Ceisteanna ó Cheannairí - Leaders' Questions

We have all been appalled at the horrific violence and threats meted out to the staff and directors of Quinn Industrial Holdings in Cavan and at the barbaric, professional kidnapping and assault on Kevin Lunney.

At the weekend, one of the directors of Quinn Industrial Holdings, John McCartin, gave a wide-ranging interview to John Lee in the Irish Mail on Sunday. What Mr. McCartin had to say was worrying and telling. He was asked to explain how the threats were tolerated for so long. Many people in the country are asking that question because this has been going on for years. Mr. McCartin responded that "the pig's head was annoying, the posters were annoying, the defamation was annoying but as regards the physical threats to our lives, I wasn't taking it seriously because the guards weren't taking it seriously." He remarked that he had met named individuals who had threatened him, his children and family and had shared those names with the Garda and the authorities. He asserted that the Garda, the PSNI and the Government had paid "scant attention" to their pleas since the intimidation, arson and assaults reached new levels four and a half years ago. The big question hanging out there is why action was not taken earlier. I watched the Garda Commissioner last week attempt to answer a question on why the intimidatory posters were not taken down and there was no answer to that question. They were left up for a long time and, apparently, they have been taken down this week.

There is also the issue of jobs. There are 850 direct jobs in Quinn Industrial Holdings and 2,500 indirect jobs. The American investor has made the point that it will close down the business rather than be intimidated into selling it off. The issue is a very serious one in terms of the challenge to the State in the Border area. There have also been other attacks, including the shocking attack on the car belonging to Deputy Martin Kenny in County Leitrim, which are unacceptable.

I ask that the Taoiseach take a point I made some weeks ago a bit more seriously this time. He had a go at me and engaged in typical partisan stuff to the effect that I was just into creating agencies. I have long asserted that the rule of law is gone in the Border area, on both sides of the Border. The State has not been in control for some time and criminality reigns supreme. We need to fundamentally alter what we have been doing in relation to that. That means establishing a multidisciplinary joint agency, similar to the Criminal Assets Bureau, between the PSNI, An Garda Síochána and others. A task force will not cut it because statutory underpinning is needed. That would send a message once and for all to these warlords that enough is enough, we are not taking any more and we will assert the supremacy of the democratic State and law and order above and beyond anything else. Operation Loft, conducted by the Criminal Assets Bureau, indicated what is going on in the Border area. I am not exaggerating this issue, which has been ongoing for a long time. The point made by John McCartin is that there has been a vacuum since the Good Friday Agreement. Will the Taoiseach give my proposal serious consideration? Perhaps he will also give me an answer on why it took so long for the authorities to move and respond to the threats and intimidation.

I say again that the threats made to the directors of Quinn Industrial Holdings are totally unacceptable, as is the violence perpetrated against Kevin Lunney. It is a question of the rule of law. Law and order must prevail in all parts of the country. I met the Garda Commissioner, with the Minister for Justice and Equality, on this matter only last week. I spoke to John McCartin twice on the phone and I will speak to him again. He has been complimentary about the interest which the Minister for Justice and Equality, Deputy Flanagan, the Minister for Business, Enterprise and Innovation, Deputy Humphreys, and I have taken in this issue over a period. The Garda Commissioner is meeting the directors of Quinn Industrial Holdings today to discuss a number of ongoing investigations relating to these threats. The posters, as far as I am aware, have been removed. They had been removed previously, were put up again and have now been removed again. We have put additional resources into the Border area, including more than 100 additional gardaí in the past two years, extra Garda staff and a fully armed service unit for the Cavan area. The Garda Commissioner informs me that the level of resourcing will continue. On foot of our discussion, he will discuss with the PSNI how the Garda and PSNI can best work together on a joint investigation. I am not sure if a statutory agency is the best way for them to do so, as something like that takes a long time to establish, but I would not rule it out.

The best thing they can do is work together in a practical way if they have not been doing that adequately up to now. We discussed some other actions that could also be taken but perhaps it is best if they are not discussed in this open forum. This is, of course, primarily a Garda matter and something for the Garda to investigate south of the Border. It involves the PSNI as well.

I equally assert and put it to the Taoiseach that we must take the multi-agency approach. I remember when the late Ms Veronica Guerin was murdered, it was the catalyst for the establishment of the Criminal Assets Bureau and it had a very significant impact on the criminals at the time. It worked as it was a no holds barred approach to taking the criminals out of circulation and not being in a position where they could usurp the State, as they have been doing in this area for far too long. In the process they have undermined the capacity of law-abiding citizens to go about their business free of intimidation and the capacity of businesses to continue doing what they do best in creating products and jobs.

Mr. John McCartan said the Taoiseach called him and expressed outrage about what is happening, frustration about how long it is has been happening and surprise that in modern Ireland, this has gotten so far. He suggests the Taoiseach and Minister for Justice and Equality were blind-sided. Before the question about a multi-agency approach, I asked why it took so long to deal even with the public manifestations of these threats, such as the signage, as well as the threats to individual directors that have been ongoing for quite some time. Will the Taoiseach explain why it took so long for the authorities to respond to those?

I am not in a position to answer questions on behalf of the Garda Commissioner or the Garda. The Deputy would have to put that question directly to them and I am sure they would be happy to answer it.

The Taoiseach met the Garda Commissioner last week.

Has he forgotten already?

As the Deputy knows, a statutory agency would require legislation both north and south of the Border. That may be impossible currently for the various reasons that the Deputy knows.

We proposed it two years ago.

It could take much time. We need practical co-operation between the PSNI and the Garda. Perhaps there could be a joint investigation; I discussed this with the Garda Commissioner and he said he would examine the practicalities of doing this. That can be done quite quickly. We need more resources in the Border region for the Garda, and that is being done. An extra 100 gardaí have been added to the force there in the past two years, there are extra Garda staff and there is a new armed support unit. We will build on that. We can see the action being taken now with the posters being removed. Action is being taken on all these fronts and this is something we take very seriously. It is about restoring law and order in the area and giving people confidence that the peace will be kept. Progress is being made in these investigations. There has been an arrest relating to the attack on Deputy Martin Kenny's property. There has been an arrest relating to the attack on the Garda station at Emyvale. Work is being done by gardaí and we need to support them. I also ask anyone with information to give it to the Garda or PSNI so they can take further action.

I raise again with the Taoiseach the dangerous overcrowding in our hospitals. I raise it again today because of figures released by the Irish Nurses and Midwives Organisation, INMO, indicating that 679 patients are waiting today without beds in Ireland's hospitals. This is the highest daily figure of 2019 and the second highest ever recorded. The INMO has rightly described this as "obscene" and it has told us its members are faced with inhumane working conditions, with patients being put at increased risk. This is a very familiar story and I and others have consistently raised these matters with the Taoiseach. Yet here we are again today with 679 patients without beds. Not all are on trolleys as in some cases there is not even a trolley.

The Taoiseach should imagine he needs to go to hospital today because he is sick or experiencing an emergency. He would already be worried and his family would be worried. He should imagine how he would feel, knowing our hospitals are creaking under the strain and pressure they face. It would be an upsetting or terrifying experience.

This is not just a matter of numbers. This is about people who deserve far better than the perpetual crisis that the Government visits on our health service. What we have witnessed on the Government's watch is a complete and utter failure in health policy. For eight years now, Governments have failed to make any inroads into tackling the trolley crisis. We have had three Fine Gael Ministers for Health, including the Taoiseach, and things have not got any better. In fact, the situation gets worse by the month and year. Record numbers of people have been left on trolleys for the first ten months of this year. As we progress deeper into the winter, this problem will become more acute. Last week, the Irish Nurses and Midwives Organisation published figures showing that 11,452 patients in Irish hospitals were left without beds in October. These numbers should cause alarm bells to ring. They reflect the fact that the Government has failed to tackle this real and immediate pressure.

As I have said previously, to address the crisis, the Government can and should do a number of things around recruitment and retention of staff, the reopening of closed beds, step-down facilities, more home help hours and investment in primary and community care. Given that the Taoiseach has consistently ignored those pleas, what does he have to say today to the staff and patients in University Hospital Limerick, which again has the highest number of people on trolleys, and Cork University Hospital, which has the second highest number and has been under extraordinary pressure for some time? What does he have to say to the staff working in dangerous conditions and the patients, in particular the 674 patients who are left today without a bed?

I thank the Deputy for raising this issue. I do not need to imagine the scenario that Deputy McDonald speaks about. I am a doctor by profession. I worked in the public health service for seven years. I worked in three emergency departments and visited all of the other emergency departments during my time as Minister for Health so I fully understand what the experience of an overcrowded emergency department is for staff, patients and their families. I assure Deputy McDonald that we are making every effort to improve the situation.

There were a lot of patients on trolleys this morning. The figure is down to approximately 317 at the moment. We anticipate most of the remainder will be in beds by tonight. That still leaves us with a severe overcrowding problem in many of our hospitals. There are now approximately 11,000 beds in our acute hospitals. That figure has been increasing year on year since 2014. We are back to the number of beds we had in our hospitals approximately ten years ago, having reversed the cuts that began under a previous Administration. We have more doctors working in our public health service than ever before. We have 600 more nurses and midwives than we had this time last year. We have in recent years put in place more beds, nurses and doctors and we will continue to do so. This is happening against the backdrop of ever-increasing demand, which puts our health service under extraordinary pressure.

The Minister for Health met the chief executive of the HSE this afternoon and has been in contact with all of the chief executives of the hospital groups to see what more can be done, whether more beds can be opened and whether more funding for the fair deal scheme and home care - which has already been put in place - can help to get more patients out of hospital quickly. Deputy McDonald will know that an additional 1 million home help hours have been provided for in the budget and fair deal applications are now ticking over in about four weeks. We are also addressing the issue of care in the community to avoid people having to go into hospital in the first place. This ranges from encouraging more people to have the flu vaccine to better chronic care in the community so that people with diabetes, chronic obstructive pulmonary disease, COPD, and other illnesses do not end up in hospital in the first place. We have signed a contract in recent months with general practitioners to enable exactly that.

Deputy McDonald specifically mentioned Limerick. I would say to the staff there that there is a new 60-bed block under construction. Once it has been completed, we will try to get the facility open as quickly as possible and hopefully that will relieve the overcrowding in that particular hospital.

The Taoiseach regularly recounts his professional curriculum vitae for the House. From my point of view, the very fact that he is a medical professional, a doctor, and that he has worked in the public health system makes this all the more shocking and intolerable.

The Taoiseach has recounted the actions his Government has taken but the figures do not lie. In October, unless the Taoiseach contests the figure, 11,452 patients were left with no beds. Despite the list of actions he has set out, this is what we are left with. I am glad the Minister for Health met the CEO of the HSE but I would not hold out any great hope that much will come of that meeting. I have a suggestion for the Taoiseach. He mentioned 1 million additional home help hours but I suggest that this be increased to 2.5 million because that is what is needed to clear the waiting list. The 1 million additional hours will simply relieve the pressure regarding 40% of the waiting list. Let us do something radical and imaginative. Let us actually try something with a prospect of working and allocate the 2.5 million home help hours that are required.

I suggest that the Deputy's own lack of practical knowledge of the health service, health policy and how it works is what gives her reason to believe that there are easy solutions to complex problems such as this, which Governments of all parties have struggled to deal with for many decades. If she wants to talk to somebody about it, she should talk to her party's deputy leader, Michelle O'Neill, a former Minister for Health north of the Border. Ms O'Neill would know a lot about overcrowding in hospitals because it is a feature of the health service in Northern Ireland as well, which Sinn Féin was responsible for until it collapsed the Executive two years ago.

I suppose Sinn Féin is responsible for the trolley count too.

The Government will do everything it can to improve access to our hospitals and reduce overcrowding. That involves providing more beds, which is being done. We are up to 11,000 beds now, which is back to where we were ten years ago in terms of acute capacity in our hospitals. We have more doctors in our health service than ever before and 600 more nurses than this time last year. Additional resources are available for the fair deal scheme and for home care, and we will roll these out. We will push all of those solutions and hopefully they will make a difference.

I wish to talk about the same issue as Deputy McDonald but from a different angle. I hope that I will get a different answer, although that would be a miracle.

In April, the HSE implemented what was, to all intents and purposes, a recruitment embargo, supposedly to run for three months and end in mid-July. This was an attempt by the Government to manage the mismanagement of the national children's hospital project and other HSE overruns over the past year. The irony is that the longer the recruitment freeze goes on, the more costly it will be because people waiting for appointments get sicker and need more expensive and intensive intervention when they are eventually seen. Meanwhile, the HSE is spending millions on agency staff to cover the recruitment freeze, guaranteeing a spending crisis for the Government in the near future. Seven months later and we still have a recruitment freeze, although the Government continues to deny that there is an embargo, referring to it instead as "controls". In a letter to me, the head of HR in the HSE said that the north-west CHO 1 area has not implemented a recruitment embargo or freeze but has introduced "interim controls". This is a freeze by another name and that is what we have. Let us call a spade a spade and call it a recruitment embargo. Furthermore, it is hardly interim if it has been going on for seven months. These measures look set to be a permanent fixture for the foreseeable future.

The consequence of this embargo is that over 100 posts in Donegal for which approval had been given by the national recruitment service are vacant. I am awaiting statistics from the Saolta University Health Care Group, of which the hospitals in Donegal are part, that will likely paint a similar picture. It took the HSE over a month to reply to my query. In its reply, the executive stated that it does not have the figures yet. If it does not respond, that might solve the crisis altogether. At Letterkenny University Hospital, over 19,000 people were awaiting inpatient or outpatient treatment at the end of June, an increase of almost 1,900, or 11%, on the figure for June 2018. Almost 2,000 more are awaiting outpatient appointments.

A total of 1,783 women are waiting to see gynaecologists at Letterkenny University Hospital. The waiting list has been growing for the past five years. The recruitment embargo has prevented management at the hospital from recruiting the nurses, doctors and support staff required to fully reopen its short-stay ward. Elective surgeries and procedures at the hospital are being impacted which, in turn, is adding to the lengthy waiting lists. Figures released today show that 47 people, the third highest number in the country, are waiting on trolleys at the hospital.

CHO 1, which includes Donegal, has fewer mental health posts than was the case ten years ago. The direct consequences of this are manyfold and include longer waiting lists, a worsening trolley crisis and, most concerning of all, worsening conditions for people seeking treatment, which they would not need if the health services had the staff in place to provide those services as required. When will the Government end the recruitment ban and fill the over 100 vacant posts in Donegal in respect of which approval has already been received?

The Deputy asked some very specific questions about CHO 1 and Letterkenny University Hospital. I am afraid I do not have the necessary details in order to give him answers on that, but I will ask the Minister for Health to do so via correspondence. I can, however, comment on the wider picture.

There is no recruitment embargo or ban in the HSE. There are between 10,000 and 15,000 more people working in the HSE now than there were two or three years ago. There has been a constant increase in the number of staff in the HSE in the last couple of years. HSE managers are no longer allowed to take on staff without the money to pay them, which is a practice that occurred in the health service. This does not happen in the education sector or the Garda, but it was common practice in the health service for a number of years for managers to take on staff without the budget to pay them. That became the overrun we often talk about at the end of the year. The new CEO has brought in more controls in that regard. Those controls, which stipulate that managers can only take on staff if they have the budget to pay them, would be considered normal practice in any other part of the public service.

As I mentioned earlier, we now have more staff in the health services than previously. There are 600 more nurses working in our public health service than this time last year, and there more doctors than ever before. We now have 11,000 beds in our public health service. During the Celtic tiger period, a policy decision was taken by the Government of the day to take thousands of beds out of our hospital system. That was a mistake. In 2014, we reversed that policy as soon as we had the money to do so. We have been adding hospital beds ever since, but clearly we need to do more.

I contend that the Taoiseach is misleading the House about this issue. There is an embargo in place right across the board. However, it is not referred to as an embargo. According to a letter from St. Joseph's hospital in Stranorlar, "interim control measures" were introduced in April 2019. That is coming from the HSE. Those measures apply nationally. The Taoiseach may not have figures specific to Donegal, but he has the national figures because he has a Minister for Health, as he so eloquently said in response to the previous question. I have two letters here from the HSE which list hundreds of posts, over pages and pages, that are on hold and cannot be filled because of the recruitment embargo, or the "interim control measures" that are in place. When will the Government lift the interim control measures and ensure that people can actually receive treatment in our health services?

An embargo would mean nobody was being recruited or replaced, which is definitely not the case.

They are not being allowed to start work.

People are being-----

They are not getting a start.

Allow the Taoiseach to respond.

People are being-----

The Taoiseach is clearly misleading the House.

This is not Deputy Broughan's question. He should resume his seat.

People who were hired eight or nine months ago are not allowed to start work in our health services. The Taoiseach is clearly misleading the House.

In this Chamber, every Member is entitled to a bit of respect and courtesy. The Deputy had the floor to put his question, and the Taoiseach has a right to respond to it.

He should give the facts.

I will give the facts if I am permitted to do so. There has been an increase in staffing levels by grade since September 2018, or this time last year.

This year. Since April.

Since this time last year, we have recruited 125 more consultants, 189 more registrars and 301 more clinical nurse managers, who would have been called ward sisters or senior nurses in the past.

There are 143 more nurse and midwife specialists and 111 more staff nurses and midwives. Since this time last year, a considerable number of front-line healthcare professionals-----

Since April there has been a moratorium.

This year. Since April.

-----have been recruited. Not only have those who have left been replaced, extra staff have been hired on top of that. What is no longer permitted is HSE managers taking on staff if they do not have the budget to pay them. That is the norm across the public service.

Even after recruitment? Even after holding competitions?

Deputy Seamus Healy, please.

They should not recruit people they do not have a budget to pay for.

People have lost private sector jobs on foot of being promised a post by the HSE.

From 2002 on, successive Governments have espoused and implemented the downgrading of hospitals and the transfer of acute hospital services to so-called centres of excellence. We all know that that policy has created chaos. It was wrong then and it is wrong now, and it should never have happened. We in south Tipperary were lucky that 15,000 people on the streets stopped the transfer of our services to other areas, but other areas were not as lucky. It is now time to recognise and reverse that policy failure.

The trolley figures are a clear example of the chaos. The human beings on trolleys in accident and emergency departments, on corridors and in wards are a clear example of the chaos, failure and indignity suffered by thousands of patients over the past ten years. The total figure for October is 11,452, which is outrageous. The figures are climbing year on year, and we have not yet entered winter.

One of the areas which has suffered the brunt of the policy about which I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects on South Tipperary General Hospital. University Hospital Limerick and South Tipperary General Hospital consistently have the highest trolley figures in the country. Today's trolley figures are obscene. Patients are suffering and dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today's figures are the second highest ever recorded.

Mary Harney, the former Minister for Health, declared an emergency when 602 patients were on trolleys. Today, the figure is 679. The particular problems at University Hospital Limerick and in Clare and north Tipperary started with the closure of the accident and emergency departments in Nenagh and Ennis general hospitals. A local campaign held a number of very successful meetings to demand the reopening of the accident and emergency departments in those hospitals.

The chaos resulting from the policy I have described has been compounded by two moratoriums. Everybody in this Chamber, including the Taoiseach, knows they are real.

Thank you, Deputy.

We have a moratorium on the recruitment of staff. There are 432 vacant posts for staff nurses, public health nurses and staff midwives. There are more than 500 nurse vacancies in mental health services. I know three nursing posts have been vacant for the past six months in south Tipperary mental health services, child and adolescent mental health services-----

Thank you, Deputy. The time is well up.

-----and mental health services in the accident and emergency department in Clonmel. Is it now time to accept that the policy of downgrading hospitals has failed and that the policy should be reversed? Is it not time to agree to the reopening of the accident and emergency department in Ennis and Nenagh?

Please Deputy. The time is up.

Regarding Clonmel hospital, which I know is very severely overcrowded at the moment, a new bed block is under construction there and we will get it open as soon as we possibly can once construction is finished.

Where will we get the staff?

As for Limerick, as Deputies will be aware, a new emergency department, perhaps the most modern in the country, is open and functioning; a new block, the Leben block, opened two or three years ago; a further block of 60 beds is under construction and should open next year; and another block of 96 beds is planned to be built after that. Deputy Healy, I think, called for the reopening of the emergency departments in Nenagh and Ennis and perhaps other parts of the country. He also quoted the Irish Association for Emergency Medicine. They are the doctors who work in emergency departments, they are the experts when it comes to emergency departments and they say we should not reopen-----

They say 350 patients are dying on trolleys.

-----any emergency departments. In fact, they say we should further consolidate them because modern emergency care can only be provided properly in a relatively small number of large centres rather than a large number of small centres. The latter might have worked in the past, when medicine was different, but it will not work in the future.

The mid-west and the north east tell different stories. In the mid-west, it is absolutely the case that Limerick experiences very severe overcrowding. I know that people there link it to changes made to the role of Ennis and Nenagh. In the north east, however, the story is very different. Monaghan and Dundalk emergency departments were closed quite some time ago - again, long before my party was in government. However, we see in the hospitals that took over from them, namely Cavan and Drogheda, the lowest levels of overcrowding in a very long time. There are record low levels of overcrowding in some of those hospitals. Therefore it is not as simple as saying reconfiguring causes overcrowding because one sees such a totally different story in the north east than in the mid-west.

I am shocked at the lack of urgency, almost indifference, the Taoiseach displays, almost as if this situation is normal. The trolley figures are absolutely obscene. We have people suffering and dying on trolleys in our hospitals. The Taoiseach is the leader of this country and has a responsibility for this obscenity, the suffering and the deaths of these people on trolleys in our hospitals over recent years, a position that continues to this day. He absolutely can solve this problem. I ask him to introduce immediately a supplementary budget to tax the 1%, the very wealthy people, the billionaires who own 27.3% of all the wealth in this country. They are not paying their fair share now, nor have they ever done so. I want the Taoiseach to reopen the accident and emergency departments at Nenagh hospital-----

I thank the Deputy. He is way over time again.

-----and Ennis hospital and to reopen Our Lady's Hospital Cashel, a state-of-the-art hospital which has been vacant for the past ten years.

The Deputy's time is up.

The Taoiseach has the responsibility to solve this problem. He can do it. The question is whether he has the political will to do it.

I thank the Deputy and call the Taoiseach to conclude on this matter.

I assure the Deputy there is absolutely no need for a supplementary budget. The HSE will get an extra €1 billion next year.

This situation is normal, is it?

This will be the biggest budget the HSE has ever had and a very high one relative to other countries per capita-----

The Government will not tax the rich then.

-----so that will not be necessary. The Deputy thinks the solution to hospital overcrowding is higher taxes; it is not.

I referred to higher taxes on billionaires, who own 27.3% of all the wealth in this country. They are the 1%.

Please, Deputy.

The solution is more beds, more funding for fair deal, more home care packages and investment in primary care and public health, all of which is being done.