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Dáil Éireann debate -
Wednesday, 6 Nov 2019

Vol. 988 No. 7

Ceisteanna ó Cheannairí - Leaders' Questions

Yesterday, there were 679 people across the country being treated on trolleys. Today, the number is 649. Behind the numbers are some horrific and appalling experiences for people in emergency departments. They are simply appalling and should not be tolerated by the Government. The Irish Nurses and Midwives Organisation, INMO, yesterday described the situation as "obscene" and said, "Winter has not even started, and Irish hospitals are overwhelmed". It went on to say that nurses are faced with an inhumane working environment, while patients are put at ever-increasing risk.

I spoke to an eye witness in Cork University Hospital. The person went there on Tuesday at 3 p.m. with a family member and was there until 5 a.m. the following morning. He said that what he had witnessed was simply unbelievable. He said the doctors and nurses were under "savage pressure", to use his own phrase. He could not comprehend how they were able to work under such circumstances. People were sitting on chairs and lying on trolleys everywhere. They ran out of seats to sit on. The chronically ill were in a desperate situation, to the great anxiety of their relatives. There were many elderly people there. I can give another illustration of these experiences. If one travels to Clare, Limerick or north Cork, and this did not start today or yesterday, the overwhelming issue on the doorsteps or when one meets people is their experiences at the emergency department of University Hospital Limerick. There is real anger from the relatives of loved ones who have gone through terrible experiences due to the overcrowding.

Critically, the Irish Association for Emergency Medicine has said that this is costing lives as people are dying as a result of the overcrowding. It says that 350 to 400 excess deaths are occurring each year because of the state of the emergency departments, the overcrowding and the long delays in treatment in those departments. This was confirmed to me by experienced medical authorities in Cork University Hospital, who reluctantly said that they had to admit and confirm that some people who attend the hospital will die as a result of the overcrowding and delayed treatment. In addition, there is a chronic shortage of consultants and a lack of rehabilitation beds, step-down facilities and home care packages.

When will the moratorium on the recruitment of staff be lifted? There are approximately 1,000 posts on the front line unfilled currently. When will the winter plan be announced? It is incredible that this is November and it has not been announced. Why is there this reactive approach as opposed to a proactive one from the Government? Will the Taoiseach, at a minimum, commit to lifting the embargo?

I am very much aware that our emergency departments are very overcrowded today. Indeed, they have been for quite some time. However, there has been a reduction in overcrowding today versus yesterday and we expect that reduction to continue through to tomorrow and Friday. As regards the actions the Government is taking, we are adding more beds to the hospital system. Since 2014, as soon as we had the money to do so, we started adding new beds to the system. That will continue. New bed blocks are under construction in Clonmel and Limerick and we will have them open as soon as possible.

We are also providing more funding for the fair deal and home care. The budget for the fair deal will exceed €1 billion for the first time next year. That will enable us to reduce the number of delayed discharges, where patients are in hospital and do not need to be there and could go to a nursing home or go home. We must ensure that happens much faster than it does currently. We are also investing in community care. We have secured a deal with general practitioners, GPs, to improve the level and depth of services they provide in the community, to ensure that fewer people go into hospitals in the first place. Much action is being taken to deal with this problem.

To answer the Deputy's questions, the winter plan will be published next week. In many ways it does not need to be published: what is in it is what has been in it in previous winters, which is funding for the fair deal and home care and to open any beds that are closed, although I understand that none is closed currently, and investment in transition care. That is already happening even though the plan has not been published.

There is no recruitment moratorium. As I explained yesterday, the number of staff in the health service has been increasing for many years now. There are approximately 15,000 more people working in the public health service now than there were three years ago. There are 600 more nurses than this time last year and more than 100 more doctors. However, it is the case that Health Service Executive, HSE, managers are not allowed to hire staff if they do not have the money to pay for them. We had a recurring problem in previous years of HSE managers taking on staff for whom they did not have the budget. That is not allowed in education, the Civil Service or the Garda. It was an anomaly that the practice was allowed in the health service.

With no disrespect, people are finding it difficult to comprehend this ongoing, robotic, detached response to their living experiences. There is a disconnect between what the Taoiseach is saying in the House about the numbers of nurses and doctors and the reality experienced by doctors and nurses at the front line in hospitals and by patients and their families. It is a huge disconnect. Either we and the people outside are not getting it or the Taoiseach has some insight, that nobody else has, in terms of the reality of people's experiences in hospitals and particularly in emergency departments.

The Taoiseach's comments on the moratorium are becoming very irritating and annoying. People have come to me who came top of the panel last February and gave up private sector jobs in the expectation that they were going to get jobs with the HSE. Those people have not been employed. They were recruited, but the contract has not been signed because there has been a moratorium since last April.

That is still the case. The Taoiseach needs to drill down and to stop coming back with the kind of response that involves seeing no evil, no damage and no harm. The scale of the Government's response to the chronic issues facing staff and patients in emergency departments is not what it should be. It simply is not there. The Taoiseach needs to engage in a fundamental reflection on the Government's approach to this crisis within our hospitals.

I do not mean any disrespect to the Deputy either, but his self-righteousness knows no limits. Let us not forget-----


I will provide some facts. Let us not forget that he was once Minister for Health and Children-----

He was a much better Minister than the Taoiseach.

-----and that he was famous for chiding Tallaght Hospital for not ordering enough trolleys-----

Was that when the Taoiseach was a doctor?

----when patients were being treated in the car park of that hospital.

I am enjoying this history lesson.

We do not even know how many people were on trolleys in those days because the then Government would not count them. The Deputy was also a member of the Government which took a policy decision - and not on the basis of financial considerations - to reduce the number of hospital beds significantly. He started that policy during the boom and continued on with it. We reversed the decision in 2014, as soon as we had the money to do so. The Deputy should get off his high horse when it comes to this matter.

The Taoiseach would not have a horse if it were not for Fianna Fáil.

This is a really difficult problem and it has been with us for decades. We know that there are also problems in many other countries as well. In that context, there is serious overcrowding in Northern Ireland. We are taking every possible action to deal with it. We are providing more beds, more staff and more funding for the fair deal scheme and home care, and we are investing in community services.

There is a growing problem with drugs and crime in Cork city. Deputy Micheál Martin and the Tánaiste, Deputy Coveney, will be well aware of this, along with all other Deputies and councillors who represent the city. On one hand, there are significant gaps in the drug addiction services being provided while, on the other hand, there is a lack of gardaí. We have been hit with a double whammy and the situation is reaching a crisis point. This crisis has seen drug paraphernalia and used needles being found in schoolyards and residential areas to such a degree that a young child recently picked up a bag of heroin from the garden of his home.

Government policy has been moving away from addressing this issue as a criminal justice matter and towards seeing it as a healthcare issue. I recognise that. I have also spoken to many of the service providers within the city. They tell me that the issue is not so much about financial resources - they recognise that money is being provided and that they have capacity - but about the recruitment of staff, a similar issue to that raised in the previous question to the Taoiseach. Services in our city are in an absolute state because they cannot recruit staff as a result of the embargo. There are posts that have been waiting to be filled since last February. The failure to fill those posts has unfortunately resulted in services being stepped down. The only victims in this situation are the addicts who are crying out for these services.

Due to the fact that these posts are not being filled and the issue is not being addressed proactively, we are seeing an increase in drug-related crime. As a result of there being 124 fewer gardaí than the number recommended to service Cork city and county, An Garda Síochána is under-resourced to deal with this increase. As I have said, it is a double whammy. I ask the Taoiseach to commit to lifting the embargo and allowing the service providers to fill those posts so that we can start to tackle this issue once and for all. They are waiting to be filled and the money is there to pay the staff.

I will not be able to speak on the issues relating to Cork in detail because I do not have an up-to-date briefing on them. If the Deputy wants to pass more details about those posts on to me, I will certainly have the situation examined. If a post has been approved and if the budget is there to fund it, there is absolutely no reason it should not be filled. The long-standing practice of advertising posts and designating people to fill them without the posts being sanctioned and without a budget to pay for them has been ended. That is not the norm across the public service. It was tolerated in the health service for a very long time and was the main driver for the overruns in the health service we have seen in previous years. That practice cannot be allowed to continue. Perhaps the Deputy will give me details of the particular posts to which he refers. If it is the case that the posts are funded and were approved, we will have the situation examined and get back to the Deputy in that regard.

With regard to the wider issues relating to drugs, the Deputy mentioned the need to treat the matter as a health issue. This is a health issue, albeit one that has a criminal justice aspect to it. Whatever can be said about the health service, there is certainly no restriction or recruitment embargo in place in respect of An Garda Síochána. There has been a significant increase in the number of gardaí in recent years. There are approximately 14,000 gardaí now. The total figure for the force will increase to 21,000, including other staff, in the coming years. As a result of this, there has been an increase in the numbers in Cork. There will be a further increase as gardaí are recruited and attested in the coming period.

We have also increased funding for addiction services. The allocation in this regard was €94 million in 2016. This was increased to €100 million in 2018. This means that there are now 793 residential beds for people who want to go into treatment and who want detox. That is a significant improvement on the situation in the past. We are also working really hard to get a supervised injection centre opened in Merchants Quay. We have run into difficulties with planning permission with Dublin City Council but we will press ahead with the project and try to get it completed. The Minister of State, Deputy Catherine Byrne, is working with Merchants Quay and leading on the project. We also have an agreement with Dublin Simon Community to provide a 100-bed detox unit for homeless people who have a problem with addiction. We are working on that and need to get it done as soon as we possibly can.

There are also increased resources for education and information. These are targeted at warning students and festival-goers in particular of the risks of taking drugs in the first place and at advising them how to reduce harm and stay safer if they do so.

I do not want to get into an argument about numbers but we do not have more than 700 detox beds. We have 144 detox beds in the State. There are no stabilisation beds outside of Dublin; not one. We have more than 700 detox and rehabilitation beds, but we are talking about people who require some sort of stabilisation because they are required to be clean of drugs to get into a detox centre. It defeats the purpose on the first day. We need stabilisation beds.

I take on board everything the Taoiseach said. However, in the context of issues relating to the Garda, 2,800 recruits have come through Templemore, which was closed by Fianna Fáil, since it reopened. Does the Taoiseach know the number of them who have gone to Cork city? It is 69. Less than 3% of these gardaí have been deployed to Cork city. The unit which investigates sex crimes in Cork has been unable to keep up with new cases. On a busy weekend night recently, only two gardaí were available to patrol the city centre. This is the second largest city in the State and only two gardaí were available. There has been an increase in crime, particularly that relating to drugs, and we are seeing an increase in burglaries and aggravated assaults. Despite this, we have fewer gardaí. The Taoiseach will state that deployment is an operational matter for An Garda Síochána, but it is also a matter for Government when 2,800 gardaí have come through Templemore and only 69 were deployed to Cork city. That is just not acceptable to the people I represent.

The Deputy is quite correct; the number of detox, stabilisation, and rehabilitation beds taken together is 793. That figure comprises 19 inpatient detox beds, 127 community-based residential detox beds, four adolescent residential detox beds, 625 residential rehabilitation beds and 18 adolescent residential beds. We now put more than €100 million a year into addiction services. That is money well spent because, if people can be taken out of addiction, they can get on with their lives, enter employment, and once again contribute to society. We will continue to increase resources for addiction services in the period ahead.

The number of gardaí stands at 14,234. The total Garda workforce is 17,275. We are recruiting more gardaí all the time. Another batch of recruits will be passing out in the coming weeks.

More and more, the Garda Commissioner is leading reforms within An Garda Síochána to take gardaí out of administrative and office positions so we can have them back on the front line where people want them to be and where we want to see them. How those gardaí are assigned around the country is a decision for the Garda Commissioner, and it is right that it is his decision. In my engagements with him I will raise the point the Deputy made and see if he will consider sending more of the next batch of gardaí to Cork.

Yesterday saw the end of a court process and the sentencing of two teenage boys for the horrific murder of a young girl in the prime of her life. It was probably the most extreme example of sexual assault and misogyny the country has seen. We send solidarity to her family.

Last month, the Dublin Rape Crisis Centre stated there was a public health epidemic of sexual violence. This time last year, thousands of people shared pictures online of their underwear with the hashtag, #thisisnotconsent, in response to victim blaming in rape trials. Ireland trended worldwide at the time and we had to bring the issue graphically into the Dáil chamber. One year on, I ask the Taoiseach what his Government has actually done about gender-based violence. Barristers are still trotting out the same old rape myths. In a recent trial, where it was not even contested that the complainant had been savagely beaten, the barrister suggested that the woman had still consented to the sex. The barrister said: "she is a worldly young girl [she is aged 20, by the way] with experience of life ... she knew what she was doing."

Women are wondering why we bothered putting a definition of "consent" into the law because it is not worth the paper it is written on. In another court this week, a complainant who was allegedly raped by two men was told by a barrister that she consented as she was not drunk enough and had the presence of mind to fix her skirt. Being beaten, raped multiple times and having video evidence does not seem to be enough to be believed. Is it any wonder there are reports of famous sports celebrities strutting around with impunity despite sexual assault allegations being made against them? Are women to go into hiding every time such a figure decides to go on a night out?

Following protests after the rape trial in Belfast, the Taoiseach commissioned the O'Malley report. It was to report by the end of last year but here we are approaching the end of 2019. The Taoiseach is already aware of the figures so I will not repeat all of them. I will say, however, that ten women are murdered annually, one in three women experience coercive control and one in four women has experienced physical or sexual violence. One must judge how important a Government considers an issue by how much funding it gives. The Taoiseach's Government gave €25 million to the entire support sector but saw fit to give €17 million to the cruel and ailing greyhound industry.

Perhaps the Deputy thinks that is fine, but most of us do not.

As a result of #MeToo and more disclosure, the rape crisis centres are reporting a massive increase in calls. The increase in funding provided by the Government goes nowhere near to meeting the demand. Why are groups not going into schools to educate young people about the signs of abusive relationships? Instead we have a culture of Hollywood movies and so on that normalises toxic behaviour by calling jealousy and manipulation "romance". I put it to the Taoiseach that we have to conclude that unless people go out to protest and stage walkouts in Google, McDonalds or wherever else, nothing seems to happen in here on these issues.

I thank the Deputy.

Over the past year, the Government has failed abysmally on three counts, namely, how complainants are treated in court; funding; and education.

I thank the Deputy for raising this important matter. I offer my condolences and my heart goes out to the parents of Ana Kriegel. I saw them speaking yesterday and I cannot imagine what they are going through and will go through for the rest of their lives because of what happened to their beautiful daughter.

There is an epidemic of gender-based violence in Ireland and across the world, and it needs to stop. The Deputy asked what the Government is doing about it. We are doing quite a lot. We have finally ratified the Istanbul Convention. That was long overdue but it has been done by this Government of Fine Gael and Independents, whereas it was not done by many other Governments that could have done so in the past. We have modernised our laws around sexual offences. These laws have been strengthened in recent years through the Criminal Law (Sexual Offences) Acts and the Criminal Justice (Victims of Crime) Act, which makes coercive control an offence. We have changed our laws around consent and have strengthened them in a way that needed to be done. There is also improved recording of sexual assault and work is ongoing with the Office of the Attorney General around the Harassment, Harmful Communications and Related Offences Bill. Next, we will introduce a distinct offence of stalking to provide for two offences to deal with non-consensual recording and distribution of intimate images. The Labour Party has been very involved in working with us on that. We need to ensure that proposed image-based offences will cover the recording and distribution of sexual assaults. The Oireachtas joint committee report will be considered in full once the committee has completed it.

An Garda Síochána is also continually improving its specialist services responding to the needs of victims. The Garda Commissioner is now rolling out digital protective service units with specially trained officers to engage with and interview victims. These personnel are better trained and know how to deal with victims of sexual violence. The Minister for Justice and Equality, Deputy Flanagan, has also launched the No Excuses campaign, a three-year national awareness raising campaign on sexual harassment and sexual violence that was launched in May 2019. The campaign aims to increase awareness of sexual violence and bring about changes in societal attitudes such as those the Deputy spoke about, with the aim of decreasing and preventing these offences. I am pleased to say that a second burst of the campaign commenced on 2 October.

With regard to funding, Tusla has statutory responsibility for care and protection from domestic, sexual and gender-based violence. The budget for that has increased by 20% under this Government and stands at €25.3 million. In addition, a further €1.7 million is being made available by the Department of Justice and Equality to support 57 organisations which support victim support services, and a further €2 million has been allocated in the budget for 2020 to assist those services next year.

The Taoiseach can sign up to conventions and put laws on the Statute Book. These are important and relatively easy things to do but they need to be backed up by change. We can see from reading the court reports that the definition of consent, which I argued for when I spoke at the committee, does not seem to be having one jot of an impact.

I welcome the No Excuses campaign. The difficulty, however, is that while it encourages more people to disclose, will they get the help they need? The Dublin Rape Crisis Centre has said it has had a 25% increase in phone calls as a result of #MeToo and a more disclosing culture. The Government increased funding to the sector by 10% across the board, even though some areas needed more while others may have needed less.

Last year, 3,000 people became millionaires in this country and 3,000 children got help from a domestic violence service. There are also more than 3,000 children who are homeless. The idea that we do not have the money to support services to assist women, men and children who experience violence is simply not acceptable. Women's Aid published a report in the past month which included a finding from a survey that people believed there was no point in taking a case and the majority of respondents said they probably would not bother doing so again.

The Deputy's time is up.

What the Government is doing in this regard is completely insufficient. International protests are taking place on 25 November, the international day for the elimination of violence against women. This should signal to the trade union movement, community organisations and women's organisations that they should mobilise for massive protest on that day worldwide.

The Deputy's time is up.

The political establishment is not taking any notice.

Spending by the Government is increasing by roughly 4% per year. It is only in the last year or two that we have gone from deficit to surplus and we are taking in as much in revenue as we spend. Government spending is increasing by about 4% a year. As the Deputy pointed out, we increased the budget in this area by 10%, which is a recognition of the priority we place on this issue. The fact is that we are willing to increase resources for this area at twice the rate we are increasing funding for other areas, some of which have had funding frozen or reduced. The Deputy mentioned some of those areas earlier.

In terms of what we are doing on the issue, we are reforming the law and I have given some examples of that. We are also investing in education and public awareness campaigns and the Deputy acknowledged that this has led to an increase in the number of women and men coming forward, which is to be welcomed. We are also improving our data in this area, which is very important too.

I am aware that the Deputy has campaigned successfully for us to go ahead with a new study on sexual violence in Ireland, which is being done. We are also providing additional resources and training to gardaí, as I mentioned earlier.

We have a complicated system in respect of capital acquisitions tax. This tax has been a feature of the tax system since 1976. The 2003 Act sets out how the tax is to be charged and calculated. The Act provides for two types of tax, namely, gift tax and inheritance tax. I wish to raise a number of anomalies in the treatment of certain people when it comes to this tax. There is very favourable treatment for some individuals while others are treated unfavourably. It is tax justice for some and injustice and unfairness for others. One group that is treated unfavourably comprises those who cohabit. They are treated differently from those who are married or in civil partnerships. Spouses and civil partners who inherit from the other person in the relationship do not pay capital acquisitions tax, which is very different from the position of those who cohabit. That is one anomaly.

There is another anomaly for cohabitants. When a cohabitant dies and provides for the surviving cohabitant, the latter will pay tax. If one cohabitant dies without leaving anything to the surviving cohabitant, the latter can apply to court for a share in the estate. If that is granted, he or she will pay no tax. There is unfavourable treatment for a cohabiting couple if they are two sisters or brothers or other family relations or two friends or where one is a long-time carer. A shared home cannot be gifted to the surviving person in those relationships without a considerable tax burden being imposed.

The term "disponer" is used in the 2003 Act to refer to a person who is providing a benefit to others. It is the relationship between the disponer and the person benefiting that will make a very appreciable difference to the tax being paid on inheritance or gifts. The child of a disponer will have a tax free allowance almost ten times greater than another family member. A disponer who has children enjoys far more advantageous tax terms than a disponer who does not. While efforts must be made to ensure that wealthy people do not avoid or evade tax, certain relationships are penalised when it comes to capital acquisitions tax. There are significant tax exemptions and concessions for relationships which are formalised through marriage and civil partnership but not for cohabitants, regardless of whether the relationship is intimate, and most definitely not for single people who do not have children. The person receiving there pays very high tax.

The Minister's reply when I raise this issue is usually to say that the State pledges to protect the institution of marriage, including civil partnership. Really, however, this is very lucrative for the State but unfair to those who are not being treated like others. This matter must be examined and addressed.

I am at a little bit of a loss once again. As is often the case, the Deputy perhaps knows the detail and facts around tax law better than I do. I may have to come back to her with a more substantive response at another date. As she stated, capital acquisitions tax involves two elements. One is inheritance tax and the other is gift tax. In the two most recent budgets, we have reduced inheritance tax. The Independent Alliance was keen for us to do that and, as a Government working together, we were happy to do it. It is our objective to allow the average person to pass on the average house in Dublin and around the country to his or her children without the latter having to pay any inheritance tax on it. Our tax code discriminates positively in favour of inheritances and gifts between spouses and from parents to children. That is treated very differently from an inheritance or gift given to someone to whom one is not related or to whom one is more distantly related.

I understand the point the Deputy makes and where she is coming from in the context of cohabiting. However, there is a difference between cohabiting and being married. Marriage and civil partnership are different relationships to cohabitation. Our law recognises this by favouring those who are married or in civil partnerships over those who are not. It would be difficult and fraught to try to change that or even to define clearly in tax law what is cohabiting and what is not. It is very clear whether one is married or a civil partner as one has to go through a legal process. There is no legal process of which I am aware to show that someone is a cohabitee or not. As the Deputy knows, the Finance Bill is currently being debated. She may take advantage of those debates on the Bill to propose amendments which the Minister for Finance, Deputy Donohoe, could consider.

I have raised the matter with the Minister for Finance but lack of progress with him made me raise it here today. With regard to cohabiting, one could have two sisters or brothers who never marry and share a home. There will be a tax burden for the surviving sister or brother unless he or she can prove dependency, which is unfair. Someone who does not marry or have children and works for 40 years may be able to buy a house and have some savings but the tax burden for whoever inherits that property and savings will be considerable. It is as if they are being penalised for not marrying and having children.

The reality is that there is significantly preferential tax treatment in respect of inheritances and gifts for married couples, civil partners and the children in those relationships. We even have superannuation schemes where an employee pays for the spouse and children benefit even though he or she has not married and does not have children. There are a great many anomalies there and there is a great deal of unfairness. It is almost like there are tax penalties for those who do not get married or have children or for those people who live in a committed although not intimate relationship who cohabit. We must amend the inheritance tax rules.

I like the Taoiseach's optimism to the effect that I could table an amendment that would be accepted. I do not think so. In the interests of fairness, we should have a look at this again to ensure certain people are not overly penalised.

I can certainly understand what the Deputy is saying. I can imagine a scenario in which two sisters or brothers are living in the one house when one passes on and the other is left with a significant tax bill, which he or she may be unable to pay, in particular if he or she is elderly. I understand the issues the Deputy raises or which could arise and they merit examination. It is not something I have discussed with the Minister for Finance but I will on foot of the Deputy raising it. However, we must be careful to get these things right. As we so often learn when it comes to tax law, one can fix one anomaly only to open up another one. One can close one loophole but thereby inadvertently open a new one. When one does these things, one has to be able to write them in law in a way that stands up in the courts and when the Revenue Commissioners seek to enforce them.