Ceisteanna ó Cheannairí - Leaders' Questions

Primary care is and should be the central part of our national health service. This morning, 506 people are on trolleys across the country. The Sláintecare report, which was shared and signed up to by every party in this House, emphasises primary care and investing in community services so that people can be more engaged in their own health and well-being. Pharmacy is a key part of primary care and community pharmacists constitute a key part of that. They are essential if we are to address the crisis in hospitals and in so many other aspects of our health service.

The Minister for Health gave very solemn assurances at the conference of the Irish Pharmacy Union last May that he would address the FEMPI cuts, which took 30% out of the incomes of our community pharmacists around the country. He said that he wanted to move beyond FEMPI to a higher terrain and to move discussions on a new pharmacists' contract. He said "Let's get that done this year." It was the usual practice from the Minister - tell them what they want to hear, run away and have no follow up. The reality for community pharmacists is that after the cut in their income of 33% the Minister then came along and said that the HSE had instructed pharmacists that as of 1 January, there would be a range of cuts to their income, services and fees aside from the new contract. For many pharmacies, this range of cuts could take between €30,000 to €35,000 out of their income, which will lead to redundancies in pharmacies and to pharmacy closures in so many areas. Again, it will undermine primary care services. Not only will dispensing fees be reduced, the practice of phased dispensing, which is a safer and more efficient way of dispensing drugs, will be made unviable for many pharmacies putting patients in danger. There will be a reduction in the high-tech care patient care scheme. This is a system that pharmacies have embraced for three years that reduces pressure on GPs and emergency departments. They have done this at a very basic cost that will be reduced even further.

We had fine words from the Minister. He keeps patting community pharmacists on the head and telling them they are doing a great job. He spoke about going to a higher terrain in his usual language but the reality is that if these cuts proceed, this higher terrain will be a marsh in which pharmacies, including community pharmacies, will sink. Why is the Government doing an absolute U-turn on the very solemn commitments given by the Minister in May? Why is it proceeding to take €45 million out of community pharmacy? Why is it targeting community pharmacists for these cuts unlike any other part of primary care?

I thank the Deputy for raising this issue. The Minister has said many times that he recognises the role community pharmacists play in the delivery of patient care and the potential for this role to be developed further in the context of health service reform and modernisation. Recognising that critical role, the Minister is committed to root-and-branch review of the pharmacy contract in 2020. Notwithstanding this commitment, any publicly funded pharmacy service expansion should address unmet public health needs, improve access to existing public health services or provide better value for money in terms of patient outcomes. Accordingly, the decision to provide such services should be evidence-based and I hope Deputy Calleary would agree with that.

The regulation governing the current pharmacy fee structure was made under section 9 of the Financial Emergency Measures in the Public Interest Act 2009 and was set to expire at the end of this year. Under the Public Service Pay and Pensions Act 2017, these regulations must be replaced on 1 January 2020 to maintain the statutory basis for contractor payments and to prescribe the fees available from that date. The fees to be set are determined by the Minister for Health with the consent of the Minister for Public Expenditure and Reform. In keeping with obligations under section 43 of the 2017 Act, Department of Health officials have begun a process of consultation with the Irish Pharmacy Union as the representative body prior to the introduction of a new fee regulation. Department officials have met with the Irish Pharmacy Union delegation on two occasions and a detailed submission was received from the Irish Pharmacy Union on 8 November. This submission is being considered by the Department in the context of the statutory fee-setting process to which I have just referred. I have just been given a note to say that the Minister for Health is due to meet the Irish Pharmacy Union in the coming weeks to try to finalise those arrangements.

Two processes are under way. As late as 10 October, the Minister gave very solemn commitments about reversing FEMPI cuts. He told Deputy Brassil, who was a pharmacist in a previous life, that he would honour that, and that pharmacists are coming up with solutions and ideas. Why did the Minister give such a false impression on 10 October when he must have known that the HSE was planning on implementing €45 million worth of cuts to community pharmacies? The Tánaiste mentioned the regulations and the deadline of the end of December. Those same regulations apply to dentistry. The Minister has moved that on without any cuts ahead of 1 January yet the Government is piling €45 million worth of cuts on community pharmacies. The Tánaiste should go to his local pharmacy this weekend if he is looking for evidence. He should see how hard they are working, the hours they work and the extra services they provide that keep people away from GPs and emergency departments. I received an email from a pharmacist who stated that they feared for the profession of pharmacy and that all the good pharmacists would get tired of being the kicking boy of the PCRS and the HSE. That is how these professionals in primary care feel. I ask the Government not to introduce the cuts but to have the discussion around reversing FEMPI in a clear and honest manner and to respect community pharmacists.

I do not know whether the Deputy knows it or not but the Minister responded to a Topical Issue on this matter raised by Deputy Brassil yesterday. I would suggest that Deputy Calleary have a look at the detailed response given by the Minister. I know only too well how hard pharmacies work. My office on the main street in Carrigaline is within 20 yd. of two large pharmacies that I know well. As Deputy Calleary knows only too well, what is happening here is a process of negotiation to put a new contract in place, as has happened with other elements of the healthcare system, that must be led by the Minister for Health. He has to get value for money for the State and ensure that patient care is the first priority and that people are being reimbursed fairly for the work they do in terms of fee structure. That process is under way and as I have already said, the Minister will meet with the Irish Pharmacy Union in the coming weeks to try to progress that.

A total of €18.4 million in cuts to councils in Dublin and Waterford are on the way due to the Government and Irish Water. This is because the Minister for Public Expenditure and Reform will no longer fund the commercial rate compensation scheme. Because of this, Dublin City Council will take a hit of €8.7 million while Waterford City and County Council will see a 13.5% drop in rates - €3.3 million - and is proportionately the worst hit council. South Dublin County Council will lose €4.1 million while Fingal County Council will lose €2.3 million. Let us be very clear. These are Government cuts plain and simple. They are not cuts by the councils themselves. Let us be equally clear that these cuts are unsustainable. They place a burden on those local authorities that cannot be met. We are hearing that from the CEOs of those councils but also from councillors across the political divide.

The compensation from the Department that was in place is now abolished, leaving those councils, which are badly affected, high and dry. On Monday night, Dublin city councillors refused to pass a budget because of these cuts. How could they pass a budget which proposed, for example, increasing council rents, commercial rates on small businesses and toll charges? All of this would have a serious effect and negative impact on householders, older people in their homes and small businesses already struggling, as well as commuters forced to drive because of a failing public transport system. The chief executive of Dublin City Council said these cuts had to be made because the council was not being compensated by the Government, despite promises made. I have spoken to the chief executive officer of Waterford City and County Council and he has the same view. This is a Government cut. Promises were made to compensate these local authorities but they have been left high and dry.

In Waterford City and County Council, the proposed budget may include cuts in funding for housing maintenance, roads, festivals for local communities and an increase in commercial rates of up to 10%. That is unsustainable. People were told when they paid their property tax that the moneys would be used to fund proper services, yet people in Waterford and Dublin will see services cut through no fault of their own.

My simple question is this. We need obviously to have a debate on how we fund local government. In this particular instance, given that these local authorities have been so badly hit and given the impact this will have on people in Dublin, Waterford and other areas, will the Government commit to restoring the compensation given to local authorities to ensure they do not have to take the axe to services, which is what they are being asked to do? Sinn Féin councillors will not do that nor will they clean up the mess created by the Tánaiste’s party. I implore him to do the right thing and restore funding to these local authorities.

I thank the Deputy for raising this issue. The background to this is that, between 2014 and 2019, compensation of the order of €47 million was paid annually to local authorities in lieu of commercial rates from Irish Water. Irish Water is liable for commercial rates from 2020 and the need for compensation in lieu of commercial rates ceases. The apportionment of the valuation of Irish Water among local authorities from 2020 will be based on population, similar to that for other utility companies with national networks. It is expected the local government sector will collect a broadly similar amount in commercial rates, as was previously paid as Exchequer-funded water rates compensation.

Most local authorities are better off under the revised distribution effect of the income from Irish Water commercial rates as compared to the compensation amount. However, seven local authorities will receive less in commercial rates than they received in compensation. Waterford City and County Council is particularly impacted, losing 70% of the income previously received through Irish Water rates related compensation. It is far less equipped to deal with such a reduction in income compared to the other impacted authorities, namely, the four Dublin local authorities as well as the Wicklow and Kildare local authorities. The loss creates a gap for Waterford to deal with of up to €3 million for its 2020 budget.

Support for local government in 2020 has been realigned, largely as a result of the valuation of Irish Water as a global utility liable for commercial rates. The Department of Housing, Planning and Local Government is monitoring the impact of this transition on local authorities and will, of course, take it into account. It is important local authorities have sufficient long-term sustainable funding to deliver critical services to local communities, rural and urban.

We are seeing a change in the way in which commercial rates will be allocated linked to Irish Water assets to ensure an appropriate distribution of those rates across local authorities. Most counties are gaining. Some counties, however, are losing as a result of that. Waterford is one of those. It is the job of the Department of Housing, Planning and Local Government to make sure it works through those challenging arrangements with the Waterford local authority to ensure it is appropriately funded through the transition.

I know the history of this issue. It is a legacy issue from Irish Water which is a complete mess and fiasco. It is not the fault of those local authorities in Dublin or Waterford that there was a global re-evaluation which has seen a massive cut in their funding. The Tánaiste said the local authorities in question have been asked to engage with the Department. They have done so for a long period and have been told that they may get funding for one year but that is it. After that, they are on their own and have to make the cuts. If the Tánaiste was watching this, Dublin City Council has proposed an increase in toll charges and rents for social housing tenants, for those who can least afford it, as well as cutting services and increasing rates. The same is being proposed in Waterford.

Solutions are not being provided other than the Tánaiste telling local councillors to take the axe to cut services because of a mistake made by the Government. That is not good enough. All the promises made as a consequence of the property tax have been thrown back in councillors’ faces. Not only are they not getting additional services in those local authorities, they are now getting fewer services. It is not good enough. Compensation needs to be given fully to those local authorities to ensure householders and older people are not the ones who will have to pay the price for the Government’s incompetence and mess.

I am sure the Deputy knows that the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, has met Waterford Oireachtas Members on this issue in recent weeks. Exchequer funding for local authorities has increased in recent years, including the allocation for next year for Waterford City and County Council of just over €3 million. This is an increase of just under €700,000 in terms of this year's allocation moving into next year.

There is an issue, however, for Waterford City and County Council in the context of the reorganisation of the rates which would have been paid in the past from Irish Water assets. According to my note, the Department has an ongoing dialogue with management in Waterford City and County Council with a view of working through these issues. I am sure the Deputy is raising it in the Dáil today to make sure the focus stays on trying to resolve these issues in a way which is sustainable for Waterford City and County Council.

There are well over 1,000 for-profit hospital beds in this country. Advertisements on the radio constantly push private hospitals and clinics, claiming “because you deserve better”. These ads turn my stomach. Who exactly deserves better? Do people with money for private healthcare deserve better than low-paid workers or single parents? The ads claim these hospitals and clinics have the most renowned specialists in the field. According to whom? Consultants in the public health system compete for senior positions and are engaged in constant professional development. Private consultants can just hire a suite in a private clinic and set up practice with nothing like the same rigorous oversight.

Private hospitals treating cancer piggyback on public multidisciplinary teams for opinions and reviews. Why are they not charged for this? Patients experiencing complications in the private sector are routinely transferred to the public hospitals for more advanced care. Is it right that private hospitals can do this without paying? When private hospitals are full, they send their overflow patients to public emergency departments. Is this not a serious dereliction of duty which makes a mockery of these adverts? How can they claim to be better on access when their emergency departments run on office hours and use the public hospitals as a pressure valve to deal with many issues?

The Government and the Fine Gael Party are wedded to an ideology of the privatisation of our healthcare system. The Government has allowed a wing of the new national children's hospital to be built for private beds. It buried the de Buitléir report on how to remove private practice from the public system. We also need to fully establish Fianna Fáil’s stance on this issue as it is unclear.

It is the same as Fine Gael’s.

The Labour Party’s is unclear as well.

Only the other day, a former health Minister, Senator James Reilly, was touting the development of a €50 million private hospital in Fingal which will charge the HSE to deliver public services. He was also happy to confirm that the Taoiseach met the developers and was happy to do so.

When did this happen? The Taoiseach needs to explain the logic behind this. There is a false economy in the idea the private sector will build this hospital. It will get back every euro of the €50 million and more by making a profit on every outsourced operation and service the State should and could deliver on a non-profit basis. Already there are five private hospitals on Dublin's north side. Fine Gael is not serious about the Sláintecare report and the Government, through its actions, keeps reinforcing the public-private divide in healthcare.

When will Fine Gael finally commit to the investment needed to end the shame of Ireland being the only country in the EU without universal healthcare? Why is the Government permitting the construction of more private hospitals, which runs totally against the implementation of the Sláintecare report? Will the Taoiseach explain why he met these developers in the middle of the process?

One of the first things the Government did from a healthcare perspective, within weeks of taking office, was to try to get agreement across all parties in the House to an approach to healthcare that would be consistent regardless of who was in government over the next ten years. We are committed to this process. Like other parties in the House, Deputy Kelly's party signed up and committed to an approach that we are now following. The Sláintecare vision is to achieve a universal single-tier health and social care system where everyone has equal access to services based on need and not ability to pay. The Deputy is trying to label my party as one that is pursuing healthcare with an ideological lens. I am not quite sure why he is doing so because the facts do not bear it out.

The implementation of Sláintecare reform is a priority for the Government and the Department of Health. We all recognise this is a long-term process but we need to continue to progress it. The Sláintecare action plan for 2019 includes a specific work stream on access and waiting lists. Sláintecare emphasises the need to invest in increased capacity, which is happening, while shifting the balance of care from hospitals to community services for better health outcomes and a more sustainable health service. Reducing waiting times for patients for hospital operations and procedures is a key priority for the Government. Obviously, the focus is on the public health system and not the private health system.

We have a challenge in terms of the transition, as the Deputy knows well. We need to make sure we use private hospitals and primary care facilities outside a hospital setting to ensure we can keep people out of hospital and when there is overcrowding in public hospitals that we have routes to try to deal with it in terms of waiting times and trolley numbers. This is what the National Treatment Purchase Fund is about in terms of sourcing bed capacity and operational capacity for much of the work that should be happening in public hospitals but cannot happen because of overcrowding or undercapacity. There is a role for private hospitals in the short to medium term. In future, there may also be a role for them if people want to pay more for a certain type of treatment. However, we must get to a point where, in terms of standards, healthcare provision is not linked to income or ability to pay for a different type of hospital experience. This is what Sláintecare is all about. It is what my party supports and, as far as I am aware, it is what virtually every other political party in the House has also supported.

What the Tánaiste has said emphasises what I said previously. He said that in the short to medium term we will move across to Sláintecare. I spent 11 months on Sláintecare. The Tánaiste would not be supporting the building of a new private hospital in Swords if he believed in what he said. We are practising health apartheid in this country as far as I am concerned. In his response the Tánaiste claimed to be implementing and supporting Sláintecare and that he is committed to it so let us test this theory. We know all complex medical cases are dealt with in the public health system, along with all major operations and all serious accident and emergency issues. Does the Tánaiste agree with me, on the record of the Dáil as a matter of fact, that the public health system has a much greater claim to enjoy the term "the most renowned specialists in the field of medicine in Ireland", as opposed to the private health system? Does he agree, and this would be a very important signal from the Government, that advertising by private hospitals needs to be regulated, if not banned, in the same way that we outlaw the advertising of prescription medicines directly to patients?

Advertising is regulated. If people are making claims that are not accurate, there need to be consequences. I accept that. I also accept we have to have a public health system that delivers the best outcomes for complex healthcare in all areas. We cannot have a situation where public hospitals are substandard compared with private hospitals. That is not acceptable. The whole point of Sláintecare is to achieve a universal single-tier health system where people, regardless of their background, income, where they come from, who they know or anything else, can expect to have the same standard of healthcare in terms of patient outcomes as anybody else. This is the point we need to get to and it will probably take us a decade to get there. I hope it will involve consistency of approach to the implementation of Sláintecare regardless of which parties are in government over that period.

Reference has been made to the possibility that Dublin City Council will decide to increase rents for council tenants. South Dublin County Council has already decided to do this. I want to ask the Tánaiste about what is quite an outrageous decision by his party, Fine Gael, together with Fianna Fáil and the Green Party, to support an increase in rents. There has been a cruel increase of €3 a week across the board regardless of income, combined with an additional €10 a week for a set of old age pensioners. This is a heartless attack on some of the most vulnerable people on low incomes. It is an attack, presumably supported by the Tánaiste, which underscores the nature of Fine Gael and the Government's housing policy as being to protect those who have it and attack those who do not.

Last Saturday, the Taoiseach, not for the first time, declared that opposition to the Government's position on housing and criticism of its approach on housing is ideological, unlike the Government's position. In the Dáil on Tuesday, he argued that anyone opposed to giving away public land to private developers has an ideological position, whereas the Government has no ideology at all. It is just a bunch of pragmatists doing their very best to resolve the crisis who have, by pure accident, stumbled into a situation where they preside over the greatest level of homelessness and housing crisis in the history of the State at the very same time as we have the highest levels of rents and profits for landlords and developers. It is an approach to ideology seen in the kings and queens who ruled the world in the past. They did not say they had a feudal ideology that justified why they ruled. They said they had a divine right to rule, just like the Government believes the market has the divine right to rule and landlords and developers have a divine and constitutional right to maximise their profits.

Those who benefit from the Government's ideology are extremely obvious. Last year, landlords received record rents of €13 billion. This was up from €5.5 billion in 2009. The largest corporate landlord in Ireland, Ires REIT, paid nothing in corporation tax last year on profits of €120 million. Developers continue to profit massively, with combined sales last year increasing by 25%. The losers are everybody affected by the housing crisis, including tenants affected by rents of more than €2,000 a month in Dublin, young people who cannot afford a home and families struggling to access mortgages. Now there are new victims. These are council tenants who will be hit by €156 extra in rent annually and the pensioners attacked by having to pay another €676 per year. Does the Tánaiste agree with this attack? Does he agree with attacking those on the lowest incomes in our society at the same time as protecting the landlords and developers? People will not accept it. They will mobilise on the streets on 5 December at 12 noon at the Garden of Remembrance. Council tenants should participate.

I hope people will come along to the protest called by Solidarity for Monday, 9 December, at the council offices to build a campaign to oppose this attack as part of building a wider movement on the housing crisis.

Every time the Deputy takes to his feet in the House, he seems to be calling for a new protest over something. I understand the frustrations and anger over the housing crisis. They are very genuine. I served in the Department of Housing, Planning and Local Government and know this only too well. There are far too many people who are homeless. There are far too many families and children, in particular, affected by homelessness and whom I am sure are being scarred by it. The Government's response to that is to try to prioritise the issue from funding, policy and practical delivery perspectives. That is happening. We have changed the planning process and increased the numbers of protections for tenants. We have included what is effectively a rent cap or ceiling. We are building more social houses now than at any other time this century. This year, there will be more than 10,000 additional social houses on our social housing list. We are working with local authorities, particularly in our cities, where the pressure is most acute, to try to drive projects. In Cork city alone, the council is involved in 78 projects. The city chief executive confirmed to the Taoiseach and me last week that, in 2014, when there was no money being spent on social housing because there was not much money available, Cork City Council had one social house under construction. It currently has 1,000 under construction. That is what the Government is trying to do for vulnerable people who need the support of the State in order to get into social housing. We are seeing the progression of affordable housing units also. Again, we are focusing particularly on our cities, where the pressures are most acute. We will continue to take action to ensure housing is prioritised because it is a major issue for so many.

Next year, the housing budget will be over €2.6 billion. This represents a dramatic increase over the budget for recent years in terms of what the Government could afford. Therefore, we are not targeting anybody; rather, we are trying to help people who are in difficult circumstances. Many are in temporary accommodation that is not suitable in the long term. The objective is to get people into homes so they can have stable lives in them with the support of the State. We are making progress on that but there is still a lot of work to do.

The Tánaiste did not even attempt to answer the question. It relates to whether, despite his talk of not targeting anybody, he agrees with the decision of his Fine Gael colleagues, together with their colleagues in Fianna Fáil and the Green Party, to increase council rents for individuals in the South Dublin County Council area. These are individuals on low and fixed incomes whom the Government is hitting with an across-the-board increase of €3 per week on a rent that is based on 10% of income. Now everybody is hit with a rise of €3 per week. Does the Tánaiste agree with hitting old-age pensioners with an increase of €10 per week on top of that? Does he agree with increasing their rent by €13 per week? If he does, how on earth can he say all this other stuff? When he comes out with the idea that this will be sorted, nobody believes him. When he says he is delivering more social housing than ever, it is a lie. It is not accurate.

It is not me who is saying it. It is in the statistics.

No, because the Tánaiste has reframed what social housing is. He believes that giving money to private landlords amounts to providing social housing. How many local authority houses is he building?

People are right to be angry. There are over 65,000 people in a Facebook group organising for the protest on 5 December. They are ordinary people. They are not organised in any political party. They are angry and right to come out to protest. It is the only thing that will force the Government to do anything to resolve the housing crisis.

I accept that there is anger. At times, protest is part of democracy. We respect and accept that. There have been many protests, understandably, in respect of the need to resolve what has been a housing crisis for a number of years. We are responding to that with a lot more money and policies that are actually working. The Deputy does not have to trust me on that; he should look at the CSO statistics on the numbers of social houses being built, affordable houses being built or in planning and the private houses under construction. There are dramatic increases.

The Tánaiste should answer the question.

The issue of how local authorities deal with their tenants is one for those authorities to debate and discuss. I do not have the detailed rationale on why a decision may be made on modest increases in rent but I believe people have a right to ask the question.

It is €600 per year for a pensioner.

People do have a right to ask why it should ever be acceptable to ask for a modest increase in the contribution towards rental charges if they are seeing changes in conditions and investment by local authorities and so on but that is a matter for South Dublin County Council. I am sure that, like us, the Deputy has colleagues on that council who are well able to speak up and argue their points.

They voted to increase the rent.

The important point is that we are providing significantly more social houses year on year. More than 10,000 extra houses have been added to the stock this year. These are not fantasy numbers; they are very real.

That relates to the housing assistance payment, not housing.

They will support families in a very real way.

How many local authority houses?