Ceisteanna ó Cheannairí (Atógáil) - Leaders' Questions (Resumed)

Last week finally saw the publication of the report of the Oireachtas Joint Committee on Climate Action entitled Climate Change: A Cross-Party Consensus for Action. The extent to which there is actual cross-party consensus for action remains to be seen. Sinn Féin took the surprising decision to reject the final draft of the report despite having been actively involved in drafting it for months. Its rejection by the Socialist Workers Party was less of a surprise.

The UN Intergovernmental Panel on Climate Change issued a stark warning last year that we have only 12 years left to make major changes to our economies and ways of life in order to keep global warming at 1.5°C. That was last year so we now have 11 years left to take action. Even that 1.5°C warming is already linked to prolonged droughts in equatorial countries and to chaotic weather patterns across the globe.

Our cross-party climate report is our response to that international challenge. It provides a pathway to achieve our international commitment to reduce our greenhouse gas emissions by nearly half over the next 11 years and a total reduction of emissions to net zero by 2050. This can be done but it will be hugely ambitious.

I am not going to reiterate the contents of the report because we will have an opportunity to do so when we debate it in the House. I want to focus on the headline challenges that the report entails. We know where our greenhouse gas emissions come from so we can identify the sectors which require immediate action. The largest sources of emissions are agriculture, electricity generation and transport, with industry and commerce and people's home heating providing most of the rest.

Ireland's current emissions are the equivalent of 16 million tonnes of carbon dioxide and includes methane and other greenhouse gases. Our commitment is to reduce our emissions to 33 million tonnes by 2030, 11 years from now. We must further reduce that to zero by 2050 which means offsetting all remaining emissions by absorbing carbon elsewhere.

My questions to the Government are not only urgent but are direct and straightforward. Is the Government prepared to oversee the agricultural sector reducing its emissions from 20 million tonnes to 11 million tonnes over the next 11 years? How will that be achieved? Is the Government willing to invest public money in a massive programme of retrofitting all the homes in the State to bring emissions from people's home heating from 5.7 million tonnes to approximately 3 million tonnes and reducing energy poverty at the same time? Is the Government ready for the challenge of getting transport emissions down from approximately 12 million tonnes to 6.5 million tonnes over the next 11 years and all that entails in transforming public transport and how all of use transport in this country?

I pay tribute to the work of the all-party climate change committee, particularly the Chairperson, Deputy Hildegarde Naughton, whom I will meet tonight to discuss the report along with the Minister for Communications, Climate Action and Environment, Deputy Bruton, but also to each member of the committee who did a good day's work. I regret that Sinn Féin and the radical left could not sign up to the report although I am not as surprised by that as Deputy Howlin. It should be evident to any of the young people who took part in those inspiring protests in favour of climate action that socialism, or this particular brand of it, is not the future. The future lies in the centre and the centre left. It is a good thing that Fianna Fáil and Fine Gael were able to sign up to this report, alongside the Labour Party, the Green Party and others.

The report was discussed at Cabinet yesterday and each Minister has been asked to examine the report and reply in detail to the individual recommendations which we expect will inform the Minister, Deputy Bruton's all-of-Government plan on climate action which we anticipate being able to publish this month or next month at the latest. I have also asked that there be a debate in the Dáil on the report so we have a chance to debate climate change and climate action. I agree that we need to catch up quickly over the next couple of years.

We are keen to work with farmers and the agrifood industry to reduce emissions. We need to do that in a way that recognises we need to protect the incomes and livelihoods of farmers and the agrifood industry and we will work with those industries to reduce emissions, modernise farming and reform the CAP, in particular, to make it more green-focused. That will require significant changes in the way we produce food and we are up for that challenge and want to do it in a collaborative way.

The cost of retrofitting all homes in the country is between €40 billion and €50 billion and it is not going to be possible for the Government to meet that cost. That would cost €5 billion a year over ten years.

The Government could offer grant aid.

We can help but it would not be possible, as some have suggested, for the Government to offer all carrot and pay for all these changes.

That is not possible. We cannot find €50 billion over ten or 20 years to retrofit everyone's house but we can help. Most of the cost would have to be borne by householders but there are models that can help, for example, people retrofitting their houses and paying for it over a number of years through their ESB bill and the savings they make from energy. Similarly when it comes to transport, the big shift we need over the next ten or 15 years as people change their cars is for them to buy electric and hybrid vehicles. It is not possible for the Government to buy a new car for everyone and no reasonable person is suggesting that. What we can do is use smart measures, such as grants and carbon tax, to make it more economical for people to choose the electric vehicle or hybrid option. That is exactly what we need to do as well as, in particular, rolling out the infrastructure and the charging points throughout the country.

It is very important that we make a decision that this is the priority which, if it were not for Brexit, should be consuming all of our focus so that all of our policies in terms of investment are aimed at tipping the balance against carbon. We need to do this. I purposely did not ask about the ambitious target of 70% for electricity generated from renewables because that will be achieved. It means we have to be very clear about the requirement of State agencies such as Eirgrid to co-operate with energy generators and community generated electricity to achieve that objective. The bottom line for us now is to embrace this strategy not simply as another report but as the last opportunity we will have as a people to make our urgent contribution to the real challenge of our time. I ask the Taoiseach to indicate how this report will be treated and that it will not simply be regarded as another report from another committee but will be the definitive guide to policy throughout all of the sectors that will impact on our climate to achieve the really ambitious targets and groundbreaking policy changes that are required by this unprecedented challenge.

With regard to how it will be treated, there was a discussion at Cabinet yesterday. This evening, I will meet the Chairman of the committee specifically on the report. We have proposed there should be a debate in the House on the report and I understand the Whip is working with the Business Committee to schedule it. Each Minister has been asked to respond in detail to each individual recommendation in the report and to pass on that response to the Minister for Communications, Climate Action and Environment, Deputy Bruton. The intention then is for us to publish a revised all-of-Government climate action plan this month or next month at the latest. Then it will be a case of getting on with it and I am really keen to get on with it. I agree it needs to be a major Government priority. There have to be other priorities too. Even without Brexit, I do not think climate change would be the only show in town. Jobs, the economy, incomes, livelihood and infrastructure are important.

They are all interlinked.

It definitely needs to be at the centre of what we do in future.

The issue of access to mental health services, specifically the total lack of access to residential psychiatric beds in Tipperary, is creating an appalling crisis in our county. Almost all of those who suffer psychological distress are forced to use the services of the 44-bed unit at St. Luke's General Hospital in Kilkenny. I remind the Taoiseach that on 21 December 2018, the Mental Health Commission issued summonses against the HSE as the registered proprietor of the department of psychiatry at St. Luke's hospital. On 19 February, Kilkenny District Court found against the HSE on a number of charges relating to breaches of the Mental Health Act 2001. St. Luke's General Hospital pleaded guilty to four charges, including poor maintenance of seclusion facilities and failure to comply with the rules governing the signing of the seclusion register by consultant psychiatrists responsible as required by law. The Mental Health Commission inspectors reported - and I apologise for this - that they were almost physically sick from the smell of a discarded colostomy bag that had been left in a clinical waste bin inside the room where electric shock treatment is administered. It is appalling. This is deeply offensive to the dignity of all patients, from wherever they come. Was anyone held accountable? Of course not. Judge Brian O'Shea fined the HSE a paltry €5,200. What signal does this send out to the families of the service users? More important, what does it do to meet the overwhelming need for residential psychiatric beds in County Tipperary? Each year since the closure of St. Michael's unit in Clonmel, the situation has continued to deteriorate rapidly. I accept the bona fides of the Minister of State, Deputy Jim Daly, and sincerely accept what he is trying to do but something is blocking the return of psychiatric beds to County Tipperary and it needs to be addressed urgently. It is way beyond time.

If this is the crisis in the provision of adult mental health services, the crisis in child and adolescent mental health services, CAMHS, is even more alarming. There is not a single senior registrar for community healthcare organisation, CHO, area 3 covering north Tipperary or CHO area 5 covering south Tipperary. There is not one full-time CAMHS speech and language therapist or CAMHS social worker assigned to south Tipperary. It is appalling. When we put all of this together it is clear we are beyond breaking point in Tipperary. The HSE indicates the south east community healthcare area has the second lowest rate of acute psychiatric bed provision. If this area were to be provided with the national average rate of bed provision, an additional 18 acute psychiatric care beds would be required.

I acknowledge the announcement by the National Centre for Youth Mental Health, Jigsaw, that it plans to add to its growing network, with new services in Tipperary earmarked for 2019 or early 2020. We are waiting for these. In the meantime, however, the provision of additional professional psychiatric services in the county is at an all-time low. What steps are the Taoiseach and the Government taking to address this very urgent matter?

I thank Deputy Mattie McGrath for raising this important issue. I am afraid I do not have an up-to-date note in front of me on the particular issues he has raised with regard to Tipperary but I read the coverage at the time of the events he mentioned and I share his revulsion at the fact that basic things such as patient care and hygiene were not attended to properly in that unit, which is relatively new. There is no excuse for treating patients poorly or poor hygiene. These things do not require massive resources; they just require people to do their jobs properly. I am sure the HSE will respond to the Mental Health Commission's report and make sure remedial action is taken and changes made.

The focus in mental health over the past ten or 15 years has been the right one. It is moving away from inpatient services to outpatient and community services and moving away from the traditional model of mental hospitals and psychiatric institutions to care in the community. This is much more appropriate and is the right way to go. The Deputy knows that in Tipperary, for example, a new Jigsaw service is being established to improve the services available in the community to people with mental health issues. There is also increased capacity in primary care, with 114 new assistant psychologists and 20 psychologists recruited by the HSE primary care unit. Most of them are now in place. There is an increased supply of psychiatric nurses, with funding for an additional 130 undergraduates per year. Ten advanced nurse practitioners in CAMHS are in training. The Minister of State, Deputy Jim Daly, has developed a mental health telephone line, which helps to signpost people to the support they need, particularly out of hours. The Deputy is aware the budget for mental health this year will approach €1 billion, the biggest budget for mental health ever, with €55 million set aside for improvements in services alone. While there has been much focus on the national children's hospital, and I know the Deputy is particularly interested in it, we should not lose sight of the fact that three new hospitals are now under construction, one of these being the national forensic mental health campus in Portrane, which will replace the very outdated Victorian facilities in Dundrum.

I do not believe the people of Tipperary and their families will take much solace from the Taoiseach's answer. More than ten months ago, on 11 May 2018, the Taoiseach's colleague, the Minister of State, Deputy Jim Daly, wrote to the chief officer of CHO area 5 outlining the need to restore some acute bed provision for adults in Tipperary following the closure of St. Michael's unit. We cannot manage without these beds. The Taoiseach said A Vision for Change is working but it is not and it is three years past its report date of ten years. It has been a disaster for Tipperary. It is a black hole instead of a vision. The Taoiseach can mention the children's hospital all he likes but we will see where it ends up. People do not have the services. They cannot get access to Kilkenny. It is not that they are not wanted there but there is not enough room there to deal with the Kilkenny and Carlow situation, not to mention the appalling vista I mentioned. There are clearly no services in south Tipperary and very few in north Tipperary. To be sent to Kilkenny or Ennis from north Tipperary is an appalling vista. The Taoiseach cannot allow it to go on. Long-stay beds will have to be reinstated in St. Michael's unit or somewhere else.

We do not want every building, such as St. Luke's and St. Michael's former psychiatric unit in Clonmel, to be used for offices and storage. We want facilities that people can attend. Nurses and clinical advisers working in this area are burnt out. Psychologists are now trying to deal with this issue. Unfortunately, many patients are ending up in their graves. It is a terrible indictment of the Government and of A Vision for Change and anything to do with it.

On the case and facility referred to by the Deputy, I am advised that the HSE has accepted the report of the Mental Health Commission and put a plan in place to deal with it and funding has been allocated to implement it.

Is responsibility being taken?

Once again, I must emphasise that patient dignity and basic hygiene do not require much resources and that there should be no excuse for treating patients------

-----with a lack of dignity or for basic hygiene standards not being followed. I cannot comment on the specific request made by the Deputy for additional inpatient beds in Tipperary.

How many additional beds?

As I previously stated, the model of care towards which we are moving in mental health is away from mental hospitals and psychiatric institutions and towards community care. By and large, that has been the right policy direction.

A certain number of beds are always required.

The Minister of State with responsibly for mental health, Deputy Jim Daly, has committed to meet Tipperary Deputies in the coming weeks to discuss this matter. I am sure the Deputy will use that as an opportunity to put across his suggestions.