Ceisteanna ar Reachtaíocht a Gealladh - Questions on Promised Legislation

There is a commitment in the programme for Government to increase home care packages and home help hours but we see the reality that nationally more than 6,200 people have been approved for home care hours but have not been able to receive them since last July. In the Irish Independent this morning we read about the rise in delayed discharges because of the lack of home supports. In January, 481 delayed discharges took place. In September, before the impact of winter was felt, there were 613 delayed discharges, which equates to 130,000 bed days lost as a direct consequence. Last week, the Taoiseach said he believed the winter plan does not work. Will he confirm that €10 million was allocated to address this backlog in home help and home care packages? Will it take effect immediately, that is between now and the end of the year, and will he give an assurance to those people and their families that the commitments given to them by the HSE to home support will be met?

The budget for home support, home help and home care has increased to €420 million this year. That is up from €306 million in 2015, which is an increase of more than €100 million year in the past three years. That is a considerable increase. It provides 17 million home help hours to 50,000 people. The allocation has not yet been made for 2019. It will be part of the service plan. In the medium term, we need to not just continue to add more money and resources to a system that is not delivering adequately; we need reform. What we propose to do, in line with the Sláintecare plan, is to have a statutory scheme for home help, something similar but not the same as the fair deal scheme. The Deputy will know from the fair deal scheme that people get an assessment and a decision within weeks. This is not happening for home help. We believe it is the model to follow. If we keep doing what we have done in the past, which is to keep adding more resources, staff and money to the system as it is currently structured, we will not get the results we need.

The Ombudsman, Peter Tyndall, has expressed his disappointment that the HSE has not fully implemented the recommendations made in his 2015 investigation into the healthcare system that found many people were afraid to complain about the treatment they received in hospitals and that many hospitals are not learning important lessons from the complaints they receive. Today he published a progress report that found only ten of the 36 important recommendations he made were fully implemented.

Does the Department of Health have a plan to implement fully the other 26 recommendations?

The Government welcomes the publication of the Ombudsman's report, Learning to Get Better: Progress Report. The HSE and the Department of Health will work with the Ombudsman and his office on making sure the recommendations are implemented. So far, out of 36 recommendations, ten have been implemented fully and 17 are being implemented. Two are being advanced by the Department of Health.

Concerns have rightly been expressed in this House over how sexual offences are tried in court, the way evidence is used and the way victims are treated. There are also concerns about the consistency of sentencing for sexual offences. Our Judiciary is rightly independent, as guaranteed under the Constitution, but major reform was championed by former Chief Justice Susan Denham. That involved the creation of a judicial council, one of the key functions of which was to standardise and promote training, deal with sentencing policy and so on. The Bill to establish the judicial council was introduced in the Seanad last November but it has not proceeded to Committee Stage. We talked about this for a very long time. In light of the concerns expressed, why has the Bill not progressed? When will it progress?

We want to progress it. We want to establish a judicial council and empower it to set sentencing guidelines so there will be more consistency in sentencing across the country. The Bill is cued, as are many others. We need to pass the Judicial Appointments Commission Bill first. It has passed through this House. It is being held up, quite frankly, in the Seanad.

The Bill in question is due to proceed to Committee Stage.

Committee Stage in the Seanad is taken on the floor of the Chamber. In order to make progress, my party has given up its Private Members' time this week to allow us to provide more time for the Judicial Appointments Commission Bill. I appeal to other parties to support us in dealing with that legislation. That will free up the time we need in the Seanad to deal with the other Bill.

Is the Taoiseach holding the council hostage to that Bill?

We have a reform programme. Our reforms are consistently being held up by the fact that we do not have a majority in this House or the Seanad, unfortunately.

The programme for Government refers to putting in place measures that would allow tenants to avoid future rental increase shocks, yet on Monday we learned that, according to daft.ie, there have been year-on-year rent increases of 11% nationally. There has been an increase of 14% in my home city, Cork. For tenants who have suffered rent increases of 14% and more over the past year, the rent pressure zones and the 4% rent cap are a cruel hoax. Where is the rent control? In the United States, housing campaigners have a slogan. They say they are actively involved in campaigning because "the rent is too damned high". It is too damned high in this country for hundreds of thousands, including young people who are locked out of the housing market. Given the failure of the Government's rent control policies to date, is the Taoiseach now prepared to implement real rent control measures, which in the current circumstances means measures that cut the price of rent?

I thank the Deputy for the question. Rents are too high in this country, and that is why we are working to implement the rent pressure zone model. The zones have been introduced and are working but they need to be strengthened. A rent Bill will be published very shortly that will do just that.

The rent pressure zones are not working.

It will strengthen the enforcement of rent pressure zones. We have provided additional money in the budget for next year for the RTB to make sure the zones are being adhered to. It will also provide for rent transparency and longer notice periods for tenants when a notice of termination is served. The strengthening measures are to be introduced in the rent Bill and they will work to strengthen further the rent pressure zones because we recognise that rents are unacceptably high.

On the day that is in it, let me return to Brexit and the indicative timetable. Does the Taoiseach expect that after March of next year, as the long-term relationship between the United Kingdom and the European Union is worked out, there will need to be some bilateral treaties between Ireland and the United Kingdom only - for example, in respect of a common travel area, in respect of which some academics have said the legal basis is perhaps very weak? Will there need to be bilateral relationships given our very close economic and social relationships with the United Kingdom, particularly the part of our own country that is still in the jurisdiction of the United Kingdom?

There may need to be. What we would like to do first is resolve the EU–UK relationship and have an EU–UK treaty on the future economic and security relationships. If individual countries need bilateral agreements that do not conflict with that, they may well be necessary.

With regard to the common travel area, it is true that there is no single piece of paper that states what the common travel area is. It is interwoven with many items of legislation, conventions and protocols involving Britain and Ireland. I can say for certain that both the Irish and UK Governments want to keep the common travel area in place. Our European partners are happy for us to do that, accepting that this is an arrangement between the United Kingdom and Ireland that is unique and predates our membership of the European Union.

The programme for Government is very strong in protecting rural people and rural communities. I attended an IFA meeting in Nenagh last Monday week at which dozens of farmers and householders stated they are terrorised in their homes. The Garda is doing its best considering that it does not have enough resources but I was shocked to hear a senior garda state there is no provision in law to deal with trespassing unless it can be proven there was intent to commit a crime. There are marauding gangs of people going around hunting with dogs without muzzles and killing hares illegally. They are also threatening and intimidating farmers and others. The gardaí are unable to deal with them. They do not have the tools or manpower. Will the Taoiseach write to the Law Reform Commission to ascertain whether we can amend the law? When people are trespassing and asked to leave, they threaten to damage the property or to cut wires or water pipes. They are intimidating and terrorising the people of Tipperary and many other communities.

And Kerry and places all over the country. The law is unable to keep up with those concerned so we need to amend it. The same applies to the bail laws, which are a total joke. The same also applies to free legal aid legislation.

Just one topic, I am afraid.

The overarching topic is the protection of our citizens. They are entitled to be able to live and sleep in their beds peacefully at night without being intimidated by these rogue gangs.

We have no time whatsoever for any kind of criminality. All the resources of the State will be focused on dealing with it.

We are about to go to the next meeting of the Joint Committee on Climate Action, at which the Secretaries General from the Department of Public Expenditure and Reform and the Department of Finance will make a presentation. We hear in advance that there has been reform of the public spending code such that, from now on, in respect of any project and its climate assessment, the arrangement will apply at triple the rate of carbon, with a much lower discount rate and a tapering out of that discount rate over time. This is totally different from the way in which projects have been assessed to date. In that context and given that we are no way near meeting any of our climate targets, will the Taoiseach conduct a review of the existing national development plan, which was agreed only six months ago without any climate assessment? There was a carbon price and it was one third of what it should have been. There was an inappropriate discount rate. Will the Taoiseach review the national development plan given the public spending code reform that has just been agreed?

As Deputy Ryan will be aware from replies to questions to the Minister for Public Expenditure and Reform and from the Minister's budget speech, the Minister is keen to drill down further into the specific issues raised today in respect of how the budget will be constructed in the future and how public spending codes will be constructed in the future vis-à-vis capital investment. This is a matter of which the Department is acutely aware.

On a point of order-----

There is no point of order. The Deputy may not have a second bite at the cherry. There is one minute in which to ask one question.

We deserve answers.

I call Deputy Gallagher.

It is ridiculous.

My question relates to Brexit. In light of the draft agreement between the United Kingdom and the European Union, to which, understandably, we are not yet privy, can the Taoiseach advise the House on the implications for the marine and fisheries sectors? Are the negotiations on the marine and fisheries linked to the trade negotiations?

Over 60% of our mackerel quota is caught in UK waters, as is over 30% of our nephrops and over 30% of crab fished by Donegal vessels. It could have devastating implications. Hopefully it will not but is the Taoiseach in a position to advise us yet?

Fisheries has been a major topic of discussion over the last couple of weeks involving all the member states and the EU institutions. Access for our fishermen to UK waters is extremely valuable. Some 30% or 40% of all the fish our fishermen take out of the sea are taken from British waters. Indeed, some of the most valuable fish such as mackerel and prawns are taken by Irish trawlers from UK waters. I often hear the narrative that Irish fisheries were sold out when we joined the European Union but, in fact, we take a huge amount of our fish from UK waters and, like the French, Dutch, Belgians and Spanish, we wish to continue to have access to those waters after Brexit. Nothing will change during the transition period but during that period it will be necessary to negotiate a future relationship which would include issues such as fisheries. Obviously, we will want to continue to have access to UK waters while the UK will want to continue to sell its fish to the European Union. The UK will want other things as well, for example, with regard to financial services. It will also want access to European markets and to have an open skies agreement for aviation. All these matters are interlinked and will be part of the future relationship-----

We cannot discuss all of them now.

-----and while the UK might have a strong hand when it comes to fisheries we have a strong hand when it comes to services and other matters too.

One of the objectives of the programme for Government is to protect farmers' incomes. In that regard, farmers throughout the country are outraged at the behaviour of the factories in how they are controlling and reducing the price of beef at will. Farmers are coming together to see what can be done to protect their incomes. I appeal to the Taoiseach to do something about these factories. They have a monopoly and are determining what farmers get. Farmers are not being paid properly for their produce and their incomes are suffering as a result. Farmers are talking about the food on their tables because soon they will be unable to survive with the current regime. Will the Taoiseach do something about it or not?

I am not sure it is correct to say that there is a monopoly. The Competition and Consumer Protection Commission has examined allegations of a monopoly operating among the beef factories. I appreciate that farmers want a decent price for the work they do, but at the same time factories need to make a profit and we also must ensure that consumers pay a reasonable price for their food. The Minister for Agriculture, Food and the Marine, Deputy Creed, has established a beef forum which allows him to engage with all parts of the sector and to make progress through that. In addition, the Deputy will be aware of the announcement in the budget of a new scheme to support beef farmers. He will be hearing more about that in the next few weeks.

Given that today is World Diabetes Day, when can we expect the roll-out of FreeStyle Libre to all diabetes sufferers? At present, it is provided up to the age limit of 21 years and there has been a major campaign by all the people who suffer from diabetes to roll it out to all sufferers. It is advanced technology that can greatly assist the people who suffer from this condition. Can the Taoiseach give a commitment as to when this will happen?

Page 53 of the programme for Government states that efforts will be made to provide safe and timely care. As my colleague said, today is World Diabetes Day. The HSE made a decision recently to provide FreeStyle Libre for children and adults up to the age of 21 years under the long-term illness scheme. That was warmly welcomed. Unfortunately, for those over the age of 21 years who have type 1 diabetes, which is approximately 20,000 adults in Ireland, access to FreeStyle Libre costs €120 per month per person. My question is similar to my colleague's. Are efforts being made to roll-out the FreeStyle Libre device to adults over 21 years? It would significantly improve their quality of life.

I do not know. The budget provides for a reduction in prescription charges for all patients with medical cards and also for a reduction in the drugs payment scheme, DPS, for those who do not. However, I believe the Deputies are asking whether this device can be included under the long-term illness scheme for people over 21 years and I do not know the answer to that, but I will ask the Minister for Health to give the Deputies a reply.

Life is very short and I am speaking on behalf of all the ladies who are still being blackguarded with regard to their pension rights and entitlements. They are not getting the pensions they should be receiving. Can the Taoiseach give an update on the status in that regard? Also, I am not an argumentative person but yesterday the Taoiseach wronged many people in Ireland who operate health shops, people who avail of health supplements-----

The Deputy can only bring up one matter at a time.

I want the Taoiseach to correct the record of the Dáil.

As I said, I am not argumentative and I am giving him the opportunity to right the wrong. Everybody makes a mistake but the Taoiseach made a bad mistake yesterday.

The Deputy made a bigger one.

Are you the Taoiseach? The Taoiseach is perfectly capable of speaking for himself.

You are not argumentative. Calm down or you will give yourself a heart attack.

He does not need a backbencher to speak on his behalf.

You will give yourself a heart attack.

There is no need for a smart comment like that.

Calm down, please. Let the Minister, Deputy Regina Doherty, answer the question.

A Cheann Comhairle, that is blackguarding now.

It takes one to know one.

Get him to retract that statement.

I did not hear any statement.

There is no reason for him to make a smart comment like that.

Calm down or you will give yourself an injury.

It is not a nice thing to say and if he had half a brain he would not say it. Do not be stupid in the national Parliament.

That is not a very nice thing to say, Michael.

What, that he does not have half a brain?

We will review the record and see what people said. I call the Minister, Deputy Regina Doherty.

To update the Deputy - I updated the House yesterday but the Deputy was not here for Oral Questions - some 79,000 people are impacted by the rate changes that were made by the Dáil in 2012. We started to write to those people last week and sent 11,000 letters. The remainder of the letters to Irish residents will be sent out this week to advise them of what will happen with regard to the review over the coming weeks. Some 8,000 people are not resident on the island of Ireland and we will write to them in December. We expect the reviews to be completed and payments to start in the first quarter of next year. The payments will be backdated to 30 March 2018 or to the person's 66th birthday, whichever came first.

I call Deputy Tóibín.

What about the other question?

I corrected the record yesterday.

Ten days ago the former CEO of the HSE, Mr. Tony O'Brien, made a serious attack on Navan hospital. He stated that the emergency department in Navan was a target of the HSE for closure. He also undermined the morale of the staff and the confidence of the general public by attacking the quality of the service there. It was shocking given that Mr. Tony O'Brien was, and the HSE is, responsible for the quality of service. The Taoiseach opened the accident and emergency department in Navan a couple of years ago. Does he have full confidence in the service? Will he ensure there is proper funding to make sure a quality service is provided there? Will he guarantee that there will be no closure of the 24-7 accident and emergency department in Navan hospital?

I worked in Navan hospital long ago as a senior house officer in medicine and, as Minister for Health, I opened the new emergency department there. My experience of the hospital is that it provides a very good level of service to patients who had medical conditions and older people with pneumonia or urinary tract infections, UTIs, the people who sadly might end up on a trolley in a big hospital. They get very good care and do not end up on a trolley in Navan. We must recognise what the hospital does well and I would be concerned about the impact any diminution in services there would have on Drogheda and Connolly hospitals, which are now performing much better than they did in the past. However, we must ensure that specialist services happen in the right place and changes may well occur over time.

There is a commitment in the programme for Government to increase the number of home help hours. Earlier this week my colleague, Deputy O'Reilly, received figures from the Department of Health which show that of those approved for home help services in the State some 6,285 are still waiting for them. In the former constituency of Laois-Offaly the figure is 578.

Given its population size Laois-Offaly is the worst in the country. Compare this with Louth where there are only two people waiting or the kingdom of Kerry where there are no people waiting, according to the figures I have. Some of the people in Laois-Offaly who have been waiting will, unfortunately, die while waiting for a home help. They are the most vulnerable people in society and they want to stay in their own homes and communities, which makes economic sense.

Reference was made earlier to hospitals and hospital services. We now have a bed-blocking situation where people cannot be released from hospital and return home because there is no home care package in place. We need to solve this problem. What steps is the Government taking to meet this growing need, especially in Laois-Offaly?

The Deputy has made his point.

Will the Government make funding available to deal with the crisis-----

Deputy Stanley's time is up.

-----in home help?

Deputy Carol Nolan has indicated. Is it on the same matter?

It is scandalous that there are 570 people in Laois-Offaly awaiting home help. I am aware there is a serious problem with home help hours and home care packages. The programme for Government refers to caring for our elderly people, but it is far from the case. I have people in my office every day of the week despairing over the fact they do not have home help hours. I have pointed out previously in the Chamber that many elderly couples are trying to take care of each other. These are elderly couples with health conditions and they are unable to cope. It is scandalous. We need something done here. Urgent action must be taken because hospital beds are being occupied. It is unacceptable and we must take action to ensure that Laois-Offaly is given adequate provision for home help hours and home care packages.

This matter was dealt with earlier, but perhaps I can reply again or in more detail. Home help and home care packages are very valuable and very cost effective. The Deputies are correct in that respect. The packages allow people to return home from hospital, allow people to avoid going into hospital in the first place and allow people to live at home for much longer before they require long-term care. For that reason we have increased the budget dramatically over the past three years. It was €306 million in 2015 and it is €420 million this year. It will increase again next year, and this will be outlined in the HSE service plan. Once again we are adding more staff, more resources and more money but not getting the results we would like to see. This is further evidence that what we need is not just more money, more staff and more resources. We need system change also. This is why we propose to establish a statutory scheme for home care modelled on the fair deal scheme.

There is significant variation from county to county but I ask the Deputies to bear in mind that the Sláintecare report, to which all Members have committed, proposes that we have greater devolution and greater regionalisation of healthcare. We need to think that through also. People cannot demand the implementation of Sláintecare one minute and then say they are against regional autonomy and regional variation the next.

Page 11 of A Programme for a Partnership Government refers to the Government's ambition for the health service. Today 56 people are on trolleys in University Hospital Limerick, which is an extremely high number in one hospital in one day, as I am sure the Taoiseach will agree. It is more shocking to know that today a record has been broken in that more than 10,000 people have been on trolleys in University Hospital Limerick so far this year. The figure is actually 10,028 people who have so far lingered on trolleys. It is a disgraceful new record set under this Government. When will my constituents in Limerick be provided with a health service that is not bursting at the seams with dangerous overcrowding? When will the long promised additional beds be delivered?

Across the country at 8 a.m. today, there were 378 adult patients on trolleys.

It was 518 people.

Obviously that number will be much lower by now and most of those patients will be in beds by the afternoon. This is a 12% increase on the same day last year, but it is down 16% on this time two years ago. Once again we see enormous variation from hospital to hospital. There are no patients on trolleys in Beaumont Hospital, two in Connolly Hospital, five in University Hospital Waterford and as many as 43 in Tallaght hospital. There is also a very large number in Limerick hospital. University Hospital Limerick, as Deputies are aware, has a new emergency department, a bigger budget, more staff and a new wing, the Leben wing, so clearly some work needs to be done there.

On a point of order, the figure was 518 patients.

The Deputies have asked their questions. I call Deputy Sherlock.

I wish to raise the issue of the welfare of children throughout the State. Today we had the publication of the HIQA report on the special care units at Coovagh, Ballydowd and Glenaulin in Cork. We have had numerous HIQA reports on child protection, foster care, residential care, adoption and so on. We do not, as yet, have an affordable childcare scheme. We have been told it will be rolled out in November 2019. We have serious issues in respect of Tusla and the absence of social workers and social care workers. We also have serious issues around residential respite places for children with intellectual disabilities. I ask that provision be made to discuss services for children across the State and across a whole range of areas. There is a lack of urgency on the part of Government on a number of issues to do with the welfare of children.

Will the Business Committee consider the request for a debate on this?

This will be a matter for the Business Committee. I would have no objection to a debate on it. We will have the affordable childcare scheme in place next year.

On Deputy O'Reilly's clarification, the figure of 376 adult patients on trolleys today came from the Department of Health at 8 a.m. this morning. The INMO does a different count that is 518. The HSE count includes patients on chairs and trolleys in and around emergency departments but the INMO has over the years widened the count out to include patients on trolleys in other parts of the hospital and also people who not on trolleys. They may be in day wards rather than night wards, or may be in an overflow ward. The INMO count includes people who are in beds.

They are not in hospital beds.

Yes, that figure includes some patients who are in beds so it is a different way of counting it, but it is not correct to describe those people as being on trolleys.

There are three Deputies remaining, and I will call on each of them. I call Deputy Brassil.

The programme for Government gives a significant commitment that all decisions and policies by the Government would be rural proofed. On 30 October this year the Department of Rural and Community Development wrote to every community service programme run by Pobal to inform them a review is to be carried out. Will the Taoiseach consult with his Minister to confirm this review is in line with the policy, which looks to expand and support services as opposed to cutting a very fine and valuable service in many places, including in my town of Ballyheigue where a very successful community service programme is operational? The programme's continued success is critical to the success of the town itself.

I thank Deputy Brassil for this important question. I am aware of the value of the community service programmes around the country, not least in Kerry. I do not have any information on that particular issue but I will ask the Minister, Deputy Ring, to provide the Deputy with a written reply.

Page 19 of A Programme for a Partnership Government refers to housing. I very much welcome the allocation of funding this summer for 70 void houses to be completed in Limerick. I have raised this issue in the Dáil on previously. I ask that the Minister would consider a common sense approach to voids. There are some voids in Limerick that are habitable and some people could live in them. Unfortunately, the houses cannot be let out because they have to go through a number of upgrades. This is quite bureaucratic because the houses are liveable. Some scheme could be put in place so the houses could be vetted to allow people to move into them and a common sense approach could be taken. People are on the housing lists and yet are looking at these empty houses that are liveable. However, as they must go through some sort of bureaucratic process and be upgraded, the houses are being left idle.

I thank the Deputy for the question. I am well aware of Deputy Neville's interest in this area because he has raised it on a number of occasions. We have the money available to deal with vacant or void stock in local authorities. The call for common sense is a good one but we also have to make sure that every process we have when it comes to spending taxpayers' money is a robust process. My officials are currently talking to the local authority to see what we can do in this area.

I wish to raise the issue of endometriosis, which is a chronic disease affecting one in ten women in Ireland. It takes approximately seven years to diagnose because many general practitioners are not aware of the condition and it is often misdiagnosed. Following a diagnosis surgery is a very painful procedure that a woman might require on a number of occasions.

I posed a parliamentary question on this matter but I was told there is no data on this. The waiting time currently for one patient I know is 52 weeks minimum before she would even see a consultant. These individuals are living in chronic pain. They can have fertility issues also. It is a disease that is incurable. We do not have the specialist surgeons in Ireland, the medication is extremely expensive and there is no assistance available.

I am asking that the Taoiseach raise the issue directly with the Minister for Health, that we try to put together some sort of process for these patients, and that the wait times be reduced. Information for patients is key and doctors must be properly briefed on the issue. It affects far more women than is actually talked about.

It is indeed a very painful condition, or certainly can be depending on the severity, and it is not rare at all; it is a very common condition. The Deputy is quite right to raise it in the House and to point out that there can often be delays in diagnosis. I will inform the Minister for Health that she has raised the issue and ask him to take it up with her directly.