Leaders' Questions

Seven years ago, Fine Gael promised universal access to health services for all and the end of long waiting times and lists. Seven years on, we have record levels of waiting times and waiting lists. Some 718,000 people, an extraordinary number, are on hospital waiting lists as of May of this year. Some 512,000 of these are on an outpatient waiting list, a record high which means that many will wait for years for an operation or procedure. For example, 66,768 people are waiting for an ear, nose and throat, ENT, consultant, with nearly 30,000 of those waiting more than a year and 17,000 waiting more than 18 months for access to ENT services. Some 62,000 people are on outpatient waiting list to see an orthopaedic consultant. Some 20,000 have been waiting more than a year and 11,000 more than 18 months. Some 41,000 are on the ophthalmology list, 41,000 for dermatology, and 30,000 are on a waiting list to see a gynaecology consultant. Some 20,000 are on a cardiology list, 20,000 are on a neurology list, and so on. The 18 month waiting list is getting longer despite the fact that the now Taoiseach, Deputy Leo Varadkar, brought that in. He widened the goalposts in a cynical move at the time. Even the target to eradicate that has been missed.

Children are hardest hit, waiting far too long for far too many operations, outpatient appointments, and access to mental healthcare. Child and adolescent waiting lists are unacceptable, and speech and language, occupational therapy and physiotherapy all have scandalous waiting lists. Some 50,000 children are waiting for an outpatient consultation and appointment. Some 10,000 children have been waiting more than 18 months to see a consultant. In excess of 4,500 children are waiting for an assessment of need under the Disability Act. Some 2,691 are on children and adolescent mental health waiting lists, with close to 400 waiting more than a year. That is appalling. An extraordinary figure of 6,000 have been waiting for a primary care psychological appointment. The elderly are no better, with 6,500 waiting for home care and help access.

In May 2017, the Sláintecare programme was launched with great fanfare. An executive director was to be appointed, yet 14 months on, nothing has happened with regard to that. No executive director has been appointed. Given those lamentable figures and appalling waiting times for people, why is there inaction and a delay in appointing an executive director to implement the Sláintecare programme? Why has it taken 14 months after the launch of the programme by the Oireachtas and the committee for the Government to do anything about its implementation?

With regard to the Deputy's last question, I am told that an executive director is about to be appointed after a long recruitment process. This is a new departure. It has taken time to get it right. We are focused on trying to get the right person and putting the right structures around that person to make sure that an executive director can deliver on the potential and ambition of the Sláintecare report.

Waiting times are too long.

That is why reducing waiting times for patients for hospital operations and procedures continues to be a key priority for the Government. A total of €50 million was provided to the National Treatment Purchase Fund, NTPF, in 2018 to secure treatments for patients. On 12 April, the Minister for Health published a joint action plan between the HSE and the NTPF to reduce the number of patients waiting for treatment. Under the action plan, the number of patients waiting longer than nine months will fall by 10,000. The NTPF commits to offer treatment to all suitable clinical patients waiting more than nine months for treatment in a number of high-volume specialties, including cataract, hip and knee replacements, tonsils and scopes. The overall number of patients waiting for hospital operations and procedures is targeted to fall below 70,000 by the end of the year. Under the action plan the NTPF will work with both public and private hospitals to access treatment for those patients.

The May waiting list figures show that 78,500 patients were waiting for an inpatient or day case procedure, which is down marginally by 800 on the previous year, but down by almost 7,200 when comparing the year-on-year figures. The number of patients waiting longer than nine months for an inpatient or day procedure is now down 5,800 in comparison with May 2017. I am not saying that makes it acceptable - it is far from it - but what I am saying is that we are making some progress. Tackling the situation will require a combination of more staff, which is happening, more hospital beds, which is happening, and more reform consistent with the Sláintecare report, which is supported by all parties in this House. Very soon we will have a director to take charge of Sláintecare and over time we will see the continued commitment of the Government to bring down waiting lists across the multiple sectors the Deputy raised.

I must point out that it was seven years ago that the Government promised universal access to services, and we are now in a far worse position. It was the Government that got rid of the National Treatment Purchase Fund in 2012. That is directly attributable to an escalation in waiting times and waiting lists. It has only been reinstated because of the confidence and supply agreement and because of Fianna Fáil insisting that the National Treatment Purchase Fund would be reintroduced. There was huge resistance to that at the time. That is the only thing the Government can latch on to now to say it is beginning to have an impact, but only on the inpatient waiting list.

All of my figures relate to the outpatient waiting list in terms of gynaecology, ENT, orthopaedics and ophthalmology, and in particular children waiting more than 18 months to see a consultant. There is no impact on the outpatient waiting list whatsoever. The marginal improvement on the inpatient waiting list is due to the extra €50 million allocated to the National Treatment Purchase Fund, at our insistence, in the previous budget. Barring that, the fact is that 14 months on, there is no progress with Sláintecare. The Tánaiste should not expect us to believe that it is because we took our time to get somebody. That speaks to a lack of urgency around health and health services and about changing the figures for the elderly, children and people in general, so that elderly people do not have to travel to the North for a cataract operation or come to our offices seeking to work out how to get there. It is not acceptable in any shape or form. There has been a lethargy to the extent that one almost gets the sense that Fine Gael has written off the health services-----

I am sorry, but the time is up.

-----such is the lack of urgency and attention to the issues.

I do find it a bit much when Deputy Martin tries to take credit for some of the things that are offering marginal improvements at the moment but takes no responsibility for his own actions and those of his party when in government. Fianna Fáil was the party that took beds out of the system when there was loads of money to spend.

That was ten years ago.

The Government is now trying to put more than 200 beds back into the system. We need to be realistic about the challenge we all face. We have for the first time a collective agreement on how to take forward health policy. This Government had the maturity to talk to Opposition parties to ensure that regardless of whoever is in government in the years ahead-----

We saw the results in the previous election.

-----we would have some consistency of health policy, unlike in Deputy Martin's time in government.

The Government is not taking it forward.

It is 14 months since the programme was launched and there is still no director.

The Tánaiste without interruption.

In its time in government, Fianna Fáil tried to bring in radical changes that did not work.

What about the smoking ban?

We now have consistency of approach------

The standard of cardiac and cancer care is rubbish. The Government has nothing to stand over.

-----such that we know where we are going. We are appointing a director to deliver Sláintecare. We are spending more on healthcare than ever before and putting beds back into the system that Fianna Fáil should never have taken out.

There is now a far bigger population. The Tánaiste has failed to recognise the demographics, which is unsurprising.

I wish to raise with the Tánaiste the ongoing scandal of children with scoliosis being left on surgery waiting lists. The four-month target has been missed for 88 children who are in dire need of an operation, some of whom have been waiting more than three years. Those children live in agony and are unable to live a full life. Their parents are frustrated and exhausted from battling the system. They are worn out fighting for access for their children to vital medical treatment and life-changing surgery, which is a battle they should not have to fight. Those who watched the "RTÉ Investigates" programme entitled "Living on the List" did so in horror and grief. It provided a harrowing insight into the daily struggles faced by these children and their families. The Tánaiste may recall that in the aftermath of the programme, the Minister for Health offered apologies and made promises. Those promises have been broken for 88 children, whose days from when they get up until they go to bed are filled with extreme pain and discomfort. I cannot imagine what it must be like for a child to endure that suffering. It is hard to imagine what it is like for the families of those children to watch as the phoney war, which we have seen again this afternoon between the Taoiseach or the Tánaiste and Deputy Micheál Martin is played out. The meaningless, egotistical jousting between the Taoiseach and Deputy Micheál Martin is not new. Rather, it is a feature of the relationship between Fine Gael and Fianna Fáil since they partnered up following the 2016 general election. Of course, Fianna Fáil seeks to mask its support for a Fine Gael-led Government------

The one from which Sinn Féin ran away.

Sinn Féin ran away from government.

------and Fine Gael policies and budgets by picking sham fights. It keeps the Government in power while faking outrage over the results of the disastrous policies it helped to implement.

Sinn Féin has also faked outrage.

It is incredible that the leaders of the government arrangement choose to focus their energies on these tiffs rather than the serious issues that need to be addressed, none of which are more serious than the issue I raise today with the Tánaiste. People do not want to see self-indulgent fisticuffs over who is the biggest boy in the schoolyard.

What about girls?

People want solutions. The Taoiseach and Teachta Micheál Martin need to cop themselves on and focus attention on the 88 children who are desperately in need of surgery. What does the Tánaiste say to the children who await this surgery and their parents? When will those 88 children have their operations?

Many Deputies have dealt with children, parents and families who are impacted by scoliosis. We are aware of the pressures involved and the need for early intervention, given how scoliosis develops. There is much stress, frustration and anger among many parents. That is why the Government and the Minister for Health, Deputy Harris, have prioritised this area for rapid progress. As more than 420 children have been treated this year compared with just over 200 two years ago, we have more than doubled the delivery in terms of operations. There is a plan in place which involves increased theatre time and the allocation of new consultants, who are being appointed. We are not yet where we need to be but we are investing heavily and have a plan in place specifically to target scoliosis because of the nature of the condition and the stress it causes in order that families and children can get the treatment they need within the target set by the Minister, Deputy Harris.

On the other commentary, unlike Deputy McDonald's party, at least Fianna Fáil engaged at a time when the country needed a Government and when her party showed no interest whatsoever in providing the kind of stability that has delivered in many areas in the past two years. The rate of unemployment is at 5.1% today. Seven years ago, that figure was over 15%. Stable Government, when it works, delivers and while Fine Gael and Fianna Fáil will have their differences, I am sure they are parties that have worked together in the national interest and have delivered significantly in the past two years. When the Deputy is asking people to cop themselves on, she might reflect on that.

The Tánaiste and his friends in Fianna Fáil have provided the type of stability that means children grow up in bed and breakfasts and hotels and an entire generation of people have given up on any aspiration to owning their own home or even having a stable and assured roof over their heads. That is some kind of stability.

Why did Sinn Féin vote against the affordable housing motion? It voted with Fine Gael to vote down the affordable housing motion.

The progress he brags about has left 88 children still in need of surgery. Some of them are waiting much longer than four months but all of them have seen the promise of a maximum wait of four months blown to smithereens and not realised. What has the Tánaiste to say to the parents of those 88 children and when will those 88 children be seen to? A straight answer to those questions might bring us somewhere close to the reality that these families do not want rhetoric, statistics or long lists of the Government's perceived virtues. The Tánaiste is aware that self-praise is no praise. These 88 children and families want to know when they will be cared for and when they will get the services they need and to which they are entitled. I would like a straight answer to that question if the Tánaiste can give it.

I refer to the activity figures for the week of 6 June in Our Lady's Children's Hospital, Crumlin, where many of these operations and spinal fusions take place. The hospital expects to carry out 196 spinal fusions and 251 other spinal procedures this year and activity figures for the week ending 6 June indicate that so far this year, 69 spinal fusions and 113 other spinal procedures have taken place. Waiting lists show there are 167 patients on the active waiting lists for spinal surgery of whom 102 have been waiting longer than four months. That is against a May target of 68. The Health Service Executive, HSE, advise that patients waiting over four months for surgery are reviewed weekly regarding their treatment plans. In addition, and in line with the scoliosis access plan 2018, the Children's hospital group will prioritise inpatient access in 2018 to include outsourcing of an estimated 51 patients to achieve a four-month waiting time for clinically deemed treatments. We are making progress. It is as simple as that.

The Minister for Finance's policies on the budget and the economy are not common sense. He has argued that it is common sense for Ireland to not spend as much money as is available to us and is permitted under the very strict European rules that we helped put in place. I said previously that we do need to manage and reduce the national debt. The most sensible way to do that is to expand the economy, as with a growing economy, the debt would become proportionately lower.

It is occurring now that the economy is back on its feet and is growing again. That is how we overcame the crises in the 1990s. This State, as the Tánaiste has heard from many Members previously, has pressing social needs right now. Across the country people are waiting for the procedures about which Members have spoken. They are waiting to get access to general practitioner, GP, appointments because of the lack of rural doctors, which will become the next acute crisis for us. The south east, my own area, is facing the real risk of having no psychiatric services for children and adolescents at the end of this month at a time when Ireland's suicide rate for teens is among the highest in the European Union.

Every day I can identify the social needs that need to be met. Inaction in addressing these issues is not defensible. The State is not like a household or company in terms of saving money. A private household or company can save its money in a bank and the bank will reinvest it in the economy. The State is so large that inaction has as much effect as an action. If, as the Government proposes, the State does not spend €500 million and puts it in a rainy day fund, that is not a neutral action. It is a large dose of inaction that will shrink the economy in proportion and lower its future trajectory.

The Labour Party's hands were obviously tied in government by the scale of the national debt and the size of the deficit we faced in 2011. Following that painful period, the economy has grown rapidly and we have growing employment. If not now, when can the people of Ireland expect to see the necessary investment in all the social provision that every Deputy in this House could outline, including the Government's backbenchers? These services are necessary, not optional, to maintain both our social fabric and a growing economy. By creating the so-called rainy day fund, Government inaction will result in weaker public services and a permanent loss of the potential growth that spending could create.

If the €500 million rainy day fund is to be created rather than investing in all the social needs I and others have outlined, where will it go? Where will the rainy day fund be put?

I have heard the Deputy raise this question before. To be honest, I was a little surprised by his argumentation given his knowledge of what it is like to try to steer a country through a financial crisis. That is what Deputy Howlin had to do when he was Minister for Public Expenditure and Reform and, by the way, I think he did it very well. People forget very quickly what it is like when nobody is willing to lend us any money and we have to access emergency funds. Fianna Fáil knows what that is like due to the failures of its policy, which resulted in the IMF having to come to Ireland to put emergency funding in place. It seems like we are a long way from there now.

Next year, we are planning to spend an extra €3.4 billion in terms of the kind of service delivery the Deputy is asking for in housing, healthcare, transportation, education and so on. That is a massive increase in expenditure in one year. We are seeing a dramatic increase in capital expenditure in particular because we know there has been a deficit in expenditure for nearly a decade now.

Where is the rainy day fund being put?

The €3.4 billion is in our view what the country should be spending next year, recognising the fact that we now have a strong economy with the capacity to fund that kind of increased expenditure. However, we are not in the business of borrowing more money and increasing national debt at a time when we should be trying to reduce it so that if in the future the economy faces a shock to which the Government needs to respond, we do not have the kind of debt that fortunately we did not have when we had to respond to the last financial crisis the country had to deal with. Personal and national indebtedness are things we need to work on and we need to increase expenditure dramatically to make up for a lack of capital investment in particular in recent years and we are committed to doing that. Over the next ten years, we will spend €116 billion on a capital expenditure programme, going from spending considerably less than the European average to spending considerably more in that period.

I asked about the rainy day fund.

The €500 million in terms of a rainy day fund is not part of that €3.4 billion. It is a prudent, sensible measure that has been recommended and supported in government to ensure that we do put some money aside in case we have shocks in the future to which the Government needs to respond in a responsible way.

The country has money aside. Under the Ireland Strategic Investment Fund, there is €20 billion of directed and undirected funds available to the Minister for Finance. My question is directly about the rainy day fund.

The Minister for Finance has indicated that the forthcoming budget will involve the State borrowing to run a deficit of 0.1% of GDP. That is what he told the House last week. This will amount to between €250 million and €300 million. What is the economic logic of borrowing €250 million or €300 million to set it aside in a rainy day fund?

In his first question, Deputy Howlin was asking us to borrow a whole lot more.

I am asking for the Government's logic.

What we have been doing - Deputy Howlin had a part in the first half of this - is fixing an economy to ensure it is fit for purpose and we do not create bubbles in any of its sectors. We have been warned by many independent economists this year not to overspend or allow Ireland to fall back into a cycle of boom and bust, which, unfortunately, has happened repeatedly in recent Irish history. We will not overspend money or borrow just because we are allowed to do so under EU fiscal rules. Ireland is now in control of its own destiny again. The Government will borrow a modest amount of money next year. We will ensure we put a rainy day fund aside which will be built up over time. We will not put too much money into the fund in any one year and our primary focus will be on investing in parts of the economy that need capital investment in particular. That is the prudent course of action and Deputy Howlin, as a former Minister for Finance, should understand that.

The logic of that is that the Government should not borrow the money and instead have a balanced budget.

We do not need a rainy day fund. We need a sunny day fund because the current heatwave and the warnings from Irish Water about water shortages have yet again exposed the completely decrepit state of Ireland's water infrastructure and the disastrous consequences of decades of underinvestment by Fine Gael and Fianna Fáil-led Governments. In particular, the current crisis has been exacerbated by the decisions from 2010 onwards, first by Fianna Fáil and the Green Party and subsequently continued by Fine Gael and the Labour Party, to cut the capital investment programme for fixing the water infrastructure by €50 million per year. We have now reached the point that 49% of water is lost through leaks from the mains infrastructure, rather than household wastage. It is particularly infuriating that spokespersons for the parties that imposed the cuts and austerity on the water investment programme have the cheek to blame householders for the problem when they know that the expert commission the Government set up to look into water usage in this country concluded categorically that there was no evidence of excessive household wastage and that household usage in Ireland is lower than that of Great Britain, which has water charges. I repeat that usage here is lower than in Britain. That is what the Government's expert commission concluded. We use 110 litres per day per house while in Great Britain, which has water charges, average household usage is 140 litres per day. Why do Government spokespersons and representatives of parties that slashed the investment programme for water infrastructure persist in blaming householders? The reality is that householders are reaping the bitter fruits of the Government's decision to cut investment in fixing our decrepit and broken water infrastructure. The evidence is still there. There has been a leak on Kildare Street for two weeks. The Tánaiste should go outside and take a look at it. On Friday, I managed to have a case featured on national radio involving one street in Dún Laoghaire where residents reported water leakage and water shortages in January. Irish Water did not arrive to look at the problem until June and has said it cannot fix it until August.

That is the consequence - leakage of 700 million litres a day, which is wasted because the Government has failed to invest in fixing our broken water infrastructure. Why does the Tánaiste not just admit it?

Sometimes it is hard to know where to start with the Deputy on this issue.

Try disputing the facts then.

Thank God we now have a single water entity that is trying to manage the challenges we face nationally.

It is doing a really good job.

It is actually doing a reasonably good job.

It is needed in Ballyhooley.

The reason we have so many leaks in our pipes is because we had more than 30 different entities managing water infrastructure in the past, many of which were under-resourced in terms of what they needed to do. What we now have is a single entity that is planning for future national water usage needs. It is managing a difficult weather situation right now and will continue to do so over the summer months. It has, for the first time, a coherent plan to reduce leakage significantly from 45% leaks to 38% leaks by 2021. It has a capital investment programme which is secure, thanks to the political agreement in this House. Therefore, for the first time, we have a proper, coherent, organised and funded plan to fix Ireland's water infrastructure once and for all. We have a plan to deal with shortages in Dublin, which would not have been solved by the local authorities in Dublin on their own because this is going to require a national approach to bring water from the Shannon to the eastern parts of the country and to Dublin in particular, as well as to many counties surrounding Dublin.

The approach for which the Deputy would advocate is to localise everything in terms of decision making, planning, expenditure and so on and we know the results of that policy, namely, leaks all over the country and the inability for co-ordination between counties and nationally.

It is under-investment.

I would like to thank Irish Water for the work it is doing in very difficult circumstances, the partnerships it is developing with organisations such as the IFA and other organisations and the partnerships it has with local authorities. This allows it to concentrate on the areas that are feeling the most water stress and shortage right now in order to ensure the resources, experience and skill sets in Irish Water, which come from economies of scale, can give the response that is necessary as quickly as possible.

Second, nobody is blaming householders. What we in government are doing is asking the country to respond in the way it did during other extreme weather circumstances earlier in the year, when communities came together and supported one another. They should be doing that now as well to ensure that neighbours take other neighbours into account in how they use water over the coming weeks, given the lack of rainfall and the obvious shortages that will come from that. That appeal from Government is something I hope communities, individual householders and businesses will heed.

Every day households in this country use 300 million l of water. Does the Tánaiste know how much leaks out of the system every day? It is 700 million l of water.

Does the Deputy know how much has been saved in the last year? He should quote the whole truth.

I have to hand the Irish Water business plan. This is the plan of the Tánaiste's crowd and what it shows is a drop in investment from 2010 onwards, first instigated by Fianna Fáil and the Greens, then by Fine Gael and Labour.

Has the Deputy heard of the economic crash?

The Irish Water business plan refers on several occasions to the decades of under-investment. That was done by Fine Gael-led and Fianna Fáil-led Governments. Have things improved slightly since the Government abandoned the wild goose chase of water charges? Yes, because €250 million a year that was being put into water meters that do not fix leaks has now been redirected to upping the investment programme on water infrastructure, although it is still way short.

The time is up.

Irish Water testified in this House in April that it needs €18 billion of investment to fix our water infrastructure.

The time is up.

The Tánaiste said the leakage will be down to 38% by 2020. That is pathetic.

The Deputy must conclude.

That does not deal with the problem. We need to significantly increase investment in water infrastructure, which the Government has failed to do.

The Deputy should have gone into Government.

The Labour Party did not do it.

We need to increase the investment in water infrastructure. I am glad, therefore, that the Deputy focused on what is needed and not on the argument he has been making for years, which is that we should have stuck with the old system of local authorities doing it all alone. I hope that even Deputy Boyd Barrett sees the logic of moving to a single utility which can deal with the economies of scale and develop the skill sets that come from that and plan nationally for how we move water around this island to ensure we do not have the kind of water shortages with which we are threatened.

Underinvestment, Tánaiste.

The pressures we feel today remind us of the logic of the need for excess usage charges. If people are blatantly wasting water, is it fair that their neighbours should pay for it?

There is no evidence of that, so why does the Tánaiste keep saying it?

Is it fair that during a summer-----

The Tánaiste said there was no evidence earlier.

Will Deputy Ellis please allow the Tánaiste to respond?

He is contradicting himself.

Generally, when I get a response like that, it is recognition that the Deputy's own approach is fundamentally flawed.

The Tánaiste is draining us.

Sinn Féin's approach to water charges has been inconsistent and a joke, quite frankly.

It would certainly not deal with the serious challenges the country faces this week, next week and later in the summer. Once again, I thank Irish Water for its work and the co-ordination it is providing. I reassure Irish Water that the Government will continue to fund the capital infrastructure that is needed. To the public, I note that while the vast majority of people are enjoying the good weather, it brings pressures we need to respond to collectively as households and businesses.

It sounds like a general election.