Taoiseach to intervene and ensure the right thing is done.

I will certainly have the case looked into and I will discuss it with the Minister for Health and ask that full consideration is given to it. However, what I will not do in the House - it would not be the right thing to do even if I had the authority to do so - is direct that the Health Service Executive do anything in any individual case. That is not how decisions should be made. It is important that decisions are made by the professionals and that where resources have to be allocated, they are allocated in that way. I do not think that because a case is raised in the Dáil, it should cause a particular decision to be ordered or made.

That is not the reason. The woman in question has been in intensive care for seven months.

As I say, from my experience as a medical doctor, providing 24-7 care in the home requiring ventilation at the level of the type of care provided in an ICU is very difficult and can be very challenging to provide, even if funding is available. I will certainly endeavour to have the Minister for Health follow up on the case. I mention again that there has been a significant increase in funding for home care packages this year, with the number of packages increasing from 15,000 to 16,750.

Yesterday, I dropped into my local mart in mid-Tipperary where I met farmers, a number of whom asked me directly how interested the new Taoiseach was in agricultural matters and how aware he was of the problems in agriculture. I assured them that the Taoiseach has a clear understanding of the significance and importance of agriculture and food to the economy, the value of our exports and the importance of these exports to sustaining and maintaining jobs. I informed them that I would have an opportunity to put their questions directly to the Taoiseach today. Conscious that the British Government has stated the United Kingdom will leave the Single Market and customs union and given that Brexit is the most significant threat facing our critically important farming and food sector, they wanted to know what the Government is doing to keep these issues at the top of the European Union's Brexit agenda in order that we can maintain access to the UK market and retain the value of that market? Farmers would also like to know what the Government is doing to ensure the budget for the Common Agriculture Policy increases following the UK's departure from the EU. Such an increase will be necessary to improve farm incomes and deliver a strong, sustainable and competitive agriculture for the benefit of farmers and consumers.

On the proposed aid scheme to support tillage farmers who incurred significant weather related losses in the 2016 harvest, will the Government commit to providing for the maximum of €15,000 permitted under the European Union's state aid rules?

The Irish Farmers' Association in Tipperary has highlighted the anomalies, unfairness and, in some cases, injustice in the farm inspection regime. These inspections have led to punitive penalties causing considerable stress and financial loss to many farmers. What measures will the Government take to remove the unacceptable strain on farm families associated with these inspections? Will the Government introduce an appeals process independent of the Department of Agriculture, Food and the Marine and with an independent chairman?

I assure the Deputy's constituents that I am very much aware of the importance of agriculture and the agrifood industry to the economy in terms of the number of jobs supported, its particular importance to the rural economy and the substantial revenue brought into the country as a result of agricultural exports. The Government is very much behind the industry in every way it can be.

Regarding Brexit, it is one of our absolute priorities that we maintain free trade in goods and services between Britain and Ireland, ideally through Britain and the UK staying in the customs union and the Single Market - in light of the election that may even be a possibility again - or, if not, negotiating a free trade agreement that continues to allow for free trade in agricultural and food products after Britain leaves the European Union.

It is something with which we are very engaged. Just yesterday, the Tánaiste met Mr. Michel Barnier and again impressed on him our strong view that we need to retain the closest possible trading relationship between the EU and the United Kingdom. I had phone calls with the Scottish First Minister and the Welsh First Minister, who both articulated to me their view - the view of Scotland and the view of Wales - that, even if Britain does leave the European Union, they should stay in the Single Market and should stay in the customs union. They endeavoured to push that view in Westminster and in London that Britain should stay in the customs union and Single Market. I endeavoured at European level to keep the door open to Britain to stay in the customs union and Single Market. Should it be willing to do so, we will keep that door open. In the absence of that, if Britain insists on leaving the customs union and the Single Market, we will advocate very strongly for a free trade agreement between the EU and the UK that maintains free trade in agricultural products and food products, thus minimising the impact on our farmers and on our food industry.

In terms of tillage, I had a discussion this morning with the Minister for Agriculture, Food and the Marine on this matter. I am very aware that the harvest in 2016 was very poor for our tillage farmers. As a result of that, the Government has decided to set aside €1.5 million, which will be a compensation scheme to be put in place for tillage farmers badly affected by the poor harvest in 2016. The exact detail of that scheme is yet to be worked out. The Minister, Deputy Creed, is very willing to meet the IFA and to discuss the details of that scheme with it-----

These people have been waiting a long time.

-----on the basis that there should be no preconditions as to what the outcome should be. However, he is very adamant, and I support him in this, that before any meeting takes place, the occupation of his offices should end. No one should be required to negotiate while his or her workplace is under occupation. Obviously, that is taking up Garda resources and also is creating difficulty for the Civil Service staff in the Department. Should the occupation end, he is very willing to negotiate with the IFA on the detail of that scheme.

Those people had to go there.

Some €1.5 million has been allocated by the Government to compensate farmers badly affected.

I appreciate the Taoiseach's response, but will he address the issue of farm inspections and having an independent appeals assessment process with an independent chairman? Farm inspections are a requirement under CAP direct payments. Will the Government give a clear commitment to apply pressure at EU level to have this matter addressed under the CAP simplification review that is under way? The inspection regime is causing a great deal of aggravation, anxiety, stress and financial hardship for many farmers throughout the country, but particularly in my county of Tipperary.

There is an appeal system in place already for applicants who consider that an inspection has not been conducted appropriately. The system involves an appeal to a senior officer within the Department, with the option to appeal further to an independent agriculture appeals office and, ultimately, the Office of the Ombudsman. As per the programme for Government commitment to do so, the Minister, Deputy Creed, and his Department are carrying out a review of the Agriculture Appeals Act 2001. That is to ensure the independence and efficiency of the office dealing with appeals from farmers. A steering committee has been established to oversee the delivery of that programme for Government commitment and the Minister will make a statement on it as soon as there is further progress.

South Tipperary General Hospital is a progressive, forward-looking and efficient hospital, but it has a major problem with a lack of bed capacity. Simply put, there are not enough beds to cope with the number of admissions. That this is a problem has been accepted by hospital management, the regional HSE management and the South/South West hospital group management.

The figures are shocking. In 2011, there were 750 patients on trolleys in the hospital. In 2016, there was a sixfold increase to 4,419. Today, at the height of the summer, there are 22 patients on trolleys in the hospital's corridors. If that is the case today, what in God's name will it be like in the winter and autumn months?

Of course, we know what it will be like. It will be chaos, as it was last winter, the winter before and the winter before that. The hospital is bursting at its seams. It is operating at 130% of its capacity overall while the medical department is operating at 150% of capacity. Everybody's preferred option for solving this problem in the medium term is a 40-bed inpatient modular, or hotel-type, unit of accommodation.

Numerous Ministers have visited the hospital in recent years. The former Minister, Senator Reilly, the Taoiseach and, in October of last year, the current Minister, Deputy Harris, have visited. When he visited, the Minister for Health said that the situation was utterly unacceptable, that a solution had to be found and that we would have a decision before the end of the year. We are, however, still awaiting that decision.

Will the Taoiseach personally take up this matter and deal with the situation at the hospital? There is absolutely no privacy for patients on trolleys in corridors. The staff of the hospital are under huge pressure. As I said, the hospital is bursting at the seams and approval for this 40-bed unit is awaited. Will the Taoiseach ensure that the provision of such a unit is approved as a matter of urgency? Will he begin the process today?

A look at this morning's trolley figures, which are provided by the HSE, shows that there were 272 patients on trolleys this morning compared to 373 on the same day last year - a reduction of approximately 100. Obviously, I appreciate that if a person is one of the 270 patients who are on trolleys - or a family member of such a patient - that figure is of no benefit because of the enormous distress and inconvenience that being on a trolley causes. I appreciate the very difficult working conditions which our staff in emergency departments have to endure, but a reduction from 373 last year to 272 this year - a reduction of more than 100 year on year - is quite significant.

I have been to South Tipperary General Hospital. It is certainly in need of very significant investment. Like many hospitals in the country there is a new section, which is very much up to standard, and an old part, which is very much not. The Department of Health is conducting a bed capacity review which will establish how many additional beds we may need across our acute hospitals. Building new hospital blocks and new hospital wings takes several years. Even just the planning, tendering and construction could take three to four years before any new blocks could come on train. In addition to that, the Department of Health is working on proposals to provide temporary accommodation in a number of hospitals, the like of which the Deputy has mentioned. It is of course just not good enough to provide temporary accommodation, it must be possible to staff it as well. This time last year, we encountered difficulty in staffing all our beds. That proposal is now being worked up by the Minister for Health and we will see if it is possible to put it in place later this year.

I will make a point on the figures from the Irish Nurses and Midwives Organisation in respect of patients on trolleys in the first half of this year. Those figures were very interesting. They show an overall increase across the country, but huge variations from hospital to hospital. Beaumont Hospital and Connolly Hospital had the lowest number of patients on trolleys since records began and St. Vincent's University Hospital had the second lowest. This is despite two of those three hospitals getting no additional beds whatsoever, whereas some hospitals which got additional beds actually disimproved considerably. That demonstrates to us that providing more staff and more beds on its own does not work. As politicians and as people who make decisions on behalf of the public, we should all acknowledge this. Good clinical leadership is just as important if not more important. We need all of those things because constantly putting more resources, staff and capacity into a system which is not led or managed well will not be enough.

The Taoiseach's reply is absolutely disappointing and unacceptable. As the Taoiseach, the HSE, the management of the hospital and the management of the South/South West hospital group well know, the situation in South Tipperary General Hospital is absolutely atrocious.

Everyone accepts the hospital's lack of bed capacity. This may be the fifth year that various Ministers and Ministers of State gave promised additional beds at the hospital. It is time to bite the bullet. The patients attending South Tipperary General Hospital are entitled to good quality hospital services but they are not getting them.

I understand that a senior medical professional from the South/South West hospital group carried out a forensic analysis of the hospital's bed capacity and has accepted that 35 to 40 additional acute beds are urgently needed at the hospital. I believe the report has gone to the HSE and that senior management of the HSE is now sitting on it, so to speak. Will the Taoiseach ensure the report is acted upon and made public? Approval should be given for beds at South Tipperary General Hospital, not at the Mater Hospital or anywhere else nationally but at South Tipperary General Hospital where there is an agreed and accepted necessity for additional beds.

When there are additional beds, one of the most important things to do is to staff them. We are hiring more staff. Some 700 additional nurses will be hired this year alone, allowing us to open beds that may have been closed temporarily and also to facilitate patients being discharged more quickly, thus allowing beds to be used by more patients and to have faster turnover of beds.

The national bed capacity review is not completed yet and we need to complete it. I do not believe a bed capacity review can be done in isolation. As hospitals have overlapping catchment areas, it needs to be done on a national basis. However, I am told it is very far advanced.

I mentioned earlier that providing new blocks or new hospital wings can take a number of years. For example, a new one has just been opened in Galway, providing 75 more beds. A new emergency department in a new block in Limerick has been opened in recent months. A new emergency department and an acute floor have opened in Kilkenny in recent months. All these things took many years to plan and build. Even if we approved additional hospital blocks now, it would take a number of years to build.

We are not asking for a block. We are asking for temporary accommodation, which is accepted by everyone.

The Taoiseach has exceeded his time.

Temporary accommodation can provide capacity quickly at under pressure hospitals. That is being actively considered by the HSE and the Minister at the moment, but it needs to be worked through.