Ceisteanna ó Cheannairí - Leaders' Questions

There are many commitments in the programme for Government to enhancing and implementing greater access to primary care services. At the centre of any primary care system is having enough general practitioners, GPs, in urban and rural areas. We all agree that the life of GPs is not an easy one. They spend long hours in surgery and in communities listening to, meeting and treating people of all ages at all times of the week. The Health Service Executive, HSE, planning office estimates that since the introduction of the GP visit card for children younger than six years, demand for GP consultations in this population will have increased by 65% in 2017 and by a further 42% by 2022.

This is also having an impact on patients' access to GPs. In some urban areas there are two to three-day waiting lists to see a GP, but the irony is that in many rural areas it is becoming more and more difficult to fill vacancies where a GP retires or moves to another location. The life of rural GPs has extra challenges because they are on call 24-7, living in the communities they serve.

The financial emergency measures in the public interest, FEMPI, cuts had a considerable impact on general practice and general practitioners. Allowances were cut by up to 38%. It is having a significant continuing impact on GP morale and on retaining people to work in general practice, which is resulting in GP shortages. According to the Irish College of General Practitioners, ICGP, there will be shortages in the order of 1,000 GPs in the next ten years and 36% of our current cohort of general practitioners are over the age of 55. The Irish Medical Organisation, IMO, which we met here last week, says there are 666 GPs over the age of 60 who will be retiring over the next five to seven years, of whom 244 will retire over the next two years.

Those statistics are real people, real lives, and people making choices about their own lives. They also represent a very vital community service that may be withdrawn or restricted. The Minister for Health and the Government are meeting this impending crisis in primary care with their heads stuck in the sand. Where are we at and why is the Government continuing to delay discussions on FEMPI reversal for GPs when there has been progress across all other cohorts? Why is the Government not responding to the crisis of GP morale and recruitment? Will the Tánaiste confirm that the concerns of the GPs about the FEMPI cuts will be addressed and that there is a pathway for them to see a future, not just for themselves but for their communities?

I accept that there is a need for continuing dialogue and discussion between the Minister for Health and GPs. The Government's focus is on shifting the emphasis towards primary care. That is why we are spending very significant capital resources on building new primary care facilities and improving facilities for GPs. That has happened in towns around the country and in the cities as well. In respect of the added pressures on GPs, our focus has been primarily on trying to deliver better patient outcomes so that parents can afford to bring their children to the GP at an early stage of sickness to avoid more complex and more expensive medical treatment being required. We continue to be committed to that policy. Affordable primary health care provision through a GP-led service is a major pillar of healthcare policy for this Government. I believe most people in this House support that. The financial arrangements to unwind the impact of FEMPI on GPs is a matter for negotiation between GP representatives, the Minister for Health and the Minister for Finance. I am not going to make commitments while that negotiation continues.

The Tánaiste speaks about dialogue but there is no dialogue. The discussions around FEMPI have been long-fingered. The National Association of General Practitioners, NAGP, which represents many GPs, is not even involved in them. Research and surveys are available to show that up to 70% of GPs are no longer in a position to take new patients because of the pressure on their practice, yet the Tánaiste speaks about wanting affordable GP access. It is not possible to have affordable GP access when there are not enough GPs or when GPs are saying they do not have the resources to take on any more patients. We spend only 3.5% of our health budget on general practice in contrast with over 8% spent by the National Health Service, NHS. In Australia, which is actively recruiting GPs from this country because of their training and skills, that figure is even higher. The Tánaiste speaks about dialogue and says it is a matter for the Ministers for Finance and for Health, but the Minister for Health is asleep on watch on this one. Seven out of ten GPs say they can take no more patients, and along with the figures for impending retirements, people walking away from the service, and incredibly committed health professionals saying they have had enough, communities are being left without a service. The Tánaiste should stop talking about discussions and start discussing and wake up to the reality of this crisis.

That discussion is under way. The Government is committed to engaging with the representatives of general practitioners on the development of a package of measures and reforms to modernise the 1999 General Medical Services, GMS, contract. Our goal is to develop a contractual framework that has a population health focus, providing in particular for health promotion, disease prevention and for the structured care of chronic conditions. This will enable general practitioners to better meet the needs of patients and will also promote general practice as a viable and rewarding career for existing doctors and future graduates.

Agreement on the delivery of the service improvements and contractual reform has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis. The Department and the HSE met the IMO GP committee in early May, with the State's side setting out the mandate agreed by the Government under the consultations conducted and the package of measures to be agreed. The conversation the Deputy talks about is under way.

Deputy Stephen S. Donnelly

It is not. It has not met since May.

It is not getting anywhere. There are people leaving in droves.

These negotiations are never easy or straightforward. They will need to conclude to ensure that we have sufficient numbers of people coming into general practice in the years ahead to fulfil the policy we are pursuing. That is what the Minister for Health is focused on.

Yesterday, thousands of people gathered outside the gates here to stand against the homelessness and housing crisis. There were people from all walks of life and sectors of society, including students, parents, teachers, nurses, pensioners, workers and the unemployed. Their message to the Government, if it was not heard, was loud and clear. It was a message to the Government that its housing policies are failing and that they want real, meaningful solutions. They represented, outside the gates of Leinster House, hundreds of thousands of people who are affected by the housing emergency, people who are affected day in, day out. They represented the 10,000 people in emergency accommodation, including the 4,000 children. They represented those who are struggling with unaffordable rents which are spiralling out of control. They represented those who cannot afford to buy their own homes and are languishing on council waiting lists. The Tánaiste must now surely accept the reality that no matter how many times he or members of his Government say it, their housing policies are simply not working. It is time to say enough is enough.

A recent Economic and Social Research Institute, ESRI, study shows that a third of households are paying more than 30% of their income on rent. That is the level that is deemed unaffordable. It gets worse because a shocking 70% of modest income households are spending more than 30%. That is a scandal. Next week's budget offers an opportunity to give renters a break. That is why we in Sinn Féin have proposed the introduction of a temporary tax relief for renters and a three year emergency rent freeze. That is a proposal befitting the scale and measure of the crisis that we face in this State. Alongside that, the Tánaiste knows that we need to see a dramatic increase in the delivery of social and affordable homes in 2019. Budget 2019 can mark a step change in that regard. That means doubling the level of capital investment in housing. That is what Sinn Féin, what last night's cross-party motion and what the thousands of people outside the gates who chanted loudly are calling for the Government to do.

The Taoiseach and Ministers keep saying that money is not an issue and that they will fund any measure to tackle the crisis. As the saying goes, the Tánaiste needs to put his money where his mouth is. There are three large-scale council developments ready to go. One is in Shanganagh in Dún Laoghaire and would deliver 500 social, affordable rental and affordable purchase homes. One in Damastown in west Dublin would deliver 1,000 homes. One in Kilcarbery in south Dublin would deliver another 1,000 homes. These are council-led proposals with cross-party support for mixed income and mixed tenure estates. They would provide 2,500 needed homes which would have a significant impact on the housing crisis right now. Will the Government directly fund these three council-led projects? Will it increase capital investment in housing by the €1 billion that is required? Will it introduce tax relief for renters and an emergency rent freeze in next Tuesday's budget?

The Government understands the frustration of many people who marched yesterday to make a point on housing. We are in the midst of a very pressurised situation for many families who are renting, cannot afford to purchase their own home or are waiting for social housing. The biggest priority in Government with regard to the domestic political agenda is and has been housing for quite some time. Over the past two years, we have delivered 15,000 new social houses. This year, we will deliver approximately 8,000 extra. Next year, it will be close to 10,000 and in the years after that, it will be close to 12,000, year on year, every year. We committed a huge capital package many months ago to delivering on that. The impression that some people would like to give, that this Government has some kind of ideological objection to putting public money into building social housing for people who cannot afford to buy their own homes, is absolutely untrue and not borne out by the facts. We are committed to a dramatic increase in the provision of publicly funded social housing, with 100,000 in the next ten years. We will follow through on that. That will be seen clearly in next week's budget and also in capital commitments. The projects which are chosen are those which have been assessed by the Department of Housing, Planning and Local Government, working with local authorities throughout the country to make sure that we deliver as many affordable and social houses as we can in the shortest possible timeframe.

In my experience as Minister for Housing, Planning, Community and Local Government, then and now, money is not the main obstacle to delivering the volume of houses that we need in the short to medium term. Processes and decision-making have delayed the pace of delivery of social housing, which is increasing by the month. Looking at virtually any metric relating to supply, whether it is the number of first-time buyers purchasing homes or affordable houses that they are accessing or social houses being delivered or planning permission applications being submitted and granted, or at the money the Government continues to spend on homeless services as well as housing, all of those are moving in the right direction, but I know it cannot happen quickly enough for many people. The housing plan that I was involved in, this Government has endorsed and the Minister, Deputy Eoghan Murphy, is building on, was always a five-year plan to correct and essentially reshape a housing market from the perspective of rentals, social housing and private purchases. That takes time to fix.

There the Tánaiste goes again, saying our housing policy is working. If he says it over and over again, maybe he will even start to believe it himself. It is simply not working. Thousands of people came onto the streets of Dublin yesterday to make it clear to the Government that it is not working. The Government is failing people, including students, those in emergency accommodation and the 80,000 more people who are now living with their parents than there were last year. The Government is failing people who want to get on to the property market because that is the outworking of the Government's policies. Rents are out of control, at nearly 40% above peak prices. Houses are out of the reach of ordinary young couples. There is a crisis of unprecedented proportions, with 10,000 people in emergency accommodation. They do not want the Tánaiste's understanding. They want action, with an increased level of capital investment.

The Government needs to double the amount of money being put into social and affordable housing. The Government will not deliver 8,000 social houses in 2018. It will deliver 5,500 social houses, and that is nowhere near what is needed to deal with the crisis. If the Tánaiste says money is not a problem, then he should put his money where his mouth is. There are three proposals for cost rental projects which can deliver 2,500 social and affordable homes in three different sites in Dublin. The Department and the Government have not given sanction to them. The Government can take to its feet and start to turn the tide by saying that it will directly fund those projects and begin to deliver large-scale social housing which is needed to deal with the crisis that the Government has brought about as a result of its underfunding and its policies that have failed those in the rental and housing sectors.

We will deal with the delivery of an extra 8,000 social houses this year. We delivered-----

There is a difference between the numbers which the Deputy likes to quote-----

I am quoting the Department's numbers.

-----which are selective quotes to try to exaggerate for effect-----

Some 5,500 real social housing units in a year. The Tánaiste should read the Department's documents.

-----as he does all the time. New social housing is not just about new builds. It is also about bringing other properties and acquisitions-----

I agree. Some 5,500.

-----back into new social housing stock. In the past two years, we have dramatically increased the amount of social housing stock that is in use, but we need to do much more. We are talking about adding another 100,000 social houses to the housing stock over time, which is a hugely ambitious social housing plan which we will deliver on. I would contend that the delay in social housing delivery right now is not about the availability of capital. It is about process and capacity within local authorities to deliver at the pace at which we are asking them to deliver.

The Minister has projects on his desk. The Tánaiste knows that.

Deputy, please.

Deputy Doherty knows that better than most but it does not suit his political narrative to accept it.

The Tánaiste knows that projects-----

The Tánaiste should be allowed to respond.

That is the reality.

The Tánaiste should not blame councils.

He is shifting the blame.

The time is up. I call Deputy Brendan Howlin.

It is an abdication of responsibility. The Government has not heard the last of the thousands who marched on this House yesterday.

Deputy Doherty should stop interrupting.

Could we please stop the shouting in the Chamber?

There is no need to shout. If one's words are strong enough, one does not need to shout. Nobody needs to shout.

The situation is serious.

Members can make their arguments but they should not shout. It denigrates the Chamber.

I thank the Minister.

The Government is worried about people screaming when we have such a serious situation.

We do not need to shout.

My apologies to Deputy Howlin.

We are well aware of the seriousness of the situation. The Deputy does not need to remind us.

The Government needs to listen.

I ask the Tánaiste not to respond.

Will the Tánaiste name one project that councils would not support? That claim is nonsense.

Excuse me, Deputy Doherty. It is becoming a habit of some Deputies on the Sinn Féin benches to barrack Ministers when they are responding. Members of the public are at home watching proceedings.

We cannot allow the Tánaiste to mislead the Dáil.

I ask Deputies to behave.

Next week's budget will test the Government in a way that previous budgets have not tested it. It is the first budget in more than ten years where it is fair to say there is genuine scope for significant investment in public services. As the Tánaiste knows, public spending here, at 26% of GDP, is low compared with many of our European counterparts. Even if we use GNI* as the criterion, it is 38%, which is well below the European average of 46% of GDP and far below the best performers, the countries we try to emulate in terms of public services, namely, Finland, Denmark or Sweden. There is plenty of scope in the budget to increase the role of the State in meeting people's needs.

Fine Gael and Fianna Fáil have flown a series of kites about tax in recent days. The choice in Tuesday's budget is simple; the Government can either cut taxes or reduce poverty. The Government in particular has been disingenuous in this House. The Taoiseach described the threshold for higher income tax in a way that is not correct. He has been at pains to say that ordinary workers are paying the higher rate of income tax when that is not true. Statistics from the Revenue Commissioners show that a little under one in five - 19% - of those who pay income tax pay any tax at the higher rate. That is an undeniable fact based on Revenue figures.

It is true that single people begin to pay the 40% rate on part of their income above €34,550, but the threshold for married couples is much higher, at up to €69,100. That is why many people on higher salaries do not pay the 40% tax rate. For this reason, it is misleading to suggest that ordinary workers are typically paying the 40% tax rate when we know from Revenue that only 19% of workers are paying at the top rate. The top one fifth cannot be the squeezed middle. Ireland's labour market remains divided between high wage earners and low wage earners. The divide is quite shocking when we look at international statistics. Far too many people are on low pay and insufficient hours. Shockingly, up to one quarter of workers are earning less than what has been defined as the living wage of €11.90 an hour, and none of them can benefit from a cut to the higher rate of tax. I do not expect the Tánaiste to go into the details of the budget but will he confirm that it is still the Government's intention to cut taxes for the top fifth of wage earners rather than reduce the burden on all taxpayers by providing money for services that every citizen enjoys?

I am not going to give a budget speech today for obvious reasons, as Deputy Howlin will understand. As a result of the sacrifices made by so many people and businesses in the past decade, Ireland is in a position to spend nearly €7.5 billion on capital next year. That is an increase of 25% in expenditure on schools, hospitals, roads, social infrastructure and housing, among other things. As a country, we have worked hard to create that possibility and to ensure we can spend more to look after the population in the way that a modern economy should do in terms of societal support.

The choices we make next week will be on the basis of trying to spend in appropriate ways without overspending or overborrowing and in order that we do not start all over again the cycle that we have repeatedly had of moving from boom to bust as Governments overspend when they cannot afford to do so. The Minister for Finance, Deputy Donohoe, will not allow that to happen. What we are doing is maintaining, protecting and preserving a sustainable growth story in the economy that will continue to allow us to put very large sums into projects that are needed throughout the country. We will be able to do that for the first time in many years with appropriate levels of capital spending next year. I hope Deputy Howlin is not suggesting that we should start spending money that we do not have.

In addition, we will have to raise some money to be able to fulfil the demands and pressures that exist. We want to give some relief to middle income earners, the squeezed middle who pay for everything. We are very unusual in the context of the European Union and the OECD that we ask earners to pay at the higher rate of tax when they are earning less than €35,000. That is not normal.

That is not true either.

We managed to give some modest relief to people last year and we hope to do so again this year by moving thresholds in a direction that is slightly closer to international norms.

All of the independent international assessments of the Irish tax system have shown that it is one of the most progressive tax systems in the world. To be fair to Deputy Howlin, he had a part in creating that. We will continue to be progressive, but we must also recognise that many hard-working families on middle incomes are under financial pressure and they also need to be given some level of a break in the budgetary decisions we make.

The Tánaiste is correct that we have a very progressive taxation system and the Labour Party was instrumental in ensuring that it remained progressive in the downtime. However, the base income divide between the rich and poor is manifestly much broader in this country than it is in any of our comparator countries. It is rebalanced somewhat by social transfers through taxation and social welfare. It is shocking, however, that one quarter of workers are earning less than the acceptable living wage of €11.90 an hour. They are the people who will not benefit from any reduction in the higher rate of taxation, which the Tánaiste characterised as applying to the squeezed middle. As I spelled out in detail, that is not the case. In addition, they will not benefit from the services that could be provided if the Government invested adequately in childcare or in increasing supports for people on modest incomes. We will spell out all of that in detail this afternoon. I am not asking the Government to spend money it does not have. On the contrary, I am asking it not to repeat the mistakes of the past by shrinking the tax base. We must maintain the breadth of the tax base so we can have decent social provision in the future. If we have risks such as corporation tax, let us ensure that our tax base is broad enough to endure.

We look forward to seeing Deputy Howlin's proposals. I am sure they will be assessed before final decisions are made from a Government perspective. The Deputy seems to be making accusations that we are not focusing enough on expenditure in areas such as childcare. He should look at the increase in spending on childcare we committed last year and wait and see what will be announced next week. We are talking about spending €3.5 billion more next year than we will spend this year.

Most of that spending is due to demographics.

Deputy Howlin is calling for more expenditure. We are advocating for a modest package for middle income earners-----

One third of workers will not be affected.

------who are moving into the higher tax bracket at very modest incomes, in a way that is consistent with the measures implemented last year. That is what is called balance. We cannot continue to ask the same people to foot the tax bill for the increased spend we hope to deliver. We need a balanced budget which recognises the pressures middle income earners are under and the responsibilities on the Government in delivering an increased spend to alleviate poverty and provide the social supports we must provide. We got the balance right in the last budget and will endeavour to do the same next week.

The Naval Service is in meltdown. For the first time in the history of the State, it is unable to fulfil its core function of sea fisheries protection. The unprecedented situation where it was not able to put ships to sea occurred not only last week but also over the summer. The issues are now in the public domain because the men and women of the Defence Forces simply will not put up with it any longer. Rather than an attempt being made to deal honestly with chronic understaffing, exhausted and overworked crews are being bullied into going to sea in unsafe conditions in order to give the illusion that we have a functioning navy. Ships which routinely were crewed by 44 personnel are putting to sea with a crew of 34.

Yesterday there was the spectacle of threatening emails being sent directing crews that notice for short-term relief no longer applied and that they had to be ready to put to sea whenever necessary. That email was issued and then rescinded. To add insult to injury, the Chief of Staff then stated there was no crisis and that the weekly haemorrhaging of expensive, experienced trained staff was all about pay. Pay has something to do with it, as does the chronic mismanagement of the Defence Forces in recent years and the move towards vanity prestige projects in an effort to cosy up to the EU military elite. A fully trained and resourced crew is taking part in Operation Sophia which is a military exercise, not a search and rescue mission.

A costly ninth vessel is being delivered, but we do not have sufficient numbers to crew the eight ships that we have. The families of Defence Forces members are living on the breadline. To cover for the shortage of crew members, on a weekly basis personnel are being bullied into finding a way around the minimum crew number of 37 and press-ganged into returning to sea on another ship after a four-week tour of duty. The Government talks about the Defence Forces being family friendly. How, in God's name, could any woman or man put up with these conditions? Even when a ship has a crew of 37, often, many of them are unskilled staff, meaning that there are not enough communications operators to maintain watch in the radio cabin and not enough engine room monitors, which means that the ship just sits there to give the pretence we have a navy. It is an absolute disgrace.

In the light of the response of the hierarchy of the Defence Forces to the crisis, can the Tánaiste express confidence in the Chief of Staff? Is it now time to suspend our involvement in Operation Sophia and bring home our crews and allow them to do the job the Naval Service was set up to do, namely, to protect our sea fisheries and coastal waters?

If I were a member of the Naval Service, I would be surprised to hear a Member of this House calling for Naval Service personnel to be brought home from the Mediterranean to focus on their main role and what they were trained for, which, according to the Deputy, is fisheries protection. Fisheries protection is not the limit of what we ask Naval Service personnel to do. The Deputy may not be proud of the Government's decision to send ships to the Mediterranean, but I am. I am even more proud of how Defence Forces personnel have responded to the challenges faced there. They have taken over 17,000 people from the water, many of them children who would not be alive today were it not for the professionalism and intervention of the Naval Service. Out of pragmatism, we have shifted from a bilateral relationship with the Italian coastguard in the Mediterranean to a collective EU effort as part of Operation Sophia. Ireland has made it clear that our role in the operation is to participate in a humanitarian search and rescue mission, rather than in an offensive or war-going capacity. We have been asked to continue to assist because of our expertise in search and rescue missions.

To make a point about pay, the Deputy has tried to twist the truth about the role of Defence Forces personnel - proud men and women - who are saving lives on a weekly basis in the Mediterranean. However, I do not believe many in the Defence Forces and, in particular, the Naval Service will appreciate the way in which she is making a case for them. Of course, there are challenges in recruitment and retention in the Defence Forces, including the Naval Service, which is why the Government asked the Public Service Pay Commission to examine these issues. The current strength of the Naval Service is slightly more than 1,000 personnel or approximately 92% of its establishment of 1,094. The personnel level of the Naval Service has not changed in recent years. Many Naval Service personnel are targeted by the private sector because they are talented and motivated; therefore, recruitment and retention are ongoing issues. However, I assure the House that safety is not compromised by decisions made at an operational level by the flag officer or the Chief of Staff and that no ship will go to sea if there are safety issues for the crew.

The proud men and women of the Naval Service will be far more surprised to hear the nonsense the Tánaiste has just come out with than the points I raised in my opening statement. I specifically stated I was not addressing the issue of pay and that the root of the crisis in the Defence Forces was mismanagement at the top level, including at the level of the Chief of Staff, on which I asked the Tánaiste to comment. The crisis was admitted to me by personnel in freedom of information requests over the summer. The Tánaiste went off on a tangent in speaking about Operation Pontus when I specifically asked about Operation Sophia which, interestingly enough, resulted in the rescue of less than half the number rescued in 82 days that the LE Samuel Beckett rescued in 12. It is not a search and rescue operation. The Tánaiste should read the letter written by Médecins sans Frontières which was published in some newspapers today. Defence Forces personnel are sick of being patronised. People with families are being browbeaten to return to duty immediately after returning from a tour of duty. Is the Tánaiste aware of this? Does he think it is worthy of comment? Is he honestly stating pay is the only reason personnel are leaving the Defence Forces and that these issues are not a factor? If he believes that, we are in bigger trouble than I thought.

Before I call the Tánaiste to respond, I would be profoundly uncomfortable if Deputy Clare Daly stated the Chief of Staff was guilty of mismanagement, which is what I think I heard her say.

I firmly believe the Defence Forces are being mismanaged at top level. I asked the Tánaiste whether he had confidence in the Chief of Staff.

That is fine. Making a general accusation is one thing but an accusation targeted at an identifiable person outside the House who cannot defend himself of herself is not in order.

It is not the first time the Deputy has targeted individuals who do not have an opportunity to defend themselves in the House. I have absolute confidence in the Chief of Staff of the Defence Forces whom I know well and with whom I worked while I was Minister for Defence. On many occasions I visited the headquarters of the Naval Service in Haulbowline with him and other members of his management team and staff.

I have made the point that there are recruitment and retention issues, some of which are linked with pay and an economy which can now offer alternatives to members of the Defence Forces. It is clear that personnel are being targeted because of their skill set. The Government is responding by examining the issue in detail. The recommendations made in that regard will be considered by the Government.

However, I cannot allow in this House the kind of accusations Deputy Daly is making against an individual who is doing an exceptional job under difficult circumstances for the Defence Forces as Chief of Staff. It is regrettable that she has chosen to target an individual in that way.