Ceisteanna ó Cheannairí - Leaders' Questions

The Government is re-announcing funding for a winter package in the Department of Health today and across the health service. The reality is that this appointment will make very little difference against a background of chaos in our emergency departments, and hospitals and of a lack of GPs being available. Right across the health system, there is a sense of absolute chaos. Crisis management is the core to the Government's health strategy, not resolving the difficulties or understanding where patients are at, or the experiences of staff across the health service. Some 100,000 patients have been treated already this year in our emergency departments ahead of the really cold part of this winter. Together with the announcement of the spin-fest that will be the winter plan today, one should look at this morning's edition of The Irish Times, in which Professor Fergal Malone, master of the Rotunda Hospital, who is not a political figure, wrote of lives of newborns being at risk because of overcrowding in the hospital. He wrote of a critically ill newborn child who was choppered into the Rotunda a number weeks ago from a regional hospital and who then had to wait four hours - in the life of a newborn child - because no critical care bed was available. The condition was serious enough to merit a chopper being used but when the child reached the Rotunda, there was no bed and treatment was delayed for four hours.

We also read in this morning's edition of The Irish Times of an increased number of patients dying from sepsis, an infectious disease the incidence of which had been improving in this country but in 2018, the number of cases rose by 10% in hospitals nationwide.

There also was the incident in University Hospital Galway some weeks ago when an elderly 74 year old lady on a trolley was assaulted by an aggressive patient in the emergency room. She fell off it, broke her hip and unfortunately, following treatment, has passed away. Her family is absolutely devastated and the devastation of their loss is compounded enormously by the circumstances in which that happened. They are looking for answers as to why this sort of thing is happening in emergency rooms across the country. This announcement is not going to change anything.

The Minister, Deputy Donohoe, and I this morning have already discussed and differed on whether there is a moratorium on staff recruitment. One has only to read any of today's reports or submissions from Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation, INMO, as to how that is impacting. There are 350 consultant vacancies and 350 consultant posts that currently being are held by non-consultants.

I ask the Tánaiste what today is about. Is this another spin-fest and attempt by the Government to pretend that everything is normal and we then have this carry-on - which I passionately believe it is - or is this something of substance? Will this make a difference in hospitals and GP surgeries across the country this winter?

I thank the Deputy for raising these issues again. I assure the House that the Government is more than aware of the pressure that hospitals and their staff are under, as well as the strain and stress that many patients experience, particularly in overcrowded conditions in hospital accident and emergency departments. That is why we are launching the detail today of a winter plan to ensure that the health services are ready for the extra pressures associated with the winter period, such as a prolonged holiday period, severe weather, seasonal influenza, and the spread of infections. Under the winter plan, nine winter action teams, each aligned to hospital groups have prepared integrated plans that will focus on demand management, staffing, timely access to the most appropriate care pathways for patients and appropriate, timely discharge from acute hospitals. The HSE winter plan is supported by an additional €26 million in winter funding, which will support access to the fair deal scheme and the availability of home and transitional care in order that patients can leave hospital sooner, as well as to reduce congestion in the emergency departments. Additional medical, nursing and therapy supports, pharmacy and laboratory staff to improve patient experience time, improved senior clinical decision-making, reduced length of stay and the facilitating of weekend discharges, are all part of the plan that is being published today. Additional aids and appliances to facilitate more timely discharges, additional home support hours to facilitate hospital-to-community transfers, communications to facilitate hospital avoidance and public health awareness are all also part of this plan. There also will be the implementation of frail intervention therapy teams for admission avoidance and reduced admissions of patients over the age of 75.

In other words, as the Deputy would expect, we understand only too well the pressures that winter will bring to our healthcare system, as everybody in this House does. We are trying to keep people out of hospitals and are trying to discharge people in a more timely manner and into an appropriate setting or at home, whether they be step-down facilities or with home supports. That is what we are looking to do with this winter plan. There is nothing dramatically new about that. It is about better management, more efficiency and resources, and ensuring we keep people out of hospital who do not need to be there.

The Tánaiste reminds me of the conductor on the Titanic orchestra who keeps playing music when the ship is going down. He has talked about extra home supports. Deputy Troy has just informed me what this means in the midlands, which is 22 extra hours for six counties. They were lucky because they were informed, whereas the rest of us have not been given that divide yet. There are beds closed right across the country because support and staff are not available to staff them. Peamount Healthcare hospital has 55 beds but cannot get the staff because of the moratorium that the Tánaiste says is not in place. Has the Tánaiste not read the inputs from Phil Ní Sheaghdha from the INMO throughout this week? Deputy Rabbitte has raised the issue about public health nursing services which are about to be curtailed in Galway because public health nursing vacancies cannot be filled. There is a moratorium and it is affecting service. What we are going to get today is the only place where is not a moratorium, which is in the spin department in the office of the Minister, Deputy Harris. There will be brochures and fancy videos. The Minister, Deputy Eoghan Murphy, wears high-viz jackets for his announcements and the Minister, Deputy Harris, will probably have a white jacket on during his. This is where there is no moratorium, namely, the area of spin. I challenge the Tánaiste to visit a hospital this weekend. Talk to a GP, a nurse, or consultant and get the real story.

The Deputy is better than his comment on spin just now. There are real issues here and are not about money that is being spent on public relations. It is about applying significantly increased resourcing to healthcare to provide better services for patients, to bring about better management of our hospitals, and to fund improved discharge in order that people can move out of hospital when they do not need to be there.

Every week we have this debate around a moratorium on recruitment in the HSE. People are being employed in the HSE but it has to be employment that has funding. The Deputy would be the first to criticise this Government if we commit to spending money that we have not budgeted for. For many years now, we have had huge overspending in health. The Government has been criticised for that. We are, however, employing extra people in a way that is consistent with the extra resources that have been made available. We cannot go beyond that. People in this House keep calling for more and more money to be spent that has not been budgeted for and at the same time are criticising the Government for potentially overspending. One cannot have both.

Earlier the HSE published its winter plan in an attempt to tackle overcrowding and deal with faster patient discharges. We are at the point where every day is winter in our hospitals because of overcrowding, patients on trolleys and undervalued staff trying their best on the front line. That is the state of the health service every day of the year. Patients face another difficult winter in already difficult circumstances and I have serious doubts whether this winter plan will be able to tackle the issues at the heart of the system that blight the health service. As the general secretary of the Irish Nurses and Midwives Organisation, INMO, stated yesterday, it will be impossible to staff more in the middle of the recruitment freeze the Government introduced in May of this year. The Government cannot staff additional beds without additional staff. It is as simple as that. The recruitment freeze is crippling emergency departments and patients are suffering as a result. Nurses regularly report that inadequate staff levels are dangerous for patients in the hospitals. The front page of a newspaper today stating that the lives of newborns are at risk from overcrowding in the Rotunda Hospital. That is how bad the situation has got.

The stupidity of the recruitment freeze is laid bare in Portiuncula Hospital Ballinasloe. Where public health services once had six nurses, they now have four vacancies which cannot be filled because of the recruitment freeze. Staff have warned the Government that these services, which provide care to the community and inpatients in their homes, face closure this month unless these vacancies are filled. This closure would prevent hospital discharges and increase admissions to hospitals. This is while the Government's new winter plan seeks to reduce overcrowding and increase discharges. It does not make sense. That is only a snapshot of the Government's reckless mismanagement of the health services. According to the latest HSE figures, there are 308 fewer staff nurses and 37 fewer public health nurses now compared to this time last year. In August, 1,300 nursing and midwifery posts were vacant and unfilled. The UK's national statistics institute for health found that when staffing levels fall the risk of death on wards increases.

Besides inadequate staffing levels, we now have a situation where this year alone more than 100,000 patients have been admitted to hospitals that did not have a bed available. What does all this mean for communities? In Limerick University Hospital, almost 12,000 patients have gone without a bed. As my colleague, Deputy Quinlivan, stated only two weeks ago, the crisis has been going on in Limerick for some years now and the Government has done nothing to address it. In Cork University Hospital, CUH, 9,500 patients have gone without a bed so far this year.

The human impact is clear to see and it was laid bear last week after Mrs. Evelyn Crowley tragically died on the corridors of CUH. That hospital currently has 16 vacancies and the Tánaiste will stand and tell me that there is no recruitment freeze.

I thank the Deputy. The time is up.

In my constituency - I will finish on this - 4,500 patients so far this year have gone without a bed, despite the fact that ten beds in that hospital cannot be opened because of the recruitment.

The time is up.

When will the Government get to grips with the real issue here, make the proper investment, and lift the recruitment freeze that is crushing our hospitals and putting serious pressure on front-line staff and patients?

I outlined in response to Deputy Calleary what the winter plan aims to do. There are two different issues here. The first is the ongoing pressure on emergency departments that we have seen through the summer and into the autumn, particularly in hospitals such as the university hospitals in Limerick and Cork. I am more than familiar with that. The answer there is increased resources and capacity over time, and the capital resources to go in to deliver that increased capacity are being delivered. What we are trying to do in the winter plan, which is being published today, is to anticipate increased pressure on top of what is a difficult situation for many staff to manage, to alleviate pressure, to keep people out of hospital, and to ensure that we can move people on from hospital care into community care, step-down facilities or back into their homes with home care packages. That is what the €26 million is about. They are two separate issues.

We continue to have serious political debate about how broader health reform needs to happen and how we can spend what are limited, but at the same time significant, increases in resources. This year, we will spend €17.1 billion on health, which is €1 billion more than we spent last year. When planning for additional beds, one cannot simply plan for the cost of building and delivering those beds in terms of capital expenditure without factoring in the cost of staffing them as well. At present, we have increased recruitment across different elements of the HSE and we must have a management system that plans for increased beds but also for the cost of staffing them so that we do not have requests coming back from the HSE to Government for dramatic increases in expenditure at the end of the year that have not been budgeted for, as one cannot run a health system like that.

As the Deputy will be aware, we are committed to significantly increasing the number of available beds. Unlike healthcare policy under previous Governments when there was lots of money to spend, they were reducing bed capacity, we are now back to the bed capacity at the height of the last boom. We need to do much more. What we are focused on today is the additional interventions that we can make to alleviate pressure on hospitals with the extra pressure that comes through the winter months, which I detailed in response to Deputy Calleary earlier.

The Tánaiste simply does not get it. He does not get the scale of the crisis. Professor Malone, the master of the Rotunda, summed it up well in speaking to The Irish Times today when he stated, "The dignity of patients doesn’t seem to resonate with decision-makers."

The Tánaiste can give us the spin all he wants. Last year, Ministers announced the opening of 20 beds in Letterkenny University Hospital where we have on average 30 patients on trolleys every day. Ten of those beds are lying empty because there is a recruitment moratorium in place. That is the reality of it. The position is the same in Cork, Limerick and throughout the country. It is not rocket science. The Government needs to open beds that are available in the public health system. The Government needs to lift the recruitment embargo so that there are the proper staff in nursing, midwifery and consultants to staff those beds, and it needs to adequately resource home care packages. The package that the Government announced in the budget will not even clear the waiting lists that have accumulated as a result of the moratorium that it introduced in home care at the beginning of the summer.

The time is up.

What we need is less spin and more action. We do not need more debate.

We do not because the time is up.

Patients who are lying on trolleys and their families want action from the Government and less spin.

On home care packages, we are providing for an additional 1 million hours next year.

It would take 2 million hours to clear the waiting lists. The Government is planning to fail.

Will the Deputy allow the Tánaiste to reply?

We are significantly increasing resources for home care packages. In terms of developing service plans, we are also asking the HSE to make sure that it anticipates the full cost of opening beds, including staff, as well as the required capital expenditure. That is how one manages a health system to ensure that one spends the funding available as efficiently as one can. One cannot at the end of the year say that we must get more resources to take on more staff. We are budgeting for significantly more staff throughout the health system but we must operate within budgets, otherwise the health budgets will be out of control.

There are fewer nurses and fewer midwives.

Both Deputies mentioned the Rotunda Hospital. I assure people that following what Professor Malone stated in the media the Department immediately sought reassurance from the hospital that safe and appropriate care was bring provided for infants cared for at the neonatal intensive care unit, NICU.

The Tánaiste should not blame the messenger.

In addition, the Department sought information regarding the immediate and medium-term actions being taken by the hospital and hospital group to address any concerns. The Minister for Health will get a report on that shortly.

Did the professor withdraw his assertion that the lives of newborns are at risk in the hospital as a result of the Government's policies?

The Deputy is being disorderly.

That is what we are getting the report on.

That is the reality.

The Oireachtas Joint Committee on Housing, Planning and Local Government is publishing a report today that calls for a national homeless family strategy that focuses on the needs of children. The Labour Party has been calling for this for some time. My colleague, Deputy Jan O'Sullivan, introduced the Housing (Homeless Families) Bill 2017, which passed Second Stage in the House in March 2018. Some 20 months later it has not been enacted. In the Dublin region there are now 3,873 children in homelessness. This is an all-time high. The situation is significantly worse than 20 months ago when Deputy Jan O'Sullivan introduced her Bill. The housing committee will ask today that the best interests of children be taken into account by local authorities when they provide homeless accommodation and other supports. Despite the central importance of the family in the Constitution, when a person becomes homeless his or her situation is individualised and there is no statutory basis for consideration of what is best for a family or for the children in a family. The Labour Party Bill would oblige housing authorities to recognise families as units in homelessness and to have specific regard to the best interests of children.

There are also 936 young adults between the ages of 18 and 24 years who are currently homeless. This is due to the cliff edge that arises for young people as soon as they reach 18 years of age. A young person in care who might be doing very well has all the child supports withdrawn and must navigate the difficult labyrinth of adult services, often going onto a long waiting list. It is wrong to expect young people to be autonomous from the age of 18 years and to be able to house themselves. In addition to dealing with child homelessness, we would prevent a large proportion of the homelessness of young adults if we introduced strong supports for this cohort of young people.

I strongly welcome the report of the Oireachtas committee, which also calls for an independent evaluation of family hubs and more supports for schools with pupils who are homeless. However, on the core issue of recognising the family unit and the individual rights of children, and recall that we had a referendum on that matter, the Labour Party introduced a robust Bill that would make a real difference. We have been waiting 20 months for it to be enacted. Given the findings of the Oireachtas committee, a cross-party group that examined this issue in detail, will the Tánaiste give a commitment on behalf of the Government to a timetable for the speedy enactment into law of the Labour Party's Housing (Homeless Families) Bill 2017?

I thank the Deputy for raising this issue. Two reports are being launched today concerning children and families experiencing homelessness. The Oireachtas Joint Committee on Children and Youth Affairs is reporting on the impact of homelessness on children and the Oireachtas Joint Committee on Housing, Planning and Local Government report is on family and child homelessness. The Government welcomes the publication of these reports. The Department of Housing, Planning and Local Government will examine in detail the content and recommendations of the reports, will liaise with the various Departments and State agencies responsible for the delivery of supports and services to families experiencing homelessness and will respond accordingly.

There are more than 1,700 families in emergency accommodation at present. This is an unacceptable level of family homelessness. However, it is important not to lose sight of the progress being made in dealing with this difficult problem. In the first six months of this year, 2,825 adults and their dependants exited homelessness into sustainable homes. In Dublin, one of every two families that presented to homelessness services in the first nine months of this year was found a home immediately, without a need to enter emergency accommodation. Family presentations to homelessness services have also fallen over the same period by almost 10% compared to last year. In the first nine months of this year, 786 families have exited emergency accommodation into a tenancy in Dublin, which is where the largest numbers are. This is a 48% increase on the 530 exits recorded over the same period last year. Since the start of the Rebuilding Ireland programme in 2016, the annual increase in the number of children in emergency accommodation has dramatically reduced, falling from an annual increase of 54% in the 12 months to September 2016 to an increase of just over 1% in the past 12 months.

This problem is not solved yet, and I do not pretend that it is. The way to solve it is through a dramatic increase in the supply of all types of housing and, in particular, social and affordable housing and affordable rental accommodation. In all those categories there are significant increases in planning permissions, commencements and completions. Next year, it is anticipated that an extra 26,000 to 27,000 new homes will come onto the market in a combination of all categories. That is a multiple of the position only a few years ago.

I share the Deputy's concern. I have visited many of the 29 family hubs, which have a capacity for just under 700 families. Housing families in emergency accommodation such as hotels and bed and breakfast accommodation is not suitable. I gave a commitment many times to move away from that and we have invested tens of millions of euro in tailor-made, emergency facilities for families in family hubs. I encourage Members to visit those family hubs, particularly if they are in their constituencies, to see how they work. They are not perfect or suitable for long-term family accommodation, but they provide emergency accommodation while we address the dramatic housing shortage this country has faced for a number of years.

I thank the Tánaiste for the response. It is a prepared response for a question on the progress being made on housing. I welcome progress being made, but my question is child focused. It picks up on the analysis carried out by the two committees referred to by the Tánaiste. The housing committee has done very good work over the past few years on a number of proposals. However, I ask the Tánaiste to deal with the focus of my question, which is the status of children. The lives of children who are homeless and in those centres are being blighted, and in a way that might take some time to recover from, if ever. The way to deal with that is through the enactment of legislation which gives a right to children. It is a right we held a referendum on and which the people of Ireland enshrined in the Constitution, which is to have a child-centred approach. With regard to the legislation that has passed Second Stage and is to go to Committee Stage, will the Government give a commitment to have it enacted so the focus on the child will be domestic law?

There is already a child focus. When we were designing family hubs we did it with Barnardos and other child specialist NGOs and organisations. When I was Minister with responsibility for housing I worked with the Minister for Children and Youth Affairs, Deputy Zappone, to ensure that children's services and supports were part of the planning and investment, as well as with other Ministers who are supporting families.

Has the Tánaiste read the reports?

I have not. They were not published before Leaders' Questions started. I will read them, as I am very interested in this area. There will be statements in the House next week on child homelessness. If this legislation makes sense, the Government will support it and if it does not, we will give reasons why we cannot.

It is 20 months.

This is about a number of things, not just passing legislation. If we pass legislation providing for rights, that does not solve the problem overnight. It is about an allocation of resources and ensuring that we can follow through on our commitments to children. Simply passing legislation and expecting that to solve the problem does not necessarily make sense on the ground for families, but perhaps the legislation makes sense. I will have to look at it. However, we will have an opportunity to debate these issues in detail in the House next week.

I wish to make the Tánaiste aware of the harm the Government and the Minister for Transport, Tourism and Sport, Deputy Ross, supported by Fianna Fáil, Sinn Féin and many others in the Dáil, have done to the social fabric of rural Ireland and especially rural Kerry. He has closed down most of County Kerry and made smithereens of the social fabric people traditionally enjoyed.

I advise the Tánaiste to get into a car with the Minister, Deputy Ross, and his Minister of State, Deputy Griffin, any night and drive around the county to see the damage and mayhem the Government has caused with its Road Traffic (Amendment) Act. The Irish pub was known all around the world as a tourism attraction, a place of culture, traditional music, song and dance, story telling, a place where farmers and workers met to have a conversation, rich with characters who provided original entertainment. People such as Tom Cruise visited Loo Bridge. Sadly he would be unable to visit it again as it is closed. Many cities around the world have tried to replicate the Irish country pub but now people all around Kerry are afraid to go out and are like rabbits trapped in a burrow. Too far east is west. Does the Government have anyone measuring depression rates and how much extra is being spent on anti-depressant medication and mental health?

Pubs have closed down in every town and village already: Rathmore, Kilgarvan, Currow, Faranfore, Curran Scartaglen where Tom Fleming's pub was the nucleus of Slieve Luachra and Irish music, Kenmare, Sneem, Castleisland, Brosna, Knocknagoshel, Caherdaniel in Waterville, Cahersiveen, Killorglin and Glencar where even someone like Schumacher could not do more than 30 km/h. What has the Government done? It has stopped many people going out to socialise. It does not want people to have a car. One Deputy suggests that 30 or 40 people should get into one car. What kind of a batmobile does he propose? Will there be baby seats in it? The Government wants to stop people farming. Ye do not want them eating meat or cutting turf or timber to keep themselves warm. The Government might wake up and analyse the lunacy of its actions if oil became scarce for two or three months. The health service is in a shambles. Kenmare and Dingle hospitals are only half open. The Government gave €900 million for two treatment plants in Dublin. It is all about Dublin. There was €145 million in total expenditure for Kerry County Council for the year but there was €900 million for one project in Dublin.

What is the Government going to do about the people who are trapped and isolated in rural Ireland? I am asking the Government to provide a permit for people who are travelling only on local rural class three roads so that they can have their two pints and drive home on those roads. If they stray beyond those roads, then nail them, but the Government should give them a chance to live because all work and no play makes Jack a very dull boy.

The Deputy claims to know Kerry very well but he is not describing a place that I recognise when I go there. It is a very vibrant county with fantastic towns. It still attracts huge numbers of tourists that increase each year who come for the experience of the music, the culture and fun. The Deputy might be in the business of talking Kerry down but I am not.

The Government is putting it down.

That is also why this Government wants to invest to ensure that more people can continue to visit the great county of Kerry. That is why we are going to invest €281 million building the Macroom Ballyvourney bypass to improve access from Cork to Kerry. That is why we continue to invest in the Wild Atlantic Way tourism initiative, on which Kerry has been a fantastic leader, and why we are investing in the Adare bypass which improves access from Limerick into Kerry. The Deputy has come into the House and painted a picture of a county which is vibrant - I know it well - as something it is not and that is not helpful in making the case for Kerry. He seems to be making the case that the way to keep pubs open is to allow people to drink and drive. That is not only irresponsible but an insult to so many families who continue to mourn the deaths of people who have been killed by people who were drinking and driving. We were reminded last week when we mourned the passing of Gay Byrne who was such a champion in this area and such a successful chair of the Road Safety Authority, that the attitudes that the Deputy brings to the House around trying to return to some sort of old Ireland that was better because people could get into their cars regardless or whether they had been drinking or represented a danger on the road is just blatant irresponsible nonsense.

The people having the two or three drinks in rural Ireland did not cause the fatalities. The statistics for this year prove that in spite of the new law accidents and fatalities have increased. It is not the people in rural Ireland who have caused that. I ask again that the Government probe the idea that the Garda would give permits to people who are rurally isolated for class three and cul-de-sac roads and if they stray outside those roads to nail them then. It would be for these roads only, not the regional roads or national primary roads. Despite what the Tánaiste says, people do have their heads down. They are socially deprived as the only outlet they had was the local pub. More pubs closed down in the past eight years than under the previous 30 Governments since the foundation of the State. It has closed down Bord na Móna and told its workers it would give them green jobs. The only green they will see is if the door on the dole office is painted green. The Government is only trying to cod them and fool them, but they will not fool the people. The election is coming and the Tánaiste will have to face the doors of the people the Government has trapped in their homes.

I agree with the Deputy on one thing. There is rural isolation which is something that the Government is responding to and will continue to do so. That is why we will spend billions of euro on the national broadband scheme, to ensure that everyone in Kerry, regardless of where they live will be able to access high-speed broadband and all the services that will bring directly into their homes. Rural Ireland is changing. The idea that we will somehow keep hope alive by allowing people to drink and drive on their own local roads as a way of reducing isolation in rural Ireland is just irresponsible and frankly will not work.

It will not work because the Government will not try it.

The first thing we need to do with people on our roads is to ensure they are capable of driving and are not impacted by alcohol or drugs or anything else that can endanger others who use those roads. Surely any responsible public representative would advocate for that as the first priority. After that we need to try to ensure that we support people in terms of socialising and getting to their local pub. That is why we are looking at providing and supporting networks for bus services that can help people do that. Please let us not start proposing solutions which we know, because the facts bear it out, put other people in danger on our roads.

Where are all the buses that the Government is putting on the road? Where are they?