Ceisteanna ó Cheannairí - Leaders' Questions

I ask Deputies to please watch the clock.

The crisis in our health service shows no sign of abating; rather, it is getting worse by the day. Patients and others in attendance experienced shocking conditions in the emergency department of University Hospital Limerick yesterday. It was compared to a cattle mart by the relatives of those present and without question, people were treated in shocking conditions over a 24-hour period. This issue has been getting progressively worse on an ongoing basis.

Today's edition of the Irish Examiner reports that the country's three main children's hospitals have begun postponing elective procedures due to mounting pressures on the system ahead of the peak winter months. Children's Health Ireland has stated that all elective and routine inpatient procedures are to be restricted at its hospitals in the coming months, due to the number of children and infants presenting for admission. That will affect Crumlin, Temple Street, and Tallaght hospitals in particular. Deputy Donnelly received information from the Minister for Health last week, which showed that more than 117,000 children are awaiting healthcare in the form of hospital appointments and various outpatient or inpatient procedures.

The waiting lists for children are quite shocking. More than 30,000 of those children and young people have been waiting for more than a year. A significant number of them are in serious pain, with many becoming sicker as they wait. Many will need further and more serious interventions by the time they are finally seen. Deputy Donnelly has not been provided with the number of children awaiting speech and language therapy, occupational therapy, psychology, audiology and many more services. He sought the figures last week but the Government was not in a position to provide them. He is expecting them in the next week or two.

In a report published in May, the Ombudsman for Children stated: "There has been an increase this year in Health complaints relating to long or non-moving waiting lists, and complaints made on behalf of children with mental health issues or those with disabilities." On mental health, more than 7,500 children and teenagers are waiting more than a year for a psychology appointment.

The picture is very bleak for children when it comes to accessing our health services. Essentially, the Government is failing the children of Ireland in respect of access to healthcare and therapy interventions. Why was the Government not better prepared to avoid the current situation whereby procedures and surgeries for children are being postponed because of the pressure on hospitals? Will the Taoiseach commit to the Government providing a comprehensive and transparent statement on the overall situation facing these hospitals, the number of procedures being cancelled and the delays that will ensue? What emergency measures does the Government intend to take to deal with this crisis and specifically to avoid delays in surgery and vital interventions for children?

I acknowledge that our emergency departments, including children's emergency departments, are under a lot of pressure. The pressure is principally linked to a significant increase in the number of people affected by the respiratory syncytial virus, RSV, and the norovirus in recent days, with increased attendances by children with chest infections, the vomiting bug and so on. As a result, the children's hospitals will restrict elective access. Obviously, urgent operations will go ahead, but there will be restrictions on elective access until the number attending decreases. That is not unusual; it often happens during the winter period or when there is an outbreak of a virus. It is necessary to reduce overall demand on hospital services at a time when demand is increasing because of a virus outbreak and for reasons of infection control. It is not a good idea to bring patients in for operations when a hospital is full of patients who have an infectious disease.

The Deputy will be aware that recent actions taken by the Government to deal with these kinds of issues include the expansion of the children's vaccines programme to include the rotavirus vaccine, for example. That vaccination will reduce attendances by children with the vomiting bug. The new urgent care centre and outpatient centre at Connolly Hospital has been opened. It provides additional capacity, which was not in place last winter. It is open on weekdays and we hope to extend its opening hours to weekends as soon as possible. The outpatient unit there has been open since July, with the result that in the past six months, more than 1,000 children were given consultant appointments that they would not otherwise have received. As a result, we have been able to reduce the waiting list for children awaiting an appointment with a paediatrician by 27% in the past six months.

I acknowledge that there is pressure on children's emergency departments as a result of the RSV and the rotavirus. The Deputy asked what the Government has done about it. We have extended the children's vaccine programme and provided additional capacity through the new centre at Connolly Hospital, which has helped to reduce waiting times for appointments with a paediatrician by almost 27% in only six months.

As the Deputy will be very aware, we have a new children's hospital that is very much under construction. It is now at roof level in certain points.

Children need early intervention in almost all cases to avert more serious illness downstream and to avoid conditions becoming progressively worse. The backdrop to this is the extraordinary number of children waiting so long for diagnostics, procedures or surgical interventions. The word "elective" does not convey the full story. When people say, "We are postponing elective...", it is routine. Some 400 children have been on a hospital waiting list for an orthopaedic procedure for at least two years before these delays kick in. A further 1,600 have been waiting for between 12 and 24 months. More than 2,000 children have been waiting for well over two years for similar procedures.

The numbers are quite staggering. We still do not have the therapeutic services, such as physiotherapy, and other interventions. We knew about the pressures that were going to come. The Government new about the pressures that were going to come. Why did it not anticipate them? Where was the preparation to ensure that the delays being experienced by children and their families would not be further delayed as a result of an inability of the health service to cope with the increasing demands, notwithstanding the winter crisis? We see the evidence daily and weekly. The figures are getting progressively worse. There is a real sense of the everything is spiralling out of control and the Minister is nowhere to be seen.

Everyone in the House understands and acknowledges that we need to increase capacity in our hospital system, particularly the adult hospitals, but also the children's hospitals. The Deputy will recall the decision made by his party when in government with the Green Party - an ideological policy decision to strip hundreds if not thousands of beds out of our adult hospitals.

Fine Gael has had nine years.

The Taoiseach without interruption.

We did not have much money in the first couple of years and we all know why that was the case. As soon as we had enough money from 2015 onwards in coalition with the Labour Party, we added beds to the hospital system. We have continued that now in the coalition between Fine Gael and the Independent Alliance.

When the Deputy was in office, his party took an ideological policy decision even when it had the money to reduce the number of hospital beds. As soon as we had enough money in 2015 and 2016 with the Labour Party, we started adding beds to our hospital system and we have done that even since.

There are no extra beds in Crumlin or Temple Street.

We will continue to do so. We have a plan in place for another 2,000 beds to be added over the next ten years.

Not for children.

The Taoiseach without interruption.

On paediatrics in particular, in the past six months we have opened the new urgent care centre in Connolly hospital. That has enabled 1,000 children, who had been waiting for a long time to see a consultant, to do so.

How long do they wait for surgery?

That has resulted in a 27% reduction in the waiting list to see a general paediatrician only in the past six months. The new centre in Tallaght is under construction and will be open next year.

More than 100,000-----

The Taoiseach without interruption.

We have a children's hospital now under construction which is reaching roof height.

That hospital has been promised for as long as I can remember. It was first proposed in 1993 by the Royal Society of Paediatricians.

And no extra beds.

Sorry, Taoiseach-----

Fianna Fáil spent €35 million on a hole in the ground. We are actually delivering a children's hospital.

Which is costing €2 billion with no extra beds.

Accounts of experiences in our hospitals make for very grim reading in today's newspapers. Aaron is the father of a child who spent the weekend in Crumlin children's hospital. He said:

We spent 24 hours with our child in A&E, a child with special needs. The place was like a warzone with the poor staff run off their feet. Our front line can't cope and hospitals are unsafe for patients and staff.

We spoke to Aaron this morning and he wants us to record here that while this was the experience of his family over one weekend, they are very conscious that this is the experience of staff in our hospitals every single day.

The daughter of an 83 year old woman attending University Hospital Limerick said of her mother:

She was soaked, there was urine everywhere. She wasn't on a trolley, she was in the waiting room on the chair. They gave her some kind of pad and told her to sit on that.

The family of a 73 year old man who had been on a trolley for 24 hours said:

We're praying for a bed at this stage. They're trying to fit oxygen bottles to people in the corridors and the staff are just thrown to the wolves.

A 76 year old woman in Limerick said:

It's like a cattle market. There are trolleys everywhere.

The INMO has again stated that the situation is intolerable for staff and unsafe for patients.

These are the words and experiences of patients, relatives and hospital staff. This crisis is not new but is years in the making. Between them, Fine Gael and Fianna Fáil have created a situation where 660 people are waiting on trolleys across the State, 33 of whom are children. Limerick, once again, has the highest number with 75 patients waiting on trolleys. I was in Cork yesterday and spoke to people in Knocknaheeny, Bishopstown and all across the north side of Cork. They tell stories of people suffering at Cork University Hospital. Today, 60 people are awaiting beds in Cork University Hospital. More generally, as has already been stated, the level of crisis in our hospitals is such that our three main children's hospitals postpone elective procedures. They have no choice. It is the only option they are left with.

What will it take for the Taoiseach to accept and recognise the scale of the crisis facing sick people and their families because people are dying in hospital corridors and children are left in pain due to cancelled operations, which is not acceptable? The truth is that the Government's health policy has failed and this failure is having a devastating impact on the lives of patients but also on staff. Will the Taoiseach listen to the solutions that have been offered to him by nurses, midwives, hospital consultants' associations and patients? Those solutions involve increased recruitment, reopening closed beds and delivery of more step-down facilities but I ask the Taoiseach to specifically intervene on the matter of home help hours, bring provision to a level that will meet need and ensure patients are in a position to be discharged and to go home. I am asking him to give a commitment on this one matter and to at least signal that he will start to put right his disastrous health policy.

At the outset, I acknowledge that our emergency departments are very busy at present. They are busy all year round but they have been particularly busy in the past number of weeks. As a Government, we deeply regret the fact that this is having a terrible impact on patients and their families and on staff. There are factors behind it, particularly when it comes to children's hospitals. It is largely related to an outbreak of respiratory syncytial virus and norovirus, which has caused a significant increase in attendances in the past couple of days.

The Deputy mentioned solutions. We know what the solutions are and we are implementing them. We have been adding more beds to the hospital system every year since 2015 and will continue to do so. We have a plan to add another 2,000 beds over the next ten years reversing the policy of a previous Government to take thousands of beds out of the system. There is more allocation for home help. There has been an increase of about 40% in the home help budget in the past two or three years and another million home help hours are factored in for next year. There are additional resources for the fair deal scheme so that more patients who are medically fit to be discharged can be discharged. There is additional money in the winter plan for aids and appliances because some patients cannot go home because they need adaptations to their homes or certain aids and appliances. We have also reached an important agreement with GPs to increase funding for general practice and expand the services they provide over the next couple of years and will take on about 1,000 staff in the community. It will take time for this to have an effect but it will have the effect of reducing the number of people who need to go to hospital in the first place.

The Deputy mentioned University Hospital Limerick. As she is aware, under this Government, this hospital has a new emergency department, which is probably the largest and most modern such department in the country. Nonetheless, it is heavily crowded. A new wing in that hospital - the Leben wing - opened in recent years and there is a €20 million investment for a 60-bed inpatient ward block that is nearing completion. I am told the enabling works are complete. The main contractor has commenced work and we anticipate that construction will be completed around the middle of next year allowing it to open in 2020. Those are the kind of things that are being done.

I know people use the term "re-open old beds" as if there are beds that have been closed that could just be opened. Those old beds that were closed ten, 15 or 20 years ago have long since become outpatient and radiology departments. They cannot just be reopened. Only about 20 out of the 11,000 beds in our health service are closed for one reason or another - either because of infection control or for refurbishment - so if we want to add extra beds, we must add entire new ward blocks, which is what we are doing in Limerick, Clonmel and other places.

The issue is not simply that accident and emergency departments are busy. To write this off as some kind of temporary busyness is, frankly, off the wall. Conditions are unsafe for patients and staff. This is not a new issue that is the result of any specific outbreak of a particular virus. This is a year-round, calendar-wide catastrophe for patients and their families such that many people are afraid to go into our hospitals. Being left on a trolley in undignified and degrading conditions and sitting on a chair in an accident and emergency department if one is lucky is the daily reality. As for the Government's capacity to deliver solutions, God help us if that is the Taoiseach's idea of coming up with solutions. All the Government has done is to make gestures in the direction of what needs to happen.

The Taoiseach trumpets the additional 1 million home help hours when he knows that is not nearly sufficient. Just to clear the backlog, the waiting list, we need 2.5 million additional home help hours. How about the Government does things that have a prospect of success and actually allow people to go home?

The failure to make the adequate allocation of home help hours has meant, for example, that in May of this year, almost 20,000 bed days were lost because of delayed discharges.

The Taoiseach will respond.

In June, almost 19,000 bed days were lost. This is a mess and a catastrophe and it is time for the Taoiseach to step up, finish with alibis and excuses-----

Deputy, please. I have to watch the clock.

-----and start making progress for people who need our services.

I did not say anything about this being a temporary issue. In fact, I specifically acknowledged that many of our emergency departments are very crowded all year round and that has, unfortunately, been the case for a very long time. However, the specific issue relating to the children's hospital is because of an outbreak of respiratory syncytial virus, RSV, and the norovirus in the past couple of days. That has had the impact it has had and will come to pass.

The solutions that I have put forward are exactly the ones that Sinn Féin supports. There is not a significant difference in our health policies.

The Taoiseach is not delivering on those health policies.

The solutions are to add beds to the hospital system, which we are doing, and to increase funding for home help. There has been an increase of 40% in home help funding within the past two or three years, with another additional 1 million hours next year and perhaps more in the years beyond that. It must be borne in mind that this is not only about money because one also has to find the necessary home helps and that is an increasing challenge at a time of almost full employment. There is also a need for additional investment in the fair deal scheme and in primary care.

I appreciate that part of the job of an Opposition leader is to tell me off and tick me off but I also follow what goes on north of the Border.

Good for the Taoiseach.

Deputy McDonald will be very aware that there is a health sector strike north of the Border today. Among the things that front-line healthcare workers, health support staff, doctors and nurses are demanding in Northern Ireland is that the parties that have responsibility for running Northern Ireland should re-enter an Executive. Sinn Féin walked out of office in Northern Ireland three years ago when Michelle O'Neill was the Minister for Health. She is here today, having a meeting with us, when she should be doing her job as Minister for Health in Northern Ireland-----

Is that seriously the Taoiseach's answer to my question?

-----instead of allowing healthcare workers to go on strike in Northern Ireland and demanding that Sinn Féin lives up to its responsibilities.

Well-established democracies around the world are struggling to deal with the issue of fake news. Part of the problem is that online political advertisements that are misleading or malicious can be purchased on social media platforms by third parties and targeted at specific audiences to maximise the damage that such misinformation can cause. In December 2017, following consideration of Deputy Lawless's Online Advertising and Social Media (Transparency) Bill, the Government established an interdepartmental group to consider the substantive issue of social media use by external, anonymous or hidden third parties.

A report published in July 2018 recognised the need to regulate political advertising. A public consultation closed in mid-October of last year. In December last year, the Government held an open policy forum on the regulation of online political advertising and finally, on 15 November of this year, the Government published proposals to regulate the transparency of online political advertising. The full report had not yet been published but the announcement is that a new law will be brought in to ensure elections held in this jurisdiction are free and fair and that they respect freedom of expression and access to legitimate and truthful information. We were promised that online political advertisements will be clearly identified as such.

The Taoiseach previously said that he had mixed feelings about the decision of Twitter to ban political advertising in response to the problem of misinformation. Last year, in a biography, it was claimed that he floated the idea of creating an anonymous social media account to comment positively on news. That might never have happened. Undoubtedly, the Taoiseach is well aware of the capacity of how social media can be gamed for political benefit.

I want to know whether the Government is serious about the announcement that online political advertising in this State will be regulated. He holds all the power in respect of whether that happens. He has the unique power of Taoiseach in being able to call and fix a date for a general election. He is also in charge of the Government's legislative programme. My question is simple and straightforward. Will the Government, and will the Taoiseach today, commit to having legislation in place to regulate online political advertising to ensure that this new law is fully in force in time for our next general election?

I thank the Deputy. When it comes to this area, what we are all striving to do is to balance the need and desirability for free speech, free expression and free association on the one hand with making sure that we do not have fake news and misinformation, whether it is online or in print. Misinformation and fake news is wrong whether it is online, in print or on posters. Many fake posters are appearing across the country, largely targeted at the Government but at others too.

I do not believe in an outright ban on political advertising, whether that is banning posters, print advertising or banning it online, but it needs to be properly regulated and made transparent so we know the source of any political advertising, who has paid for it and how it is being targeted. We set up an interdepartmental group on that point. The group identified that there is an obvious gap in the treatment of print broadcast media and online platforms when it comes to political advertising. That is something we need to change. It is easier to spread disinformation online because it is not properly regulated.

The current proposal is to regulate the transparency of online political advertising. We are committed to legislate as soon as we possibly can to mitigate this gap. The regulation of political advertising in the broadcast media is part of a wider regulatory framework for advertising. Advertising in the print media is subject to a self-regulatory code of the Advertising Standards Authority of Ireland. However, political advertising is not covered within the scope of this code. It is the view that overhauling the regulatory provisions across all platforms is therefore a significant piece of work that is best done by the electoral commission when it is established, in conjunction with the Broadcasting Authority of Ireland. In the meantime, it is our priority to press ahead with legislation to ensure that online advertising is properly regulated and transparent. We will progress that legislation as soon as we possibly can.

We have no commitment from the Taoiseach that it will be done in time for the next election. Is that his ambition at least?

I am genuinely concerned about the open use of racist, sexist and other bigoted language on social media by fringe political groups and movements. I had a conversation with somebody who is regulating that for one of the platforms and he told me one would be shocked at what is going on. They appear to have become bolder in recent months. I believe there is a real fear that this toxic rhetoric will encourage violence against people.

In the last local elections, I was pleased to see candidates from our new community standing for a multiplicity of parties and as Independents, but the sad truth is that many of them faced relentless attack of a racist nature online.

Does the Taoiseach agree we need this legislation? Will he give a commitment now that he will have it enacted or seek to have it enacted in time for the next general election?

I do agree. We made a Government decision on 5 November this year to do exactly as suggested, that is, to prepare legislation to require political advertising online to be transparent. However, our current estimate is that we will have the general scheme for quarter 2 of 2020. Whether that will be in advance of the election is undetermined. That is as quickly as the Department believes it can draft the legislation. We will do it as soon as we possibly can.

Separate to that, the Minister for Justice and Equality has launched a public consultation on the issue of hate speech. We have legislation already, the Prohibition of Incitement to Hatred Act, but everyone acknowledges it is quite old and needs to be updated to reflect modern times. Therefore, there are separate issues: political advertising, which needs to be properly regulated, and hate speech. The Minister for Justice and Equality is working on the latter, in particular, with a view to updating the legislation and making it much stronger.

The south and south west of Donegal have been without respite services for more than a year after Seaview Respite House, Mountcharles, closed last December. The home, outside Donegal town, was owned and operated by the HSE to provide residential respite care for physically and intellectually disabled people across south-west Donegal. The HSE tendered the service initially, indicating that a full service of seven days per week would be provided by the successful applicant. However, when RehabCare was given the contract, the service was, to the despair of families across Donegal, for only five days per week, from Monday to Friday. Over 100 families were using the services for much-needed respite for themselves and those they cared for.

The transfer of services to RehabCare has been besieged by delay after delay. Seaview Respite House was due to open by the end of July this year. The opening was then extended until the end of August, then September, then November and now December. Families and service users have been without a respite service for the entire summer, a time when families spend quality time together and when holidays and outings are common.

Families were further angered when, at a public meeting I attended in recent weeks, the HSE confirmed that while the facility will be fully transferred to RehabCare in December, it will not be open for service users until 13 January 2020 and will operate for only five days per week. No one, including me, believes for a second that this deadline will be met, although we hope it will be.

Really and truly, the deadline is not the major issue. The latest setback for families comes after years of disruptions to services at the centre caused by staffing shortages and rostering issues. I have been raising these issues for many years, yet there is still no full-time respite service available for families in south-west Donegal.

The transfer of management to RehabCare was supposed to be for the benefit of all families who depend deeply on this service but even when it reopens in January, if it does, families will be provided with a restricted service once again. The main reason for the years of delays by the HSE is that it is trying to use the transition to RehabCare so as not to deal with funding requirements to address the over-expenditure in the health sector.

Families in Donegal have been through enough. It is time to address the reasons behind these delays once and for all and commit to reinstating a full-time service - not a Monday-to-Friday service, which would be basically useless, but a service for seven days per week that would be of benefit to the families and their loved ones. That is the least they deserve. Will the Government ensure that the Seaview facility opens in January and that everything will be done to ensure a seven days per week respite service will be reinstated from then on?

I thank Deputy Pringle for raising this important issue. From our constituency work, all of us will know how valuable respite services are, not just for those with disabilities but also those who care for them. Just having the opportunity to give the carer a break can be so valuable and can really help people to keep going.

Just this year alone, 164,000 respite overnights were provided by the health service and nearly 34,000 day respite sessions were provided. Therefore, there is a considerable resource being made available. There have been 165,000 respite overnights this year alone. We acknowledge, however, that there is demand for much more.

We are committed to providing services for people with disabilities that empower them to live independent lives and provide greater independence in accessing the services they choose and enhancing their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the programme for Government, which is guided by two principles, namely, equality of opportunity and improving quality of life for people with disabilities. HSE disability services confirmed today that respite services will commence in Seaview House in Donegal from 13 January 2020. We acknowledge that there was a delay in opening this new facility. I am told that was due to a requirement to undertake fire compliance and maintenance work before the house could be opened. I am told that it will open on 13 January, initially on a five-day week basis, but that could be expanded at a later point subject to the availability of staff and finance.

I thank the Taoiseach for his response. Unfortunately, that is not much consolation for the families in south Donegal who had this service previously but which was withdrawn over the past year. The Taoiseach said 164,000 overnight respite services have been provided in Ireland this year. That may be, but none were provided in south Donegal in the past year. That is because the HSE did not got its finger out to deliver it and then it decided to tender the process. I believe that was so it could get out of being blamed and it could pass the blame onto somebody else.

Families must have this service at the weekends because that is when they need it. That is when other family members can have their parents to themselves when they are not busy looking after a disabled person. That is the reality of the situation for first communions and other such family events. A respite service must be provided in order for two parents to attend and the service must be available at weekends. If it is to be a five-night service it should be available from Wednesday night to Monday night and then it would be a perfect service, but that will not happen because it would cost extra money, which is unfortunately what this comes down to. I urge the Taoiseach to put the pressure on. I am sorry that it has come to this level to be raised here in this House to put pressure on to ensure that a seven-day service is provided.

This year the Government provided an extra €10 million for respite services. That sum provides for the opening of 12 new respite houses around the country, one in each region. Most are open, including the one in Sligo, but I acknowledge that the one in Donegal is not open but it will be opened in January. Initially, it will be a five-day service but it can be expanded to a seven-day service subject to the availability of staff for the weekends, as well as funding for the service.

I am told a particular issue arose in Donegal during the year when one teenager with very complex needs required a bespoke package of care, which necessitated access to three separate respite facilities on a rotational basis. The outcome of that was that respite services for Donegal were only operating at 50% capacity throughout much of the year. However, from January 2020 this service user will have their own residential placement appropriate to them and therefore it is anticipated that services for children will return to full capacity once the placement commences.