Ceisteanna ó Cheannairí - Leaders' Questions

Earlier this week the figures provided by the National Screening Service to my colleague, an Teachta Cullinane, show a massive backlog in cancer screening throughout the State. It highlights that a catch-up programme is urgently needed. The figures show that fewer than 100,000 people have been screened through the State's three cancer screening programmes this year compared with five times that - half a million people - who were screened last year. More than 450 cancers and 1,600 precancer diagnoses may have been missed this year, according to the Irish Cancer Society. We understand that services have had to be curtailed due to Covid-19, but we need a catch-up programme and the Government must deal with that urgently.

Today, I raise a report published last week into gynaecology services in Letterkenny University Hospital. The report was commissioned after a hard-fought battle by patients and their families who knew that there was something deeply wrong about the services in that hospital. Hospital consultant, Dr. Margaret McMahon, who watched her sister die from endometrial cancer, was at the heart of this. She contacted Saolta University Health Care group in Letterkenny and made it aware that she believed women's lives were at risk as a result of the practices in the hospital. She knew from her sister's experience that it was a serious issue, but it fell on deaf ears. She contacted the Minister for Health, Deputy Harris, in 2016 and relayed the same information to him. Desperate, in 2017 she contacted him again and told him she would leave her consultancy practice in England and jump on a plane if he could give her five or ten minutes to explain to him why women's lives were being put at risk in Letterkenny University Hospital. I understand that the Minister responded by giving her the address of the Ombudsman.

Margaret McMahon and other patients' families have been completely vindicated by the report that was published last week because it is clear that the situation in Letterkenny University Hospital did put women's lives at risk and women have lost their lives as a result of the practices there. Of the 133 cases of endometrial cancer over a ten-year period, one in three women experienced a delay in their diagnosis, one in five women who had endometrial cancer suffered significant consequences as a result of a delay. Ten of these women have passed away since, and a significant portion of those deaths is because of the delays and the service. The report reveals a litany of failures which had devastating and life-changing consequences for these women. At the time of the independent review, when Margaret was forced to go public and reach out to politicians like myself who raised these cases in the Dáil, two women were waiting for urgent referral to that hospital for four years. That is how bad the situation is.

I will put some of the findings on the record:

It is clear that the experience for these women, and the service provided to them, was unsatisfactory. All cases, in one form or another, are typified by delay – delay from an urgent GP referral to a gynaecology outpatient appointment; from gynaecology outpatient appointment to urgent diagnostics ... and-or from diagnostics to intervention.

It says there were suboptimal practices with no evidence of implementation of recommendations that were previously given. A significant amount of responsibility lay with the oncology liaison nurse who had no written description of her roles or responsibility.

Will the Minister ensure that each and every recommendation by the independent panel is reviewed? Will he ensure that there is a proper review that goes wider than endometrial cancer in that hospital? Will he consider the independent panel recommendation for a full audit to be carried out throughout the State to ensure that Letterkenny is not an outlier?

I thank Deputy Doherty for raising the case, representing the family in question, and trying to relieve some of their terrible loss by ensuring that if there are failings in our system, they do not go unchecked and are actually addressed. I commit to following up with the Minister of Health to ensure that the report's findings are implemented. Our cancer system has improved significantly in recent years - everyone would recognise that - but that is not to say there are not failings in the system. A key issue we need to improve is the connection between the GP primary care system and our hospital system so that referrals happen in a seamless, quick, timely manner, which is one of the recommendations of that independent report. While there have been improvements in our cancer treatment system, we cannot rest. We must ensure that we press on and where there are failings in the system, be it in any one hospital or be it systematic, that we address them. I will certainly follow up on that.

On the Deputy's first point, it is a valid point as well that we must ensure that, in managing our Covid system, we do not lose sight of other preventative measures that can save lives. Critical to that is ensuring the return of cancer screening. I understand that BreastCheck is due to return next month. It cannot happen soon enough because we know that early intervention, particularly in cancer, and catching cancer cases early is critical to good outcomes, whether in cervical, breast, prostate or other cancers. We will look at the report and I will make sure that the Department and the Minister for Health in particular comes back to the Deputy on the recommendations. We must also work collectively across the board to ensure that screening and testing systems for cancer are restored, enhanced and are fully operational again within the Covid period so that we catch cancers early and avoid the terrible losses the McMahon family and many other families have suffered from this terrible disease.

This was not only an issue of delay but also of misdiagnosis. It was an issue of serious flaws at management level in Letterkenny University Hospital, at Saolta level, but also at governmental level. One of the recommendations of the review is that a maternity or obstetrics ward would be commissioned. That ward was built, not yesterday or the years before that but in 2000. A state-of-the-art theatre has lain idle for 20 years which has resulted in some of the issues I outlined.

We cannot brush over the fact of the matter, which is that the consultant and families such as those of Annie Farrell, who had to go public, went through all the right channels. They went to the hospital, to Saolta and to the Minister and met with deaf ear after deaf ear. They continued to fight and had to explain their story in the media and reach out to others to ensure that the review took place. We cannot get away from the issue, which is that women in Donegal lost their lives as a result of the practices in that hospital. That is at the core of this.

On the recommendation that an audit be carried out throughout the State on endometrial cancer, will the Minister ensure that that happens? Will he ask for a wider review about what is happening in Letterkenny because many of the patients are not happy with how Letterkenny University Hospital or Saolta are dealing with them, even at this point today?

I cannot commit here to specific reviews being carried because that is a matter for the Department of Health and the Minister who has to read the report, listen to the expert advice and ensure that we do apply the lessons and learn. Where there is a case that a ward has been in place for 20 years but is not properly equipped, staffed or operational, we must examine that.

I do not have the full details, so I am reluctant to comment on any hospital or any one unit within a particular hospital for fear that I would not be accurate or fair in approaching it.

I fully agree with the Deputy on the following. There can be no hiding from instances where there is failing in the system. There has to be full transparency and accountability. If it is shown by the Department of Health that an audit is needed of such diagnostic facilities throughout the country, I would fully support it, but that has to be done on a science and health basis. I cannot give a commitment in the Chamber without referring to the best scientific and health advice. The report will be considered in real detail. I will certainly commit to asking the Minister for Health to follow up and make sure it is not ignored or swept under the carpet, and that the issues and recommendations within it are addressed in a proper, scientific and healthcare manner.

At a time when it seems there are many internal tensions within the Government, with Fianna Fáil dealing with its own internal problems, Fine Gael dithering, to put it mildly, over the nomination of our Commissioner role, and the Tánaiste playing a dangerous political game within the Government, the reality for the rest of us outside of Cabinet is that Covid-19 rates continue to grow steadily. There seems to be a mindset within the Government that a second lockdown is inevitable. Indeed, the Minister for Health said as much last week. Increasingly, there is a sense among the public that they are forgoing so many different aspects of normal life while the business community is paying an enormous price, but the other key partner in all of this, the Government, is not playing its part.

It is not playing its part in three key ways: the need to honour its commitment to ensure we have an effective testing and tracing system in place; to ensure we have proper controls at our airports and ports; and to ensure that open information and data are made available, and that they would drive the policy in this area. None of those things are happening. As for testing and tracing, from the beginning we have been told this must be about test, test, test, and we described our own early policy of being one of test, trace and isolate, but we are not doing that. For so long we were playing catch-up while the numbers were growing earlier in the year. Finally, when the numbers, thankfully, started to drop, we were told the capacity was there. We are told the capacity is for 100,000 tests a week. I do not believe that. It has never been achieved or nearly achieved. What is happening in that area? We heard on the radio this morning that staff are being taken away from audiology and other key services to prop up the testing and tracing system. When are we going to have an effective testing and tracing system?

When are we going to have proper controls for international travel? We have been promised this form, which is supposed to be online. Up to now, there has been little more than forms being handed out, and the follow-up has been hopeless. When are we going to have a proper system in place at our ports and airports?

Third, when is the Government going to ensure that it is open about the data and information? We have to keep the public with us. Actions being taken at the moment are simply not understandable because they are not backed up by any data or evidence.

When is the Government going to address these three areas and when is it going to play its part in responding to the virus?

I assure the Deputy that the Government is working collectively, and in my mind coherently, not just in managing the Covid crisis but in every aspect of the economic crisis that comes with it and across every brief. The Deputy is correct that Covid is first and foremost, because it is the essential crisis we have to manage. I am confident that the HSE is managing and has the capability in the testing and tracing regime we need for this country. That capability needs some flexibility within it to increase to 100,000 tests per week and flexibility so that if the testing needs to be ramped up for a particular outbreak, that can be done. Last week, 58,000 tests were carried out, many of which systematically targeted the key areas where we have to protect the most vulnerable, such as nursing homes, which are a key source of the problems, or the likes of meat plants, where the key element is the focus of that testing. There are 200 contact tracing staff in place and the turnaround time, as I understand it, from referral to the giving of the test result, has fallen from three days to 2.2 days. We need to push that further and we cannot rest on our laurels, but I believe that the HSE is managing, and can manage and deliver, the testing and tracing regime we need.

With regard to aviation and airports, it is a difficult balancing act between protecting lives and protecting livelihoods. Aviation and international travel are part of protecting livelihoods in this country because, as a small, open island economy, we need connectivity to other countries. To date, judging from the health data, the level of the virus coming in from international travel is very low, but we have to maintain vigilance and not necessarily just open back up, with everybody travelling again. There was valid advice from the health system to try to minimise travel and contact, but the Government now has to start preparing for the next six, nine or 18 months - a medium-term approach - where, in the absence of a vaccine, we have to manage the virus.

Within that, we will have to manage international travel. The Government will present a new medium-term Covid plan on 14 September that will include a planned approach allowing for connectivity. At a meeting yesterday with my departmental officials who are working with the Department of Health and the Department of the Taoiseach, I asked them to look, as we have said we would, at international experience, such as where other countries require testing arrangements for air travel that may reduce the risk of increased air travel and that may allow us, in certain instances, to waive the requirement for a 14-day restriction on movement when someone comes here. We have set up - my Department was helpful in this regard - the electronic register and contact tracing system, which will be an important part of that.

On the Deputy's third point, I absolutely accept the need for transparency and openness in respect of all the figures. At the same time, we have to be careful that if we had complete transparency, there could be stigmatisation of certain communities where the virus might exist. We have to avoid that while still providing transparency.

With all due respect, these lines are being trotted out by everybody in Government, and they do not stand up to any kind of scrutiny. The Minister is jumping ahead and talking about a medium-term plan. We have a real-time, now problem in respect of the figures rising all the time. The response from the Government has been wholly inadequate in respect of testing and tracing. The Minister talked about last week. A total of 57% of what we are told is the capacity was used last week, and that was the highest percentage that has ever been used. Where is this 100%? We have heard reports about staff being redeployed from other areas where they are needed. That is not an adequate response. The Government needs to start taking this issue seriously again. The early response was fine but it took its eye off the ball. There are a whole lot of gaps in our response. Nobody knows what the strategy is now in respect of Covid. We are supposed to be testing, tracing and isolating, but that is not happening at the level required. Will the Minister give any kind of commitment that this issue is going to be taken hold of by the Government and that we are going to see action in those three areas rather than vague promises?

This is the most important thing the Government has to do. This medium-term plan, which as I said will be within the next two weeks-----

Now. The Government needs to take charge now.

Yes, but it will take us two weeks.

Where is the Government now?

The managing and taking charge now is to make sure that the medium-term plan is fit for purpose. It is as important, if not more important to my mind, as the budget facing us because how we manage this will allow a return to some normality of life as we manage life with Covid, and try to minimise and suppress it-----

That is more promises.

No, it is giving-----


Please allow the Minister to respond.

I think there is a role for the Oireachtas. We do it with the Special Committee on Covid-19 Response and other Members. First and foremost, we heed the best advice we have, which is coming from our health services and others, about how we manage this. We have a balancing act to do with regard to how we get economic recovery at the same time. The Government is focused on that more than anything else and will present that plan, which will hopefully give us the mechanism to restore livelihoods and protect lives.

I raise the issue of funding that will be necessary to provide the infrastructure we need to stimulate the economy post Covid. I believe Irish Water, in particular, is a key driver of this infrastructure. Irish Water needs to be financed to ensure vital services such as water and sewerage are available to stimulate growth in houses being built, in providing serviced sites for commercial activity and in ensuring IDA Ireland has serviced sites to attract foreign direct investment and indigenous investment. The programme for Government contains aspirations for balanced regional development. If they are to be realised, the Government will need immediately to set the agenda for Irish Water and to supply the necessary funding.

I give as an example my own county, Galway. It has been held back because of this lack of investment. Growth centres all around Galway city are at a standstill. Why is this happening? Galway County Council cannot give planning permission for developments because there are no municipal wastewater treatment facilities available in the towns and villages. For example, Craughwell, Corofin, Abbeyknockmoy, Clarinbridge, Kilcolgan, Ballinderreen, Ardrahan, Labane, Turloughmore, Lackagh, Kilconnell, Cappataggle, Mountbellew and so on are precluded from building any housing developments due to decisions by An Bord Pleanála that any development in these towns or villages is premature until a public wastewater treatment plant is built. An Bord Pleanála has compounded the matter by ruling out housing in these areas with individual septic tanks. It has ruled all development out.

Another example is the IDA Ireland site in Athenry. Athenry is at the crossroads of motorways and railways and it is ripe for development but that site does not have any water or sewerage connection so no investors can use that site. Galway County Council has a county development plan setting out the way that County Galway and Galway city will develop, but this plan has also been stalled. For example, we have what we call the Ardaun corridor, stretching east from Galway city towards Athenry. Since we do not have what we call the east Galway wastewater treatment plant on anybody's agenda, no development can happen here. We talk about the congestion of traffic in Galway city. Until we get this investment and Irish Water is fully financed, we will not be making any regional development happen, especially when one looks at an example such as County Galway.

I thank Deputy Canney for raising an important issue in the development of our country, planning forward. I have some broad points to make with regard to the funding of Irish Water. There was agreement in the last Dáil at an Oireachtas committee about the approach that would be taken. I believe there was and still is cross-party and independent support for that approach, so I do not see it changing. It will involve the introduction of water charges where the excessive wasteful use of water is clear and evident. That will provide certain funding but more importantly it will provide a signal to avoid wasteful use of a precious resource.

The broad economic approach of this Government will have to involve managing ourselves out of an economic difficulty through investment. We will not contract our way out of this economic downturn. Investment in capital infrastructure has to be our guiding star. At a time of low interest rates, when our infrastructure is holding back development in a variety of ways in water, public transport and housing, that is the critical investment we need to do, which will create jobs and avoid some economic mistakes of the previous period. This Government is and will be committed to expanding or investing in capital projects, especially those which, as the Deputy says, have co-benefits in that they allow other developments to take place.

When it comes to water investment, it is interesting that the Deputy takes Galway as an example because Galway has historically suffered more than many other counties due to lack of investment in wastewater treatment as well as water supplies. The wastewater treatment, which is often less visible or seen as less of a priority, is where particular problems have occurred in Galway. I support and agree with the Deputy's case for investment in that type of infrastructure in places such as the Ardaun corridor and Athenry. If we can combine that development with improving and upgrading the rail system there, that would the sort of co-ordinated, planned and sustainable development we seek to achieve.

It is vital in that regard that we heed the advice of the national planning framework and look for concentrated development. The authorities are right to say we should move away from the use of septic tanks, because that has brought significant difficulty to managing water quality and the problems that brings for our rivers and water systems elsewhere. By concentrating development around infrastructure spending and existing towns and villages and new developments close to public transport and infrastructure development, that is where success will lie. In any dealings with the Government, I will absolutely look to see how we can prioritise capital investment in Irish Water and in projects such as the ones the Deputy cited because they provide the sort of sustainable development we need.

I welcome the Minister's positive words about the development. A significant issue in Galway and other counties is that many housing estates were built with private wastewater treatment plants that are not being taken in charge by Irish Water or by Galway County Council. It is left to the residents to provide the funding to maintain these treatment plants and to provide for future investment to keep them alive. The reality, which I see and know at first hand, is that in many of these estates the treatment plants are an environmental disaster about to happen. There is no maintenance happening and nobody is taking responsibility, and this also needs to be factored in. I believe a working group in the Department of Housing, Planning and Local Government was looking at this, but looking at it is no good. We need the funding to make sure it is sorted out. I ask the Minister to look at it because an environmental disaster is waiting to happen if we do not invest in it.

I will certainly take it into account. My understanding is that the political agreement about managing water recognised that we will continue to have private water schemes and group water schemes. I recall some of the analysis of it stated that they sometimes have the greatest difficulties. It is not as if they will all completely switch to the Irish Water system, but they have to be included and managed in a way that avoids pollution problems and all the other problems that come with it.

One thing that this feeds into is the question of the future of Galway County Council and Galway City Council and a potential merger of the two, which may help with the management of our water management system. Water does not know boundaries. It tends to go from city to county and getting the strength of our local government back to assist local communities, even where they are not taken in charge, to make sure standards are applied and resources are available might be one way we can help this particular situation.

Over the past two weeks, the beautiful constituency of Cork South-West has seen devastation due to severe flooding which has destroyed businesses, private homes and people's property. The people of Rathbarry, Rosscarbery, Connonagh, Leap, Skibbereen, Bandon, Dunmanway and Bantry have experienced flooding beyond belief. Businesses such as the Eldon Hotel in Skibbereen, Wiseman's shop in Bantry and Con Linehan's clothes shop in Bandon are just a few that I can mention which had substantial losses due to these floods.

On this shocking night Lucey's Bar, the Anchor Bar, the Cosy Cabin in Bantry, as well as Cahalane's in Skibbereen opened their doors for the first time in almost six months but this was just to let flood water and muck out of their ruined premises. I spent hours in Bantry on the night of the floods and saw the sheer agony on people's faces. There were neighbours helping neighbours to try to save what was left of their businesses and homes. One lady told me that her business was closed for 12 weeks due to Covid-19. They had just reopened and she asked me to look at her stock. It was swimming around, which I could clearly see as my knee-high wellington boots filled with water. Private residences in Rosscarbery, Connonagh and Leap have also been ruined. This is simply due to rivers not being cleaned out. One house in Connonagh has been flooded three times in two weeks. The first flood was 5 ft high, the second time it was 12 in. high, and the third time it was 8 in. high.

The floods in each area have left dozens of unanswered questions. Much of this flooding could be avoided but common sense has gone out the window. Some 90% of flooding problems can be solved on the ground. I thank the Minister of State, Deputy Patrick O'Donovan, who came down to west Cork on three occasions during those two weeks, leaving his family while on their short break. He saw first hand the devastation and met with the powers that be who are now going to do all in their power so this would never happen again. It is a little too late for the property that has been destroyed. I also thank the Minister for Public Expenditure and Reform, Deputy Michael McGrath, who came to west Cork on two occasions since the floods to meet with people in the affected area. My own group leader, Deputy Mattie McGrath, also came to west Cork over the weekend to look at the flooded areas. The Taoiseach came to Skibbereen to inspect the flooded area and the Tánaiste was spotted visiting the beauty spots of west Cork, as were many more politicians this summer.

I put it to the Minister, Deputy Ryan, that it is now more than two weeks since many people's premises were flooded and to date all they have got is a Red Cross humanitarian form, which has been extended to areas in west Cork such as Bandon, Bantry, Skibbereen and other places. No private residence can get funding from this fund. If one's business has insurance one will not get funds from this fund, even though many insurance policies have an excess of some €10,000. Also, if the insurance is drawn down once, the person may never get cover again. This is outrageous. These innocent people have had their lives destroyed and this Government stands idly by without a clear compensation package in place for the businesses and private residences of these areas so they can pick up the pieces to try to start again. Will the Minister answer a clear question? Has the Government discussed funding for these people in west Cork? If so, what kind of compensation package was discussed and when will the Government announce it?

I join with Deputy Collins in extending every sympathy to those who have suffered from the floods across west Cork. I am very familiar with many of the towns, villages and areas the Deputy mentioned. Deputy Collins is right that it is devastating when one wakes up in the morning to see ones house or business flooded. It is particularly worrying in places such as Skibbereen where extensive investment of some €20 million was invested in flood protection measures. Despite all of those best efforts still the streets and houses were flooded. We saw it again in Clifden yesterday. We are seeing extreme weather events that are a cause or function of climate change, which means what was once seen as a one in a 1,000 year event is actually happening every two or three years. The severity is also beyond any projection and becomes increasingly difficult to counter because what is happening is beyond compare, due to climate change.

Yes, the Government has considered looking at flood measures. From my recollection, we have passed special motions within the Cabinet twice in the past three weeks to agree additional funding. This will continue and we will look at it again. With regard to those businesses and householders, this is through no fault of their own and it is important that we manage it.

There is a particular issue around insurance and flooding. I am aware that in my constituency it is increasingly difficult for many people to get insurance because of areas that are routinely flooded. Deputy Doherty and others have been questioning how we manage the insurance industry. There is the whole issue of how insurance is provided, what the rules and regulations are, and what the guarantees and protections are, which is particularly important. I hope the new legislation on the regulation of insurance will help in that regard.

More than anything else, we need to take a really big view on managing this project. We need a national land use plan. Central to that is looking at how we develop and manage our land, our forestry, our farming and planning and development, including where we put houses and the sort of infrastructure we put in place. We should take a long-term view, knowing that climate change will lead to more extreme rainfall events. We should try to use nature to help us in that regard so the flow coming down off the mountains is actually held back in order that we restore our wetlands, bogs and the ways water is stored rather than in the bottom of someone's home. We need to really think big and long term. This problem is not going to go away. In some instances it can be addressed by short-term engineering fixes but the best long-term fix, to my mind, is us collectively and as communities managing our land and using natural systems to help store, stall and hold back water. That is probably the biggest, best and more economically effective way for us to protect our people from severe flood damage.

I am disappointed to hear the Minister say today that there is no clear compensation package being considered by the Government for the businesses and properties that have been destroyed in west Cork. Humanitarian aid through the Red Cross is nowhere near enough. It will not even cover 20% of those people who are affected. Has the Minister any idea of the pressure these people are under? Whether they are in Rathbarry, Rosscarbery, Connonagh, Leap, Skibbereen, Bantry or Bandon, people face tens of thousands of euro in damage due to others neglecting their surroundings. No one cleans overfilled rivers. The rivers are full of muck, silt or whatever polished word people want to call it. The rivers are full of it. I ask the Minister to come down to west Cork and I will show him first hand what is in the river at Connonagh. It is full of silt and branches that block drains and gullies, which then results in people's homes being flooding. There is no funding anymore for council staff to clean drains and watercourses. There is also no one to cut back the roadside verges, biggest scourge in rural Ireland, which leads to blockages and forces floodwater onto roads and into towns and villages. It was pointed out to me that if a Third World country was affected by flooding the Irish Government would send aid out immediately, and rightly so. The simple question is, why not send aid to west Cork? There is little point in the Taoiseach and Ministers coming to west Cork to sympathise with the people if they do not compensate them. These people feel codded. They feel that no one cares. I ask the Minister again today whether there is a clear compensation package for the people who were affected by floods in west Cork. "Yes" or "No".

As I said earlier to Deputy Collins, the answer is "Yes". I will provide the specific details for the Deputy. In Kenmare, Skibbereen and in other locations where we have seen such instances the Government responded immediately by trying to give immediate supports to alleviate the specific areas where it was a problem. I will send that on.

Going back to the bigger picture, I do not believe the problem of flooding is due necessarily in every case to silting or material in rivers. I believe it is due to that wider land management issue. The wider perspective in how we manage waterways and how we manage our water systems is going to be the best way, to my mind, of solving this huge problem.