Saincheisteanna Tráthúla - Topical Issue Debate

Housing Assistance Payment

I thank the Ceann Comhairle's office for selecting this matter for discussion as a Topical Issue. I thank the Minister, Deputy Eoghan Murphy, for coming to the Chamber for this debate. I would like to outline three areas of significance that are contributing to people unnecessarily ending up homeless or being unable to access the services that have been put in place to prevent them from becoming homeless and help them to get into some form of semi-permanent or permanent accommodation. I believe a policy change from the Minister or the Department will be needed to address some of the issues I am raising. Perhaps a letter of approval can be sent to each local authority to clarify the position, provide more flexibility and assist in a positive way. As a representative of the Kildare North constituency, I am speaking about Kildare County Council. Everybody in this House wants to prevent people from becoming homeless and help them to secure a roof over their heads through the social housing allocation of each local authority or through private rental accommodation.

The first area I will touch on is the homeless housing assistance payment, HAP, scheme. The Minister put in place a placefinder service under the homeless HAP scheme to help people to find private homes to rent. When a tenant who has received notice to quit presents himself or herself to Kildare County Council or any other local authority, he or she has to find a home so that he or she does not end up homeless. We are finding that people in such circumstances are unable to access upfront deposits until very close to their eviction or get-out dates. It can be extremely difficult for such people to find homes at short notice. Some people do not get their deposits until three or four weeks before their eviction dates. As it is very difficult to find properties in north Kildare, like everywhere else, through the private rental market, people need to be given as long as possible to try to source private rental accommodation.

Having spoken to various groups about this issue, I am aware that when people present themselves to a local authority after receiving notice to quit - three or four months' notice is normally given, but it might be as little as two months in some cases - they aggressively pursue new properties in order to ensure they and their families do not end up homeless. If people in such circumstances are able to prove that they have found a property, if they have confirmed to the homeless section of the local authority that they are going to be homeless and if the notice to quit is in order with the statutory guidelines, I believe they should be able to access a deposit and one month's rent to assist them in finding alternative accommodation. It does not matter whether this happens a month or three months in advance of the eviction date. As it gets closer to the eviction date, it gets far too tight to try to find a property. That is how people end up in hotels. I know of cases in which people from County Kildare are being accommodated in hotels in Carlow and Portlaoise. This is not very practical for families when children are going to school and people are going to work. People in these circumstances need all the time and all the supports they can get to try to find alternative accommodation.

I can understand where the Department's 30% disposable income calculation comes from. It is acceptable that people must have a disposable income to live on after they have paid their rent and made their top-up payment. As I have said in this House previously, the difficulty is that even with the 20% discretion under the HAP scheme, there is still a gap with current rental market values. I have asked for this discretion to be increased temporarily while we are waiting for supply and stock to come into the market. In the absence of such an increase, the gap between the payment under the HAP scheme and the actual current rental market value needs to be made up so that families in these circumstances can find homes. People are getting letters of support from reliable family members - parents, brothers and sisters - who are in full-time employment and are willing to help with their efforts to get homes and pay the balance. Under Kildare County Council's current policy, unfortunately, it is unable to accept such letters unless it can get bank statements and letters from employers to confirm that the people in question are in permanent employment and can support their family members in making top-up payments. That is adding to the substantial distress and concern of families. It is very difficult to get a property. If one is lucky enough to get a property, one should be allowed to get family support to make a top-up payment as long as one has a strong letter of support. I believe it is unwarranted to require people to undertake needless tasks like getting personal details from those who are providing support to them.

I thank the Deputy for raising this issue. I acknowledge his hard work and dedication on it. We have been in contact on HAP and homelessness prevention measures on a number of occasions. The Deputy has been working with my staff over recent months to bring various concerns to my attention. He has explained his concerns about the terms and consistency of application of homeless HAP in his area. I have heard what he has said. HAP is operating as a flexible and immediate housing support and is available throughout the State. It is playing a vital role in families and individuals that are eligible for housing supports. More than 40,000 households are having their housing needs met via HAP. Over 21,000 landlords and agents are in receipt of payments under the HAP scheme.

As the Deputy knows, the rent charged for HAP accommodation must be within the limits set down for the household type in each local authority area. HAP tenants pay a weekly rent contribution to the local authority, based on their income and ability to pay. The HAP rent limits were increased significantly in July 2016. They were increased by up to 60% in some areas. The Government has given each local authority the flexibility to agree to make a payment under the HAP scheme of up to 20% above the maximum rent limit if that is necessary because of local rental market conditions.

The increased rent limits, together with the additional discretion available to local authorities to exceed the maximum rent limit where necessary, are allowing HAP households to find suitable accommodation and willing landlords. At the end of the second quarter of 2018, excluding households accommodated under the homeless HAP arrangements operated by the Dublin Region Homeless Executive, 21.3% of households nationally were benefitting from the additional discretion. In those cases, the average rate of discretionary payment was 15.7% above the relevant rent limits. In a further reply, I can give more detail on this to the Deputy.

In addition to the flexible and immediate housing supports set out, a significant dimension to homeless HAP was the establishment of the place finder service, to which the Deputy referred. Homeless HAP is a targeted support for homeless households who may find it difficult to secure HAP tenancies and, under the place finder service, the local authorities can appoint new dedicated staff to assist individuals in emergency accommodation to find appropriate long-term housing solutions. The place finder service has been in operation in the Dublin region since 2015 and the option to establish the service was made available to all local authorities from January 2018. It was take up in Kildare earlier this year. It is a matter for each local authority to determine the appropriate deployment of the place finder service based on local needs, including the point at which a household will be directed to the service. I understand that many local authorities are focusing on those households who are already in emergency accommodation, assisting them to transition into HAP tenancies. The place finder service recognises that, for a certain number of people, particularly those already in emergency accommodation, sourcing property and securing a tenancy, including the financial constraints around deposits and advance rent, might be very challenging.

The provisions of the homeless HAP scheme provide local authorities with the discretion to assist homeless households by providing a deposit to secure property and paying up to two months' advance rent. This discretion was provided as an exceptional measure for exceptionally challenging circumstances and, as such, must be applied only where necessary. To broaden the provisions of advance rent and deposits is contradictory to the principles of the HAP scheme, and could undermine the careful checks and balances that are in the system to ensure the best use of public funds. That said, the Deputy has been engaging with my Department on this matter. I hope he will be able to have further engagement in which he can bring to light more specific issues that can be examined given what he has raised in the Dáil today.

The homeless HAP scheme has been successfully utilised by the Dublin Regional Homeless Executive across the four Dublin local authority areas since February 2015, supporting more than 3,600 households to date. More than 1,600 new homeless HAP tenancies have been set up so far this year. That goes for people at risk of homelessness or coming out of emergency accommodation. Therefore, it is an important support for people in this crisis.

We monitor HAP data on an ongoing basis. I have a report to hand for the Deputy that he will be interested to see. We also monitor other key information relating to the private rental market. I am satisfied that the current HAP rent limits and the flexibility to exceed them in certain circumstances provide local authorities with the capacity necessary to assist households in securing rented accommodation that meets their needs. However, I am grateful to the Deputy for raising his concerns. I hope he will engage further with me and the Department over the coming days.

To that end, I am meeting some of his officials tomorrow on these three issues, in Dublin as far as I know. If there is clarity and flexibility in respect of the issues, it will assist positively. I am not criticising the measures at all. What I am saying is that the homeless HAP and place finder services put in place in Kildare County Council earlier this year were welcome. This was a debate we had just before the summer recess. Anything we can do to prevent people from becoming homeless is welcome. The issue, however, is the timing associated with one's ability to gain access to the upfront rent and deposit. That is the key and the point I wanted to tease out with the Minister.

Departmental officials and the council are saying one has to be very close to one's eviction date before one can gain access to the upfront deposit and rent. That is contributing to homelessness because one will not get the property the day one goes out looking for it. If one is looking for a property before one can access the fund, one is competing with someone who has the money in his or her back pocket. Therefore, if someone has notice to quit - a statutory document that meets the criteria - he or she is virtually on the home stretch to being homeless unless he or she gets another home. If one has a notice to quit in two or three months, one will have to go into emergency accommodation unless one can find a home. That is costly. We want to avoid that. Therefore, I suggest that tenants should be able to access the payment immediately on getting the notice to quit to help them to get another home between then and being evicted.

On the 30% threshold related to disposable income and the letter of guarantee, the problem is that most families need a three-bedroom semi-detached house. I know the HAP relates to the family unit but, rather than getting into that calculation, as we do not have time, we should note it equates in some cases to the rent for a three-bedroom semi-detached house. With 20% discretion, the HAP in Kildare is about €1,250. The current market value is €1,500 so a top-up is needed. We need to be able to get the local authorities and Department to agree to accepting the letters of guarantee that are coming in without forensically subjecting them to post mortem analyses, which leads to further problems.

The final issue concerns people on the housing list who are currently in HAP units. They could be in them for one, two or three years. Where these houses come up for sale, perhaps because the landlord or landlady is under financial pressure from banks or other personal reasons, is there a possibility that the Department could engage with the local authorities to ask them to purchase them? They are not purchasing the units. The families affected need to look for alternative accommodation but may not be able to gain access to any, perhaps due to the lack of supply, and end up going into hotels, not even in the county but perhaps in a neighbouring county. That is a problem. Can some clarity be brought to this? Can approval be given to the local authorities such that if a property occupied by someone getting the HAP payment is being sold, it can be purchased either by the local authority or the departmental agencies?

I welcome the fact that the Deputy recognises that the HAP is working. Of course it can be improved. Not every Deputy in this House recognises the considerable support the HAP is giving to people who are at risk of homelessness or coming out of emergency accommodation. Tens of thousands of people throughout the country have been supported. Some individuals, for ideological reasons, refuse to recognise that. Therefore, I welcome the Deputy's comments.

Let me address the three specific points the Deputy raised. On the matter of when someone can access the deposit and the first month's rent, we should consider it. I want the Deputy to engage on that. I will tell my officials to engage with him to determine what is going wrong. We do not want, for administrative reasons, to be putting people into distress when they should not be in distress.

On the Deputy's second point, on the gap and letters of comfort, we should examine this also. We are talking about taxpayers' money so we have to ensure appropriate checks and balances are in place. I do not want to be taking discretion from local authorities. Since they are at the front line of the services and at the coalface, they might have a better understanding of what they are dealing with themselves. Of course we can examine it, however.

With regard to the third point, on the Department potentially buying homes or allowing the local authority to buy a home with a tenant in HAP and which might be sold, the difficulty concerns value for money and cost. It may not represent value for money for the local authority to purchase the home. That is a call it has to make. It is based on the costs of the time, its own building programme, other acquisition programmes it has, prevailing market rates and everything else. I appreciate the Deputy's highlighting of these issues. We can engage positively on them through my Department over the coming days and through the meetings the Deputy is having.

I will give the Deputy the official report being prepared for the Oireachtas joint committee tomorrow. Let me give the Deputy a couple of figures on Kildare. The total number of active HAP tenancies is 1,667,355 of which were set up in 2018. That is roughly 14 per week. Therefore, HAP is helping people in the Deputy's county, which is great. We want it to help more. The average rent being paid in Kildare by the local authority to the landlord is €916, which is above the national average. Of course, Kildare is very close to where many people want to live and work.

The Deputy also raised the use of discretion. About 42.6% of people getting HAP, or almost half, are getting the discretionary payment. They are getting some uplift above the HAP rate. With regard to the amount of uplift, they are getting an average of 14.1%. The Deputy, when talking about the gap, should note that even those who are coming into the system do not need the full 20%. Most of them are in this category. Therefore, there is still plenty of flexibility and plenty of headroom in the 20%, notwithstanding the point the Deputy raised about letters of comfort and the additional payments. We can consider these issues. The HAP is working. Anything we can do to make it work better, I will absolutely welcome.

Hospital Staff Recruitment

The Minister for Health is not present. In saying this, I mean no disrespect to the Minister of State, Deputy Jim Daly. I said this to him in March in respect of a similar topic when he came in to deputise for the Minister. I understand the Minister for Health is very busy and I have no problem with that but he has never once come here to address one of my Topical Issue matters. Normally all of the issues I raise are related to University Hospital Limerick. Can the Leas-Cheann Comhairle, Ceann Comhairle or Minister of State, Deputy Jim Daly, raise my concern with the Minister so he might try to get here himself the next time one of my Topical Issue matters is selected for discussion? By March, I had tried to get him in here 13 times.

Obviously, there have been more occasions since then. It is quite disappointing that this hospital has the worst crisis in the State and has the highest number of people on trolleys every day, yet the Minister has been unable to appear on even one occasion. I understand that he is busy but he cannot have been unable to attend on every occasion it has been selected as a Topical Issue. It is simply not good enough.

To be honest, I have lost count of the number of times I have submitted a Topical Issue on this matter. There is an issue in the hospital every day and every week. The full capacity protocol is used every day in Limerick even though it is supposed to be a temporary emergency measure. That means staff are under huge pressure and elective operations are cancelled. A number of them were cancelled this week. There have been 166 people on trolleys already this week. There were 46 on Monday, 63 on Tuesday and 57 on Wednesday. However, I am astonished that I am obliged to ask the Minister for Health today, and the Minister of State might convey this to the Minister, to explain why there were not enough staff to feed patients in the emergency department in Limerick's largest hospital last week. It is a crazy and outrageous situation.

On Monday I was contacted by somebody who works in University Hospital Limerick. That person stated there was only one attendant providing food for over 90 patients in the emergency department for the previous four days and, as no staff cover was available, some patients could not get food or even a cup of tea. The agreed figure for such staffing at the hospital is a minimum of three. This is inexcusable. Today there are 57 people on trolleys in the hospital. That is more than the number of patients on trolleys in 17 other hospitals across the State combined. Can the Minister explain this situation? I hope he or his Department will contact the hospital management immediately to ask what is happening. What additional funding will be provided to ensure there are enough staff to feed the patients at least?

I thank the Deputy for raising the important issue of the challenges arising in University Hospital Limerick and, on behalf of the Minister, Deputy Harris, I welcome the opportunity to address the House on this issue.

The emergency department in University Hospital Limerick, UHL, is one of the busiest in the country, with approximately 67,000 attendances annually. Demand for emergency department services at the hospital continues to rise with an increase of 6% in attendances at the emergency department at UHL in 2017 compared with 2016. I acknowledge the distress overcrowded emergency departments cause to patients, their families and front-line staff working in very challenging working conditions in hospitals throughout the country. Behind every trolley number there is a patient in need of effective, timely and compassionate care from the health service. That is why the Government is committed to breaking the cycle of overcrowding in the health service. As emergency department attendances continue to rise, those departments are under increasing pressure to meet the new level of demand and ensure the provision of timely, safe and effective care for patients. A considerable number of patients presenting to the emergency departments are frail or acute patients who often require admission.

With regard to the claim that some patients are not being fed, the University Limerick, UL, hospital group has advised that except for one catering attendant who is currently on leave there is a full catering staff complement. UL hospital group has advised that it is managing this deficit from its relief pool. At times there may be unscheduled sick leave that could create pressures on the service but full catering is available to all patients who are not fasting due to medical reasons.

As regards patient experience, the House will be aware that overcrowding at the UHL emergency department has been a concern for some time. The emergency department is frequently working above capacity using the full capacity protocol and this contributes to inefficient ways of working and poor patient experience. In recognition of this high demand, funding of €24 million was provided for the new emergency department at UHL, which opened in May last year. The new facility is triple the size of the old emergency department and immeasurably improves the experience of patients in terms of their comfort, privacy and dignity. Furthermore, against a background of increasing demand for unscheduled care services, an extra €30 million was made available nationally to respond to winter pressures in 2017, with a further €40 million being provided in 2018.

To conclude, the UL hospital group has assured me that full catering is available to all patients who are not fasting due to medical reasons. Regarding the overcrowding, I am acutely aware of the current situation and I am monitoring it closely. The Department, the HSE and UL hospital group are carrying out measures to improve the situation.

The Minister of State said the UHL emergency department is frequently working above capacity. It is doing that every day. The emergency measure has been in place every day this year and was in place every day in 2017 so it is not frequently but daily. That leads to elective surgeries being cancelled and extra beds being put into wards, which is not safe. When this measure was introduced by the HSE a number of years ago in consultation with the nurses, the nurses expressed huge concern but they were told at the time that it would be an emergency measure. However, it is used every day in Limerick and that is not good enough. It is not true to say in the House that it is frequently used as it has been used every day this year and every day in 2017.

The Minister of State mentioned the new emergency department. It is a good facility but, as I highlighted previously in this Chamber when the Minister of State, Deputy Finian McGrath, was in attendance as the Minister, Deputy Harris, did not turn up again that day, the nurses were concerned about the proposal to have 24 people usually on trolleys in the new department. The Minister, Deputy Harris, rubbished that and said it would never be the case and would never happen. The hospital in Limerick would almost be happy if there were 24 people on trolleys because the number is far more than that every day.

I wrote to the Minister last January seeking a meeting with him to discuss ways to reduce the overcrowding problem in the hospital because it is abundantly clear that his plan for our local hospital is failing miserably. I have yet to hear back from the Minister. University Hospital Limerick is in a terrible state. It is constantly overcrowded and operations are being cancelled all the time. It is unfair to make nurses, doctors and staff work in such pressurised, overcrowded conditions and even worse to make sick patients lie on trolleys for days waiting for a bed. How does the Minister expect to attract nurses home from places such as Australia to work for lower wages and in far worse conditions? I was proud to stand with the nurses outside the hospital a number of days ago. The full capacity protocol is being used every day despite it being designed only for emergencies.

The Minister might refer back to me on my questions this time, although I was told previously that he would and he did not. What plans does he have for the 96-bed extension? When will it be built? Is there any progress on speeding that up? The last we heard is that the plans might be ready in 2019 but we need the building work to start.

I will relay the Deputy's concerns to the Minister, Deputy Harris. To address the issue of the Minister not being present, it is a very fine balance. I appreciate the Deputy's frustration and I am not saying this to be argumentative but to illustrate the challenges the Minister faces daily in getting the balance right between trying to deal with the issues and engaging with the parliamentary process. The House places many demands on the Minister's time, as do the Seanad and the committees, as well as the pleas for hearings from numerous lobby, interest and advocacy groups and representative bodies. The Minister, like every Minister, has to make a judgment call between the amount of time to spend actively engaging one-on-one with complaints and issues and actually dealing with the problems behind the scenes, such as by meeting with UL hospital group, the management and getting one's head around the issues that exist. That is a continuing balance. I can assure Deputy Quinlivan it is not a snub to him. Diary challenges are always difficult, and they are probably more challenging for the Minister for Health than for other Ministers.

With regard to the emergency department in UHL, I wish to reassure the people who are using the facility that there is a full catering service available at the hospital. I believe the Deputy emailed the management about it and he probably should engage more proactively with the management.

They came back to me ten minutes before this debate.

That is something he could do with the management as a public representative, as the Minister does not manage the UHL or, indeed, any of the acute hospitals throughout the length and breadth of the country. That is done by the HSE and the management team in place. I will relay the Deputy's concerns to the Minister and make him aware of the issue.

Hospital Waiting Lists

When the Dáil resumed last week, a father, Mr. Aaron Daly, was waiting outside Government Buildings for the Minister for Health, Deputy Harris, because he wanted to tell him about his lovely daughter Sophia who is waiting for scoliosis surgery. Notwithstanding that others took the time to talk to him, the Minister did not, which is disappointing.

Mr. Daly is one of a large number of parents dealing every day of the week with the broken promises that have been repeatedly made. There is a pattern emerging in that whenever there is an exposé in the media, such as "Living on the Lists", the Minister issues an apology and commits to ensuring things improve, and when there is no improvement and this generates further media interest, we get another apology. The scoliosis waiting lists are not being dealt with in any meaningful way, particularly for those children who have complex medical needs. More than 60 children with complex needs who have been on the waiting list for a long time have been moved to what is known as a "suspended list", in some cases because they have been on the list for so long their health has deteriorated to the point of them not being able to have the surgery.

The theatre in Crumlin children's hospital is not yet open five days a week. It should be open seven days a week but it is not yet open five days a week as promised. Children were also promised that they would be sent abroad for treatment. So far this year, only one child has received treatment abroad. Hundreds of children await this surgery and only one has been sent abroad to have it. This is not fair to them. I met Sophia McGuinness, who cannot speak but uses assistive technology to communicate. The first thing she said to me was, "I am in pain". She is in pain while she waits for surgery but she is not the only one. There are other children in pain while they wait for surgery. Their parents want to see real efforts to address their children's pain. People like Aaron Daly should not have to stand outside Government Buildings begging for a few minutes of the Minister's time.

The situation which reveals itself in the case of Sophia is shameful. I met her father a couple of weeks ago in Dún Laoghaire and he told me of her case. He has since told me that, in 2015, he wrote to then Minister for Health, Deputy Varadkar, who told him that no child would be waiting for scoliosis surgery for longer than 15 months. At that time, Sophia had to wait 16 months following her initial diagnosis in 2013. More recently, the Minister for Health said no child will wait longer than four months for surgery. Sophia was placed on the urgent list in April 2017 and, without having had her surgery, she was removed from it in August 2018, which is 17 months later. The Government, at the highest level, through the Taoiseach and Minister for Health, has let this young girl down. Sophia suffers from scoliosis. Her condition is deteriorating and she could face the possibility of emergency surgery because the screws in the rod in her spine, which goes into her hip, are loose. Her internal organs are being affected and the curvature of her spine is worsening. This deterioration may impact on her ability to undergo surgery. It is not fair to put a child, and her parents, through that suffering and pain.

As stated by Deputy O'Reilly, this is linked to the wider issue of 52 people having been removed from the surgery list, giving the impression that the list has reduced when in fact these people have only been moved to what is known as a "suspended list" and still need surgery. Many of them have complex needs and the State is letting them down. This is not acceptable and I want to know what the Government intends to do about it.

I thank the Deputies for the opportunity to address the House on this issue. The Minster for Health and I are sorry that any child and his or her family experience a long waiting time for treatment for scoliosis. Improving access for these patients is a key priority for this Government and specific plans have been developed and funded in 2017 and 2018. However, I fully accept there is room for further improvement in patients accessing timely scoliosis treatment. The Minister has prioritised the development of a sustainable scoliosis service in Ireland and an additional €9 million has been provided to the HSE in 2018 specifically to develop paediatric orthopaedic services, including further increasing access to scoliosis services.

Last Monday, the Minister met the deputy director general of the HSE and the chief executive officer, CEO, of the Children’s Hospital Group to discuss their short-term and long-term plans to provide a better service for patients and their families. The Minister sought assurance from the CEO regarding the management of children with complex needs, as a great deal of concern has been expressed by parents of children with such needs. The CEO advised that there are a number of complex and difficult cases at present and that the hospital has provided all support and services required to children and their parents, and will continue to do so.

Where a child has multiple clinical complexities and medical conditions, consultation between parents and a multidisciplinary team of specialist consultants is required to develop and manage a treatment plan. Given the complex nature of the care required, this often requires extensive discussions and planning so that appropriate surgery can be scheduled in a timely manner, if clinically safe. Notwithstanding that, the Children’s Hospital Group has made progress towards the development of a sustainable scoliosis service this year. It published the scoliosis co-design ten-point action plan in July and an orthopaedic implementation group has been established to oversee its implementation. The action plan was developed through the participation of professionals,

families and advocates. Importantly, this has ensured that the voice of the child has been incorporated.

This year, the group aims to deliver 447 procedures. This equates to a near doubling of 2016 activity. By the end of last week, 314 surgeries, of which 151 were spinal fusions, had been delivered. Overall activity is slightly ahead of surgical targets. Waiting list figures for 21 September show that there are 77 active patients waiting for scoliosis treatment, of which 35 have been waiting for more than four months, which is a reduction of 21 since the start of this year.

I thank the Minister of State for his reply but it was an elaborate response to a question I did not ask. This is about children with complex needs. The Government's mechanism for dealing with these children is simply to move them from the primary list to a suspended list. These children do not need an action plan or another working group; they are in pain and need surgery. Is this lost on the Minister of State? What these children and their parents need from the Minister for Health is a timeline for treatment for those on the urgent list; confirmation of when the theatre in Crumlin children's hospital, which is currently only open three days per week, will be open five days a week; an explanation as to the reason only one child has received treatment abroad, although they were told this mechanism would be used to address the waiting lists; and if will he commit to an independent clinical review of the cases we have raised, namely, the children who are on the urgent list, the children that have been forgotten and those who are in the most pain?

With no disrespect to the Minister of State, it is disappointing that the Minister is not present. It is even more disappointing for Sophia's father that despite repeated requests the Minister will not meet him. Consequently, we get answers which do not respond to the questions asked. Yesterday, I asked the Taoiseach when the backlog of urgent and complex will cases be addressed. The Government needs to stop trying to manipulate the figures by moving people to a suspended list. As stated by Deputy O'Reilly, only one person has had scoliosis surgery in the UK under the treatment abroad scheme, despite many people being in pain and suffering. Why has the scheme not been approved for people on the list who are urgent, complex cases? If the Minister or the Government does not fully understand what is going on, they should meet Sophia's father who will explain the problem and discuss what solutions can be found to end Sophia's suffering and the suffering of other urgent and complex cases.

There is nothing simple about this. Deputy O'Reilly keeps using the word "simple" in that she wants simple answers to simple questions but this is a very complex, difficult area of surgery. The Deputy can nod her head all she likes but we sometimes have to listen. Nobody in this room has a monopoly on understanding or compassion for what is involved for these patients. I am a practising politician the same as everybody else in this House and we all have constituents and are aware of people, sometimes family or other people connected to us, who are awaiting these urgent, difficult and complex procedures. There is a variety of challenges and difficulties, both in capacity of personnel and in a lack of theatre space. There are other competing procedures because scoliosis is not the only procedure that has waiting lists. There are many other waiting lists in the medical system competing for the same theatre space, skill set, time and resources. We as a Government prioritised scoliosis in 2018 and put an additional €9 million towards it. As I understand it, as of today that money will not be spent by the HSE in its entirety because of the difficulties and challenges that are there. Despite what the Deputy might say-----

What about the treatment abroad?

-----neither the Minister, Deputy Harris, nor I have ever carried out one of these procedures and never could do so because it is a clinical matter and there are clinical decisions and considerations. The Deputy can shout me down all she likes but it would be in her interest and in everyone's interest to listen to me as well. She can nod and if she wishes to play politics with this she can continue to do so but there is another side to the story that has to be understood before we can reach a solution to this difficult and challenging issue. It is not just about resources because that is what is within our gift.

If the Government simply kept the promises it made-----

We can throw money at it and we are doing that but there are other challenges in the system.

As a matter of absolute fact, and I am not manipulating waiting lists, this year there will be 447 procedures carried out by the children's hospital group. Two years ago 224 procedures were carried out by them so that is a 100% improvement rate in two years in the amount of procedures carried out by the children's hospital group. That is a matter of fact and it is not borrowing from any other list to manipulate the figures. It is on the record to be understood and I would like the Deputies to take note of that.

We asked about the treatment abroad scheme.

Teachers' Remuneration

I thank the Minister for coming in to deal with this issue himself. I am speaking on the role of primary school principals - teaching principals and those who are walking principals. I raise this after meeting the Irish Primary Principals Network and also from working closely with my colleague Councillor Alison Gilliland of the Irish National Teachers Organisation, INTO, which consistently raises this issue with me.

Put simply, the working conditions of primary school principals are unbearable. I know the Minister has set up a forum to deal with many of the issues I will outline but as part of the budget the Minister now has a unique opportunity to deal with these working conditions. If he does not do so, the educational benefit for children at primary level, which is so important and where my own children are today, will suffer.

I was gobsmacked to find out that the guidance on the role of principals has not been updated since a circular in 1975. That was the year I was born and this is not acceptable. There has been a range of missives and circulars issued on the role but the actual role has not been updated. Principals are expected to be in charge of all education and teaching in schools but are also expected to be administrators and the administration has now grown to an insufferable level. For instance, last year there were 84 circulars issued to primary school principals. How in the name of God can principals be in charge of the teaching component of the school, which is so important, and be in charge of administration at that level as well with the resources that they have?

Three people who I know well, one of whom is a good friend and all of whom are female, have resigned their jobs as primary school principals and teachers. They are more or less the same age as me and a couple of them are younger than me so they are all in their late 30s and early 40s. They are resigning as principals because they cannot bear the conditions they are working under. It is a real issue for them that it is actually more difficult to get back into teaching because teachers do not really have any rights in that sense. They do not even have panel rights so that is another issue the Minister needs to deal with.

Given all of the responsibility that principals now have and the fact that in many cases they now have to work through the summer to deal with the backlog of administration, the Oireachtas, including the Minister, must now deal with these real issues. They need more resources and they need greater pay and conditions. They have to know that the Department will support them in their role because voluntary boards will not cut it in terms of picking up the slack. There are so many good people on those boards and so many brilliant chairs of boards of management but it is still ultimately left with the principals to deal with having the best teaching conditions and to do all of the other administration, much of which is necessary but some of which could probably be better dealt with. A model for helping these people and resources for doing it must be found or the educational opportunities and benefits for my children and the children of this country will be affected.

I welcome the Deputy's interest in this issue because the role of leaders in our schools is hugely important and I wish to give him some reassurance. We have successfully recruited 6,000 additional teachers to our schools in the last three years and as the Deputy knows, the standards of reading and mathematics among our ten years olds are the best in Europe. We have a great deal to be grateful for around the manner in which our schools are managed. That does not mean that we should stand still and I have set an ambitious target that by 2026 we will seek to have the best education and training service in Europe. That means improvements in literacy, digital technologies and the learning environment, breaking down cycles of disadvantage and reforming curricula to update them and make them more relevant to people. That involves change and we of course rely on principals to be the leaders of change within their schools.

I mention some of the measures we have taken, for example, last year we appointed 2,600 additional assistant principals. Not only have we done that but we negotiated an agreement with the trade unions on a new approach to management which involves a more devolved and collective leadership. It also involves reporting on the role that these assistant principals will take within their schools and will move away from appointments based on an approach of one's turn having come around. We have also made a substantial investment in primary education which has helped principals in having additional resources at their disposal and I have mentioned some of these in the written reply. We have reduced the pupil-teacher ratio to the lowest level ever in the history of the State and we have provided over 600 resource teachers and over 1,800 special needs assistants, SNAs. Hundreds of schools are now operating innovative projects in clusters where principals and others within the school are taking on leadership roles in adopting technology and applying DEIS initiatives and creative initiatives.

On teaching principals specifically, this year I allocated additional time off to allow them to manage their responsibilities more effectively. I increased it by between two and four days depending on the size of the school as is outlined in the written reply. Extra time off has been a continuing demand from teaching principals.

The other thing I did, which came directly from the INTO because its former president was impressed by the initiative, was to introduce clusters. There were 14 clusters in existence which meant that more remote schools could come together in a cluster and pool their time off, which allowed them to employ a permanent position. It has been really beneficial. I have extended the number of clusters from 14 to 50.

The biggest thing, which the Deputy did not refer to at all, is the creation of the centre for school leadership, which is now investing in the leaders in our schools. Each year about 1,000 principals get the opportunity to have mentoring or coaching or to gain postgraduate qualifications to improve their capacity to manage their resource. They are very significant changes. As the Deputy rightly observed, many principals feel there is too much coming at them. They recognise the importance of child protection, new curricula and new ways of teaching. All of these things are important. We have set up a forum to look at the sequencing of those things to try to allow them to manage those issues. In terms of pay, principals are benefitting under the pay agreement. I absolutely support the Deputy's belief that investing in leadership is possibly the best bang for our buck we can get. We have started to put in place measures that show our commitment in this area.

The Minister has not answered the question of why so many young principals are resigning from their jobs. It has to be a concern for the Minister. Will the Minister please update the guidance for principals, which has not been updated since 1975? I am sure people will be shocked when the Minister outlines what their full role is. A survey by the Irish Primary Principals Network showed that 89% of principals felt their mental health has been affected by the amount of work they have to do and 84% said they are considering stepping aside from their job. I have a very good friend who went to school with me, who has been working in a local school but has resigned from her job. She does not have any rights. Will the Minister address this situation in order that principals who choose to go back into the classroom, because of the volume of work, have some rights, given the amount of time they have given?

The Minister also is not dealing with issues of pay parity. Pay equality across all areas for teachers is required. Commitments with regard to pay parity that were given to principals in 2007 should be addressed. We need to look at the issue of the restoration of posts across the board in the primary sector. My wife is a teacher. Posts were suppressed and they need to be brought back in to help principals. We need to understand why there has been a change on the appointment figure needed to get a mainstream teacher back. Why is it higher than to retain a teacher? It does not make sense. We need an immediate increase in the ancillary grant allowed for secretarial staff, caretakers and cleaning staff. Once and for all, will the Minister help those teaching principals who work in small schools? A friend of mine who sat beside me in primary school is a brilliant teacher and a brilliant principal. His name is John. They deserve a day off a week to deal with what I have already outlined. There are 84 circulars. To be a working principal in a three-teacher, four-teacher or five-teacher school and to deal with this at the same time is impossible. Is it any wonder that principals are resigning from their posts? They want to stay teaching but they did not sign up to do this amount of work. It is inconceivable to do the work. They do not get paid well enough. They cannot do it. Will the Minister please deal with that issue as well?

Deputy Kelly is long enough around the House to know the current Government, the previous Government and all Governments I know of have engaged in collective bargaining across the sector with the public service unions. It has not been a question of segregating different groups or principals within that. We collectively negotiate arrangements. We have recently, as the Deputy acknowledged albeit grudgingly, negotiated restoration to young teachers who were recruited at lower rates of pay. All Deputies know why they were.

That is not what I am talking about.

They were recruited because of that. The Deputy asked about the posts of responsibility that there used to be. I do not know whether the Deputy listened to my reply but I have restored-----

Not all of them.

-----2,600 such posts. That means 37% of teachers are now in positions where they have assistant-----

Many of them are still suppressed.

I do not know if the Deputy is interested in the answer or just in imparting information.

The Minister, without interruption.

I do not know how I can answer without interruption when every moment I am interrupted. We are restoring this. The centre for school leadership is a fantastic initiative. We are investing in it and seeing more principals getting the opportunity to develop their skills. That is really important. I am extending and have extended the days when teachers who are teaching principals have time off in order to manage those resources. I provided for clusters-----

One day a week.

Again, the Deputy did not listen to the answer. It was two, three and four days a year depending on the size of the school. In addition, I have provided clusters where schools can pool their resources to take on a permanent position to support them. We are making progress. I am glad the Deputy is urging more investment in education because it is something I want to do. The Deputy should acknowledge there are many really good principals doing great work and we have succeeded at a very difficult period in driving our education system to have the highest standards of literacy and numeracy in Europe. That is no mean achievement. We need to credit our leaders in the schools with that.