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Dáil Éireann debate -
Wednesday, 19 Jun 2019

Vol. 983 No. 8

Ceisteanna ó Cheannairí - Leaders' Questions

I get a sense that the Government does not fully appreciate the terrible impact that tomorrow's strike by healthcare assistants, laboratory and theatre operatives and chefs will have on our health services. These workers are the cogs and wheels of our health service. It cannot operate without them. Patients will be discommoded. Elective admissions will be cancelled. Necessary X-rays, scans and other procedures will not happen for many patients if the strike goes ahead. I raised this issue with the Taoiseach yesterday and he said the Government wanted to ensure that these workers are paid adequately and are fulfilled in their roles. The Taoiseach attacked me and my party and tried to lecture us for daring to even raise the issue yesterday and for saying something similar to what he said. He also criticised my party for raising the issue of low pay within the Defence Forces and for tabling a motion last week to highlight the terrible conditions that many in our Defence Forces have to endure. The Taoiseach has a tendency to be dismissive when it comes to low-paid workers and their situation.

When we on this side of the House raised the issue of the more than €1 billion of additional expenditure on the national children’s hospital or the €2.5 billion additional expenditure on the national broadband plan the Taoiseach dismissed our concerns. He also dismissed the concerns of the Secretary General of the Department of Public Expenditure and Reform who warned him that this broadband project did not represent value for money. He had no problem then with the massive overspends and the runaway nature of the spending on both those projects. He dismissed anybody who raised any concerns about them, yet when it comes to low-paid workers in our health services and Defence Forces the Taoiseach gets on his high horse, adopts a dismissive tone and attacks the Opposition for daring to even raise the issues. The health service workers have abided by the public service stability agreement. Their unions have adhered to it. The process has been ongoing since 2015. The Government, however, has put preconditions on a referral to the Labour Court and that has remained the stumbling block to this issue. The HSE has agreed to pay but the Government stopped that. It wants to try to fix the outcome in advance of the hearing. The Department of Public Expenditure and Reform confirmed in the talks that it would consider paying the money owed to the workers in 2021. Is it not the case that the real agenda on the Government side is to kick this out to 2021 and not to deal with it now as per the public service stability agreement? That is at the core of this. The Government has not played with a straight bat on this issue.

I have no difficulty with the Deputy raising questions. This is a parliament, a democracy and the place where the Leader of the Opposition asks questions and it is where I answer them. I am very happy to answer his questions but I think he needs to be a bit less querulous, less sensitive and much less precious. It is entirely reasonable for me to point out the hypocrisy of the position of the Deputy's party. Just before this, during priority questions, the Minister for Finance was criticised by Fianna Fáil for increasing spending during the year and using corporation profit tax receipts to do it. Then Deputy Martin comes in here and demands more spending just as he did yesterday and the week before. It is entirely reasonable for me to point out to the Irish people and to everyone the hypocrisy and two-facedness of the positions the Deputy takes.

That sounds like an election.

The Government made these promises.

When it comes to concern about low-paid workers I would like to once again point out the hypocrisy and two-faced nature of Fianna Fáil's position. It is the party that cut the minimum wage.

That is a nice thing to say.

We brought in the minimum wage.

Fianna Fáil cut the minimum wage.

We have increased it four times. Fianna Fáil is the party that brought in the financial emergency measures in the public interest, FEMPI, and slashed the pay of low-paid workers.

Talk about biting the hand that feeds.

It is entirely reasonable for me to point out the hypocrisy and two-facedness of the kind of positions that the Deputy and his party take.

Getting back to the substantive issue of the threatened strike tomorrow, which it is important to talk about, as I said yesterday, the Government does not want this strike to happen. We are willing to work with the unions through the industrial relations mechanisms - the Workplace Relations Commission, WRC, and Labour Court - to come to a resolution so that the strike can be avoided. All strikes are sorted out sooner or later. This one will be sorted out sooner or later. I would rather that it is sorted out sooner, thus avoiding strike action tomorrow and I have suggested that the Labour Court could be the mechanism by which this dispute could be resolved. I hope that can be possible during the day.

I remind the Taoiseach that Fianna Fáil has facilitated the public service pay agreements under the confidence and supply agreement. It also facilitated the last three budgets and in the context of Brexit has fulfilled its parliamentary duties in a constructive and responsible manner.

Fianna Fáil cut the minimum wage.

Those are the facts. When it comes to the health service workers, the Taoiseach talks about the other side but he is the other side because it was the Government which confirmed that it would try to pay this out in 2021. This has been going on since 2015. We are not responsible for how the Government deals with the wider issues and the mismanagement of big projects such as broadband and the children's hospital. When it comes to something already agreed as far back as 2015 the Government is saying "No" to the workers, for example, the chefs whose additional pay would cost approximately €2 million, and that it wants them to go to the Labour Court but before they do that, it wants to fix the outcome by imposing preconditions on how the dispute gets referred to the Labour Court. That is exactly what is happening because the Department of Public Expenditure and Reform confirmed that the money would be considered for payment in 2021, possibly in a successor agreement. The review that took place in 2017 recommended that chefs be linked to craft workers’ pay scales. The HSE asked for that to be done and agreed to it but the Government decided they should not get it. That was approximately €2.9 million for the 2019 estimate. Let us stop the pretence here. It is the Government that is saying it will not pay this, notwithstanding the agreement, and that it wants to kick it out to 2021. Is that not the official Government position?

The Deputy made a very serious allegation. Perhaps he did not realise that. He did not make it against me, the Government or the HSE but against the Labour Court. He suggested that somehow it was possible for the Government to fix an outcome of the Labour Court or in some way seek to fix an outcome of the Labour Court. The Deputy knows better than that. The Labour Court is an independent body, staffed by very professional people-----

It depends what it gets asked.

-----and they act independently and judiciously. To suggest that they would ever co-operate or somehow be involved in fixing an outcome is wrong and the Deputy should withdraw it.

The Deputy can ask to correct the record.

The Taoiseach did not answer the question.

Deputy Martin should calm down.

This dispute is scheduled to take place tomorrow, when 10,000 workers who are absolutely essential to the functioning of our health services will take to the picket line. These are low-paid workers such as chefs and healthcare assistants. This strike will happen because the Government has broken its word.

The Taoiseach knows, as the workers know, that back in 2015 there was an agreement to reintroduce job evaluations. The reason was that there was a recognition that low-paid workers had taken on additional tasks and responsibilities and that due to austerity, the financial collapse and the policies of many assembled here, the workers were not receiving the correct levels of pay. The Taoiseach agreed to this job evaluation scheme in 2015 but of course he welshed on that and dragged his heels. Eventually, in 2017 a job evaluation scheme was initiated to avoid strike action at that time. When the exercise was carried out, it found in phases 1 and 2 that more than 6,000 workers were being underpaid. Low-paid workers are being substantially underpaid, by between €1,500 and €3,000 per year, which is a lot of money when one is on a low wage. The curious part of it is that the HSE accepted the validity and necessity of the evaluation process and its outcome. It then asked for this shortfall to be funded. As the Taoiseach knows, the cost would amount to some €16.2 million, which is a drop in the ocean and minuscule when compared with the waste and overspend his Administration has stood over.

The Taoiseach says he does not want the strike to happen. It strikes me that he does want it to happen because the basis of the strike action is his failure to honour and keep his word. There is no need for a Labour Court intervention and there is no need for the Workplace Relations Commission. What is required is a political decision and a political acknowledgement that these workers hold our health system together and a recognition that they are not being paid what they are due. It requires the Taoiseach, as Head of Government, to ensure that the moneys required to give these workers what they are entitled to is released. Sin é; that is it. That is the beginning, the middle and the end of it. If the Taoiseach really does not want this strike to happen, he should make sure that the word of the Government is kept and the request by the HSE for these moneys is met.

It is somewhat curious that the Deputy's solution to overspending by the HSE or in the health budget is to spend a little more. It is not just today but nearly every day and every week that Deputy McDonald or the Sinn Féin Party has another suggestion as to how we can overspend or breach budgets by even more. Whatever about the shortcomings that this Government may have, is it not a good thing that we are the Government and the Opposition is not? I can only imagine what the overspending would be like if Sinn Féin was involved in government.

Members of the public will make up their own mind on that too.

On resolving this dispute, and I believe it can be resolved, what is needed is engagement between the employer and the unions. That can happen and has happened already under the auspices of the Workplace Relations Commission. It can potentially happen now under the auspices of the Labour Court. The Government is very aware of the important role that support staff play in the health service. I know it as Taoiseach, as a former Minister for Health and as somebody who worked in public health in our hospitals for four years. Healthcare assistants, maternity care assistants, porters, laboratory aides, surgical instrument cleaners and other staff have an essential role to play in the health service and in keeping our hospitals running. We do not want to see this strike happen. I believe it can be averted and there is a mechanism to do that.

We will always insist that the health service is fully and properly resourced but we will always call the Government out, not on its spending but on its waste of public moneys and its wilful disregard for the public purse. Everybody has seen that, in particular in the case of the children's hospital.

The Deputy has not read the PwC report.

What is required here is not an intervention by the Labour Court or any other third party but for the Taoiseach to keep his word. That is what he has failed to do. We heard this line before about nursing staff and midwives and now we hear it about chefs and healthcare assistants. The Taoiseach waxes lyrical about their contribution to the system but he is not prepared to pay them. As Head of Government, he is not prepared to ensure that, for example, a grade 2 chef whose entry level pay is €24,000, which is hardly a fortune, and similar workers are fairly paid. The Taoiseach accepted the need for job evaluation, signed on the dotted line for it and now he is not prepared to honour the outcome of that process. That is the reality of this dispute and that is why there will be strike action tomorrow. The only way to avert that is not to reach for a third party but for the Taoiseach to keep his word and respect these low-paid workers.

I am not sure if there was a question in there but it is worth pointing out in the first instance that all of the staff involved in this dispute are receiving pay increases this year. It is pay restoration in some cases and pay increases in most cases. This dispute is about additional pay increases on top of those pay increases they are receiving under the public service stability agreement. The dispute centres on the timelines for implementation. As I said yesterday, the first two phases are complete. The third phase, which involves home help and home care workers, and the fourth phase, which involves other support staff, have yet to be completed and fully reported on. The dispute is around the implementation of these pay increases, which are in addition to the pay increases under the public service stability agreement that have been and will be paid. I believe this matter can be resolved.

One of the clear indications of Catholic influence on the new Irish Free State was the establishment in 1926 of the Committee on Evil Literature. It led to the Censorship of Publications Act 1929. Over the course of the following decades, many works of literature were banned, as were manuals on reproductive and sexual health. Works by Frank O'Connor, Brendan Behan and Edna O'Brien were banned, among many others. Censorship was used as a tool of social engineering and control, including for the suppression of sexual freedom. Some might like to think that this was long ago in a different Ireland but the appalling treatment of Majella Moynihan has reminded us that social policing was still ongoing in this State up to the 1980s. In countries such as Hungary and Poland, we see attempts to roll back on people's freedoms in this area. Few people, certainly no one in my party, want to see a return to anything like that regime. It does not mean, however, that there is no such thing as evil literature. Following the conviction of two 14 year old boys for the horrific murder of Ana Kriégel and her sexual assault by Boy A, it has been revealed that Boy A had two mobile phones full of pornographic images. His Internet searches in previous years are reported to have included child pornography and animal pornography.

I advise the Deputy that as we are dealing with a matter that remains before the courts, we need to be extremely cautious.

I do not intend to go into the case any further than that, other than to refer to the conclusions we need to draw from it as a Parliament. It is up to professionals to assess the impact of such material on impressionable children but we can clearly and unambiguously say that this material should not be accessible to children.

The United Kingdom has introduced a new law, taking effect from mid-July, which means that people using the Internet will not be able to access adult images or videos without first proving that they are over 18 years of age. This is intended to stop a situation reported by the National Society for the Prevention of Cruelty to Children, NSPCC, where it is claimed that more than half of children and teenagers end up viewing pornography by accidentally coming across these sites. The Minister for Justice and Equality has already suggested that the Government might consider introducing a similar system of age verification here. Can the Government give us any clarity on its intentions in this regard? Will the Government commit to seeking a report from the United Kingdom by the end of this year on how well its system is working and if it is having the desired effect?

I am aware the case is still before the courts and sentences have yet to be handed down. We must all, therefore, be very careful about any commentary on a case that has not yet concluded except to say that all our hearts go out to the parents of the young woman who was killed and also to the parents of the two boys, but I do not want to say anything beyond that.

I am aware of the relatively new law in the United Kingdom, which is designed to prevent minors from accessing pornography online. It is a matter of concern to all of us that pornography is now so accessible to young people and that many young people learn about sex through pornography, which is not an accurate representation of what is healthy in life. I agree we do not want to repeat the mistakes of the past by engaging in censorship, moralising or deciding for others what they should do and watch. The UK law is relatively new and we do not yet know whether it will be effective. The Deputy's suggestion is very good that at the end of the year or perhaps after a year or so of implementation, the Minister for Justice and Equality would make contact with his British counterpart to seek advice and a report on whether the law has been effective and whether there have been unintended consequences. We should learn from other jurisdictions and the Deputy's suggestion is appropriate in that regard.

Separately, the Minister for Communications, Climate Action and Environment is bringing forward an online safety Bill as part of our plan to ensure that children are protected online. It will put new requirements on online platforms, including an online safety code. It will also prohibit cyberbullying of minors and harmful material such as that which promotes suicide, self-harm, bulimia or anorexia. There will also be an online safety commissioner who will certify that the codes are fit for purpose and who may have the power to order take-down in certain circumstances. In developing that legislation, the Minister will draw on some of the work the Deputy and his party have done, as well as work done by Sinn Féin and Senator Freeman, by trying to take together their legislative proposals. A six-week consultation is under way. On its conclusion, the Minister will bring the heads of the Bill to the Government and after that will consult the Oireachtas Joint Committee on Communications, Climate Action and Environment.

I welcome the Taoiseach's response. There are two separate items of legislation. I hope the online safety Bill announced by the Minister for Communications, Climate Action and Environment in March will give rise to a digital safety commissioner. The Taoiseach might confirm that is the intention of the Government.

The second item of legislation is the Labour Party's Harassment, Harmful Communications and Related Offences Bill, which deals with the separate issue of online bullying. I raised this with the Minister for Justice and Equality yesterday. I had hoped the Bill would be capable of being enacted in this session. They are both important items of legislation and I would be interested in hearing from the Taoiseach the timeline he perceives for each.

On the question regarding an online safety commissioner, the answer is "Yes". The legislation being prepared by the Minister, Deputy Bruton, will have a number of elements, the first of which is the requirement of platforms to have online safety codes, while the third will prohibit the cyberbullying of minors and the promotion of harmful content, particularly suicide and deliberate self-harm including eating disorders. To ensure that the codes exist, are fit for purpose and are properly enforced, there will be an online safety commissioner as part of that. That is the shape of the legislation the Minister, Deputy Bruton, is developing and the consultation in that regard is under way.

On the Deputy's legislation, I will need to check with the Minister, Deputy Flanagan. We will support it in principle, although I know the Minister wishes to speak with the Deputy about some amendments and I am not sure whether that has yet happened.

It has been done.

I will revert to the Deputy before the end of the day with a further update on the matter.

I raise the issue of a perfect storm facing the health services, into which the Government has sleepwalked over the past eight years. I refer to the recruitment and retention of consultants in the hospital system. This results from years of accumulated neglect in reforming models of care and developing the health services to maintain critical service delivery to patients. With a booming economy and almost full employment, we still have a dysfunctional health service, which affects many specialties. Fiscal prudence is as much about how we spend our money as how much money we spend and we need to get maximum value for the money we spend. Throwing money at a failed health system will not solve the problem. The Government's lack of curiosity in this regard is astounding. We are speaking not about additional funding but about spending money which has already been allocated.

I will highlight a number of issues. Vacant consultant posts are caused by pay disparity and intolerable working conditions. Employing locums and non-qualified consultants in a vain attempt to plug the gaps in consultant numbers is compromising the quality of care. There was an accepted maxim that there was a bottleneck when entering the system but that once one did so, one was guaranteed quality of care. That is no longer the case. Approximately 500 consultant posts are vacant: 54 in general medicine, 34 in anaesthesiology, 25 in emergency consultants, five in intensive care, 17 in obstetrics, 34 in paediatrics, 56 in pathology, 101 in psychiatry, 37 in radiology, 57 in general surgery, four in medical oncology and three in cardiology at least. This will not be news to the Taoiseach or the Minister for Health as it has been highlighted in many reports. The consequences are that more than 500,000 people are waiting for a first appointment to see a consultant, 150,000 of whom have waited for more than one year and 96,000 of whom have waited for more than 18 months. Some 10,000 children are waiting to see a consultant for the first time, before they ever go on an inpatient waiting list if they require ongoing treatment.

In addition, the Taoiseach showed a great lack of understanding of home help services last week, when he said that in spite of a 50% increase in the funding allocation to home help services, he saw no tangible benefit in the reduction of people attending hospital services. That is to misunderstand completely the purpose of home help. Provision of home help is the right thing to do. It is not about saving money or reducing attendances at hospitals.

When will the Taoiseach understand that the manner in which we spend money, rather than the amount we spend, is critical to the health service?

I agree with the Deputy on one point, namely, that providing home help is the right thing to do, which is why the Government has increased funding for home help by 50% in the past three or four years. On the occasion to which the Deputy referred, I was responding to an argument I often hear made, namely, that not funding home help is some sort of false economy because it then leads to higher costs up the line through longer hospital admissions and so on. Unfortunately, while that seems logical on the face of it, it never seems to stack up when looking at the finances. I agree home help is the right thing to do, but it does not save hospitals money. That is unproven at the least. The point I was making is that some people say it is a false economy but it is not.

On recruiting consultants, the Government absolutely acknowledges the enormous difficulties and challenges we face. Notwithstanding that, the number of consultants in the health service is at an all-time high, as is the number of doctors. This year, for example, 10,500 doctors and dentists work in the health service, whereas ten years ago, there were only 8,000 and three years ago, there were 9,300. Many new posts are being created all the time and there is difficulty filling them. The figures change and vary from area to area. There are many vacancies in psychiatry, for example, but one will often meet registrars or young doctors waiting for a post in their specialty to be advertised because there is none. There is variation across the specialties and regions. Unfortunately, more peripheral hospitals are often not able to recruit consultants, whereas those attached to universities in the cities receive many applications, which we need to be realistic and honest with people about.

I am not sure where the figure of 500 posts comes from. When the Public Service Pay Commission examined the issue, it was not able to verify the claims of the Irish Hospital Consultants Association or the Irish Medical Organisation, or even the HSE's numbers in that regard. Many of the posts that are described as vacant are not. They are filled with locums or temps or, in some cases, they are in recruitment.

We acknowledge that this is a difficult issue but it is one that we will have to manage. We will do so in consultation with the representative bodies and the HSE.

The Taoiseach ignored the main point I was making, namely, that understaffing in the context of consultant posts is reducing not only the quantity but also the quality of the care being provided. There are hospital departments where consultants are burning out because of the dysfunctional service they work in and where agency locums fill gaps. The cost of employing an agency locum is twice that of employing someone in a permanent post. While the remaining consultants are holding departments together against the odds and struggling to get access to diagnostics and facilities to carry out their work, the system is chewing them up and repelling those who might wish to work in the health service.

Hospital departments are losing their accreditation because the accrediting bodies are looking at the volume of consultants in departments and the fact junior hospital doctors are not being supervised. The level of training the latter are receiving is insufficient to allow for accreditation to be given. This means that a particular hospital department will not only experience difficulty in recruiting consultants, it will also have difficulty recruiting non-consultant hospital doctors. Not only has the Government a casual approach to increasing bed capacity, a matter to which we have referred on many occasions, but there is also a recruitment paralysis when it comes to filling vacant posts. Urgent action is required. We cannot reform our health service if it does not have a proper complement of consultant staff.

My basic point was different. Nobody doubts that we have real challenges when it comes to recruitment and retention across the health service. However, one would think from what is said in this Chamber and from the common narrative that this meant there are fewer doctors, nurses and therapists than was the case one year ago or three years ago. The reverse is true. Notwithstanding the difficulties involved, we have had a recruitment surge in our health service. There are 117,000 people now working in our health service. Three years ago, the figure stood at 107,000. This means that there 10,000 more staff than was the case three years ago. In the past three years, 1,132 more doctors and dentists have been employed and there are also 1,291 more nurses and midwives. That gives the Deputy an example of the success we are having in terms of recruitment. The impression created is that these real challenges, which I acknowledge, are resulting in an outflow of doctors, nurses, therapists and midwives, but that is not the case. We have more every year. We have been successful in increasing the number of front-line staff in the health service over the past three years. There is more to be done. We have made some good progress in recent months in the context of concluding new contracts with GPs, which the Deputy welcomed, and staff nurses. The next step is to engage with the representative organisations of consultants to see if we can agree something there as well. However, it has to be realistic and affordable.