Ceisteanna ó Cheannairí - Leaders' Questions

The House will be disappointed at the lack of progress at the October European Council meeting. The issues were well discussed in the House yesterday. We hope that more progress will be made through today. This is an opportune time to pay tribute to the officials in the Department of Foreign Affairs and Trade who are putting in such work for the country.

This morning, I wish to focus on a more domestic issue, that is, the problems and difficulties with accessing our health services. Yesterday, a figure was revealed showing that 9,864 people aged over 75 were left lying on trolleys in emergency departments for longer than 24 hours. Almost 10,000 people, aged 75 or older, in the first eight months of 2018 were waiting longer than 24 hours on a trolley.

When people get through our health services there is fantastic treatment. The staff work incredibly hard to give them world class treatment. Yet, when we see that figure and the trolley figures for July and August, which are traditionally quiet times in our hospitals, they show the crisis facing our health service.

Regrettably, there is little action to deal with the crisis. Today is 18 October but we have yet to see details of the winter initiative or the ongoing capacity review. Have the 600 or so beds promised by the Minister for Health, Deputy Harris, amid the usual flurry of spin and public relations, actually been delivered? The evidence suggests they have not. We have oceans of promises and spin, yet 10,000 people aged 75 and over have been left for more than 24 hours on a trolley in our hospitals. That figure will only rise as the winter kicks in with the usual avalanche of cases of the cold and flu, etc.

The Minister for Health launched the bed capacity review and outlined the country's bed capacity requirements until 2031. He said that some 600 extra beds would be delivered in the system in 2018. Many hospitals cannot see these extra beds. For example, in Letterkenny a 19-bed unit remains closed, as my colleagues, Deputy McConalogue and Deputy Pat The Cope Gallagher, have pointed out on many occasions. The unit is closed, yet the hospital is overcrowded.

What commitments can the Tánaiste give today that 10,000 people over the age of 75 years will not be left on trolleys for longer than 24 hours and that we will not have a repeat of the situation we had last November, December and January when trolley figures went into orbit? What work or action is the Government undertaking now to ensure that will not happen? When will the winter plan for 2018-19 be published?

I thank the Deputy for raising these issues and giving me an opportunity to respond to them specifically. Plans are under way for the winter initiative and have already begun to start kicking in to place. The Department of Health is working with the HSE to ensure local and regional plans are consolidated and supported through policies and plans at national level. The idea is to ensure the most effective response to the challenges that we know always come through the winter months.

As part of budget 2019, an additional €10 million in funding is being provided in 2018 to prepare for and manage the expected peak in demand for health services in the winter ahead. This funding will focus on initiatives to enable the hospital system to de-escalate before Christmas. Support for patients in the over-75 age group will be a priority, with measures to respond to a surge in capacity, transitional care beds and aids and appliances to support the journey home for patients following a hospital stay. The Minister for Health has asked for a significant increase in the provision of social care measures to promote hospital discharging in the first quarter of 2019 in response to the expected surge in demand after the Christmas period that we can always expect.

I assure Deputy Calleary and patients that while of course we recognise the pressures in the system that result in patient care not being as good as it should be – in other words, far too many people, including elderly people, are on trolleys - we are trying to plan ahead for the surge in demand that we know our hospitals will have to cope with in the months ahead.

This is seasonal and happens every year. It is predictable. The Minister has allocated more money and has put plans in place. There are ongoing conversations between the HSE and local hospitals to ensure that we prepare for this and try to de-escalate the system in hospitals in preparation for the surge that will come in the post-Christmas period. Planning is very much under way for that.

The Tánaiste's first comment was that there are plans. There is no shortage of plans. The difficulty is with implementation and follow-through. The plans get published and the Minister for Health does a tour of a hospital. He puts on a white coat like the Minister for Housing, Planning and Local Government, Deputy Murphy, puts on a hard hat for housing. Despite all the plans, 10,000 people aged over 75 spent longer than 24 hours on a trolley up until the end of August. Where were the plans for those people?

The Tánaiste spoke about the Minister for Health wanting to ensure community discharge and early discharge, yet there are not enough resources for home help hours or home care packages. Throughout the country people are being accepted and are eligible for home help packages but the local health services do not have the resources.

I will ask the Tánaiste the question again. The Minister for Health announced 600 extra beds during 2018 to address capacity issues. We are now in the middle of October 2018. How many of the 600 beds promised in one of the plans to which the Tánaiste adverted have been delivered? Given all the planning and, to use the Tánaiste's phrase, that this is predictable, can he give a guarantee today that we will not have a repeat of what we had last December and January in terms of a trolley crisis in our hospitals?

What I can give the Deputy is a commitment that we are planning for this. We have put money behind those plans. We will ensure that everything possible is done through better management, better policy and more funding to ensure the pressures that come through the winter on our healthcare system, in particular on our hospitals, are managed in the best way they can be.

The Minister for Finance, Deputy Donohoe, has provided an extra €1.2 billion for healthcare next year. Much of that will go into our hospital system and driving down waiting times and waiting lists. An extra €25 million has been allocated for the National Treatment Purchase Fund. Next year we will spend €75 million on the NTPF because we know it works.

The Government did not spend extra in 2016.

We have seen the benefit of that. From the peak of 86,000 people on waiting lists in July 2017, we have seen quite a dramatic reduction since then. The figure is a little over 70,000 now, which is a reduction of 16%. This is not only about promises and plans. It is about reducing waiting times and waiting lists, but there is still more work to do.

Last May in the wake of the CervicalCheck scandal many assurances were given to women. In what was a difficult time for women and women's healthcare in the State one of the appropriate and sensible responses by the Minister for Health was the offer of a free repeat smear for those women who were concerned.

It was what many people had been calling for at the time. It was generally assumed that the Minister for Health, Deputy Harris, had this under control and that he was liaising with GPs and with the laboratories to ensure the tests would be carried out swiftly and the results returned within the normal timeframe. What we did not expect was that nothing would be done.

Last May, when the Minister announced this response, GPs told us that they had not been consulted on the provision of additional tests. It should have been clear then that different responses were being announced, but that no actual strategy or planning had gone into them.

Announcements are becoming the hallmark of this Government; delivery, on the other hand, is often sadly lacking. Furthermore, the Minister did not even plan for how to categorise the delivery of additional smear tests so that high-risk tests, those who were due for scheduled tests and those attending for a re-test were separated. What was, and still is, a good idea has been completely mismanaged to the point that it is having the reverse effect of what was the intention.

The measure was supposed to assure women, but now we have women articulating further worry and discomfort over the length of time they are waiting for the results of their tests. Women were told that they would have the results in six to eight weeks, but they have now been left waiting for up to 18 weeks because the laboratories cannot deal with the additional volume of tests being sent to them. That is having the knock-on effect of samples expiring because the laboratory cannot process them quickly enough. That is creating a cyclical effect where samples are being taken and then expiring because of the increased waiting times due to the volume of tests taken, and it is being repeated again and again.

Not being able to plan and resource services is the inevitable consequence of outsourcing. If we do not tackle the issues around a lack of human resources at the laboratories to deal with the backlog, these issues will continue and women will not get the peace of mind they need.

The Minister, Deputy Harris, has said that this serious issue is a priority, so what is being done address it? Can we, and the women affected, be given a realistic timeframe for when these issues will be dealt with because there are people who are worried? Has the Tánaiste a realistic plan and a timeframe to repatriate testing to this State? Will he initiate a publicity campaign to advise women of the delays and reassure them? Will he use that campaign to highlight the realistic timeframe for repeat tests?

We know that screening saves lives. I have said that many times, but as a user of the service I and other users must have confidence in that service. Being honest with women has to be central to this and it must involve being honest about the timeframes.

I thank the Deputy for raising this issue, which is both topical and very important. The Minister, Deputy Harris, announced the availability of a free smear test in response to women who are feeling concerned. This was one of the key issues raised on the helpline, and doctors also raised it with the Minister. The level of uptake showed that many women wished to get the reassurance of a smear test out of cycle. The Health Service Executive regrets that there are significant delays currently in the reporting of smear test results.

I know that addressing the backlog is a priority for the Minister and the HSE. The programme was operated for many years with a reporting time of between four and six weeks. Unfortunately, results are currently being reported within 18 weeks of the test being taken. In a small number of cases, it is even longer than that. That is not good enough. I would like to apologise to those patients affected and assure them that everything possible is being done to try to improve the position.

I acknowledge the difficulties these delays are causing smear takers and GPs as well as patients, primarily. These delays have been caused by an upsurge in women presenting for smear tests. There are two main factors contributing to the increase in demand. As well as women presenting for out-of-cycle smear tests since April, we have also seen an increase in the number of women attending for normal CervicalCheck appointments.

While this increase in participation by women in cervical screening is very welcome, it is contributing to delays and pressures. Between 1 May 2018 and 30 September, 42,469 repeat or out-of-cycle smear tests were undertaken. As of 13 October 2018, 86,210 smear test samples were still in progress and not yet reported on. That compares with approximately 23,000 smear test samples which would normally be expected to be in progress in the system. What we are seeing, therefore, is a dramatic increase in both out-of-cycle tests for understandable reasons, as the Deputy said, to reassure people, and CervicalCheck seeing an increase in the normal testing system as well.

We have asked laboratories to undertake additional recruitment and that they try to streamline processes around release of reports. Laboratories are continuing to provide for overtime and to manage annual leave and schedules, with their best efforts, to try to reduce the backlog.

The whole point of this process was to be able to get test results back in a timely manner that would reassure women. I can tell the Deputy that addressing this issue is a top priority for the HSE and for the Minister, and we are working with the laboratories to try to do that.

While the Tánaiste's apology is welcome, there is not much evidence that this is actually a priority. Anybody could have predicted that there would be an upsurge in the uptake of smear tests because women were concerned. I thought it would have been very easy to predict that but, instead, a promise was made and a commitment given, and that was broken. I put the question again to the Tánaiste. Will he commit to an information publicity campaign advising women of the realistic timeframe they can expect?

I will not personalise this but there are women who are waiting, and they are justifiably anxious. They need to know when they will get their results. At the heart of the CervicalCheck scandal was the fact that information was withheld from women. Dr. Gabriel Scally found there was a paternalistic attitude on the part of some people in the HSE. Withholding information from women is what was wrong. Being honest and up-front with them is what is required. If the delays are going to continue and if the plans were not made, the Tánaiste should be honest and come out and tell women publicly the length of time they can expect to wait before they get a repeat test and a result.

I do not disagree with the Deputy on that. The least women deserve is a full understanding and truth around the timelines and the pressures involved in this process. Many people will understand the reason for those pressures. We have a finite number of laboratories we have contracts with and with which we work. Repatriating laboratories for testing will not solve the problem in the short term. We have received assurance from Dr. Scally on the quality of the laboratories we currently use. There are medium-term planning issues that will undoubtedly progress but in the short term we need to be able to provide reassurance to women on what they can expect from this service in terms of timelines and accuracy and integrity in the system.

I will commit to the Deputy that we will certainly endeavour to make sure that everybody who has a smear test gets a very clear picture in terms of the estimated accurate times they are likely to have to wait to get back their results. I believe that is the least we should be doing.

For weeks now there has been a chaotic breakdown in the delivery of illness benefit by the Department of Employment Affairs and Social Protection. My colleagues in the Oireachtas and in local authorities across the country have shared information with me about a succession of very challenging cases. People have been left for weeks without payment. This morning, a Labour Party councillor in Wexford spoke to a woman, who is in work, who is awaiting an appointment to have surgery. She has no money to buy food and today she had to resort to getting vouchers from the Society of St. Vincent De Paul; thank God they were there.

People have been given minimum payments instead of their full entitlement. In one case I dealt with, a person was offered €33 to cover two weeks payments. In another case, a woman who called to my advice clinic advised she had to wait nine weeks for a payment.

There is a social protection helpline available to Members of the Oireachtas, but calls are not being answered effectively. In a statement issued this morning the Department accepts this fact. It is greatly impeding our ability as public representatives to respond to the needs of persons who are waiting day by day to receive money to which they are fully entitled. Urgent action is required. I understand there have been IT difficulties that have led to delays in processing forms GPs send to certify people's unfitness to work. The bottom line is that people who are off work owing to illness or an injury are not receiving the money for which they have paid through an insurance fund and on which they are absolutely dependent. It is leaving them in dire straits. In addition, some long-standing recipients of illness benefit have found that their payments have stopped suddenly. Many of those who depend solely on this payment have been left with no money whatsoever for a number of weeks, placing them in an impossible position. No adequate explanation has been provided by the Department or the Minister as to why this has happened. The Minister claims to have consulted the IMO and that her Department has written to all contracted GPs setting out the changes that have happened recently. The commitment given by the Minister to continue to consult the IMO is not the same as actually stepping in to solve the problems people have. Will the Government clarify when it will engage directly in actions to end the delays and ensure all overdue payments will be made to those affected who are in dire need of money?

I will come back to the Deputy with a detailed answer from the Minister.

The Minister has not been seen in the House in the past two months since the problem first arose.

My understanding is the Minister is endeavouring to resolve the issue as quickly as possible. Of course, it is unacceptable that those who rely on illness benefit are not able to receive the basic income they should expect and are entitled to receive from the State. Whether there are IT or negotiation issues in dealing with concerns about delays in obtaining information from GPs, I understand the Minister is dealing with the issue to try to resolve it. People who are in dire need of money should certainly speak to the community welfare officer in the short term, but that is not a sustainable answer. What is needed is for the system to deliver illness benefit payments on time in a predictable manner in order that people's income payments will arrive into their home when expected. I will come back with a more detailed answer from the Minister, rather than give the Deputy any further information.

The Tánaiste tells me what is needed; the Government and the Department should be doing it. We are talking about working people who are paying PRSI. When they are ill, awaiting an operation or injured, they expect the insurance system into which they have paid to provide what they are entitled to, yet that is not happening as the system has collapsed. It has not been happening for weeks. I read the press release issued by the Department this morning and it was a case pf more excuses. Genuinely, the people with whom I have dealt in my office in Wexford and those who are attending colleagues' offices across the country are in dire need. The matter must be dealt with as a matter of urgency. I accept that the Tánaiste will come back to me to tell me what has happened, but I hope he will come back to me today to tell me when this matter will be resolved in order that people will not be without the benefit payments to which they are entitled.

I received a note while the Deputy was asking his supplementary question. The Department wants to reassure all customers that they will be paid the correct amount up to the end of the period of their illness as certified by their GP. No customer will lose out in respect of-----

That is no good. It is a case of live horse, get grass.

The Department is working to address the issue and hope to have it resolved quickly. It is assigning additional staff to claim processing work to enable other experienced staff to be dedicated to call answering and dealing with customer queries. It recognises that, owing to the high level of calls to the illness benefit section, customers have not been able to reach a dedicated staff member to discuss their illness benefit claim. Additional staff are being assigned from other departmental sections and will be dedicated to the customer phone line. The Minister, Deputy Regina Doherty, has sought a detailed report from the Department on how the changes to the illness benefit scheme were communicated to customers, including timelines for changes and the rationale for decisions taken on timing. We are working to resolve this issue and will get it done as quickly as we can.

I am glad to have the opportunity to raise the matter of the clearing of the Flesk river in the parish of Killarney. The river needs to be cleaned from Gortahoosh bridge through Curreal and Glenflesk village up as far as Loo Bridge against Clonkeen. This stretch of the river is almost totally blocked with trees, silt and gravel which in the past nine or ten years has caused many houses in the catchment area to be flooded several times. Up to 35 homes in the area of Glenflesk are under threat or affected in one way or another. The houses have been flooded or people cannot get into them. In the last couple of days one eye of the bridge at Glenflesk has been blocked by a fallen tree. There have been many deputations led by me to the area committee meeting in Killarney and they have been supported by all of the area councillors. My daughter Maura led a deputation last May, a meeting I also attended and at which I was a spokesperson. People are very agitated and upset that the river has not been cleared. In the early 1980s Jackie Healy-Rae brought locals in a deputation to meet Charles Haughey at the Gleneagle Hotel and the river was cleared at the time. There were few problems for 25 or 27 years, up until nine or ten years ago. I thank the Minister of State, Deputy Kevin Boxer Moran, for coming to County Kerry last year when he saw for himself the problems in Glenflesk and other places in the county. He gave an assurance to the elected Members in the Chamber that he would provide funding once Kerry County Council had made an application for it. Last April the council applied for funding to clear half of the river. That is why we had to have a second deputation to get agreement that the other half of the river would also be cleaned. A total of €168,000 is needed to clear the river from Gortahoosh bridge to Curreal bridge. Rivers - the Flesk is no different - need to be cleared and maintained all of the time. However, in the past 20 years landowners have not been able to touch any river because if they do, they will lose their farm payments. This rule of cross-compliance has to be adhered to. That is why the river is so bad again and affecting so many. Houses cannot be lifted, but roads can. The N22 was raised because it was being flooded. However, even though it has already been raised by 10 ft, it is still being flooded to a height of 3 ft. The river needs to be cleared. That is what we are asking the Government to do. There is a need for ambulances to be able access hospitals and people to access everything else.

In some ways, this is an example of a bigger issue and challenge we face nationally. We are seeing more extreme weather cycles. Undoubtedly, climate change is happening. Not only do we need to do more to mitigate its effects, we also need to spend very large sums of money to adapt to more dramatic weather cycles, including for flood relief measures.

We need to ensure that rivers large and small have the capacity to move much larger volumes of water in flooding instances. Having said that, before this can happen a process, involving environmental impact assessments if necessary, needs to be followed. Many local authorities have put in place regional flood strategies. I am glad that the Minister of State, Deputy Moran, working I am sure with the Minister of State, Deputy Griffin, has looked at the challenges of flooding and river basin management plans for County Kerry.

I do not think the Deputy could seriously expect me to confirm funding for an individual project that requires an application, probably from the local authority. The Minister of State, Deputy Moran, has a very considerable sum of money to spend in coming years on flood mitigation. It is about €400 million from memory, which is a significant allocation to deal with the increased flooding risk, particularly in the Shannon basin but also in other parts of the country, including in the south west where the Deputy lives and where rivers need to be managed in a way that allows them to deal with flash flooding and more extreme weather cycles. I suggest that the local authority should work with the OPW and the Minister of State, Deputy Moran, who is somewhat of a flood expert, to ensure this project gets the priority it needs.

We are looking for no more than the people in Kerry deserve. We have gone down all the routes and all the surveys have been done by CFRAM. It was going on for six or seven years. There was agreement between Kerry County Council and the OPW to make an application under what was known as the minor flood mitigation scheme. That has been done. There are two applications with the OPW, one for €98,000 and the other for €71,000. I am asking the Tánaiste to ensure the local authority gets this funding to clear out the river.

I am doing nothing out of the way in asking the Tánaiste because we are fully entitled to get funding to clear this stretch of the river to ensure that people's houses will not be flooded and that the roads to those houses will not be flooded. The last trip Paddy Healy had from his house was on a boat and he died in hospital subsequently. I pass that place every day. I ask the Tánaiste to ensure that-----

I thank the Deputy.

-----these people are not left behind. The application has been made; it took a long time to get it in. That is what I am asking.

I thank the Deputy. He can get an answer now.

I ask the Tánaiste to talk to the Minister of State, Deputy Moran, and fast-track this funding so that the people will not be affected again as they were in 2014, 2015 and 2016.

I thank the Deputy.

There were six floods and no one could get in or out of their houses. Ambulances could not pass up or down the main road to Cork.

The Deputy has made his point.

That is what I am asking the Tánaiste.

As I said, in order to access funding for projects a process needs to be followed.

The process is there.

With respect, we do not bypass the process because the Deputy raises it here in the Dáil. I am sure the Minister of State, Deputy Moran, is considering this application. As I said, he understands flooding and is doing an excellent job in understanding local complexities and investing in flood management systems. One of those investments is to ensure rivers flow and are not blocked unnecessarily and that river basins are, if necessary, altered appropriately. We also need to ensure that the environmental responsibilities we have towards river basin management is followed. This does not sound like a huge amount of money to me, but the process needs to be followed. The local authority needs to engage with the OPW's flood experts to progress this project and I am sure it will.